Latest / Skin Anarchy / Shino Bay Aguilera, MDBoard Certified Dermatologist and Dermatologic Surgeon

Transcript

Shino Bay Aguilera, MDBoard Certified Dermatologist and Dermatologic Surgeon · Skin Anarchy

• 0:11
  SPEAKER_01: Treshino V.
• 0:12
  SPEAKER_01: Aguilera, um he is a board-certified dermatologist and dermatologic surgeon.
• 0:17
  SPEAKER_01: Dr.
• 0:18
  SPEAKER_01: Aguilera has uh a lot of experience in not only dermatology, but he's also an international keynote speaker on the newest laser advances in cosmetic techniques and also has tons of experience in running of FDA clinical trial studies for a leading laser manufacturer.
• 0:35
  SPEAKER_01: So welcome to the show, Dr.
• 0:36
  SPEAKER_01: Aguilera.
• 0:37
  SPEAKER_01: I'm so excited you're here.
• 0:39
  SPEAKER_00: Thank you for having me here.
• 0:40
  SPEAKER_00: It's always exciting to talk about skincare.
• 0:42
  SPEAKER_01: Absolutely.
• 0:43
  SPEAKER_01: I would love it if you could tell us a little bit about your background.
• 0:46
  SPEAKER_01: I know I covered it very, very um, I skimmed over it, but I would love to tell our listeners a little bit more about you.
• 0:53
  SPEAKER_00: So um I started my career as a laser expert, actually, even before I got into dermatology, I just had such a great passion for laser technology and laser medicine.
• 1:04
  SPEAKER_00: And uh, and that caused me to want to be a dermatologist because at the time only dermatologists and plastic surgeons were doing aesthetics, or at least lasers.
• 1:14
  SPEAKER_00: And uh that was my my venture on on um on the world of aesthetics, but I always love uh skincare and always been fascinated with skin.
• 1:26
  SPEAKER_00: Um reason why because I think um the skin basically is a good way to measure health and other things.
• 1:36
  SPEAKER_00: Just it's never never gonna people never gonna stop caring about what the skin looks like because it's on our primitive brain, where we know that when people are looking at us, the the primitive brain is serving in the skin to see if you are of good reproductive age, like you have 40 eggs with one egg or no eggs, or also what kind of healthy status you are, you know.
• 2:03
  SPEAKER_01: Yeah, yeah.
• 2:04
  SPEAKER_01: Absolutely.
• 2:04
  SPEAKER_01: No, I completely agree with you, and I think the skin is such a reflection of, you know, like you said, like the rest of our body and the rest of our health, especially something like gut health.
• 2:13
  SPEAKER_01: You know, I know there's a huge um movement right now where people are talking about using probiotics more and whatnot.
• 2:18
  SPEAKER_01: But I actually I want to ask you about lasers because I don't know anything about laser treatments, and I would love it if you could tell our listeners some, you know, some tips and some advice for people who are beginners um when it comes to laser uh you know techniques and and what to do and how to approach that.
• 2:34
  SPEAKER_00: Yeah, so lasers are great, and they've been around for a long time, thanks to the to the great work of Albrecht Einstein, and basically it's a light that has a preference for a target on your skin, so that's why different wavelengths.
• 2:53
  SPEAKER_00: So the way I like to explain lasers, like imagine you have a rainbow, and out of that rainbow you get a yellow light.
• 2:59
  SPEAKER_00: Well, that yellow light is close in wavelength of um the light of the post light laser that lights things that are red, and then let's say you get on the green light, and you see that this green light has preference for things that are brown, so you can get a target that is going to be matched with a particular color of the visible light spectrum.
• 3:23
  SPEAKER_00: So, really, in order for us to get a laser to work, the laser light, that green light, needs to have affinity for the target, let's see, pigment on your skin, like freckles, and the freckle also has to have affinity for that light.
• 3:38
  SPEAKER_00: So it's like a marriage made in heaven.
• 3:40
  SPEAKER_00: Yeah, the light is attracted to the target, the light turns into heat above 40 degrees Celsius and destroy.
• 3:47
  SPEAKER_00: We nook things with the laser.
• 3:49
  SPEAKER_01: Interesting.
• 3:50
  SPEAKER_01: That's very interesting.
• 3:51
  SPEAKER_01: So, you the way you're describing it though, it sounded like a ligand receptor relationship, but um, yeah, you know, that's interesting.
• 3:58
  SPEAKER_00: Unfortunately, in relationships, somebody dies.
• 4:01
  SPEAKER_01: Yeah, I know.
• 4:03
  SPEAKER_01: Well, I want to know.
