Latest / F*ck, I’m Nearly 50! / What Happens to Your Skin After 40? | Dr Philip Tong | F*ck, I’m Nearly 50!

Transcript

What Happens to Your Skin After 40? | Dr Philip Tong | F*ck, I’m Nearly 50! · F*ck, I’m Nearly 50!

• 0:00
  Dominique Hind: Hi, I'm Dom Hind and F*ck, I'm nearly 50.
• 0:03
  Dominique Hind: Actually, I'm 47 and four months, and I am starting to count.
• 0:08
  Dominique Hind: Let's be real. Ageing is a bit of a minefield. One minute, your skin is holding it together, and the next, you're wondering when your jawline started migrating south, why your face looks permanently tired, and if that new freckle is just a freckle or something more sinister. And of course, the beauty industry loves this moment of panic. They throw every miracle cream serum and skin tightening treatment at us like we're supposed to believe. They'll actually do something, and I've seriously tried so many of them and been disappointed. We're bombarded with ads promising to reverse ageing, and yet no one really tells us what's actually happening to our skin or what it really needs as we get older.
• 0:56
  Dominique Hind: Because here's the thing, your skin is not the enemy. It's the largest, largest organ in your body. It regenerates itself, and it's constantly working to protect you, and yet we're conditioned to think of it as something we need to fix. But what if we stopped obsessing over wrinkles and instead focused on keeping our skin healthy. What if we stopped treating skin cancer as an afterthought and actually looked at how to prevent it? That's exactly what we're getting into today, because skin care is one thing, but skin health is the real game changer. And my guest today, he's not just working in dermatology, he's changing it and he's challenging it. So let's get into it because fuck, I'm nearly 50, and isn't it amazing? You I Dr Philip Tong isn't just a dermatologist. He's a force for change in an industry that desperately needs it. He's the mastermind behind dermscreen, an AI powered skin cancer detection platform, making checks faster, more accessible and more accurate than ever. He's also the founder of dermatology junction, a clinic that's flipping the traditional model of dermatology on its head. He's all about early detection, smarter systems and putting patients first. And for me, this conversation is personal.
• 2:37
  Dominique Hind: Growing up in Noosa, sunscreen was optional, and a deep tan was practically currency. The result, I've had melanoma grow back eight times in my right eyebrow, it's been cut out six times. I've gone through our Dara treatment twice, which, for the record, is revolting, but it works, and it kick starts your immune system to attack abnormal cells. And let me tell you, it's not gentle. And through every biopsy, every Is this normal text that I sent him, and every treatment, Phil has been the calm voice of reason in today's episode, we're cutting through the noise. We talk about what's actually happening to your skin as you age, what's worth your time and money when it comes to sagging skin, and how AI is shifting the game when it comes to skin cancer detection. We also get into how hormones, lifestyle habits like sugar and stress can impact the way your skin looks and feels in your 40s and your 50s, plus the biggest myths we need to let go of once and for all. So let's get into it. Phil, welcome to fuck. I'm nearly 50.
• 3:59
  Dr Philip Tong: Thank you. Dom
• 4:01
  Dominique Hind: How would you how would you introduce yourself in the least medical way possible?
• 4:07
  Dr Philip Tong: Isn't that the way and the only way that I introduce myself these days?
• 4:09
  Dr Philip Tong: Yes, so I would say I'm a very curious person. I like finding out about new things. Yes, venturing into spaces that make me uncomfortable, and I would say I'm the eternal optimist.
• 4:25
  Dr Philip Tong: Yeah,
• 4:27
  Dominique Hind: I would absolutely agree with that. I really my
• 4:31
  Dr Philip Tong: passions are the intersection between health, which is, I'm a practising dermatologist here in Sydney, wellness. Part of what I do is making people well, and I practice that both in my personal and professional life, but technology as well. And I guess that's why we're here today, yes
• 4:49
  Dominique Hind: and yes, I think it is why we're here today, because you're doing some amazing things in technology, but we will talk about that later. But for now, let's talk about skin. Love it. Yeah. Yeah, what's really happening to our skin in our 40s and 50s, and why does it feel like everything suddenly shifts?
• 5:11
  Dr Philip Tong: That's an excellent first question. And you know, it all starts kind of after 30 so I know this podcast is about kind of two decades later, but the changes in your skin are quite noticeable even after the age of 30, whereby you're losing about 1% of collagen every year from that point on. But the changes are more than that. You start losing that elasticity in the skin. You start noticing pigmentation, yeah, you start losing the fat and that change, those changes in your face, is what we as everyone will see as ageing. And that's normal, yeah? And that's the real emphasis of this. As a dermatologist, we want to tell people that these are normal changes, yeah. We can help people achieve the skin that they want in the, I guess, freshest possible, possible way.
• 6:06
  Dominique Hind: And so with the collagen, because everyone's talking about collagen, is the collagen that you can drink, which I drink every morning, noon and lunch and afternoon? Is that actually helping with building those collagen supplies? Or
• 6:19
  Dr Philip Tong: that's a really interesting question, and, and it's a very controversial question. Actually, I think there has been research done in smaller mammals, yes, say yes, and there is certain evidence that would suggest that the collagen that you're talking about, it's called hydrolyzed collagen, and it's often from protein like Marine, yes, or bovine, they somehow make its way into the skin in those laboratory settings, right?
• 6:51
  Dr Philip Tong: Okay. Now, whether that translates to human settings, yeah, remains to be seen, okay, and unfortunately, I haven't seen that evidence yet. Okay, right, all right, you'll keep hoping, though.
• 7:04
  Dominique Hind: Yeah. Do you know what? I always say that I love to buy hope, and I do love to buy hope because it's like, Yes, I hope it works. And when people say, does it actually work? I'm like, Well, I don't know, because I'm not going to stop it because it makes me feel better. But
• 7:20
  Dr Philip Tong: there's nothing wrong with hope. Yeah, true.
