Latest / The LIVING Room Podcast | Inside The WNDR Lab / Anti-Aging Myths Most Believe: Mayo Clinic MD on Retinol, SPF, Skinspan, Peptides & Red Light

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Anti-Aging Myths Most Believe: Mayo Clinic MD on Retinol, SPF, Skinspan, Peptides & Red Light · The LIVING Room Podcast | Inside The WNDR Lab

0:00
SPEAKER_05: The skin is the only external facing organ, but it also ages from the inside out.
0:04
SPEAKER_05: How your other systems are aging, your heart health, your liver, your brain health can actually show up on the skin.
0:10
SPEAKER_05: We stumbled onto 3D bioprinting skin out of a need.
0:14
SPEAKER_05: And it what's really exciting about it is that we can now map it to humans, right?
0:19
SPEAKER_05: So it's your digital twin.
0:20
SPEAKER_05: Oral collagen is way overhyped.
0:22
SPEAKER_05: It's just another source of protein.
0:24
SPEAKER_05: Keep sunscreen in your car.
0:26
SPEAKER_05: We see a lot of this damage on the left side of the face more prominently.
0:30
SPEAKER_05: About 40% of my patients are on GLP1 right now.
0:33
SPEAKER_05: They're losing a lot of the hypodermis, and we're seeing influences at the structural surface changes.
0:38
SPEAKER_05: So you see patients that are having soft tissue damage and volume loss.
0:42
SPEAKER_05: For every 20 pounds of weight loss on GLP1s, you have about 10% of facial fat loss.
0:48
SPEAKER_05: So it's considerable.
0:49
SPEAKER_05: You can still activate vitamin D through sunscreen application.
0:53
SPEAKER_05: You'd be surprised, Chris.
0:54
SPEAKER_05: It's only 25% of how we age is genetically determined.
0:59
SPEAKER_05: I mean, 75% is epigenetically influenced, and we can control and reverse and modify how that is.
1:06
SPEAKER_05: You really just need two steps in your skincare regimen.
1:09
SPEAKER_05: It's really two things.
1:29
SPEAKER_01: But what if we looked somewhere else, not at the end of the story, but what's actually visible along the way?
1:34
SPEAKER_01: The skin is our most exposed organ, this surface where biology meets the outside world.
1:39
SPEAKER_01: And it's often treated cosmetically, but quietly, it reflects how we live, how we recover, and how we age.
1:46
SPEAKER_01: Today I'm joined by Dr.
1:47
SPEAKER_01: Saranya Wiles.
1:48
SPEAKER_01: Saranya is the director of the Regenerative Dermatology and Skin Lab at the Mayo Clinic, a board-certified dermatologist and physician scientist, and a leader in translating regenerative medicine into clinical skin aging.
2:02
SPEAKER_01: Her work sits at the forefront of a major shift from treating visible signs of aging to understanding and restoring biology beneath them, using advanced therapeutics that are grounded in regenerative science.
2:13
SPEAKER_01: And in many ways, skin may well become one of the first places we can truly see this future of longevity, moving beyond slowing decline towards regeneration and repair.
2:23
SPEAKER_01: This isn't a conversation about beauty.
2:25
SPEAKER_01: This is a conversation about biology, resilience, and what it really means to age well in a way that you can see.
2:32
SPEAKER_01: Sonia, thank you so much for joining and welcome to the living room.
2:36
SPEAKER_04: It's good to be here, Chris.
2:37
SPEAKER_04: Thanks for having me.
2:38
SPEAKER_01: Hey, I'm excited to speak to you today for a number of reasons, but two main reasons are this is a field that I knew nothing about until we started working together.
2:49
SPEAKER_01: And and so every day feels like a school day for me when it comes to talking about skin aging.
2:55
SPEAKER_01: But secondly, it feels like this is either becoming or has become the new big trend in longevity, skin span and skin aging, and I think that's both good and bad.
3:08
SPEAKER_01: I think with that there's obviously lots of promising breakthroughs and new developments, and I've seen some of these, thankfully, um, but also a lot of misinformation.
3:17
SPEAKER_01: And so I think it would be cool to unpack both sides of that story today.
3:22
SPEAKER_01: But perhaps a good place to start would be to maybe give the listeners a bit of background because you you're you sit at this kind of unusual intersection between running a research lab and practicing aesthetic medicine, right?
3:36
SPEAKER_01: So maybe we start there.
3:38
SPEAKER_05: Sounds good.
3:38
SPEAKER_05: Yeah, I'm a physician scientist at the Mayo Clinic.
3:40
SPEAKER_05: So a few days a week I spend some time seeing patients, mostly in the aesthetic practice.
3:45
SPEAKER_05: And then the other half the week, I have a research lab.
3:48
SPEAKER_05: And really my patients inform the research that we're doing.
3:51
SPEAKER_05: So patients coming in asking about concerns about their skin, how and why things work a certain way as we age.
3:57
SPEAKER_05: And then we translate that and ask questions at the cell and molecular level with our postdocs and grad students in the lab.
4:04
SPEAKER_01: I was actually at Saranda's lab recently and it was fascinating.
4:09
SPEAKER_01: It was so cool.
4:10
SPEAKER_01: And we should get into some of those sort of regenerative medicine elements of what you're doing because it's kind of unbelievable what what we think is coming, or certainly what you've already found.
4:21
SPEAKER_01: Perhaps though we could take a step back because I think getting a better understanding of what aging of the skin actually means.
4:32
SPEAKER_01: Like I think that would be a really cool place to start.
4:34
SPEAKER_01: What even is, like, why do we age?
4:37
SPEAKER_05: Yeah, I I was very fascinated to study the skin because it's the largest regenerative organ.
4:42
SPEAKER_05: And the skin is the only external-facing organ.
4:45
SPEAKER_05: So your skin is influenced by a lot of the outside environment and the world, but it also ages from the inside out.
4:51
SPEAKER_05: So it reflects of how your other systems are aging, your heart health, your liver, your brain health can actually show up on the skin.
4:59
SPEAKER_05: So we can look at skin in a very unique way as an interface that both reflects and influences holistic aging.
5:06
SPEAKER_05: So that's where we started to ask these questions because aging became this fundamental mathematical problem very recently when we could understand through the lens of hallmarks of aging, we had these specific pillars and we knew the equation of where things went wrong.
5:21
SPEAKER_05: It was like looking at um and from a lens of an engineer.
5:24
SPEAKER_05: You know the you know where the problems are.
5:26
SPEAKER_05: So how do we wire, rewire to fix it, right?
5:29
SPEAKER_05: And so thinking about the skin, we were really started to look at the idea of function of the skin and how can we better understand, understand the skin as not just a structural reflector of how the age looks like.
5:41
SPEAKER_05: It's beyond beauty.
5:42
SPEAKER_01: Yeah.
5:43
SPEAKER_05: It's actually a functional aspect that we can understand more.
5:46
SPEAKER_01: There's a performance element.
5:47
SPEAKER_05: Exactly.
5:48
SPEAKER_05: Exactly.
5:48
SPEAKER_01: And so you're saying sort of skin is like a proxy for internal health as well.
5:52
SPEAKER_05: It is.
5:53
SPEAKER_05: It is.
5:53
SPEAKER_05: So, and and the skin has its own functionality.
5:56
SPEAKER_05: I'm really glad you alluded to that performance component because there is that skin fitness component.
6:02
SPEAKER_05: Your skin does a lot of different functions.
6:03
SPEAKER_05: So people don't realize this, but your skin is a barrier first and foremost.
6:08
SPEAKER_05: So it keeps everything out.
6:09
SPEAKER_05: You know, without your skin, you're going to be susceptible to so many different types of infections and wounds.
6:15
SPEAKER_05: And it also helps with sensation.
6:17
SPEAKER_05: So this is how we perceive the world, whether it's hot, cold, touch, sensation, vibration, pressure, those are all feelings that we encounter with the skin first, right?
6:27
SPEAKER_06: Yeah.
6:28
SPEAKER_05: And then um it allows us to be an organ that also makes vitamin D.
6:32
SPEAKER_05: Your skin's the main first organ that absorbs UV light and converts that precursor vitamin D's to active forms of vitamin D.
6:40
SPEAKER_05: So it's a it's a hormonal regulator.
6:43
SPEAKER_05: It absorbs things in, it secretes things out, it's a thermoregulator.
6:47
SPEAKER_05: We sweat through the skin.
6:48
SPEAKER_05: So all of these different functions happen at the level of the skin.
6:51
SPEAKER_05: And that's what really skin longevity is about.
6:54
SPEAKER_01: Why did you pick skin as an area of focus for your research?
6:59
SPEAKER_05: Because it's we can understand how regeneration works through the lens of the skin a lot faster.
7:05
SPEAKER_05: Our skin turns over every 30 days.
7:07
SPEAKER_05: So the dust on the floor that you're seeing, that's from our skin that's shedded down.
7:12
SPEAKER_05: So every 30 days we have a new layer of skin.
7:15
SPEAKER_05: And so with that in mind, we can understand every 30 days, you have a new layer of skin.
7:21
SPEAKER_01: Remarkable.
7:23
SPEAKER_05: So it's it kind of is a microcosm of or an ecosystem that can quickly adapt and quickly be able to understand how aging works.
7:31
SPEAKER_05: So it's a system that you can see when something goes wrong, we can get answers fast.
7:36
SPEAKER_05: And then that way it's like the perfect conduits to study aging because you don't have to wait long term to see these long-term outcomes like in longevity and functional decline.
7:45
SPEAKER_05: You can actually start to see these much earlier on with the skin.
7:48
SPEAKER_01: So, what would be some examples of that?
7:50
SPEAKER_01: Like how we could from testing or observing changes in our skin, we can infer that other things are going on internally.
7:59
SPEAKER_05: Yeah.
7:59
SPEAKER_05: Let's look at this and break this down across ages, right?
8:02
SPEAKER_05: Because think about the aging population in your in your teens and when you're going through puberty, people are seeing changes at the level of acne.
8:11
SPEAKER_05: You have more oilier skin, acne-prone skin.
8:14
SPEAKER_05: And then in your 30s and 40s, you you change again.
8:17
SPEAKER_05: So for women, that's women going through pregnancies or perimenopause and postmenopause changes that you're seeing where your skin becomes more drier, you get more flushing of the skin and vascular changes.
8:29
SPEAKER_05: Um, you're more likely to get damage easier.
8:32
SPEAKER_05: So I have a lot of patients that say the all of a sudden factor, all of a sudden I have this gray hair.
8:38
SPEAKER_05: All of a sudden, this wrinkle appeared on my skin.
8:40
SPEAKER_05: All of a sudden, my skin is feels dry.
8:42
SPEAKER_05: So it's it's actually not an all of a sudden effect.
8:45
SPEAKER_05: It has been brewing for a while.
8:47
SPEAKER_05: And it's these cell molecular changes that when it presents all of a sudden, that means the damage has occurred enough to a point that we're seeing a functional shift.
8:55
SPEAKER_01: I was going to ask you that.
8:57
SPEAKER_01: I feel like since I've turned 40, all of a sudden I I I've started looking a lot older.
9:04
SPEAKER_01: Maybe it's because uh since we started recording the podcast, in fact, because you don't often watch yourself on a screen in any way, I'm like, huh, I thought I looked a lot younger than that in real life.
9:14
SPEAKER_01: So you're saying that this is a um compounding of something going on over time.
9:21
SPEAKER_01: What would what would what are the sorts of things that are happening that have made me look older?
9:26
SPEAKER_05: Yeah.
9:26
SPEAKER_05: So for you, Chris, specifically, you're having stress, exactly.
9:30
SPEAKER_05: Your cortisol, your stress hormones are up way higher.
9:34
SPEAKER_05: And, you know, in our skin, we have some things called oxidative stress because you're encountering stress from the outside world in.
9:40
SPEAKER_05: You're probably on flights a lot and you're traveling, um, just being up on different um altitudes and different shifts in humidity, different shifts in environments changes your skin microbiome.