• 4:04
  SPEAKER_01: Um, actually, uh one quick follow-up question is um, what are some of the differences uh that you've noticed in patients with more melanated skin versus not?
• 4:12
  SPEAKER_01: I mean, I know that's a very um buzzworthy topic these days in skincare.
• 4:16
  SPEAKER_01: So are can you tell us about some differences you've noticed or some differences in laser treatments um between the two?
• 4:23
  SPEAKER_00: That's a great, great question because you know, uh and I and I'm very happy that I mean I'm Latino, but I'm very mixed.
• 4:30
  SPEAKER_00: Um, my mom's Chinese and Costa Rican, my father Spanish, Portuguese, uh Native Indian, and black.
• 4:36
  SPEAKER_00: So I have everything.
• 4:37
  SPEAKER_00: Wow, you are quite ethnic.
• 4:41
  SPEAKER_00: Yeah, and I have a uh a dark olive skin tone.
• 4:44
  SPEAKER_00: And uh yeah, you know, that's a very important question because usually we use Fitzpatrick skin types, which is uh different, uh scale that we use to kind of predict who should use more sunblock to prevent skin cancer, but we also use it to use lasers, so you have to be very careful with the darker skin types, not to use a laser that's more too aggressive because it can lead to pigmentation.
• 5:10
  SPEAKER_00: That's why I really love uh for darker skin types, things like the Vivaci and things like that, that's radio frequency with microneedling, where we don't depend on light because it is safer to do devices like that, like microneedling radio frequencies on the dark skin type.
• 5:27
  SPEAKER_00: Because the problem with dark skin type, if whenever there's inflammation, it may lead to pigment.
• 5:33
  SPEAKER_00: Let me use myself as an example.
• 5:35
  SPEAKER_00: When I get if I get a pimple, the pimple goes away, but I can get a brown spot that can last me six months.
• 5:42
  SPEAKER_00: So it's very, very important to when you are looking to do an energy device, you need to understand the the what type of skin do you have, what color skin you have, and what devices are safe for skins you own natural skin tone, because not every laser will work on all skin types.
• 6:05
  SPEAKER_01: Right.
• 6:05
  SPEAKER_01: So, what are some of the techniques that you love for hyperpigmentation?
• 6:09
  SPEAKER_00: Well, there's so many things, depending on the hyperpigmentation.
• 6:13
  SPEAKER_00: Uh, we can do chemical pills, those are great.
• 6:17
  SPEAKER_00: Um, uh, if the pigmentation is not something like terrible, like melasma.
• 6:23
  SPEAKER_00: You can use lasers that have affinity for melanin, and you can also have things like uh microneedling with radio frequency in combination with agents that you add immediately after you do your little microneedling opening.
• 6:42
  SPEAKER_00: So the product seeps into the dermis deeper, and it helps by bleaching out the skin and the areas where you need to.
• 6:50
  SPEAKER_00: There's so many ways to treat hyperpigmentation from um um topical creams, yeah, that things natural like cogic acid and licorice and to more um aggressive things like hydroquinone and trimexemic acid.
• 7:09
  SPEAKER_00: You know, there's a lot of different chemicals that bleach out the skin cysteamine, and then a lot of energy devices that will do so as well.
• 7:18
  SPEAKER_01: So I have a question about um, you know, like in terms of hyperpigmentation, when you treat it, does it cause like a lightning effect in that area?
• 7:26
  SPEAKER_01: Where, you know, because you know in Vitiligo, for example, this is very extreme.
• 7:30
  SPEAKER_01: You have the light and the dark patches um because of the disease.
• 7:33
  SPEAKER_01: Now, when you get rid of hyperpigmentation, what's left behind?
• 7:36
  SPEAKER_00: Your normal skin tone.
• 7:38
  SPEAKER_00: So usually imagine think about hyperpigmentation that is caused from sun damage or from a scar, you know, like or a pimple.
• 7:47
  SPEAKER_00: These are things that are secondary, it's not your natural pigment.
• 7:52
  SPEAKER_00: So when you use these bleaching agents or energy devices, you just remove the pigment that is there.
• 7:57
  SPEAKER_00: Imagine that you just got a natural tattoo with brown in the area where you have the injury or the area where you have sun damage or the area where you have the melasma.
• 8:08
  SPEAKER_00: So you only bleach out the extra exogenous or the extra uh pigment that is not your natural skin tone.
• 8:16
  SPEAKER_01: That's very interesting.
• 8:18
  SPEAKER_01: Now, I actually want to um ask you, you had mentioned radio frequency earlier for darker skin types.
• 8:22
  SPEAKER_01: What is the difference between radio frequency and light therapy?