• 7:23
  Dr Philip Tong: There is nothing.
• 7:23
  Dominique Hind: There's nothing wrong with hope. No. Well, as the eternal optimist, there's definitely nothing wrong with hope. This the saggy skin, what actually works and what is a waste of money.
• 7:39
  Dr Philip Tong: Let's start with what's a waste of money. Yeah, those topical skin firming creams, okay? With a lot of claims, yes, beautiful packaging, yes, probably save you money there, right? I think we've touched on collagen supplements, yeah, but there are a number of strategies that one can prove either both, generally in the clinic, yes, to improve sagging skin, obviously, hyaluronic acid fillers, yes, are available globally. And the reason why they work is because we lose the, if you like, the cement in between the bricks and mortar. Yeah, we lose that extracellular matrix and the hyaluronic acid that's in between them keeping the skin looking plump. So there is no doubt that fillers do help and actually draw in water into the skin, but each has their own issues as well. Other ways of improving sagging skin include a technique called needle radio frequency, whereby we deliver energy underneath the skin through these tiny needles.
• 8:49
  Dr Philip Tong: Again, that's very useful.
• 8:49
  Dr Philip Tong: Another way of delivering that energy is a technique called high intensity focus ultrasound.
• 8:55
  Dr Philip Tong: Yes, that's or HIFU, also known as hip you're very well versed DOM. Only because I've done it so that those technologies do have evidence and are generally done in medical grade practices.
• 9:11
  Dominique Hind: Yes, okay, so not the ones on the side of the road
• 9:14
  Dr Philip Tong: only because these technologies have risks and it needs to be delivered by professionals who know what they're doing, and also to get the results that
• 9:24
  Dominique Hind: you want. Yeah, true. And to know how you how far you can actually push it.
• 9:27
  Dominique Hind: That's right, because, you know, some people get scared, and for me, I'm like, if I'm paying for it, I want the best results possible.
• 9:35
  Dr Philip Tong: Yeah, it's be able to know what is the capabilities of the equipment, the machine, and also balance that with the patient's skin type, yeah, and and the outcome that they want to achieve. Can
• 9:48
  Dominique Hind: I just ask you talked about hydrolonic acid? I can never say that word. I always get it mixed up. But topical hydrologic acids, what do you think of that
• 9:57
  Dr Philip Tong: probably just sits on the top of the
• 9:59
  Dominique Hind: skin? Oh. Oh, well, I think it's been amazing for me. But again, I'm buying hope. It may not
• 10:05
  Dr Philip Tong: be what you think is happening, but it probably gives you the impression that the skin is brighter, okay, yeah, and that's what you see is working. So there are a lot of things that you can do topically, yes, that can help make the skin look brighter and that gives you the appearance of, you know, youthful skin.
• 10:25
  Dominique Hind: Okay, I actually like that, like the there's the topical. So is that like the superficial, immediate, but it's not the longer term. That's
• 10:33
  Dr Philip Tong: right, so that, but in this is what we do for all our patients. Yes, there are things that you can do topically, at home, treatments, the the the things that you can do in between, this is what I would call your homework. Yeah, and then there's the in clinic treatments as well, which you can do, which we help you with.
• 10:50
  Dominique Hind: Okay, so the two have to work in, I think so, yeah, okay, good. And what do, like, what's the bare minimum skin routine that you think we should be doing from well, you say 30 is when it starts to go south, yeah, fall apart. But what about when you're like mid 40s or getting towards your 50s?
• 11:13
  Dominique Hind: What do you think the skin routine should be? There's
• 11:17
  Dr Philip Tong: still hope.
• 11:17
  Dr Philip Tong: Yeah, good,
• 11:19
  Dominique Hind: great. Thanks.
• 11:22
  Dr Philip Tong: I would like to start with the three pillars, cleanser, yeah, a moisturiser and a sunscreen, okay, and if you could add a fourth by May, topical tretinoin, if you could do those four, hang on. What's the last one? Tretinoin? Okay, it's a prescription grade version of retinol. Okay,
• 11:39
  Dominique Hind: right, okay, okay. And why? Why all those four
• 11:43
  Dr Philip Tong: so a cleanser will help remove dead skin from the face, yeah, and if you can incorporate a cleanser that has some anti ageing ingredients, okay, right, like glycolic acid, that will help to remove the dead skin from your face that comes through just wear and tear, pollution and so forth.
• 12:03
  Dr Philip Tong: And then a good moisturiser would help, just to fill in those cracks and just rehydrate your skin again, from what we subject our skin to, yeah, pollution, sweat, makeup, etc, beach, swimming, all of that salt and then obviously, a good sunscreen makes a huge difference. Broad spectrum, factor 50, protecting against UVA and UVB rays. Again, the reason why we that's so important is because the sun has incredible effects on breaking down collagen, elastin, yeah, for skin, and that's some of the telltale signs of ageing, right?
• 12:43
  Dr Philip Tong: See, it's so hard because,
• 12:45
  Dominique Hind: I mean growing off indies, I love, love, love, love the sun, yeah, which is why melanoma eight times. But it's so hard to can you still go out in the sun with the sunscreen on and or you were just saying, hard, no,
• 13:02
  Dr Philip Tong: you know, I have this conversation with my patients all the time, and we live in a beautiful country, which is Australia, and there's no reason why we should not enjoy that outdoor lifestyle that we're blessed to have. I just think we can just do it safely, okay, not in the middle of the day. Well, a broad brim hat, sunnies, sunglasses, sunscreen, and reapplying that sunscreen every four hours, covering it where you can long sleeves and yes, try not to go out in the middle of the day would be ideal. Try to seek some shade. And I think that's the best you can do.