9:52
SPEAKER_05: And these shifts in skin microbiome can reflect further by creating barrier disparities.
9:57
SPEAKER_05: So you have more water loss, more drier skin, um, more susceptibility to free radical damage, which happens over time just from being exposed to these pollutants and stress from the world.
10:09
SPEAKER_05: And then it manifests on your skin by brown spots, aging lines, fine lines, dry skin, red skin, et cetera.
10:16
SPEAKER_01: So stop flying too much.
10:17
SPEAKER_05: So stop flying and applying, you know, there are things that you could do from a preventative aspect.
10:22
SPEAKER_05: So if you are going on a flight, you know, I would talk about a really good moisturizer and making sure that's not just applied once, but reapplying continually staying on top of your skincare as if you're taking care of yourself in the gym and doing fitness.
10:36
SPEAKER_05: You know, make it a routine.
10:37
SPEAKER_05: I talk to patients about thinking about skincare as thinking about dental care.
10:41
SPEAKER_05: You know, you don't, it's it's a mindless shift when you get up in the morning and you brush your teeth and you brush your teeth at night and you floss.
10:48
SPEAKER_05: Those are just habitual things that you do, right?
10:51
SPEAKER_05: So, in the same manner, you know, getting used to applying sunscreen, keeping sunscreen in the car and reapplying when you're in the car, keeping moisturizer in the bag and putting this on when you're on flights, these are all become habitual after time.
11:04
SPEAKER_01: And very low friction.
11:05
SPEAKER_05: Exactly.
11:06
SPEAKER_05: That's the goal.
11:07
SPEAKER_01: Yeah.
11:07
SPEAKER_01: Since we've been we test people here, obviously, thanks to some of the um uh testing suite that you set up for us.
11:15
SPEAKER_01: And one thing that's I found pretty remarkable is that the yield we can get from such a small amount of time doing the thing, right?
11:25
SPEAKER_01: It's not like you know, we have to carve out so much time to, I don't think relatively to the benefit, but exercise and you know, meal prep and sleep and all of those things require a high friction or a high um amount of time to carve out of your schedule.
11:39
SPEAKER_01: Whereas this is, I don't know what, five to ten minutes you can do.
11:43
SPEAKER_05: Exactly.
11:44
SPEAKER_05: And I think our consumers and patients are really overwhelmed.
11:47
SPEAKER_05: You know, if you look at the beauty industry right now, you go on TikTok or any social media platform and you're seeing up to 10-step skincare regimens, and there are a lot of products that are encountered that you're encountering and it becomes overwhelming.
11:58
SPEAKER_05: So for a lot of people, it says, okay, well, I I might as well, you know, stick to the basics or not do anything because it's overwhelming if you don't do a lot of these things.
12:06
SPEAKER_05: But skincare can be two things.
12:08
SPEAKER_05: It can be um active and functional, but it can also be an experience.
12:12
SPEAKER_05: So at the end of the day, a lot of people do skincare because it's a it's a way to unwind from the day.
12:18
SPEAKER_06: Yeah.
12:18
SPEAKER_05: It's it's an almost like an experiential process meditative that you go through.
12:22
SPEAKER_05: And it's a way to like, you know, whether it's rose that you're using in your skincare regimen or other type of fragrances, um, it's a way to unwind too.
12:29
SPEAKER_01: Yeah, I I must admit, I find it quite relaxing now.
12:33
SPEAKER_01: I've only relatively recently started doing it diligently.
12:37
SPEAKER_01: I mean, you've since I came to the lab, I've been doing it really diligently because of what I saw there.
12:42
SPEAKER_01: And you have kind of made me.
12:44
SPEAKER_01: Um but I I'd always I think for most, I could be hyper generalizing here, but for most men that we see, you know, sometimes we'll we'll go to the testing suite and and the practitioners will ask, you know, what is your current skincare regime?
13:00
SPEAKER_01: And and often it's soap and water, right?
13:02
SPEAKER_01: And and so for them, actually, it's relatively easy to get them to do a sort of one or two-step routine.
13:08
SPEAKER_01: I think from the other perspective though, um, often we see it being overcomplicated.
13:14
SPEAKER_01: Do you do you think in general we're overcomplicating how to protect our skin from aging?
13:18
SPEAKER_05: Absolutely.
13:19
SPEAKER_05: I mean, I think you really just need two steps in your skincare regimen.
13:22
SPEAKER_05: So, aside from washing your face, you should do that at the end of the day every day.
13:26
SPEAKER_05: But it's really two things moisturize your skin.
13:28
SPEAKER_05: So keep your barrier intact and apply SPF.
13:32
SPEAKER_05: So sunscreen, SPF 30 or greater, a broad spectrum sunscreen that needs to be reapplied.
13:37
SPEAKER_05: But it's really just those two things consistently done.
13:40
SPEAKER_05: And that's the key, Chris.
13:41
SPEAKER_05: It's consistency.
13:42
SPEAKER_05: Yeah.
13:43
SPEAKER_05: It's small, consistent habits that build up over time that supersede any actives that are currently on the market.
13:49
SPEAKER_00: Is that right?
13:50
SPEAKER_05: That's right.
13:51
SPEAKER_05: We actually did this study with Wake Forest University.
13:53
SPEAKER_05: Uh, it's a study called SOMA, study on muscle aging, mobility, and aging over time.
13:58
SPEAKER_05: And so we partnered with them to start a skin ancillary study.
14:01
SPEAKER_05: We deployed a skin health questionnaire on these 700 patients and looked at frailty.
14:05
SPEAKER_05: So we looked at vigor to frailty and looked at results of their skin health.
14:10
SPEAKER_05: So, what have they been doing?
14:11
SPEAKER_05: Skin health practices, their skin um exposure and sun exposure history, skin cancer risk, et cetera.
14:18
SPEAKER_05: And what we found was very interesting.
14:20
SPEAKER_05: And that was that we found that the patients that were consistent with skin cleansing habits, moisturizing habits, and sunscreen use actually had less likelihood of frailty.
14:32
SPEAKER_05: Now, I'm not saying that there's a correlation here, but I think it just speaks to a person that tends to be more consistent and disciplined.
14:39
SPEAKER_05: Yeah.
14:39
SPEAKER_05: Right.
14:39
SPEAKER_05: Because I think that's where you're getting to somebody that is doing it diligently.
14:42
SPEAKER_05: Exactly.
14:43
SPEAKER_05: And that diligency really can translate across time to having more impact on systemic aging.
14:48
SPEAKER_01: Yeah.
14:49
SPEAKER_01: Well, I think it does for certain across all of these different disciplines.
14:53
SPEAKER_01: I do the thing that we know to work consistently, like adhere to the things that we know to work, and you're you're always going to see this compounding benefit over time.
15:02
SPEAKER_01: But two things.
15:03
SPEAKER_02: That's it.
15:04
SPEAKER_01: So sorry, explains to me like I'm like I'm a child, because that's really my level of IQ when it comes to skincare.
15:11
SPEAKER_01: When you say cleansing, that is not one of the two steps.
15:16
SPEAKER_05: So cleansing, I would include that as a step at the end of the day.
15:18
SPEAKER_05: So I would say three steps.
15:19
SPEAKER_05: So let's go back.
15:22
SPEAKER_01: I wake up in the morning.
15:23
SPEAKER_05: Yes, wash your face.
15:24
SPEAKER_01: Okay.
15:25
SPEAKER_05: And then I would do um taking that box.
15:28
SPEAKER_05: Taking that box.
15:29
SPEAKER_05: If you can, it's some of it.
15:30
SPEAKER_05: I'm gonna add some clauses here.
15:32
SPEAKER_05: If you're living in like a a major city and you're having a lot of pollutants and exposures in the air, you're gonna be exposed to more free radical damage.
15:41
SPEAKER_05: You're basically stressing your skin out more.
15:43
SPEAKER_06: Yeah.
15:43
SPEAKER_05: And in that context, I'd do antioxidants like vitamin C, niacinamide.
15:48
SPEAKER_05: So those are just gonna help your skin prevent this type of damage down the road.
15:52
SPEAKER_00: Are they pills?
15:53
SPEAKER_00: Or you're you're they're topical.
15:54
SPEAKER_05: Yes.
15:55
SPEAKER_05: They're topical vitamin C in the same thing.
15:56
SPEAKER_00: New Yorkers, that's a great idea.
15:58
SPEAKER_05: Exactly.
15:59
SPEAKER_05: And now they even have sunscreen with antioxidants built in.
16:02
SPEAKER_05: Right.
16:02
SPEAKER_05: So that's a great way to bring in two actives into one.
16:06
SPEAKER_05: So I would use a sunscreen and an antioxidant in the morning.
16:09
SPEAKER_05: And then if you no moisturizer.
16:12
SPEAKER_05: A lot of times a sunscreen has moisturizer in it.
16:14
SPEAKER_05: So it's like an all-in-one stuff.
16:16
SPEAKER_05: The trifecta.
16:16
SPEAKER_05: The trifecta.
16:17
SPEAKER_05: Okay.
16:17
SPEAKER_05: There you go.
16:18
SPEAKER_01: Yeah.
16:18
SPEAKER_05: Yeah.
16:19
SPEAKER_01: And then maybe throughout the day apply more sunscreen if it's reapply.
16:22
SPEAKER_05: I and I just say to keep sunscreen in your car.
16:25
SPEAKER_05: Because most of our most of the time, people get exposed in the car.
16:29
SPEAKER_05: And we see a lot of this damage on the left side of the face.
16:36
SPEAKER_05: Exactly.
16:37
SPEAKER_05: Exactly.
16:37
SPEAKER_05: Like the truck driver's unilateral dramatic.
16:39
SPEAKER_01: I'm pretty sure the one I saw was AI generated, but no, it's true.
16:43
SPEAKER_05: There is a there is a New England Journal Medicine paper where there's a truck driver and it's a pretty staggering image.
16:48
SPEAKER_01: And it was the whole arm as well, right?
16:49
SPEAKER_05: The whole arm and that face.
16:51
SPEAKER_05: So keeping sunscreen in the car is super important and keeping some in your purse or your bag so that you always have it with you.
16:57
SPEAKER_05: It could be a stick, it could be a a topical powder that you can apply over maybe.
17:01
SPEAKER_01: Are you recommending wearing those sunscreen even when it's not exposed to sun itself?
17:09
SPEAKER_05: And on cloudy days, exactly.
17:11
SPEAKER_05: There's also different tints in sunscreen filters.
17:14
SPEAKER_05: So sunscreens, if they're tinted, they have iron oxide in them.
17:18
SPEAKER_05: And iron oxide is really important for patients that are melasma prone because it's not just UV light, it's visible light as well that can influence these different changes and pigment patterns on the skin.
17:28
SPEAKER_01: So the tinted ones could be beneficial?
17:31
SPEAKER_05: The tinted ones are beneficial not for coloring the skin, but actually to create protection against visible light.
17:36
SPEAKER_01: But they do color the skin.
17:38
SPEAKER_05: They do.
17:38
SPEAKER_01: So there is a little bit of both.
17:40
SPEAKER_01: Okay.
17:40
SPEAKER_01: Who knew?
17:41
SPEAKER_01: Wow, every day is a school day.
17:44
SPEAKER_01: So even on cloudy days, what about in like the winter in New York?
17:50
SPEAKER_05: It's especially important in the winter in New York because you have snow.
17:53
SPEAKER_05: The snow reflects the sun.
17:54
SPEAKER_05: So again, it gets back to if you were skiing, you know, you're constantly getting way more sun in those environments.
18:02
SPEAKER_01: You do often get burnt skiing.
18:03
SPEAKER_05: Exactly.
18:04
SPEAKER_05: So it's it's that concept of the snow uh reflecting the sun and creating.
18:09
SPEAKER_01: Some sort of pushback I've seen on the media recently, and this is almost certainly noise, but about, you know, when we wear too much sunscreen that we remove the capacity to absorb vitamin D or create vitamin D.
18:23
SPEAKER_05: Yeah, let's talk about this.