• 8:25
  SPEAKER_01: I mean, is uh in terms of is it just the wavelength that you're using or the it the amount of damage you're inducing?
• 8:31
  SPEAKER_01: What is the real difference?
• 8:32
  SPEAKER_00: So, in in physical terms, when you're talking about lasers, it's just a light that turns into heat.
• 8:40
  SPEAKER_00: Radio frequency, it also has a certain type of wavelength, but again, it's radio frequency.
• 8:47
  SPEAKER_00: So it works more on those levels of things that you want to think maybe like sound, and then you have things like like ultrasound, like ultra therapy, right?
• 8:56
  SPEAKER_00: It's ultrasound.
• 8:57
  SPEAKER_00: Yeah, at the end of the day, whether it's light that turns into heat or sound that turns into heat, um it is uh it is a mechanical force, yeah.
• 9:10
  SPEAKER_00: That is an energy that turns into something else.
• 9:14
  SPEAKER_00: So remember uh another of the things that our wonderful uh Albert Einstein's uh led us um to play with is that energy is never created or destroyed, it's always turns into something else.
• 9:30
  SPEAKER_00: So in laser you have light that turns into heat, and then you have other devices that are sound that turns into heat.
• 9:37
  SPEAKER_01: So it's really the amount of heat that is released in the reaction, right?
• 9:40
  SPEAKER_01: That's that's the difference.
• 9:42
  SPEAKER_00: Like, is that well it's it's the no, it's the me, the me that for example, in lasers, there's different lasers, right?
• 9:48
  SPEAKER_00: That create different wavelength.
• 9:50
  SPEAKER_00: If I use a pulse dye laser, which is a dye, that will create a yellow light that lies oxychemoclobin, that's why it's good for blood vessels, right?
• 10:00
  SPEAKER_00: So you can you can use a gas, CO2, the CO2 laser is a gas that will emit a wavelength that goes after the water under the skin.
• 10:12
  SPEAKER_00: So it's the medium that generates uh a wavelength, and that wavelength will turn into heat.
• 10:20
  SPEAKER_00: When you talk about like acoustic wave sounds, radio frequency, things like that.
• 10:25
  SPEAKER_00: It's a different mechanical force that will turn into heat.
• 10:30
  SPEAKER_01: Wow, that is so fascinating.
• 10:32
  SPEAKER_01: I'm sorry, I kind of picked your brain there for a minute, but uh this is so fascinating to me.
• 10:37
  SPEAKER_01: I don't know anything about lasers, but um, I want to ask you um some advice for people who, you know, they're just getting into treatments.
• 10:45
  SPEAKER_01: Um, you know, like I know in our 30s we often do that.
• 10:48
  SPEAKER_01: So, you know, what are some of the most common procedures that you see um or that people opt for with laser treatments?
• 10:56
  SPEAKER_00: Well, most people always um worry about the tone and texture of the skin, tone being one because blemished skin is unsightly for most people.
• 11:07
  SPEAKER_00: That's why there's makeup and concealer.
• 11:10
  SPEAKER_00: Uh uh a skin that is flawless with with a good tone and no blemishes, it's a very desired skin because it's a skin that advertised I'm healthy, I'm young, I'm attractive.
• 11:25
  SPEAKER_00: It's sending all those messages.
• 11:27
  SPEAKER_00: Um, so people are always gonna try to do uh a laser treatment according to what they see.
• 11:34
  SPEAKER_00: Um if you have a lot of red in your skin, then you're gonna look for a laser that addresses redness.
• 11:41
  SPEAKER_00: If you have a lot of brown, you look for a laser that treats brown.
• 11:45
  SPEAKER_00: If you have melasma, you're gonna find a laser that treats melasma without making it worse because that can truly happen.
• 11:52
  SPEAKER_00: Um so you're really trying to match what you see.
• 11:55
  SPEAKER_00: But on the early torches, most people are starting to see that the pores are getting bigger, the fine wrinkles are starting to happen, and there's a lot of blemishes from some damage that you didn't have on your younger ears.
• 12:08
  SPEAKER_00: So nothing too aggressive.
• 12:10
  SPEAKER_00: There are so many devices out there that are gentle lasers that can address your issues without having a lot of downtime.
• 12:19
  SPEAKER_00: Because when you pick a laser, your lifestyle is very important.
• 12:22
  SPEAKER_00: I mean, you want to take off from work for a week or two or a month, or you want to do a laser that you should hide over the weekend.
• 12:30
  SPEAKER_00: So you just don't do anything aggressive.
• 12:33
  SPEAKER_00: It's very important the lifestyle of the patient.