• 13:37
  Dominique Hind: Yeah, okay, all right. And so what was the fourth one, the topical
• 13:41
  Dr Philip Tong: tretinoin, okay,
• 13:44
  Dominique Hind: right? I'm not doing that.
• 13:47
  Dr Philip Tong: Or maybe you are okay. I'm not sure.
• 13:52
  Dominique Hind: We'll talk about that later. Talk about that later. What's your go to treatment for looking fresher, not frozen? Oh,
• 14:00
  Dr Philip Tong: very good.
• 14:00
  Dr Philip Tong: Tretinoin will be part of that, because that really helps cell turnover. So what that means is that your skin, the dead skin cells, are removed, pigmentation is reduced. So that's a really good foundation for that.
• 14:17
  Dr Philip Tong: There's nothing wrong with a little bit of toxin. Yep, particularly, well, hang
• 14:23
  Dominique Hind: on and you're talking about like, Botox rather, yeah, that's right in like,
• 14:28
  Unknown: can you
• 14:31
  Dominique Hind: come on, yes, that is what I'm talking Okay, right, right. Okay,
• 14:38
  Dr Philip Tong: well, placed in the right areas, done judiciously, carefully and with consideration. Yes, can do wonders just to make you feel like bit fresher, fresh. Yeah, I had a, I had a presenter come to me yesterday, two weeks after her first treatment. Oh, and she was, you know, towards, you know, I. You know, around 50, around your age, is what you were trying to say, But, but?
• 15:02
  Dr Philip Tong: And she said, because all her friends were doing it, and she wanted to see what it would do for her, yeah, and she was amazed what to be achieved. But she just felt that confidence that she gave and the and then, as a result of that, she was actually getting inquiries about additional jobs. And, oh, really, she was getting
• 15:26
  Dominique Hind: Yeah, and confident, yeah, it's a little confidence. Yeah. The thing that really annoys me, what is the age that someone should be starting or, I mean, I know it's a personal thing, but like when you're sitting there and you hear an 18 to 21 year old talking about their injections, because it's all preventative, yeah, is that something that should be considered, or is that, I
• 15:52
  Dr Philip Tong: think that's very controversial.
• 15:54
  Dr Philip Tong: Prejuvenation is a term that's being used preventative rejuvenation. And I think when there's no obvious lines that are static, so lines that are present at rest. So you're
• 16:06
  Dominique Hind: talking about wrinkles correct, like any normal person's language,
• 16:10
  Dr Philip Tong: I should be like wrinkles at rest. Yeah,
• 16:13
  Dominique Hind: right? Wrinkles at rest. Great.
• 16:17
  Dr Philip Tong: That's probably the time that you should consider it. So I would say, I don't offer those types of treatments to 18 year olds. I would only offer it to those that I can actually see visible signs of
• 16:32
  Dominique Hind: wrinkles at rest. Wrinkles at rest. Okay, great. That's right. It is like, yeah, it is very interesting.
• 16:39
  Dominique Hind: What are the other go to treatments?
• 16:44
  Dr Philip Tong: It there aren't this. Gets this question gets asked by dermatologists all the time. There's not much you have to do to your skin to make it look healthy. Yeah, moisturising. Vitamin A, which is tretinoin that I mentioned before, a good sunscreen. Okay, all right. Is a good is a good foundation.
• 17:05
  Dominique Hind: So many of us don't realise that our skin is being impacted by perimenopause.
• 17:08
  Dominique Hind: What is going on under the surface then?
• 17:15
  Dr Philip Tong: So they say that when you go through perimenopause, oestrogen has a huge impact on collagen content, so they say with there are statistics that inform us that once you hit perimenopause, or have gone through menopause, collagen drops by up to 30, yeah, right. And that's where that sudden cliff, if you like, yeah, changes. And unfortunately, there's a very minimal ways that you can help with that. There are, of course, hormone replacement therapies, HRT, that you could do to help with that. But you know, if you're losing collagen that rapidly, there are very few things that can replenish that, but there are, of course, treatments that you can do that are available, yeah, in clinic to help with that.
• 18:12
  Dominique Hind: Yeah. And do you think so? Because I do know a few of them, like sculpture, or what they're talking about now is Roger and on the salmon sperm one correct. Do you think in the lead up to going through perimenopause or menopause, it's better to try and stock, bank those collagen stores so that when it does fall down, there is more that is there, and
• 18:35
  Dr Philip Tong: to add to that profile? Oh, yeah, sorry, profile, yeah, that is all. But everything that you've listed is, is our treatments for that, we don't have the evidence as yet to say whether stop banking prior to menopause could actually have a preventative effect right post menopause.
• 18:55
  Dr Philip Tong: It'd be very interesting in, say, 10 years time. Yeah, to see what to see those that have been using these types of treatments in their 30s and 40s. What they're compared to those who have only started after the after turning 50, whether or not that early intervention makes a difference. Now, that being said, this has been done in with
• 19:15
  Dominique Hind: hasn't been done in Korea for such a long time.
• 19:18
  Dominique Hind: It's it has
• 19:19
  Dr Philip Tong: been done in Korea. But that being said, I haven't seen any studies actually compare that to those that have started it later.
• 19:26
  Dr Philip Tong: Okay, so it's that, it's that providing that control trial that hasn't been done. But you know, all I could say is that there has been studies done on treatments such as topical tretinoin. Those who have started earlier in their life.
• 19:39
  Dr Philip Tong: Do look better than those who have started later? Yeah, those who have used botulinum toxin, Botox as a brand earlier in their life, they find that the amount that they need to use later on, right? Yeah. Okay.
• 20:00
  Dr Philip Tong: Yeah. So there are those types of studies that have shown that.
• 20:04
  Dominique Hind: Okay, so what you're saying is start now to start preventing, you know the the impacts of ageing, potentially, yes, yeah, like, depending on what, what works for you. That's right, yeah. And how, what? What can we do now to start supporting our skin through those hormone changes?