18:24
SPEAKER_05: This is really important.
18:25
SPEAKER_05: So vitamin D production is mainly done through the skin, and you need UVB to get that activation of vitamin D.
18:32
SPEAKER_05: However, you can still activate vitamin D through sunscreen application.
18:37
SPEAKER_05: So, sunscreen, most of the time, it's actually inconsistently applied.
18:41
SPEAKER_05: We don't, we don't apply enough amounts and/or it wears off.
18:45
SPEAKER_05: And technically, you actually only need about 15 minutes of sunlight to really activate that vitamin D process.
18:51
SPEAKER_05: So it's not a long-term exposure.
18:53
SPEAKER_05: Um, so avoiding sunscreen, the risk of you getting skin cancers and downstream damage really outweighs that vitamin D absorption because you're still passively absorbing UVB enough to make vitamin D.
19:05
SPEAKER_06: Sure.
19:05
SPEAKER_05: So I think that we can dispel that myth right away and have people use sunscreen and still get vitamin D.
19:12
SPEAKER_01: Huh.
19:14
SPEAKER_01: What about for um you know, I think that the only reason why people would not do that habitually is to get tan.
19:24
SPEAKER_01: Right.
19:24
SPEAKER_01: And I'm I have this British very pasty skin.
19:30
SPEAKER_01: And and so, you know, I I think and everyone kind of looks hard with a tan, right?
19:34
SPEAKER_01: I think we all think that um about ourselves when we've got like a good bit of colour and yeah, and then you bump into someone you haven't seen recently and they're like, you look well, and and you've just got a bit of colour to your skin.
19:45
SPEAKER_05: Yeah.
19:46
SPEAKER_01: How how are we able to do it?
19:48
SPEAKER_01: Like, do we still have the capacity to generate any kind of tan without removing that?
19:54
SPEAKER_05: So I still have you know, patients that are getting spray tans and other ways that you can or tinted do tinted SPF, exactly.
20:01
SPEAKER_05: So you can kind of create these other opportunities to get tan.
20:05
SPEAKER_05: But I would I mean, I think long-term wise, if you're kind of consistently getting tans, then your the risk of skin cancer goes up, your risk of getting you're damaging collagen at the end of the day.
20:17
SPEAKER_05: So you do have structural consequences that you're gonna see collagen degradation, elastin changes in your skin that I think create more harm than good.
20:26
SPEAKER_05: So best to avoid.
20:28
SPEAKER_01: I think I needed that advice 15 years ago.
20:32
SPEAKER_05: It's never too late though.
20:33
SPEAKER_05: Yeah.
20:34
SPEAKER_01: Can you explain to me about some of these structural damages, like what's actually happening mechanistically?
20:41
SPEAKER_01: Yeah.
20:42
SPEAKER_01: Like why do we look older?
20:43
SPEAKER_05: Why do we look older?
20:44
SPEAKER_05: So I think about the skin as cake layers.
20:46
SPEAKER_05: Okay.
20:47
SPEAKER_05: So if you have the skin, there are three layers really that are important.
20:50
SPEAKER_05: So there's the epidermis, which is the outside most layer that's regenerating constantly.
20:54
SPEAKER_05: The dermis, which every 30 days, every 30 days, you got it.
20:58
SPEAKER_05: You're learning quick.
20:58
SPEAKER_06: Yeah.
20:59
SPEAKER_05: And then we have the dermis.
21:01
SPEAKER_05: We have um well, this is a scaffold of the skin.
21:03
SPEAKER_05: So this is where fibroblasts live.
21:05
SPEAKER_05: So anything that's collagen, elastin, that matrix production.
21:08
SPEAKER_05: This is also where your nerves live, your vascular blood flow.
21:11
SPEAKER_05: This is all here.
21:12
SPEAKER_01: This is the second layer.
21:13
SPEAKER_05: This is the second layer of the dermis.
21:15
SPEAKER_05: And it's important for wound healing too.
21:16
SPEAKER_05: So if you have any wounds or scar maturations, that's all keeping a healthy dermis is super important.
21:21
SPEAKER_05: And then you have the hypodermis, which is where fat lives, and fat's super important for the skin.
21:26
SPEAKER_05: Actually, about 40% of my patients are on GLP1 right now.
21:30
SPEAKER_05: And because of that, they're losing a lot of the hypodermis, and we're seeing influences at the structural surface changes.
21:36
SPEAKER_05: So you see patients that are having like soft tissue damage and volume loss.
21:41
SPEAKER_01: And looking a little older, like at times, exactly because we're losing that volume.
21:44
SPEAKER_05: Exactly.
21:45
SPEAKER_05: For every 20 pounds of weight loss on GLP1s, you have about 10% of facial fat loss.
21:50
SPEAKER_05: So it's considerable and it's noticeable for a lot of patients.
21:55
SPEAKER_01: So, what do you do for those patients, given that 40% of them are on?
21:59
SPEAKER_05: So we we can Do things like biostimulators, which are injectable fillers essentially, but they're not the traditional synthetic hyaluronic acid fillers.
22:09
SPEAKER_05: These are more synthetic polymers like polyolactic acid or calcium hydroxylapatite.
22:14
SPEAKER_05: They're just basically polymers that go in and stretch your skin fibroblasts.
22:18
SPEAKER_05: I call it like Pilates for your fibroblasts.
22:21
SPEAKER_05: They stretch them out and that activates them to produce collagen and elastin.
22:25
SPEAKER_05: And same for other types.
22:27
SPEAKER_05: Some of them create low levels of inflammation.
22:29
SPEAKER_05: So they're kind of creating like an exercise type of environment, a stressor that can produce collagen and elastin.
22:35
SPEAKER_05: So we do a lot of biostimulator injections for patients on GLP1 so that it can help rebuild some of the collagen and soft tissue loss that they've had.
22:45
SPEAKER_01: Okay, we're gonna dive into the things that we can do in the treatments.
22:48
SPEAKER_01: Okay.
22:49
SPEAKER_01: A little later, later in the episode.
22:51
SPEAKER_01: Okay.
22:51
SPEAKER_01: But going back to the structural damage, you know, you mentioned these three layers.
22:56
SPEAKER_01: Can you um explain then what causes me to look old?
23:00
SPEAKER_05: Yeah.
23:00
SPEAKER_05: So when you yeah, so when you when you start having these stressors, like free radical damage, oxidative stress, they go in and we have these enzymes that are like scissors.
23:08
SPEAKER_05: Okay.
23:09
SPEAKER_05: They basically go when you have overexposure of UV, they go and cut up these collagen and the elastin.
23:14
SPEAKER_05: So we start losing the scaffold.
23:16
SPEAKER_05: That house that's been built up and the things that are holding your house up, they start breaking down.
23:21
SPEAKER_05: The walls start coming down because they're the materials are looser, the matrix is not as well supported.
23:28
SPEAKER_05: Um, you don't have the right ingredients because you're constantly undergoing stress.
23:32
SPEAKER_05: Um, and if you think about the skin, we talked about every 30 days, it's regenerating.
23:35
SPEAKER_05: But I also want to introduce the idea that the skin's on a circadian rhythm.
23:39
SPEAKER_05: So in the morning, your skin is a defender.
23:42
SPEAKER_05: So it's a defense, kind of goes out in defense against the world's stress and radical damage and UV and pollutants and et cetera.
23:49
SPEAKER_05: So it goes into defense mode, again, why antioxidants and sunscreen become vitally important.
23:54
SPEAKER_05: And at night, it goes into regenerate and repair.
23:57
SPEAKER_05: So at nighttime, we switch into clearing out a lot of these stress that we've accumulated.
24:04
SPEAKER_05: And at nighttime is when we rebuild that dermis, that second layer of the skin that we talked about, have healthy collagen and matrix proteins.
24:12
SPEAKER_05: And this is again why sleep is so important because when you sleep, you're actually rebuilding that skin's matrix support structures.
24:21
SPEAKER_01: Huh.
24:22
SPEAKER_01: Sleep for the win again.
24:24
SPEAKER_05: That's right.
24:24
SPEAKER_01: So, so what about your evening routine?
24:27
SPEAKER_05: Yeah, let's get to that.
24:28
SPEAKER_05: So, again, let's talk about this three-step, right?
24:30
SPEAKER_05: Because in the morning we talked about our defenders, and then at nighttime it's our offense.
24:35
SPEAKER_05: So, really bringing in regenerative and ingredients that are going to help boost that skin repair.
24:40
SPEAKER_05: So, I'd start off with cleansing the skin because you've just been in the outside world, you're encountering a lot of pollution, et cetera.
24:46
SPEAKER_05: So cleanse the skin, super important.
24:48
SPEAKER_05: And it could just be a very gentle cleanser, even a bar of soap.
24:52
SPEAKER_05: And then I would follow it with a regenerative active.
24:55
SPEAKER_05: So, like products with peptides, collagen peptides, hyaluronic acid, low molecular weight, anything that's going to kind of help rebuild that moisture back into the skin.
25:04
SPEAKER_05: Um, exosomes, there's a lot of actives like platelet exosomes that are helpful to repair and rebuild.
25:10
SPEAKER_05: And then finally a good moisturizer.
25:13
SPEAKER_05: So a lot of people talk about retinol.
25:16
SPEAKER_05: And I kind of want to dispill this myth about retinol.
25:19
SPEAKER_05: You know, it's it's been around for 20 years.
25:22
SPEAKER_05: Dermatologists wear by retinol, it's been, it's been super active, but it's not well tolerated by a lot of my patients.
25:28
SPEAKER_05: So if you're overpeeling your skin, then you're over-inflaming and kind of causing low levels of inflammation, which actually can make it worse.
25:36
SPEAKER_05: So I don't recommend retinol for patients that can't tolerate it and overscaling it.
25:42
SPEAKER_05: So even an over-the-counter product that is a very simple mild retinol is fine.
25:47
SPEAKER_05: Or you can even go without it because there we have ingredients like peptides and platelet exosomes that are much better in that repair.
25:54
SPEAKER_01: But this is more than two products that you're talking about.
25:56
SPEAKER_05: So I would just pick one.
25:57
SPEAKER_05: Okay.
25:58
SPEAKER_05: One of these.
25:58
SPEAKER_05: So these are all regenerative active.
26:00
SPEAKER_05: So I would just pick a peptide or a active, like an exosome or um or even a retinol if you're tolerating it, that's gonna help you build.
26:10
SPEAKER_05: So pick one of them and then a moisturizer.
26:13
SPEAKER_01: Okay.
26:14
SPEAKER_01: I'm gonna I've got two three trails of thought here.
26:18
SPEAKER_01: So I'm gonna do them one at a time.
26:20
SPEAKER_01: Exosomes.
26:22
SPEAKER_02: Okay.
26:22
SPEAKER_01: What are they?
26:23
SPEAKER_01: I've heard this a lot.
26:25
SPEAKER_01: Um, and how does that actually work?
26:26
SPEAKER_01: Let's start there.
26:27
SPEAKER_01: Okay.
26:27
SPEAKER_01: I'll get back to the other two.
26:28
SPEAKER_05: Sounds good.
26:29
SPEAKER_05: So exosomes are the greatest story from trash to treasure.
26:32
SPEAKER_05: We've known about them since the 50s, and we've always thought about them as cell waste.
26:36
SPEAKER_05: This is cell garbage.
26:37
SPEAKER_05: We don't really need to pay attention to it.
26:39
SPEAKER_05: But later on, we've come to filter them out as cell talk.
26:42
SPEAKER_05: This is how cells communicate with each other.
26:44
SPEAKER_00: Cell talk.
26:44
SPEAKER_00: Cell talk.
26:45
SPEAKER_00: Okay.
26:46
SPEAKER_05: Yeah.
26:46
SPEAKER_05: So in the very simple, it's text messages.
26:48
SPEAKER_05: It's how cells text each other.
26:49
SPEAKER_05: But you can have spam or you can have really, you know, you've won the lottery type of really good messages.
26:54
SPEAKER_05: So you have to filter them out.