• 12:35
  SPEAKER_00: If you're very outdoorsy, most likely you don't want to do a laser.
• 12:39
  SPEAKER_00: You may want to do microneedling, your radio frequency combined with microneedling, because the laser it'd be a big no-no if you're a person that cannot get out of the sun.
• 12:49
  SPEAKER_01: Now, after you have a laser treatment, are you supposed to like even if it's like a month or two down the line, should you be using higher levels of SPF to protect your um skin as you would normally before you had the treatment?
• 13:01
  SPEAKER_00: Yeah, especially the first two to three weeks of the treatment.
• 13:05
  SPEAKER_00: Those are the first two weeks are very crucial that you do not get some because imagine you're red, you're inflamed because you the skin got injured, and now you adding UV rays to the make sure because we know UV rates are not only can be detrimental for the collagen on your skin because it will break it down, causing a solar scar or wrinkles, but also it can stimulate pigment.
• 13:32
  SPEAKER_00: So you have a skin that's inflamed, and now you're having a wavelength, the UV wavelength that adds pigment, so you get stain and very, very dark uh blemish is your own doing because you should not go on the sun when you do a laser.
• 13:49
  SPEAKER_01: Now, I have a question about the science behind um lasers and especially UV light.
• 13:53
  SPEAKER_01: I mean, I know that there are there is this thing called you know uh formation of dimers, um DNA damage that can occur by UV light.
• 14:01
  SPEAKER_01: Now, is there any risk of such DNA damage with laser therapy for cosmetic reasons?
• 14:07
  SPEAKER_00: No.
• 14:08
  SPEAKER_00: Okay.
• 14:09
  SPEAKER_00: And the reason why is that laser, the the laser wavelength that we use uh in aesthetics and in medicine, they are non-ionizing wavelengths, they're not like your UV wavelengths or your uh X-rays wavelengths or your gamma X-rays that are ionizing, therefore, they will change your DNA and can be detrimental in terms of changing the configuration that can lead to um problems with your health, like cancers and things like that.
• 14:46
  SPEAKER_01: Right, right.
• 14:47
  SPEAKER_01: That's why I asked you, but that that's really good to know.
• 14:50
  SPEAKER_01: I'm glad that there's no um adverse effects like that.
• 14:53
  SPEAKER_01: Um, my last question for you, um doctor, is about the FDA clinical trials.
• 14:57
  SPEAKER_01: I'm very curious because I know that um right now in the skincare industry, there are a lot of companies who are conducting their own uh version of clinical trials, but then I also know that when you're doing it with from the academia aspect, there's this huge list, right?
• 15:10
  SPEAKER_01: That you have to go through, you have to get approvals and all this stuff.
• 15:13
  SPEAKER_01: So, what are some of the differences or or key points that um everyone should keep in mind for clinical trials?
• 15:19
  SPEAKER_01: Can you share that with us?
• 15:20
  SPEAKER_00: Yeah, I mean, definitely when we do clinical trials, we're trying to find just two things.
• 15:25
  SPEAKER_00: This is efficacious and it's safe.
• 15:28
  SPEAKER_00: They're all doing the same way and they're presented to the FDA because they want to know that the results are reproducible, but also that the patients are gonna be safe.
• 15:39
  SPEAKER_00: And if there's anything negative happening during the trial, although that's those are premises for the product not get approved by the FDA.
• 15:49
  SPEAKER_00: Having uh the seal of approval of the FDA is important because we know how finicky and sometimes fastidious the FDA can be in order to approve things, but you know, safety first.
• 16:04
  SPEAKER_00: So I uh I kind of like the the FDA's put a lot of rigorous rules in order to approve things in the United States.
• 16:13
  SPEAKER_00: Sometimes it's like a little too much, but it is done with with good intentions.
• 16:19
  SPEAKER_01: Now, is there more like options in Europe, Doctor, because they don't have the FDA thing, like the the hurdle of FDA?
• 16:25
  SPEAKER_01: Do you know if there's like a huge difference in treatments?
• 16:28
  SPEAKER_00: Yes, yes.
• 16:29
  SPEAKER_00: A good example is like heliocare, which was uh an when uh when heliocare came into the aesthetic market, which is a song block.
• 16:41
  SPEAKER_00: Um in Europe, it took almost 10 years to get here to United States.
• 16:46
  SPEAKER_00: It's like 10 years for a song block.
• 16:48
  SPEAKER_00: Are you kidding me?
• 16:49
  SPEAKER_00: Wow, yeah, that's ridiculous.
• 16:55
  SPEAKER_00: You know, there's always also uh uh agendas, you know.