• 20:28
  Dr Philip Tong: I think we have mentioned some treatments already, but they can be very expensive. Yeah, that's the thing. It's not necessarily accessible to everyone and but by all means, if you can explore those treatments. I think they are worth exploring. But moving beyond that, I think looking at needle radio frequency
• 20:54
  Dominique Hind: or RF, needling, RF, needle in normal, yes,
• 20:57
  Dr Philip Tong: RF, needling, or needle RF, which is what the how they call it on the street, as they say, and hi, food, yeah, those are treatments that may not be as expensive. They still are treatments, yeah, that might be able to provide longer lasting effects. Okay? Because what they're doing is actually, again, stimulating the body's own response to produce elastin and collagen. Okay, great,
• 21:23
  Dominique Hind: all right. Okay, so we've talked about skin.
• 21:26
  Dr Philip Tong: Oh yes, the last probably thing that one can do, if I mean, and people might be against this, but you know, if you want potentially bang for buck, yeah, a facelift, obviously you can't go but, well,
• 21:43
  Dominique Hind: you've seen Kris Jenner lately. Oh my gosh, her 70 year old.
• 21:47
  Dr Philip Tong: She all that's wrong, but I think she's had a combination of things. Oh, okay, what do you think she's had done? I think she's had both injectable treatments as well as surgical treatments. Yeah, okay.
• 21:58
  Dr Philip Tong: And I think that it's that, and I think it was done very well, yeah, to be honest, yeah. I think that ability to know what can be achieved with non surgical and surgical strategies is why you go to someone that is a true professional,
• 22:14
  Dominique Hind: yeah? And I think that it is, yeah, the right thing. And the other thing is, it's your face, it's your skin. It's like, you do want to make sure that you are going to someone
• 22:22
  Dr Philip Tong: trusted. Well, I mean, I think Christiana can afford that.
• 22:25
  Dominique Hind: I think someone was telling me the other day that her, after that facelift, there's now a three year wait list surgeon. I was like, what?
• 22:32
  Dominique Hind: Anyway, they still put their name down. It is that's a US. So you've been part of my melanoma story for years. What do most people not understand about skin cancer?
• 22:53
  Dr Philip Tong: That even though you've done the damage, say, in Noosa, you've done the damage in your 20s, 30s and 40s, protecting your skin now, from this point forward, can still have a measurable impact on preventing skin cancers later on in life, and they've proven this in the lab, right? Yes. So there was a University of Queensland study that actually says, Yes, we do suffer damaging DNA from damaging the DNA from the UV rays early on in life. We know all that, right, but protecting your skin now can still prevent those effects of DNA damage on cells that then transform into skin cancer. Oh, wow. So a lot of people say, Oh, I've done all the damage. I can't do anything about it. Yeah, okay, it's not correct, right? So it's still worthwhile, okay, right, protecting your skin and not giving up hope,
• 23:53
  Dominique Hind: okay, good, like that, hope. Besides SPF, what can actually help protect our skin from long term damage. So
• 24:05
  Dr Philip Tong: again, drawing from what's been published in the literature. Yeah, there has been early evidence of the use of a vitamin B supplement nicotinamide. Yes, that has been shown to the reduce pre cancers and some skin cancers, right? So that's available as a supplement in pharmacies, and you just follow the instructions to take it. And for some dermatologists, they swear by it. I think a lot of us dermatologists do recommend it to their patients.
• 24:35
  Dr Philip Tong: Okay, I do know it's popular among some people who have spent a lot of time outdoors, and some patients swear by it, okay, but it's, it's very safe,
• 24:44
  Dominique Hind: yeah, okay. And I'm sure what you don't use, or what your body doesn't use, it just excretes anyway, correct?
• 24:51
  Dr Philip Tong: And the idea is that it quenches all those free radicals that gets generated from the from UV damage. Damage and DNA damage, right? And what was it called, again, nicotinamide,
• 25:04
  Dominique Hind: vitamin B.
• 25:04
  Dominique Hind: Nicotinamide. Okay, great for people with a history like mine.
• 25:09
  Dominique Hind: What extra steps should we be taking? I think just from what you said, is making sure that the damage can be stopped, that's a big one that I've taken out, I
• 25:21
  Dr Philip Tong: think threefold, one, have daily habits and routines to help prevent future occurrence of skin cancer, and that includes taking supplements, wearing sunscreen, checking yourself, yes, so either in the mirror or with the aid of you know, if you've got some photographs in the past, I know you keep a really excellent diary to have a healthy relationship with your GP and or dermatologist, and I think that's where having that relationship is very good, because that way you can if you're worried about something, you don't feel embarrassed to go to No just to Speak up. Because I think the worst thing that can happen is that, you know, I think most people actually know that that part of their body doesn't look quite right, but they don't want to say anything, or they feel embarrassed that they might be wrong or that it's just nothing. But I think having that relationship with your doctor can actually make a huge impact regarding early
• 26:22
  Dominique Hind: detection. I think that is, it is so important. I mean, you know that I love Dr Susie, because she's just the best and will make sure that you are looked after 100% of the time. But it is a game changer, having a doctor that you can actually talk to and say, Hey, what about this? Yeah, and not feeling because, you know, in the past, I've had doctors that are so like, bedside manner is they're just not warm. They don't want a relationship with you. They're just wanting to get through to the next patient. But when someone actually cares about you, it makes such a difference.
• 26:57
  Dr Philip Tong: That's right, it's a real partnership, I think, yeah, between the health professional and the patient, yeah,
• 27:03
  Dominique Hind: and, I mean, I've learned because I've got amazing people around me, like you and Pascal and Susie, but you do have to have that relationship, and you have to own it as well. Like, if you personally do not own your health, yes, the doctors aren't going to Yes, like they care, but it's on you to own it Yes.