26:56
SPEAKER_05: And the source is really dictates what can is contained in that message.
26:59
SPEAKER_05: So I would I would think about exosomes as highly variable and dependent on the source.
27:05
SPEAKER_05: The function is basically reliant on where it's coming from.
27:08
SPEAKER_01: And there are like a topical product.
27:11
SPEAKER_05: There are a lot of different exosome products that are now available over the counter as a topical.
27:15
SPEAKER_05: If you're injecting exosomes or using them for any medical grade indications, then you would need FDA approval and it has to go through the proper regulatory channels.
27:23
SPEAKER_05: But as a topical um cosmetic indication, there are a few that are out there that are highly um, you know, you want to look for clinical grade papers and making sure that they're, you know, showing the proof in the pudding, but um they can be really helpful if they're coming.
27:36
SPEAKER_01: So how do you how do we as consumers understand the difference between a good exosome and one that is not good?
27:44
SPEAKER_05: Yeah, that's a great question.
27:45
SPEAKER_05: Because you can also have cancer exosomes and you know, cells that are metastasizing.
27:49
SPEAKER_05: Can we want them?
27:50
SPEAKER_05: No, we don't want those.
27:52
SPEAKER_05: Um, but you I would look at the source.
27:54
SPEAKER_05: So mesenchymal stem cells, platelets, um, and you know, I mean, now there are plant exosomes that are coming into the market, but we really you really want them to show you papers and w work that they've done in peer-reviewed publications that show their efficacy.
28:09
SPEAKER_05: Um, and if they're going through FDA IND investigational new drug studies, that's another way to know that somebody has looked under the hood and seen the source, the efficacy, um, the characterization.
28:22
SPEAKER_05: So there are exosome markers on the outside that decorate the exosome, like gift wrapping papers.
28:27
SPEAKER_05: So you want to look and see where they're coming from.
28:29
SPEAKER_05: Are they properly characterized?
28:31
SPEAKER_05: So you have you really have to do the homework.
28:34
SPEAKER_05: And it's hard for consumers.
28:35
SPEAKER_05: So I would just ask the companies if they have any FDA studies that are that are ongoing.
28:40
SPEAKER_01: Do you think we could add a list of reputable companies to the show notes?
28:44
SPEAKER_05: Absolutely.
28:45
SPEAKER_05: Yeah.
28:46
SPEAKER_01: Because I I think even knowing what we should be looking for, it's still kind of hard to pass through as a consumer.
28:52
SPEAKER_01: The reason being, like I think all of these companies have got such an incredibly high marketing budget that quite often you read the website or the the collateral literature that comes with it and it sounds pretty compelling.
29:04
SPEAKER_05: Everything sounds good.
29:04
SPEAKER_05: Yeah.
29:05
SPEAKER_05: Everything sounds good.
29:05
SPEAKER_05: The before and afters look amazing.
29:07
SPEAKER_05: It's hard to you know reliably say what's truly there.
29:10
SPEAKER_01: Um talking of things that sound good, peptides.
29:13
SPEAKER_01: Yes, you know, there's been such a huge divide amongst um our scientists, certainly, about um not necessarily the efficacy in some animal models, but like for humans especially, there's not much data for a lot of these very popular peptides.
29:30
SPEAKER_01: And then the the manufacturing source.
29:33
SPEAKER_01: Um, yeah, we go online now and and you you you've kind of made to feel bad not to be exploring peptide therapy of some description.
29:41
SPEAKER_01: Now I know that that is different between these different verticals, and skin is very different to a lot of the others.
29:47
SPEAKER_01: What's your what's your position there?
29:50
SPEAKER_05: So before we talk about peptides, I'm going to define it for people.
29:53
SPEAKER_05: Okay.
29:53
SPEAKER_05: So we have amino acids, which I think about as letters.
29:57
SPEAKER_05: Peptides are little short chains of amino acids, which I think of as words, and then growth factors, which are bundles of peptides together, which I think about as sentences.
30:08
SPEAKER_06: I like that.
30:08
SPEAKER_05: And so it's it's like kind of building on these alphabets, right?
30:11
SPEAKER_05: So, and again, it's these are small chains of protein byproducts that can be absorbed through the skin.
30:18
SPEAKER_05: So, and it it really is super variable.
30:21
SPEAKER_05: We have thousands of types of peptides, and the studies of what works in the skin versus not is highly reliable, unreliable.
30:30
SPEAKER_05: And I would, I would take pause on topical peptides.
30:33
SPEAKER_05: However, there are companies that formulate them really well for better delivery.
30:38
SPEAKER_05: And there are a group of peptides that have been shown to have high, high efficacy because what they do at the end of the day is they're building blocks, right?
30:46
SPEAKER_05: They're small chains of proteins that can help that matrix structure over time.
30:50
SPEAKER_05: So I'm a I'm a big fan of, you know, copper peptides injectable.
30:54
SPEAKER_05: We don't know how much of that translocates to the skin, but topically applied and formulated well can really help influence positive changes in the skin.
31:02
SPEAKER_05: And I can share some companies that are doing this well.
31:05
SPEAKER_01: That would be great.
31:06
SPEAKER_01: And there's good human data on there.
31:08
SPEAKER_05: There's good human data as well, because this is in the cosmetic world, they will do a lot of different studies and and then in a lot of ways, it's already been tried on thousands of patients, you know.
31:19
SPEAKER_05: And so if a consumer comes back and buys these products, that's how I also screen in my clinic, is when some a patient comes back and they consistently buy a product over and over again, they've we've gained their trust because they're seeing the results.
31:36
SPEAKER_05: Exactly.
31:37
SPEAKER_01: Am I right in saying that I get that the using a topical peptide is inherently less risky anyway?
31:46
SPEAKER_05: They do get metabolized a lot faster.
31:48
SPEAKER_05: So compared to an injectable peptide, you know, and their systemic effects.
31:52
SPEAKER_05: A topical peptide, you know, it's it it the delivery is localized.
31:57
SPEAKER_05: You also have a lot less that's uh that's topically applied and absorbed.
32:02
SPEAKER_05: So it is um, and again, coming back to consistency, it's it's important that how much of the product is consistently applied and how much of the product is well formulated.
32:10
SPEAKER_05: Yeah, you also have to be cautious because in skincare, you can have 40% of skincare effects from just the vehicle in the product.
32:18
SPEAKER_05: Yeah.
32:18
SPEAKER_05: So if it's a really good mo we talked about moisturizing the skin, a lot of these products are just excellent moisturizers.
32:24
SPEAKER_05: So you're gonna get benefit from just using a consistent moisturizer, and then you have an added effect of a peptide.
32:30
SPEAKER_05: So hopefully they're doing the right testing.
32:31
SPEAKER_01: It's difficult to discern which element is actually causing.
32:34
SPEAKER_05: It is, unless you do the clinical trials for it.
32:36
SPEAKER_01: Yeah.
32:38
SPEAKER_01: Okay, the third part.
32:39
SPEAKER_01: So we're gonna add those in the show notes.
32:41
SPEAKER_01: I think that's gonna be incredibly beneficial for people.
32:44
SPEAKER_01: On the peptide thing, I think that's the real challenge for everyone listening and just consuming these things in general, or wanting to consume things that improve their health in general, is that that is a peptides are a catchal term in and of itself, right?
32:58
SPEAKER_01: And so there are so many things that fall into that term that to just say these are beneficial or these are not beneficial doesn't really do it justice, right?
33:07
SPEAKER_04: Exactly.
33:08
SPEAKER_01: On that, on that same note, not everything that works for some people works for everyone else.
33:15
SPEAKER_01: And so, how do we, when it comes to to skincare products, especially, how do we determine what is right for us or wrong for us?
33:22
SPEAKER_01: Because again, we've had members internally that, you know, some people have done really well on certain products and some the opposite.
33:30
SPEAKER_05: Yeah, that's a good question.
33:31
SPEAKER_05: So male and female skin is different, every decade of your life is different.
33:36
SPEAKER_05: So I always tell patients to listen to your skin as it evolves over time, right?
33:40
SPEAKER_05: You're gonna treat a 20-year-old different from your 40s, from your 60s.
33:44
SPEAKER_05: So you really wanna be mindful of what your skin is showing.
33:47
SPEAKER_05: A lot of it is genetic.
33:48
SPEAKER_05: So when you're younger, pay attention to what's happening to your mom and dad or what has happened to your grandmother and grandparents, right?
33:55
SPEAKER_05: Because you can you can see where your genetic trajectory is going and then build back from that to say, what can I do from a preventative lens to start in my 20s and in my 30s and 40s?
34:07
SPEAKER_05: And I and I really tailor this to every patient's own needs.
34:10
SPEAKER_05: So if you're having acne-prone skin, oily skin, dry skin, rosacea-prone skin, it's a totally different game-changing skincare routine for you.
34:19
SPEAKER_05: And you may need to have oral medications to supplement too.
34:22
SPEAKER_05: So if you have considerably significant acne, you will need to be on antibiotics or acutane or the other medications to help you out, not just topical products.
34:30
SPEAKER_05: So um, topical products are helpful, but they only go so far.
34:34
SPEAKER_05: So it's important to see your dermatologist too, if you have more skin conditions that are presenting.
34:39
SPEAKER_01: Do you think it's valuable for people to go and have like some kind of baseline testing?
34:43
SPEAKER_05: Absolutely.
34:44
SPEAKER_05: I would recommend everybody goes to your dermatologist once a year and get an annual skin check.
34:50
SPEAKER_05: Um, you know, you want to be screening for skin cancers first and foremost, but they can also get clues about your skin health and talk to you about, you know, what should you be doing for moisturizing and hydration or laser therapies and things.
35:01
SPEAKER_05: Yeah.
35:02
SPEAKER_01: And just imaging, like we we do the imaging here, the imaging done with consistency over time, and you can start observing those those changes objectively, right?
35:11
SPEAKER_01: Like we know how you are aging exactly.
35:14
SPEAKER_05: Exactly.
35:14
SPEAKER_05: It gives you great insight into that.
35:18
SPEAKER_01: And that's across different elements of performance as well as aesthetic, like barrier function and hydration and UV damage, all of those things we can now measure, right?
35:27
SPEAKER_05: Exactly.
35:27
SPEAKER_05: And it's a reflection of your systemic health too.
35:30
SPEAKER_05: So you want to be paying attention to skin health because it can really tell you and give you clues to where you could be adjusting things at the level of the skin and then help influence your systemic health.
35:41
SPEAKER_01: But you and and you mentioned that some of this is genetic or a lot of this is genetic.
35:45
SPEAKER_01: Do we have an idea as to what that ratio looks like?
35:48
SPEAKER_01: The reason I ask, my dad, like annoyingly, looks younger than me these days, or certainly doesn't look the same gap of age that he is.
35:56
SPEAKER_01: Um, and I know people, you know, one of our members in particular, who I'm sure you're familiar with, looks incredible for his age.
36:04
SPEAKER_01: He's 20 years older than me.
36:05
SPEAKER_01: He does not look one year older than me.
36:08
SPEAKER_01: How are we, how are some people just getting that lucky?
36:11
SPEAKER_05: Yeah.
36:12
SPEAKER_05: You'd be surprised, Chris.
36:13
SPEAKER_05: It's only 25% of how we age is genetically determined.
36:18
SPEAKER_05: That means 75% is epigenetically influenced, and we can control and reverse and modify how that is.
36:25
SPEAKER_05: The other good news about the skin is that it can be reversed.
36:28
SPEAKER_05: You know, so I think some of the stressors that you're seeing on your skin could be localized to certain time points.
36:33
SPEAKER_05: You know, it's at the end of the quarter, you have deadlines coming up, you're getting to a certain event, you we have, you know, we're all busy, right?
36:40
SPEAKER_05: So it's during those busy seasons of the life, you're gonna see changes that are reflected on your skin.
36:46
SPEAKER_05: But when you step back and go on holiday or vacation and you come back from it, you're gonna see that skin bounce back.