• 16:59
  SPEAKER_00: Like I sometimes I feel that there's money to be made when things get approved, and that also can kind of yeah, there's a huge, there's always politics involved.
• 17:09
  SPEAKER_01: There's always you know, somehow because you know it's interesting you say that because I wonder about all those skincare lines right now in the US that are just there's no you know regulation at all, and they're unsafe, you know, for consumers, but then you have something like this sunblock, it takes 10 years to get into the states.
• 17:26
  SPEAKER_01: That makes no sense.
• 17:27
  SPEAKER_00: Well, I tell you how that works.
• 17:28
  SPEAKER_00: It's like so you have commissosceuricals, which are still it's common, it's kind of like neutraceurical cosmos, they're not heavily regulated by the FDA unless you make claims.
• 17:41
  SPEAKER_00: Okay.
• 17:42
  SPEAKER_00: If you make a claim, then the FDA says, uh-uh, I need to.
• 17:46
  SPEAKER_00: So you cannot create a for example, I'll tell you an example because I created a shampoo long time ago because I I suffered with dandruff and I found this amazing shampoo, yeah.
• 17:58
  SPEAKER_00: Um, and uh and then went off the market.
• 18:00
  SPEAKER_00: But I have other uh bottles because when I find something I like, I buy a lot of it.
• 18:05
  SPEAKER_00: Yeah, yeah.
• 18:07
  SPEAKER_00: But you never know, and it happens to me all the time.
• 18:09
  SPEAKER_00: So they took it out of the market.
• 18:10
  SPEAKER_00: Well, I just like okay, I have the box, the bottle.
• 18:14
  SPEAKER_00: I'm gonna go and tell people to replicate the shampoo for me because I need the shampoo.
• 18:19
  SPEAKER_01: I love that, that is brilliant.
• 18:22
  SPEAKER_00: I was a guinea pig, like it made my dandruff worse.
• 18:25
  SPEAKER_00: It was itchy, couldn't sleep, but finally they got it right the way it was.
• 18:30
  SPEAKER_00: And uh, so I wanted to sell it in my practice.
• 18:34
  SPEAKER_00: I'm a dermatologist, but you know, I could not say that was um anti-itch or anti-dandruf because once I say it's anti-dandruff, it becomes a claim and a medical claim.
• 18:46
  SPEAKER_00: So FDA wanna regulate it, and it costs lots of money, yeah, yeah, and trouble and all the time.
• 18:57
  SPEAKER_00: And one hurdle after all, because you could do everything right, and you pay thousands, if not millions, and and the FDA says, Well, we don't like it, we don't like this word, and then you have to reapply it again, and then you have to pay the same amount of money.
• 19:09
  SPEAKER_00: Wow, so they don't even they don't even refund you, yeah.
• 19:11
  SPEAKER_00: They're just like, nope.
• 19:13
  SPEAKER_00: So you know what I did, I didn't call anti-itch or anti-danders, I just call it soothing.
• 19:19
  SPEAKER_00: Yes, brilliant, yeah, soothing shampoo, you know.
• 19:24
  SPEAKER_01: Yes, I mean it is though, you know, you're soothing the itch of the dandruff.
• 19:27
  SPEAKER_01: That makes sense.
• 19:28
  SPEAKER_01: It's I love that.
• 19:29
  SPEAKER_01: Nice, nice goring.
• 19:34
  SPEAKER_00: My practice without claims, of course.
• 19:36
  SPEAKER_00: Behind doors, I would tell my patron, I use this and I would tell the story.
• 19:40
  SPEAKER_00: I told you I did it because it continued shampoo is the best thing.
• 19:44
  SPEAKER_00: But then, you know, I got so like I just stopped making it.
• 19:47
  SPEAKER_01: Yeah, but I mean, you had a you had a nice little run there for a while with it.
• 19:51
  SPEAKER_01: I like that.
• 19:52
  SPEAKER_01: I like how you went about it.
• 19:53
  SPEAKER_01: But thank you so much, Doctor.
• 19:55
  SPEAKER_01: This has been amazing.
• 19:56
  SPEAKER_01: I would love to have you back anytime um if you have any room in your schedule to talk more and really dive into the science.
• 20:02
  SPEAKER_00: Oh, it's my pleasure.
• 20:03
  SPEAKER_00: Always great to talk to people, but cosmoceuticals, lasers is my um my part.
• 20:09
  SPEAKER_00: So always happy to do it.
• 20:11
  SPEAKER_00: Thank you so much, Doctor.
• 20:12
  SPEAKER_00: Have a blessed day.
• 20:14
  SPEAKER_00: You too.
• 20:26
  SPEAKER_01: Okay, that was good, and now the next guest will be ready.
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