• 27:22
  Dominique Hind: And
• 27:25
  Dr Philip Tong: the third tip that I would give would be have some kind of record, and it could be a record on your phone.
• 27:31
  Dr Philip Tong: You could have something a bit more structured and standardised, like what we do here at home screen. It doesn't really matter, as long as you have some kind of record keeping to allow you to track your skin over time. I think then it empowers the patient outside of the consultation, because at the end of the day, I'm only seeing the patient at one time point, and that's I can't follow you at the time, so I kind of need the patient to be part of this checking process. Yeah.
• 28:02
  Dominique Hind: But you know what I love about dermscreen, and I always say this, like, with everything, is it to baseline? Like, it is your baseline check in, and you only have to do it once. I mean, you update it, but like, once as your baseline. And I know I've sent you so many spot checks, going, oh my gosh, I've got this is this? And you go, no, no, it was on the original photos. It's fine. It doesn't look like it's changed. But if I didn't have that baseline, I'd be freaking out all the time. And I think, yeah, that record keeping, but having photos that you can refer back to, yeah, like that is a game changer.
• 28:41
  Dr Philip Tong: They say, with more data points, you can make better decisions, right? Yeah, and that's just more data points that
• 28:46
  Dominique Hind: was such a sign that was such a medical thing to say, oh, sorry,
• 28:50
  Dr Philip Tong: I've been labelled this. I've been labelled again.
• 28:55
  Dominique Hind: Why is early detection so crucial? I
• 28:58
  Dr Philip Tong: think when it comes to certain types of skin cancers, like melanoma, early detection makes a huge difference. But also, you know, using tools like what we do here at dermscreen means that we can also reassure patients, yes, and because the last thing I want happen is a young person because they are anxious about their skin, or are anxious about their moles, they ended up having it cut out and resulting in scars.
• 29:29
  Dr Philip Tong: Yeah, and I have seen these patients, and not that, you know, getting it cut out was necessarily the wrong thing, but if we had a second set of eyes, yeah, or an opportunity to follow that up, could we have saved that person an additional scar? And I think these, you know, over your lifetime, these scars
• 29:48
  Dominique Hind: accumulate, yeah, but they also grow as you grow. They grow as well, sure.
• 29:52
  Dr Philip Tong: And I think you need someone who is can actually take that entire journey of your skin, so to speak, into content.
• 30:00
  Dr Philip Tong: Text and say, Hey, yes, by all means. And this is the same mole, but you've kind of grown taller, more sideways, yeah.
• 30:10
  Dr Philip Tong: What are you saying? Not saying anything. And, and it's just the same mole, yeah, right. And like I said that to a lot of my younger patients, they coming me, coming to see me. So as you grow taller, this mole will stretch. Yeah, normal, don't be alarmed,
• 30:25
  Dominique Hind: yeah. And I think that you do need that steadying voice. And I know because when I I mean the first three times it was cut out of my eyebrow, it literally looked like I was in a bar fight, because I didn't go to a plastic surgeon. I just went in clinic to a dodgy doctor that I shouldn't have, and the gap was massive. But you know, over time, you get to know the doctors and the people on your team, and they help recreate or, I guess, correct it. I
• 30:54
  Dr Philip Tong: do feel for patients, because it's it's here in Australia, the there are different people that checks your skin, and everyone has different levels of qualification. And as a consumer, it's hard to actually see who, who, where along the qualification line those people sit at the end of the day, as long as you have a good relationship with that doctor, GP, dermatologist, plastic surgeon, that's all that
• 31:24
  Dominique Hind: matters. Yeah, okay. All comes back to the relationship and owning your owning your own. Think
• 31:30
  Dr Philip Tong: so. I think there's an element of empowering the patient to be comfortable, to come to you when they feel that they're worried about something, but at the same time reassure them to say actually, and be confident enough to reassure them to say, actually, we can watch that. Yeah, I'm not worried. Yeah.
• 31:46
  Dominique Hind: And I think that's what you do really well, is that I normally come in freaking out, and you go, no, no, let's look at the photos. Or no, we can just watch it. I'm not worried about it. Just put your mind at rest. But your
• 32:00
  Dr Philip Tong: journey, you're not alone in this journey. No, a lot of people being diagnosed with melanoma do have that health anxiety. They're checking their skin all the time because they don't want to get another melanoma that yeah, and they don't want to be another statistic. And I don't blame them, but at the same time, it's it's important I don't feed into that health anxiety. Yeah, yeah.
• 32:18
  Dr Philip Tong: And be that voice of reason to say, hey, let's just watch this.
• 32:23
  Dr Philip Tong: I'm not concerned right now, but we're not going to let it go.
• 32:28
  Dr Philip Tong: No, keep an eye on it
• 32:30
  Dominique Hind: well. And I think it's hilarious. Justin said that he came to see you the other day, and I'd given him 20 things
• 32:37
  Dr Philip Tong: reality here,
• 32:40
  Dominique Hind: he was just like, oh, Dom, she's just to her anxiety levels about everything.
• 32:43
  Dominique Hind: Just let it go. But I think you do, you get cautious and you just want to make sure that it's checked.
• 32:49
  Dr Philip Tong: But I don't expect consumers or patients to diagnose their skin problems, and it's so it's completely acceptable to flag something, but then we need a process to be able to ensure that those patients who are concerned, their concerns are addressed.
• 33:08
  Dr Philip Tong: Yes, timely manner, yeah, I
• 33:10
  Dominique Hind: think that the timely manner is a big thing. So we talked about dermscreen before, and so what it is, it's total body photography in like, my language, not yours. Sure, what is it and what are the photos that you do need to get done?