36:51
SPEAKER_05: So it is forgiving in that sense because it's highly regenerative, but you have to support it with these actives that can help that journey.
36:58
SPEAKER_01: Isn't it ironic that building a longevity business has aged me more than ever?
37:04
SPEAKER_01: What about nutrition?
37:06
SPEAKER_01: Do we have some insight, good data into how nutrition improves or can slow down that process?
37:11
SPEAKER_05: Huge.
37:11
SPEAKER_05: Yeah, because this the skin has its own microbiome, and the skin microbiome is influenced by the gut microbiome.
37:18
SPEAKER_05: So we actually are getting more and more understanding of the skin-gut axis.
37:24
SPEAKER_05: So by influencing our diet and making sure we're eating certain types of probiotics and different types of foods, you can actually influence a presentation on the skin.
37:34
SPEAKER_05: So lactobacillus, for instance, is hugely important for acne-prone skin.
37:40
SPEAKER_05: Um, and for eczema and psoriasis, there's also certain types of microbial shifts that we're seeing on the skin.
37:46
SPEAKER_05: And if you're eating certain types of nutritious foods, you can actually help influence that skin microbiome pathway.
37:53
SPEAKER_01: Oh, so then are there some universally known foods that will help improve that?
37:58
SPEAKER_05: Yeah.
37:59
SPEAKER_05: So I mean, I think fiber-rich foods, going back to it, and then um probiotic and fermented foods are key here.
38:06
SPEAKER_05: So thinking about the things that are naturally good for your gut health, because if your gut is healthy, you're gonna have less of a leaky gut, and a leaky gut presents on the skin.
38:16
SPEAKER_05: So a lot of times patients with Crohn's or irritable bowel disease have eczema that presents on the skin because it's reflecting a leaky gut.
38:24
SPEAKER_05: So you want to think about fermented foods, probiotics, and you know, high fiber-rich foods will be super good.
38:31
SPEAKER_05: Antioxidants that you eat orally, like blueberries and other antioxidants, great for your skin.
38:38
SPEAKER_01: What about alcohol?
38:40
SPEAKER_05: Alcohol.
38:40
SPEAKER_01: Asking for a friend.
38:41
SPEAKER_05: Yeah.
38:42
SPEAKER_05: No, alcohol and other sugars.
38:44
SPEAKER_05: I have a sweet tooth myself, so I'll tell you those just go and bind collagen and they sit heavy on your skin.
38:50
SPEAKER_01: So it's I know it's why do we sometimes get like a puffy face after like a heavy night or like a big meal?
38:58
SPEAKER_05: Yeah.
38:58
SPEAKER_01: Is that some something to do with like fluid retention?
39:01
SPEAKER_05: Lymphatic drainage.
39:02
SPEAKER_05: So a lot of times uh the way our lymph flu fluid flows in our skin is really reflected after you know these heavy nights and things.
39:11
SPEAKER_05: Um so it affects lymphatic drainage.
39:13
SPEAKER_05: Even after jet lag, you may see shifts in lymphatic damage.
39:16
SPEAKER_01: For sure.
39:17
SPEAKER_01: Okay, last naive question.
39:19
SPEAKER_01: No, this will not be the last naive question, but maybe the most.
39:22
SPEAKER_01: Why did you give me a different cream for my eyes?
39:26
SPEAKER_05: The under-eye skin is your thinnest skin in your body.
39:29
SPEAKER_05: So as the thinnest skin, it's most influenced by every damage that we're talking about.
39:34
SPEAKER_05: It presents there first.
39:36
SPEAKER_05: So typically, these skin serums that are eye-specific serums are gonna be more concentrated and more rich in these actives.
39:45
SPEAKER_05: Right.
39:45
SPEAKER_05: But there's a trick around this.
39:46
SPEAKER_02: Okay.
39:47
SPEAKER_05: So if you just take your facial moisturizer and double apply it under the eye, you're gonna just get it more concentrated.
39:53
SPEAKER_05: So you can work around it.
39:54
SPEAKER_05: Right.
39:54
SPEAKER_05: It is, it is, you just have to double apply.
39:57
SPEAKER_01: Hey, this might sound naive as well, but but I will ask are you supposed to apply the product in a certain way in like a certain direction, or or have I just made that?
40:09
SPEAKER_05: No, you have an especially for the neck products on the neck, you want to massage up.
40:14
SPEAKER_05: So you want to kind of go in lines of elasticity and you want to kind of go in certain always up on the neck.
40:20
SPEAKER_05: Always up on the neck.
40:21
SPEAKER_01: What about the face?
40:22
SPEAKER_05: I would move inside to outside, so lateral, um, and then kind of massaging.
40:26
SPEAKER_05: It typically you I you there's no specific direction for the face.
40:30
SPEAKER_05: You kind of just want to make sure it's fully covered.
40:32
SPEAKER_05: Um, but what I do tell patients is whatever you're putting for your face, at the end of the day, make sure you get it on the backs of your hands.
40:38
SPEAKER_05: So people often neglect the backs of the hands, and that gets a lot of damage, especially if you're driving a lot.
40:45
SPEAKER_05: You know, I I recommend patients wearing sun protective gloves when they're driving so they can kind of help prevent that and save the backs of their hands.
40:52
SPEAKER_05: Oh, yeah.
40:52
SPEAKER_05: Okay.
40:53
SPEAKER_05: I have some really stylish ones I can share with you.
40:55
SPEAKER_05: Okay.
40:55
SPEAKER_01: No, I'd definitely wear them.
40:57
SPEAKER_01: Um, okay, so we had Dr.
40:59
SPEAKER_01: Gary Miller on recently talking specifically about the exposome, but environmental factors that impact the exposome.
41:06
SPEAKER_01: Um, and it strikes me that that is something that is obviously very important for this barrier that faces the outside world.
41:12
SPEAKER_01: Are there things that the listeners should know that are just obvious, easy wins, you know, when you're traveling to and from work, when you're traveling on a plane, and we've we referenced the plane um briefly.
41:24
SPEAKER_01: Any other things that are just really obvious, easy wins?
41:27
SPEAKER_05: Yeah, I mean, I think moisturizing the skin consistently and sunscreen, like we talked about, but I want to also bring attention to humidity.
41:34
SPEAKER_05: And it the humidity shift, whether if you're in Denver or Florida, is really perceivable, right?
41:40
SPEAKER_05: And in a lot of ways, humidity, especially at nighttime, is super important.
41:45
SPEAKER_05: So I always tell my patients to have a humidifier in the room.
41:48
SPEAKER_05: That's the most simple thing you could do, just by creating a humid environment when you're sleeping, when your skin's circadian rhythm is shifted to that repair build mode and you're humidifying it.
41:59
SPEAKER_05: It's just going to be the most optimal to regenerate and repair those processes.
42:04
SPEAKER_05: So sleep with a humidifier.
42:05
SPEAKER_05: And if you're traveling, you can get those mobile humidifiers that you can put on your water bottle to really help that.
42:11
SPEAKER_01: I sleep with a fan on.
42:12
SPEAKER_01: Is that bad?
42:14
SPEAKER_01: Like it directly on me.
42:15
SPEAKER_05: Is it it could dry your skin if you're having it on at a high speed?
42:19
SPEAKER_05: So, you know, you could combat it by putting a little moisturizer on, but it's, you know, if you get hot, then it's also important to cool your skin.
42:26
SPEAKER_05: So Okay.
42:27
SPEAKER_01: I'm asking a lot of questions about me at the moment.
42:29
SPEAKER_01: So let's switch, let's switch gears and talk about um some of these treatments and tools and things that are being promoted.
42:37
SPEAKER_01: What are the most promising?
42:39
SPEAKER_01: Are there any that are just complete trash?
42:41
SPEAKER_01: What what are your favorites?
42:42
SPEAKER_05: Yeah.
42:42
SPEAKER_05: So when patients come to me, again, I start, I draw this pyramid out for them.
42:46
SPEAKER_05: And in the bottom I put foundations and we talk about skincare for the longest time of the visit.
42:51
SPEAKER_05: Because most of the time it's spent on consistently using skincare.
42:54
SPEAKER_05: And I tell them, I need you to do this for four to six weeks before I graduate you to the next rung, which is procedures, and then the top rung, which is injectables.
43:02
SPEAKER_05: So some of these procedures that we'll talk about, energy-based devices, lasers, and then injectables like Botox and fillers and others that you're alluding to, are built upon that foundation of consistency.
43:12
SPEAKER_01: Major in the mages.
43:13
SPEAKER_05: That's right.
43:14
SPEAKER_05: Your favorite phrase.
43:15
SPEAKER_05: Yeah.
43:15
SPEAKER_05: And then when we go to procedures, I it's so individualized, but it's so important.
43:20
SPEAKER_05: Lasers like non-ablative, fractionated laser or fraxal can reduce skin cancer risk up to 50%.
43:26
SPEAKER_05: And even pulse dye laser, which is a laser for reducing redness in the skin, also reducing skin cancer risk considerably.
43:34
SPEAKER_05: So it's not just about um aesthetics and vanity, but it's really a functional change that you're going to see and preventative from a skin health and skin cancer risk prevention mode.
43:44
SPEAKER_01: And what what when you when we talk about lasers and having that as a treatment, how frequently are people expected to do these kinds of things?
43:52
SPEAKER_05: So you really have a spectrum of lasers, you know.
43:54
SPEAKER_05: So some lasers have very low downtime versus others are more ablative.
44:00
SPEAKER_05: And aggressive, then they can have considerable downtime.
44:02
SPEAKER_05: So those aggressive lasers, you may only want to do them once you enter that accelerated aging phases in your life, which is your 40s and your 60s.
44:10
SPEAKER_05: So doing them maybe once every two to five years versus those non-ablative, low downtime lasers like Fraxel.
44:17
SPEAKER_05: I would do them twice a year.
44:18
SPEAKER_05: So spring and summer or spring and fall is a really good time to do these lasers.
44:22
SPEAKER_05: Um and then keeping up with it.
44:24
SPEAKER_05: I talk about, you know, setting a five-year plan for you.
44:27
SPEAKER_05: So by doing this consistently, you're going to see these results at five years and 10 years.
44:32
SPEAKER_05: It's compounded.
44:33
SPEAKER_01: You have a graveyard of lasers in your lab.
44:36
SPEAKER_05: My garage.
44:37
SPEAKER_05: Yeah.
44:37
SPEAKER_01: Yeah.
44:37
SPEAKER_01: It's pretty crazy.
44:39
SPEAKER_01: Um, what would you say?
44:41
SPEAKER_01: You know, all of this sounds pretty expensive, right?
44:43
SPEAKER_01: And what would you say for someone who is approaching this with a budget in mind?
44:47
SPEAKER_01: Like, is there one specific low-hanging fruit for them when it comes to procedures?
44:53
SPEAKER_05: Yeah.
44:54
SPEAKER_05: I mean, there's also a lot of low frequency, low energy, energy-based devices, like ultrasound and microneedling that you could do um multiple times a year.
45:06
SPEAKER_05: So three or four times.
45:07
SPEAKER_05: And they're on the budget-friendly basis.
45:10
SPEAKER_05: So you can do them consistently.
45:12
SPEAKER_05: You just have to make sure that you're doing the good skincare before it.
45:16
SPEAKER_05: Um, but doing something like that is just as equivalent as these non-ablative lasers.
45:21
SPEAKER_01: So for someone who is, you know, ticking all of the boxes when it comes to majoring in those foundational pieces, would you recommend being proactive with these things?
45:32
SPEAKER_01: Like, you know, some people are, you know, they look great for their age, but it's not going to stay that way forever.
45:38
SPEAKER_01: And so it is it always a case that the earlier you start this the better, or is it is that counterproductive at times?
45:43
SPEAKER_05: The earlier you start, especially with skincare and foundation, it's preventative.
45:47
SPEAKER_05: So you're you are gonna build that resilience.
45:50
SPEAKER_05: So the idea between having really healthy skin earlier on is that when you accrue that injury and damage later on, you have more resilience to come back and fight it.
46:03
SPEAKER_05: You know, so as we age, we are gonna see an accelerated time point where once you lose estrogen, lose other protective hormones, you're gonna see an accelerated decline in that matrix scaffold of the skin, right?
46:15
SPEAKER_05: So having higher resilience at the barrier level and these preventative protective factors is just gonna help you combat that injury model.
46:22
SPEAKER_01: Yeah, in the same way as it would every other element.
46:25
SPEAKER_05: Exactly.
46:29
SPEAKER_05: Exactly.
46:31
SPEAKER_01: Okay.
46:32
SPEAKER_05: Yeah.
46:33
SPEAKER_05: So the skin is pretty remarkable.
46:35
SPEAKER_05: Yeah.
46:35
SPEAKER_05: I mean, I think taking care of it earlier on can really allow you to have more functional skin long term.
46:42
SPEAKER_05: And this also reflects in like drier skin, itchier skin, um, and the functionality of just having healthier skin over time.
46:50
SPEAKER_01: It's just a great feeling as well when you like are really on top of it and you just feel like you look, you're like kind of glowing, right?
46:57
SPEAKER_05: Exactly.
46:57
SPEAKER_05: It's a lot of confidence, right?
46:59
SPEAKER_05: People get to show up in their best version of themselves through their skin, you know.
47:03
SPEAKER_05: And I think they walk in a room and you know, I see a lot of executives in our practice, and you know, they are going up for a promotion when their colleagues are asking them when they're gonna retire.
47:12
SPEAKER_05: Yeah.
47:12
SPEAKER_05: And this is a really important aspect of how they who they want to be, how they show up.
47:17
SPEAKER_01: Yeah.
47:18
SPEAKER_01: And I think people have become much more diligent and mindful about all of these different aspects of optimizing health in the recent years, and that that's only going to continue to grow, I think.
47:28
SPEAKER_01: Well, hey, can I ask you what you think about specifically about red light therapy?
47:32
SPEAKER_01: And the reason I ask is I've become, I was originally kind of skeptical about red light therapy until we started working quite closely with the the people actually creating the the um protocols and the the technology behind how to to use it.
47:47
SPEAKER_01: And then we we have a number of different um pieces of tech here.
47:52
SPEAKER_01: And having used them consistently myself, you know, I've actually been really impressed with how they've made me feel acutely.
48:00
SPEAKER_01: Like there are there are a number of protocols that I've done and I feel immediately better.
48:04
SPEAKER_01: Um, certainly when it comes to mood and inflammation and recovery.
48:10
SPEAKER_01: How does that apply to skin?
48:12
SPEAKER_01: Because I've seen one really compelling bit of research about reversing markers of skin aging.
48:18
SPEAKER_01: Can you unpack that?
48:20
SPEAKER_05: Yeah, absolutely.
48:20
SPEAKER_05: So red light can be quite variable.
48:23
SPEAKER_05: However, even at the NIH, they've done some really great studies showing benefits of red light for age reversal and helping that mitochondrial or the energy house of the cell be boosted.
48:34
SPEAKER_05: So red light has really shown that if you consistently use it at the right wavelength, it can help boost that collagen production of the skin.
48:42
SPEAKER_05: But think about it as an adjuvant, right?
48:43
SPEAKER_05: It's an add-on.
48:44
SPEAKER_05: At the end of the day, making sure if you're doing all the steps that we've talked about, and then you put on your red light mask before going to bed just for five, 10 minutes, you're going to incrementally improve.
48:54
SPEAKER_05: And the way I think about red light is it's optimally beneficial for those patients that are either recovering from, you know, lasers, so because it can help with wound healing.
49:03
SPEAKER_05: And then second, to use it for patients that are accelerated aging zones.
49:08
SPEAKER_05: So perimenopause and menopause skin, that's your prime time to be using red light or in your 60s, prime time again.
49:14
SPEAKER_05: There's also red light hair caps, which can help as an adjuvant to hair growth protocols.
49:19
SPEAKER_05: So they're helpful, but the only time I would avoid using red light is for melasma prone patients because they can generate low levels of heat and make your melasma worse.
49:28
SPEAKER_01: And am I right in saying um, you know, not all protocols work for all people?
49:34
SPEAKER_01: And it's it's mostly dependent on skin tone and heritage, the efficacy of those.
49:39
SPEAKER_04: Absolutely.
49:40
SPEAKER_01: Huh.
49:40
SPEAKER_01: And and when you mention perimenopause and menopause skin, how is that working?
49:46
SPEAKER_01: Like why would it be a period of accelerated skin aging?
49:51
SPEAKER_05: Yeah.
49:51
SPEAKER_05: So what happens during perimenopause and menopause is that your estrogen declines.
49:55
SPEAKER_05: And so that's your protective hormone.
49:57
SPEAKER_05: And then in the same time, you have stress hormones like cortisol that go up.
50:01
SPEAKER_05: So you're having this dichotomous change that one declines, it's been super important, and another increasing.
50:07
SPEAKER_05: And that shift really matters because what happens at that shift is you start responding to the stress cues and you start breaking down with matrix metallic proteinases or scissors for collagen, um, the matrix protein.
50:19
SPEAKER_05: So you see the decline happen more accelerated.
50:25
SPEAKER_02: Yeah.
50:25
SPEAKER_05: And these present as wrinkles, these present as redness, these present as skin cancer.
50:32
SPEAKER_05: So it can be quite significant.
50:38
SPEAKER_01: Is there anything that the women can be doing preventatively for in the run up to that to sort of build an insurance policy?
50:44
SPEAKER_05: Yeah.
50:45
SPEAKER_05: I mean, I think speaking to your doctor, if you qualify for hormone replacement therapy, I think that is hugely important, even for skin health.
50:52
SPEAKER_05: And then if on the other side is also these protective lasers, energy-based devices, making sure that you're applying these newer skincare products.
51:01
SPEAKER_05: And this is where I'm really excited about where the skincare industry is going.
51:05
SPEAKER_06: Yeah.
51:06
SPEAKER_05: And they're really shifting towards these longevity and like molecular basis of how the skin functions.
51:13
SPEAKER_01: Okay.
51:13
SPEAKER_01: Before we talk about that, Saranya, I want to ask you of any of the products that do exist that you're seeing promoted on social media or in the media in general, is there any specifically that jump out as huge overreaches or things that just don't work?
51:29
SPEAKER_05: Oral collagen.
51:31
unknown: Yeah.
51:31
SPEAKER_05: Oral collagen is way overhyped.
51:34
SPEAKER_05: It's just another source of protein.
51:35
SPEAKER_05: So if you can get any source of protein, pick your favorite.
51:38
SPEAKER_05: And oral collagen is marketed as your skin health protein, but it does not, you know, translocate to the skin.
51:46
SPEAKER_05: So it, you know, you're just getting a good source of protein, but oral collagen is way overhyped.
51:51
SPEAKER_01: Interesting.
51:52
SPEAKER_01: What about devices and treatments?
51:55
SPEAKER_05: I think a lot of devices are so tailored and patient specific, it's hard to say one way or another.
52:04
SPEAKER_05: But I am getting more interested in these at-home devices that are coming through because I think we're going to see patients are going to shift towards applying skin care in combination with at-home devices.
52:16
SPEAKER_05: And that's going to really shift that landscape.
52:18
SPEAKER_01: Yeah.
52:19
SPEAKER_01: And that's that can be kind of tumultuous as well, because there's, you know, how is that going through?
52:25
SPEAKER_05: Variability and exactly.
52:26
SPEAKER_05: And in accountability and, you know, risk aversion for some patients.
52:31
SPEAKER_05: You may make things worse, like melasma skin or certain acne-prone skin.
52:35
SPEAKER_01: So what correct me if I'm wrong, but what you're saying here is that we're probably in many cases overcomplicating all of this.
52:42
SPEAKER_01: And that might be wishful thinking because I think so much of this longevity space, we're bombarded with all these different things that we should be doing, that we have this kind of anxiety when we see a new trend or a new tool or technology online.
52:56
SPEAKER_01: Would that be safe to say for skin?
52:58
SPEAKER_05: Absolutely.
52:58
SPEAKER_05: I think you have to master the foundations first and then think of the others as fringe, right?
53:04
SPEAKER_05: It's great to add on, but really building that consistent platform and being um diligent and disciplined in that, just as you would after workout or certain types of meals and sleep and recovery.
53:18
SPEAKER_05: You want to think about skincare in that scope.
53:21
SPEAKER_01: And that's why I think it's just so tough for people though, when we're, you know, it's very difficult to pass through who the experts really are and who has an agenda to sell a product or to grow a platform.
53:33
SPEAKER_01: And I think that's why it's so challenging because quite often it is people with great credentials that may be just trying to push a specific agenda.
53:45
SPEAKER_01: Is there a way that people can pass through that for your specific field?
53:50
SPEAKER_05: Yeah.
53:50
SPEAKER_05: I mean, beauty brands in general are shifting more towards a biology focus, right?
53:56
SPEAKER_05: And it's actually the expectation of the results that they're having to show before announcing certain types of products or longevity serums.
54:05
SPEAKER_05: There's so many in the market right now.
54:07
SPEAKER_05: It's not just about making a claim, it's also showing the outcome.
54:11
SPEAKER_05: What is the proof that you're shifting these metabolic biomarkers that you're sharing that you're doing, or um, or how does that reflect on the skin from a very molecular and cellular way?
54:24
SPEAKER_05: So I think there are publications that are coming out.
54:27
SPEAKER_05: They're doing a lot of clinical trials and building that foundation of evidence before you make the claim.
54:33
SPEAKER_01: It seems like it's improving the rigor.
54:36
SPEAKER_01: Certainly in your field, I think.
54:37
SPEAKER_05: I think it's moving away from just collagen and elastin.
54:40
SPEAKER_05: You know, those were the two that people chased, and to they do to a certain extent, but it's not just about collagen and an elastin.
54:47
SPEAKER_01: Yeah.
54:47
SPEAKER_05: There's so many markers of resilience that you need to be thinking about that influence the skin.
54:53
SPEAKER_01: Is there any is there a governing body in the in the field?
54:57
SPEAKER_05: Right now we look at um our institutional academies, like the American Academy of Dermatology, the American Society for Dermatologic Surgery is establishing a longevity committee.
55:09
SPEAKER_05: So that's the first time this year and creating guidelines around what we should be doing when we think about skin health.
55:16
SPEAKER_01: I think we're gonna see a lot more of that across these different fields.
55:19
SPEAKER_01: This is a great move in the right direction, I think.
55:23
SPEAKER_01: Can I ask you one last question about this specifically?
55:25
SPEAKER_01: I promise you I won't continue.
55:27
unknown: Sure.
55:28
SPEAKER_01: Is there any considerations about like stability of ingredients and dosage of ingredients?
55:34
SPEAKER_01: Because if I think about supplements, for example, um, and there's some very famous um, you know, supplements that are promoted on lots of different podcasts that uh are made to make us feel like I absolutely should be taking this.
55:49
SPEAKER_01: But when you break down the dosage or the ingredients inside them, sure, they may have been shown individually at some level to help with a specific mechanism, but that collectively that's not always the case.
56:00
SPEAKER_01: Does the same apply for skincare?
56:01
SPEAKER_05: Absolutely.
56:02
SPEAKER_05: And you really have to be careful with the actives that are listed in skincare ingredients because sometimes they will list a whole barrage of ingredients, right?
56:11
SPEAKER_05: And then at the end of the day, it's fairy dusting.
56:14
SPEAKER_05: So you have like sprinkling of some key actives, and most of it is that vehicle control.
56:20
SPEAKER_05: So this is where I think asking the studies on actives only on human skin, actives are the key ingredients.
56:28
SPEAKER_05: So if you're saying to me that platelet exosomes are the hero ingredient in this, but the product has glycerin and beta-glucans, which are humectins, they draw water in.
56:39
SPEAKER_05: How do you know that it's one active or the vehicle?
56:43
SPEAKER_05: Exactly.