• 33:32
  Dr Philip Tong: So dome screen is actually entire platform, as you said in the introduction, it's, it's incorporating photographic technology which has been around before, yeah, but a process with which we're able to efficiently but comprehensively flag lesions of concern by taking individual spot photos, but also do a whole scan of your body in a very standardised way. By doing so we have, as you say, your first baseline, yeah, and then we use that baseline scan for future skin checks for my higher risk patients. I see them in between, but I effectively use dermscreen as a triaging surface. Yes, something that I think could be done more efficiently here in Australia, because when we receive a referral to have a skin check, there's no photos.
• 34:24
  Dr Philip Tong: There's no estimate of how long it's been there or how severe it looks. But by actually having and reviewing these photos with the person that's been there, and this doesn't have to happen at the same time as well, and that's where the we can improve access that's when we can actually prioritise patients that should not be sitting on a wait list, yeah, and bring them forward and have that reviewed in person, and if necessary, do a biopsy than them sitting on that wait list. And for some dermatology waiting list, that's could be months. Yeah, I know right in. Imagine having something on your skin that maybe you may or may not be aware of, something on your back, on the back of your leg, or maybe you are aware of, but you just this, just can't get in. Imagine waiting all those months, having to then realise, oh, I should have done a biopsy, but if you could compress that to a matter of weeks, wouldn't that be better for everyone involved, yeah,
• 35:21
  Dominique Hind: yeah. And I think the thing that with when I first did the full body photography, it's always a bit like, Oh, this is a bit weird, but at least you go, I've got it. I know, I know it's there.
• 35:32
  Dominique Hind: I've got my five or six shots of every part of my body, and it's just, yeah, just that safety net, I think,
• 35:42
  Dr Philip Tong: because, I think as we get into the whole concept of, you know, whole body health assessment, so, yeah, that's an emerging part of health that we're seeing, and as that becomes much more standardised across Australia, as well as globally, the concept of actually stripping down to your underwear and having this scan performed may not seem as confronting as it sounds, yeah,
• 36:11
  Dominique Hind: and I think it is. It's, you know, the initial first one, and then you're like, Oh, whatever. If it's going to help me, I'll just get it done.
• 36:17
  Dominique Hind: And how are you using So we've talked a lot about AI and how, because you've got a lot of different photos of melanomas, moles, lesions, as you like to call them, how are you using AI to help with the detection? So
• 36:37
  Dr Philip Tong: that's a really interesting point. A lot of the AI tools are not available for, I would say, clinical use, yes.
• 36:45
  Dr Philip Tong: So a lot of the AI tools we use for more as a check, but at the end of the day, a dermatologist is reviewing every scan, every Yes, where AI comes in is actually improving the workflow efficiencies with the report turnaround and helping the reports look very structured and beautiful, but ultimately, what will happen is, and we're seeing this with some of the bigger AI companies out there, that they're actually able to digest an image like a radiology film and actually produce a report faster than the reporting human, yeah, and I don't think skin is that far away, so we're actually poised to capitalise on that advancement when it is ready, yeah, for clinical use. And when do you think it is going to be ready? I think within the next five to 10 years, right? Wow,
• 37:41
  Dominique Hind: yeah. So that'll even made speed to getting assessed is a lot quicker.
• 37:44
  Dominique Hind: Absolutely
• 37:47
  Dr Philip Tong: we can, we can get through more patients. And there it's actively being investigated by the government, right? Yeah. The government has invested just under $10 million to set up these scanning facilities all around Australia to assess the ability of technology to actually address the burden of undetected skin cancer that's just in the community, just because the workforce to address that is just at it seems what
• 38:16
  Dominique Hind: and I mean that will also help with the size of Australia as well. Because, obviously, getting into regional Australia is, you know, the higher risk of skin cancer because they're not detected or getting to a dermatologist or a GP,
• 38:31
  Dr Philip Tong: that's right. So dermscreen is actually has a separate platform that is more to assist doctors, yeah, in regional areas, whereby, say, getting to a dermatologist could be hundreds of kilometres away.
• 38:43
  Dr Philip Tong: So I support GPS, say as far west as Broken Hill, as far south as Ulladulla, as far north as Port Macquarie, actually even Toowoomba in Queensland, whereby they can send a photo on a short statement summary, and I actually can reply back to them, okay, and allow them to actually take care of the patient within the home, within their location, yeah, which is good thing. Would I think it's a good thing. It means you get eyeballs on skin and an opinion, and then the health practitioner, GP, feels backed up. Yeah, yeah. They don't have to make that decision themselves. And it just means that if, if we can actually get a mole or a lesion assessed sooner by simply using special tools to take a photograph, getting it sent to me, and I could provide an opinion, that just means that, again, time to treatment is shortened.
• 39:40
  Dominique Hind: So with all of this, and I mean, we've spoken about it, what about self guided checks at home? Like, How often should we actually be looking and checking our skin? I think
• 39:50
  Dr Philip Tong: it depends on whether your your own risk factors as well, but I do say as a minimum, maybe quarterly.
• 39:59
  Dr Philip Tong: Yeah. Yep. And if you could do it kind of just after a shower, in front of a mirror or something like that. And there are guides to examine. If you have two mirrors, it's even better, right? You can then see your back, and we don't have to do it on this podcast, but there are plenty of you know techniques to help you examine your skin, yeah, okay, after that, so, but of course, if you've had melanoma, for example, yeah, important to check the scars. Yes. It's also very important to feel your lymph nodes right so you know, the neck, yeah, under the it depends on how aggressive the melanoma was, yeah, but for those patients that have a more aggressive form of melanoma, it's also important to incorporate that as part of your self checks.
• 40:48
  Dominique Hind: I think even the last time that it came back, it was in the scar, like for me, it was in the scar. And I actually had one of those magnifying mirrors, and I was like, what is that? Oh, there's some pigment there. And that's when, yeah, I saw that it came back. So it is, yeah, the scars are really important to check.