56:44
SPEAKER_05: Yeah.
56:44
SPEAKER_05: But I think there are companies like Plated that have done studies that compare head-to-head vehicle versus the active and other studies.
56:51
SPEAKER_05: Aveno has done a lot of work on colloidal oatmeal, and they've looked at colloidal oatmeal versus glycerin and peep pieced out the vehicle versus the active and seen this on pediatric patients and adults and geriatric patients over time.
57:06
SPEAKER_05: So there's there's a lot of great evidence that has been generated with these companies.
57:12
SPEAKER_01: Yeah.
57:12
SPEAKER_01: Okay, we're wrapping up this section, right?
57:15
SPEAKER_01: So major in the majors.
57:16
SPEAKER_01: Then if you're doing all of that, then there's some additional treatments and technologies you can use.
57:21
SPEAKER_01: We're gonna add those in the show notes, the things that we think are universally beneficial, and then see your dermatologists annually for this sort of checkup and imaging if that's something that you can weave into your budget.
57:33
SPEAKER_01: Now I want you to talk about the exciting stuff.
57:36
SPEAKER_02: Right.
57:36
SPEAKER_01: And can you give the listeners a glimpse into the things that you are actively researching right now?
57:42
SPEAKER_01: Because I saw some wild technology at your lab.
57:46
SPEAKER_05: Yeah, we're very excited.
57:48
SPEAKER_05: So we're studying senescence in our lab.
57:50
SPEAKER_05: So we look at the skin aging at a very high level of cell molecular biology, and we try to figure out why these zombie cells or senescent cells present in the skin.
58:02
SPEAKER_05: So as we age, these cells instead of dying away, they're kind of put under house arrest and they're just locked into that non-dividing state.
58:10
SPEAKER_05: But they sit there and it's sort of this rotten apple spoils the cart idea where they kind of secrete these harmful factors and influencing their neighbor fibroblasts to stop producing collagen elastin.
58:22
SPEAKER_05: So it's a really harmful neighborhood model that can be propagated and perpetuated.
58:27
SPEAKER_01: So they don't die, they just stop replicating, they just hang around like a bad smell.
58:31
SPEAKER_05: Exactly.
58:31
SPEAKER_05: Yeah.
58:32
SPEAKER_05: And so we're working on figuring out ways to clear these senescent cells and also to model this.
58:37
SPEAKER_05: So we 3D bioprint different skin cells and skin layers in the lab and figure out how we can test drugs like synolytics, which clear senescent cells or xenomorphics, which can modify that signal that's coming from these cells and figure out if we can improve that environment, that ecosystem, then can we accelerate the aging, um, preventative aging processes and the resilience of the skin?
59:04
SPEAKER_01: What's been the most exciting thing that you've discovered?
59:07
SPEAKER_05: Right now, we're very excited about the different peptides that we're finding that are helping with senescence clearance, but also in hair growth.
59:17
SPEAKER_05: So we have some very exciting developments that we're looking into to see how we can study this and compare it head to head with our existing topicals and medicinal products.
59:28
SPEAKER_05: And um, I'm also excited about bringing wearables into this space because as the skin, the most accessible external-facing organ, how can we better read and sense the skin so that we can get earlier cues and find that amber alert before it presents?
59:49
SPEAKER_01: Do you think we solve for hair loss entirely?
59:53
SPEAKER_05: I think hair loss is really complicated because there's multiple factors that influence it.
1:00:00
SPEAKER_05: And thus far, everything that we've done for hair loss has been an accidental finding.
1:00:06
SPEAKER_05: So things like monoxidal or rogain that people are using, right?
1:00:09
SPEAKER_05: That was a blood pressure medication.
1:00:11
SPEAKER_05: So when people were on a blood pressure medication, they noticed that their hair was growing.
1:00:15
SPEAKER_05: So then they repurposed it and now it's a big agency for hair growth.
1:00:20
SPEAKER_05: But I think if we're intentional about looking at these hair growth peptides and, you know, hair follicle mechanisms, I think we're at a very exciting time where we can think through senescence clearance and that regenerative aspect of bringing in healthier actives to create growth status.
1:00:39
SPEAKER_01: So more to come.
1:00:40
SPEAKER_01: So do you think that if if we could figure out I say we, I mean you, um, a way to clear those senescence of these zombie cells, that that would slow down or reverse the aging process?
1:00:53
SPEAKER_05: It could be both.
1:00:54
SPEAKER_05: It's yes, yeah.
1:00:55
SPEAKER_05: So it's gonna slow down for patients.
1:00:57
SPEAKER_05: It and it's it depends on the damage, right?
1:01:00
SPEAKER_05: So if you have, we know that senescence can be a very high burden or low burden, depending on the patient.
1:01:06
SPEAKER_05: And we see this to be true on facial skin versus body skin.
1:01:09
SPEAKER_05: So we did this study with King's College London on the human cell atlas, and we compared human skin from facial aging skin, sun exposed, and then skin from the body.
1:01:19
SPEAKER_05: And what we found was there's a higher senescence burden in skin from the face compared to the body.
1:01:24
SPEAKER_05: So and this is true, right?
1:01:25
SPEAKER_05: Because we our faces more exposed to the sun.
1:01:28
SPEAKER_06: Yeah.
1:01:28
SPEAKER_05: Um, and in those situations, you are gonna see that you asked about reversal versus slowing down.
1:01:34
SPEAKER_05: It just depends on if it's the face or the body and the extent of damage.
1:01:38
SPEAKER_01: Can you unpack the 3D printing model?
1:01:42
SPEAKER_01: Because it sounds like science fiction, right?
1:01:45
SPEAKER_01: And I and I've seen this with my with my own eyes.
1:01:48
SPEAKER_01: I know that this exists, I know this is happening.
1:01:50
SPEAKER_01: And it's not just happening with skin, it's happening in in different systems of biology.
1:01:55
SPEAKER_01: Um, how do you see that playing forward over the next uh five to ten years?
1:02:01
SPEAKER_01: Because if you could uh genuinely print someone's skin and it is unique to their biology, I I don't see there being much of a limit as to what you can do with that.
1:02:13
SPEAKER_05: It's such an exciting area, Chris.
1:02:15
SPEAKER_05: Right now, the we stumbled onto 3D bioprinting skin out of a need.
1:02:21
SPEAKER_05: We weren't even going down this path.
1:02:22
SPEAKER_05: We were looking to test these topical biologics for eczema, and we needed an animal model, and it was really hard to get one.
1:02:30
SPEAKER_05: So we decided to look into printing skin.
1:02:32
SPEAKER_05: You know, if you can't find one, can we just print human skin and make this model?
1:02:36
SPEAKER_05: We said that about a year and a half ago, and it took us this long to build that model, build those cake layers of the epidermis, dermis, and hypodermis, and figuring out how to deposit these cells.
1:02:48
SPEAKER_05: And it what's really exciting about it is that we can now map it to humans, right?
1:02:53
SPEAKER_05: So it's your digital twin.
1:02:54
SPEAKER_05: So we can take your skin biopsy, sequence it, and profile it to understand where are your senescent cells, where's your damage and normal healthy cells, and then take that as a CAD drawing that architects use and induce it to 3D bioprint skin.
1:03:09
SPEAKER_05: So you would have a very specific model of your skin.
1:03:12
SPEAKER_05: So we can do that patient type modeling.
1:03:14
SPEAKER_05: And now the FDA is recognizing this as an alternate animal model, which is a huge benefit for drug testing.
1:03:22
SPEAKER_02: Yeah.
1:03:22
SPEAKER_05: And scaling products.
1:03:24
SPEAKER_05: Yeah, the road to IND has become a lot shorter because of these types of models.
1:03:28
SPEAKER_01: So like in vitro testing for you as an individual and for the human any number of nature at large, yeah.
1:03:34
SPEAKER_01: Any number of different molecules or therapeutics or topicals and then see how it reacts.
1:03:39
SPEAKER_01: Exactly.
1:03:41
SPEAKER_01: And there's no limit to the I mean, it's not in vivo, right?
1:03:44
SPEAKER_01: It doesn't cause any damage.
1:03:45
SPEAKER_05: Yeah, and we can also print skin of color, so which is great because we can do these earlier tests on different skin types and be able to see how skin types respond to different therapeutics before we take them to a patient's.
1:03:59
SPEAKER_01: What is stopping you?
1:04:01
SPEAKER_01: I because I I know uh just from my inside insight that this is has incredible promise for wound healing.
1:04:08
SPEAKER_01: But what would be stopping someone from, you know, just printing me a face that's 20 years younger?
1:04:16
SPEAKER_05: Yeah.
1:04:16
SPEAKER_05: I mean, I think yeah, we have to talk about some ethics around those types of things, but I think at large, if we have the right resources, financial means to set up a GMP facility where we can print to take to patients, we have the recipe on how we can scale this up.
1:04:33
SPEAKER_05: So I think with time we'll see a lot of these translations be more therapeutic.
1:04:38
SPEAKER_01: Yeah.
1:04:39
SPEAKER_01: And and and one can only hope that that would scale to become a lot more affordable over time, much like any element of science.
1:04:49
SPEAKER_01: We see this all the time with any of these pioneering technologies or tools or developments.
1:04:54
SPEAKER_01: It's incredibly expensive to run a lab like yours and even try and prove efficacy for these things.
1:05:00
SPEAKER_02: Yeah.
1:05:01
SPEAKER_01: Um, but do you ever see a world where this becomes much, much more affordable?
1:05:07
SPEAKER_05: Absolutely.
1:05:07
SPEAKER_05: I mean, even now we've streamlined so many things of what makes it easier to print or resources getting more affordable, and how do we scale the basics of 3D printing?
1:05:17
SPEAKER_05: But we want to add structure to this.
1:05:19
SPEAKER_05: We want to one day add vasculature, we want to add hair follicles, we want to add sensation nerves to this.
1:05:25
SPEAKER_05: So as we advance the model, each iteration may take a lift, a moonshot, if you will, to get us to the next step.
1:05:32
SPEAKER_05: But the previous steps become scalable.
1:05:34
SPEAKER_01: Yeah.
1:05:35
SPEAKER_01: Yeah, yeah.
1:05:35
SPEAKER_01: And more affordable.
1:05:37
SPEAKER_01: More affordable.
1:05:37
SPEAKER_01: And I think with this um just crazy rapid developments in AI and computational biology, we're seeing that growth curve just it's faster than we can keep up with.
1:05:48
SPEAKER_05: Yeah, yeah.
1:05:49
SPEAKER_01: With the wound healing, you know, I think there are probably more people than we care to realize or or or hope to realize that have been.
1:06:00
SPEAKER_01: You know, by accident or or otherwise, left with some kind of debilitative feature, debilitating feature, even, where um it's completely robbed them of confidence or changed their life.
1:06:13
SPEAKER_01: Are we seeing examples where this kind of technology and these developments can give them that back?
1:06:21
SPEAKER_05: We're at a really exciting time.
1:06:23
SPEAKER_05: We're just about to have a conversation with the Department of Defense on making a 3D bioprinted wound patch.
1:06:29
SPEAKER_05: So we're taking this for a clinical trial for our wounded warriors.
1:06:33
SPEAKER_05: And what we're doing is we're creating a scaffold that contains these very simple um polymers of how they're oriented.
1:06:43
SPEAKER_05: And I love this because I actually had an injury myself.
1:06:46
SPEAKER_05: And when I was healing, it took me like three months.
1:06:50
SPEAKER_05: I was like, if me as a dermatologist can't figure out wound healing, I don't know how other people are figuring out how a surgical wound can heal or close.
1:06:58
SPEAKER_05: And what I realized at that time is that people think of wound healing as an outside in process.
1:07:04
SPEAKER_05: But what actually is happening is a bottom-up process.
1:07:08
SPEAKER_05: Okay, so we need to build that wound bed from the bottom up instead of trying to close these things from the side to side.
1:07:13
SPEAKER_05: I mean, it's both, but really getting that vasculature and that wound bed up is key.