• 41:03
  Dr Philip Tong: Yeah, absolutely. So it's really important that we know the patient's history and check their scars accordingly.
• 41:10
  Dominique Hind: Okay, is there anything else we need to know about skin or checking our skin before we move on to the great stuff, like sugar?
• 41:21
  Dr Philip Tong: I think we've covered it. Okay, good, pretty well. I
• 41:24
  Dominique Hind: think the key things are good relationship with your GP and dermatologist.
• 41:27
  Dominique Hind: You own your health. That's right. It's not on the doctor to own it, because they've got so many patients that they are saying that if it's not you like, you've got to be doing it start now. So make sure that the skim routine is starting now, and it can be customised depending on where you are and irrespective of the damage that you have done to your skin in the sun, you can still make a difference. Spot on. Yes, eight plus. Okay, now let's talk about the fun stuff, like just the sugar that we were eating, or sugar, alcohol, sleep, stress, yeah. How much do they actually impact our skin? You know
• 42:14
  Dr Philip Tong: how I was talking about those free radicals before? Yes, okay, they're producing free radicals in the skin and are ageing you, right? Yeah, so if you can limit those types of stress on the skin, yep, seems unachievable, but it is achievable.
• 42:33
  Dominique Hind: Just in May, it's unachievable. Maybe in June, it won't be
• 42:37
  Dr Philip Tong: I think it could go a long way. But, I mean, these are vices that one can have, yeah, now and then, but there are certainly much worse vices that you can do on your skin, yeah, yeah, yeah, okay, like baking in the sun. Like smoking. Oh, okay, right, yeah, okay. Like smoking, really, ages, you.
• 42:55
  Dominique Hind: Okay, all right, good. Thank goodness I don't smoke. What's one small lifestyle shift that makes a big difference to skin health?
• 43:06
  Dr Philip Tong: Drinking plenty of water.
• 43:08
  Dominique Hind: What if you think water's boring?
• 43:11
  Dr Philip Tong: Add a squeeze of lemon. Okay,
• 43:14
  Dominique Hind: it's such a boring drink. And I know I need to drink more, but it's so boring. Anyway, it might
• 43:21
  Dr Philip Tong: stem off the sugar, and should we both partake?
• 43:26
  Dominique Hind: Yep, I'm gonna have a sip of water now. And I know, I know I do need to take a bottle with me wherever I go. So I think I'm gonna, that's gonna be one of my try this before 50 challenges is for two months, take a bottle wherever I go.
• 43:41
  Dominique Hind: Great. Is there such a thing as glow from the inside out, or is that just wellness marketing? I
• 43:50
  Dr Philip Tong: think when you look after yourself, both from a physical standpoint, you're working out, you're eating well, you spend the time to take care of your skin, take care of your hair, take care of your nails, yeah, you have that confidence.
• 44:07
  Dr Philip Tong: And that is the glow that I think people, yeah,
• 44:11
  Dominique Hind: okay, I think that's a great spin on it, the confidence and it is, it is taking the time to invest in you. That's right, like even now I think about the exercise that I'm doing, and I used to run a lot of marathons, but now I'm like, my 80 year old body will hate me if I'm still running. My knees won't work, my joints won't work, but it is taking that interest in you. I
• 44:35
  Dr Philip Tong: was listening. I was watching an old video Warren Buffet, teaching some high school kids about life lessons, yeah, and he describes the human body as an automobile. You only have one car, right? And you need to make sure that you look after that car the best that you can, because you've only got one and that changes your mentality about. Or body. I think, yeah, because with you, without that car, you can't go to places you can't so the more that you can actually think about looking after your yourself, both physically, mentally, emotionally, the further you can go, yeah, in that car. And I thought that was really powerful. Yeah, it is. It's a really important message for young people, I
• 45:21
  Dominique Hind: think, yeah, I do, yeah. I think that, yeah, yeah, I Yes. That's a great thing. What's the most over hyped trend you're seeing now,
• 45:30
  Dr Philip Tong: the ice water facial Oh, really, have you seen that? Yes,
• 45:34
  Dominique Hind: I may have the cryo car. What is it? The cryos?
• 45:38
  Dominique Hind: I don't know. It just makes you feel like, okay, like you've
• 45:43
  Dr Philip Tong: woken up. Yeah, that I've woken
• 45:45
  Dominique Hind: up, which I need to do. It's great after. It's great for soothing the skin, yes, if you've had a treatment that hurts,
• 45:55
  Dr Philip Tong: true, that is true. Yeah, the equivalent of that is putting a spray bottle in the fridge and then spritzing your face. Yeah,
• 46:02
  Dominique Hind: all right, okay, so the ice water hilarious? Oh, okay, good. And why do you find it hilarious? Oh,
• 46:09
  Dr Philip Tong: because people are doing it all over the internet. Yeah, no. And you know, putting a bucket in it ice takes time to make you have to dunk your face in it. Water gets everywhere. It's messy. Is
• 46:19
  Dominique Hind: it messy? No, I've got the sticks the Kairos.
• 46:22
  Dominique Hind: What are the other chiros? Okay, you've elevated it. I've elevated it. So I just get the sticks out, put them on my eyes.
• 46:29
  Dominique Hind: But I do only do it after a treatment, okay? Otherwise, I forget. It's one of those things that I'm not really good at. Um, what's something people think is helping their skin, but is actually doing more harm than good? I
• 46:44
  Dr Philip Tong: would say exfoliating. Oh so. I mean, before, a lot of skin cleansers have these kind of beads in them designed to kind of take off that top dead layer of skin. I think that could be drying your skin unnecessarily, right? So there are good cleansers nowadays that can do that chemically with glycolic acids and so forth. So I don't think it's good to over scrub, okay?
• 47:13
  Dr Philip Tong: And that being said, in addition to that, if I have a may have a second one the use of toners as well. Oh, really, yeah. So toners have a property that kind of helps to have that squeaky clean feeling, particularly if you're wearing makeup. But modern cleansers these days have, in my opinion, replaced the need for toning, right?
• 47:38
  Dominique Hind: Yeah. Okay, and it's one less step, I agree. How good. Sam, what's one thing most people over 45 wish they'd started doing earlier. I know you wearing sunscreen?
• 47:53
  Dr Philip Tong: No, I probably would say the use of tretinoin or a vitamin A, topical vitamin A, okay, I think if you can start that in your 30s, it's a good you will do a lot of good later on. Why didn't I start that? Funny? You didn't meet me. But
• 48:11
  Dominique Hind: what's the one skin care myth that drives you mad
• 48:15
  Dr Philip Tong: is that patients say, Oh, I'm indoors all the time, so I don't need wear sunscreen. And you'll be surprised how important it is to make that as part of your routine, because even if you're indoors, you might be driving to work the front wind windshield is not tinted, yes, right?
• 48:35
  Dr Philip Tong: You're sitting in an office.
• 48:35
  Dr Philip Tong: Maybe there's a window. You're getting UV coming through that window, and don't forget the effects of television screens, computer screens, blue light, all has an effect on your skin.
• 48:46
  Dr Philip Tong: So I believe wearing sunscreen as part of your daily routine has a lot of anti ageing benefits, okay, in addition to obviously preventing skin cancer.
• 48:59
  Dominique Hind: So make sure you wear sunscreen inside, yeah,
• 49:03
  Dr Philip Tong: even it may just make it part of your routine, okay, all right. If it means you cleanse, moisturise, you put your sunscreen layer, then your makeup, yeah, that is your routine, and you don't deviate from that, even if you plan to be inside the whole day, even if it's a rainy day,
• 49:17
  Dominique Hind: yeah, okay, I was gonna say, what about if it is a rainy day, still just screen. Okay, so it's just part of everything you do is put the sunscreen on. Yeah, okay, if you could write a midlife skin manifesto, right? What would be the top three things on it?
• 49:35
  Dr Philip Tong: I know it sounds really boring, but I'm sure all dermatologists would agree wearing sunscreen, topical tretinoin, and getting the occasional skin treatment. I don't care what it is, as long as you're starting, whether it starts from chemical peels, needle RF or some kind of treatments, whether it's injectables, biostimulators and so forth.
• 49:57
  Dominique Hind: Hang on, what's a biostimulator? Like there's there's collagen. Reducing colleges producing ones,
• 50:02
  Dr Philip Tong: they will at least help set you up for success later on. Okay,
• 50:07
  Dominique Hind: all right, good, okay. Phil, yeah, this has been a great conversation to have. I love talking about skin. I can always talk about skin and skin treatments, yes, before we wrap up, if I could try just one thing before I hit 50, something that shifts my perspective, pushes me out of my comfort zone or makes me do something different. What do you think I should do?
• 50:37
  Dr Philip Tong: I've heard your other podcasts and some of the guests that you have who come from incredible backgrounds and amazing life journeys, probably have much more perspective than I will ever be able to give. But if I was to try my best to suggest something to you and your listeners. It would be something that one would have done in their early 30s. So now, if you're heading towards 50 and you want to, I would encourage you to write a letter to yourself, speaking to your future 60 year old, Yep, yeah, in the persona of your future 60 year old, and listing out and describing your life at in your 60s or 70s and what you've achieved, okay, in that period of Time, and describing your life, who your relationships are, where you are in the world, what you've done in the last 10 years, 1020, years, and frame that up nice.
• 51:52
  Dominique Hind: What? Put it away until you're 60 or
• 51:55
  Dr Philip Tong: now, I think, keep it next to your study or maybe in a room that you have for reading or choir, yeah, and just reflect on that.
• 52:04
  Dominique Hind: Okay, good. So it's actually like a vision for what the next period or the next decade will be and what you'll need to do, absolutely. Yeah, okay, that's a good one. All right, I will, I'll start that.
• 52:15
  Dominique Hind: God, what do I actually want to do now?
• 52:21
  Dr Philip Tong: But you're, you're, you're visualising, yes, you are visualising your future self, yeah, and writing it to your present Yeah,
• 52:29
  Dominique Hind: yeah. I think that's a good thing to do. We'll just get you out of your head of now and thinking about where you want to
• 52:37
  Dr Philip Tong: be, but write it in the present tense, yes, as if you've achieved it, yep. Okay, good.
• 52:45
  Dominique Hind: I keep getting homework after that. Sorry. Ah, seriously. All right, Phil, thank you for sharing your expertise, and for me putting you on the spot, even with things like beef tallow and pushing the boundaries of what skin health can look like.
• 53:00
  Dominique Hind: You've reminded us that ageing isn't something to dread, and that we can still start now irrespective of what age we are.
• 53:08
  Dominique Hind: And I do love the glow from within comes from confidence, and that is, it's so true. If you've got confidence, it really doesn't matter what's happening around you, and take care of taking care of yourself. To everyone listening, if you, if this chat resonates with you, go book in your skin. Check go and check out DERM strength, DERM screen. I do think it is amazing to have a baseline of your body so that you know what has changed what hasn't changed, and it does help with that skin or that anxiety. And maybe finally, toss that overpriced toner away and make sure that your cleanser is actually just a cleanser with a little bit of acid in it. And if you love this episode, subscribe, send it to your friends and even maybe to your mum. And maybe you should also take on Phil's challenge to write a letter to your future self as if it has already happened, something that pushes you and challenges you, because I know that it gets you to think about yourself, so let's all try and be better to our skin, and we can start now because fuck, I'm nearly 50, and isn't it amazing? You?