1:07:18
SPEAKER_05: So we started to bioprint wound patches at a vertical orientation and create polymers in a different orientation altogether.
1:07:26
SPEAKER_05: And we partnered with this company to bring this to life.
1:07:29
SPEAKER_05: And now we are getting ready to talk with the DoD to take this into an FDA um device type of clinical trial that we're gonna deploy.
1:07:37
SPEAKER_05: And I think that's where we're gonna see some major shifts in wound healing treatment.
1:07:41
SPEAKER_01: What a time to be alive.
1:07:42
SPEAKER_01: That'd be that's so incredible that we've we've got that far that quickly.
1:07:46
SPEAKER_05: And it's and really made possible by the droplet.
1:07:53
SPEAKER_05: We have this really cool droplet bioprinter.
1:07:57
SPEAKER_05: And I think that's the that really was what enabled this technology.
1:08:01
SPEAKER_01: Is that the big monster one in the corner?
1:08:06
SPEAKER_05: And and that vertical or the orientation of all these patches can be so individualized and tailored to, you know, the needs of the patient.
1:08:14
SPEAKER_01: Hey, your dad works in your lab.
1:08:15
SPEAKER_05: He does.
1:08:16
SPEAKER_01: That's cute.
1:08:17
SPEAKER_05: When I was growing up, my dad's a pathologist.
1:08:19
SPEAKER_05: So our dinner table conversation, he would teach me the signs of wound healing in Latin.
1:08:25
SPEAKER_05: So me and my sister.
1:08:27
SPEAKER_05: Yeah, I know.
1:08:27
SPEAKER_05: It was a very different household.
1:08:29
SPEAKER_05: Yeah.
1:08:29
SPEAKER_05: We would make these songs out of, you know, rubor color, two more dolar, functional.
1:08:33
SPEAKER_05: You know, it was like a very nerdy dinner table with me and my sister.
1:08:37
SPEAKER_05: And um, and that really, you know, when he was going to retire, I um I could, I, I really wanted to have him, you know, as part of our lab, as a teacher, an educator, a pathologist.
1:08:49
SPEAKER_01: And it's just been amazing working with him.
1:08:51
SPEAKER_05: Unbelievable.
1:08:52
SPEAKER_01: You've got a great team there.
1:08:53
SPEAKER_01: They were great because they all explained, they all did a little sort of lunch and learn for me, which was I which I really appreciated because that's aren't they amazing?
1:09:03
SPEAKER_05: They're from all around the world.
1:09:05
SPEAKER_05: They bring the best talent to Rochester, Minnesota.
1:09:08
SPEAKER_05: Yeah, and they're just great people too.
1:09:11
SPEAKER_01: Yeah, yeah.
1:09:11
SPEAKER_01: And they clearly love what they do as well.
1:09:13
SPEAKER_01: I mean, I had a great experience at Mayo.
1:09:15
SPEAKER_01: I I think what they're building there is truly remarkable.
1:09:19
SPEAKER_01: The the hospital of the future is I mean, it's another world.
1:09:24
SPEAKER_05: Yes, another world.
1:09:25
SPEAKER_01: It it gives me great hope for the future of medicine in this in this country and and beyond.
1:09:30
SPEAKER_01: Hey, can we move on to some quicker fire questions?
1:09:36
SPEAKER_01: Right, because um I like to round off the episode with with a selection of these.
1:09:42
SPEAKER_01: I'm gonna give you a bit longer than usual to answer some of them because they're a bit more nuanced.
1:09:47
SPEAKER_05: I'll need more time.
1:09:48
SPEAKER_05: Okay.
1:09:48
SPEAKER_01: Yeah, maybe I don't know.
1:09:50
SPEAKER_01: So, first one is uh if you weren't a scientist, what would you be doing?
1:09:56
SPEAKER_04: If I was not a scientist, uh I would be an engineer.
1:10:01
SPEAKER_05: Well, I guess if that would count, um it doesn't it doesn't count, I would be an architect.
1:10:07
SPEAKER_01: Okay.
1:10:07
SPEAKER_01: Yeah.
1:10:07
SPEAKER_01: You kind of are in many ways.
1:10:10
SPEAKER_01: All of those things.
1:10:11
SPEAKER_05: Building.
1:10:11
SPEAKER_01: Yeah.
1:10:12
SPEAKER_01: Okay, next question.
1:10:13
SPEAKER_01: If you weren't working within your field, what's the the the field next to that that excites you the most?
1:10:23
SPEAKER_01: With regards to what you're most optimistic about for the future.
1:10:28
SPEAKER_05: If I was not in my field, I would I would I would be in um gene editing, um, CRISPR Cas9 and figuring out how we can reverse engineer these genetic mutations.
1:10:42
SPEAKER_05: There's so much potential and what is coming through that's remarkable, right?
1:10:47
SPEAKER_05: Yeah.
1:10:47
SPEAKER_05: So I think it's gonna change our predisposition to cancers, our predisposition to heart disease, and really uh I think if we can reverse that button, that's our key to you know, the lifespan number, number scale.
1:11:03
SPEAKER_01: But also uh on the flip side, how to express genetically more like these exceptional, exceptionally long livers.
1:11:10
SPEAKER_05: Exactly, the super centenarians, yeah, yeah.
1:11:13
SPEAKER_01: With that resilience and their um avoidance of cognitive decline.
1:11:17
SPEAKER_01: I think that compressing that um period of of physical and cognitive decline, regardless of if we can extend lifespan, will will change everything.
1:11:27
SPEAKER_01: Okay, what's the most overhyped skin longevity intervention?
1:11:33
SPEAKER_05: NAD, probably.
1:11:35
SPEAKER_05: I think right now um we don't really have a good understanding of IV NAD, oral NAD.
1:11:41
SPEAKER_05: A lot of clinics are utilizing NAD as uh a conduit to re-establish um metabolic and and functional health.
1:11:50
SPEAKER_05: I'd also put alongside that the glow stack peptide stack.
1:11:55
SPEAKER_05: Have you heard about this?
1:11:57
SPEAKER_05: So glow stack is copper peptide, and it's got BPC157 and TB500 stack with copper peptide.
1:12:09
SPEAKER_02: Right.
1:12:09
SPEAKER_05: So a lot of patients are doing this as the glow recipe for healthier skin.
1:12:14
SPEAKER_05: But I think you have to be careful because we don't truly have protocols.
1:12:17
SPEAKER_05: It is super off the rails with some of the timing and the cadence of treatments.
1:12:23
SPEAKER_05: So I would I would be avoided.
1:12:24
SPEAKER_01: Which is where you're sourcing it from.
1:12:26
SPEAKER_05: 100%.
1:12:27
SPEAKER_05: These peptides that market is wild.
1:12:29
SPEAKER_01: Yeah.
1:12:29
SPEAKER_01: What's the most underrated skin longevity intervention?
1:12:33
SPEAKER_05: I think we talked about consistency, moisturization, sunscreen.
1:12:37
SPEAKER_05: It's really, really simple.
1:12:39
SPEAKER_01: What do you think we look back on in 10 years' time and we're like, I can't believe we used to do that to our skin?
1:12:46
SPEAKER_05: Tanning beds and getting into tanning beds.
1:12:50
SPEAKER_05: And um I think the other thing is we're gonna look back at this time and feel that we would wished we would have invested more in preventative skin health.
1:13:03
SPEAKER_05: We're learning so much about these longevity treatments that you know really don't show us an amazing before and after in the short term.
1:13:12
SPEAKER_02: Yeah.
1:13:12
SPEAKER_05: We have to wait five, 10 years to see that molecular cellular resilience.
1:13:17
SPEAKER_05: So I think we're gonna look back and wish we would have started in our 30s on some of these newer skin health type of topicals.
1:13:26
SPEAKER_01: The prevention's just so much easier than the cure.
1:13:30
SPEAKER_01: What's one thing that surprised you about your research that you didn't think you'd find?
1:13:38
SPEAKER_05: I think it's our ability to pivot quickly.
1:13:41
SPEAKER_05: I think is if I think back to when we were creating the 3D printed skin model, it should have failed probably the first 10 times.
1:13:50
SPEAKER_05: Um, and the reason why we kept at it and trying to troubleshoot it is because some one aspect of it worked.
1:13:57
SPEAKER_05: So we kept going back to that and building off of that.
1:14:00
SPEAKER_05: And we built it actually, we built from bottom up to there.
1:14:03
SPEAKER_05: We did the dermis first and then the epidermis on top of it.
1:14:07
SPEAKER_05: And it was in reverse order than what people would think it would be.
1:14:11
SPEAKER_05: So it um, I mean, I think our ability to continue to pivot and keep keep at it has probably been the most surprising.
1:14:18
SPEAKER_01: Yeah.
1:14:19
SPEAKER_05: Yeah.
1:14:19
SPEAKER_01: If if you on that note, if you had just an unlimited amount of resources, a blank check to answer one unanswered question in your field, what would it be?
1:14:32
SPEAKER_05: I would want us to create a a skin sensor that can better serve as a readout of systemic aging and systemic health.
1:14:42
SPEAKER_05: I think we could truly detect certain types of skin or cancer in general, uh just from skin readouts.
1:14:48
SPEAKER_01: Do you know what's remarkable?
1:14:50
SPEAKER_01: Most of the guests that I've asked that question to have alluded to some kind of systemic answer that that we need to create some way in which we can understand how these verticals impact one another horizontally.
1:15:04
SPEAKER_01: I think that is collaboration and funding, and I think we get to that.
1:15:08
SPEAKER_01: That's the thing I'm most optimistic about in general.
1:15:11
SPEAKER_05: Exactly.
1:15:12
SPEAKER_05: And I think a lot of what we do is in silos and big into a collective umbrella, like what you guys have built here is incredible and it creates a lot of opportunity.
1:15:26
SPEAKER_01: Love it.
1:15:26
SPEAKER_01: Okay, two more questions.
1:15:28
SPEAKER_01: Okay.
1:15:29
SPEAKER_01: Well, two more and then one ask at the end.
1:15:31
SPEAKER_01: So if someone had just tuned in to this episode right now, um, what would be your three top tips for them to take away and get started with urgency today?
1:15:42
SPEAKER_05: With urgency.
1:15:43
SPEAKER_05: Three top tips.
1:15:44
SPEAKER_05: First is I would tell them about consistency as king or queen.
1:15:50
SPEAKER_05: Um, I'd have them use moisturizer and sunscreen consistently.
1:15:55
SPEAKER_05: Two, I'd have them think about skincare as healthcare and reframe the mindset that taking care of your skin has systemic influences as well as influencing your vigor to frailty scores.
1:16:10
SPEAKER_05: And three, I would leave them feeling hopeful about the future.
1:16:17
SPEAKER_05: I think there's a lot of marketing and noise right now, but the right questions are being asked, and the biology of skin is really shifting to a more skin health platform.
1:16:27
SPEAKER_02: Yeah.
1:16:28
SPEAKER_05: So we are we're being more cognizant and moving away from anti-aging and into this world of skin health, which is exciting.
1:16:35
SPEAKER_01: I love that.
1:16:36
SPEAKER_01: Where do you see yourself in 50 years' time?
1:16:39
SPEAKER_05: I think 50 years from now, I while I would still, you know, go on a vacation, honestly.
1:16:44
SPEAKER_05: Um, but the second thing is I think I'd be in some way, shape, or form involved still in the science.
1:16:51
SPEAKER_05: My mom was a scientist.
1:16:52
SPEAKER_05: I grew up pipetting water.
1:16:54
SPEAKER_05: And she would take me to the lab when I was five years old, and I just sit there pipetting water.
1:16:59
SPEAKER_05: I can't see myself in any other role than being in that lab environment.
1:17:04
SPEAKER_05: So I probably will be in some shape or form involved in a lab.
1:17:09
SPEAKER_01: Well, I'm glad for all of our sakes that that you that you will be and that you are right now.
1:17:13
SPEAKER_01: Where does where do our listeners find out more about you, Sarania?
1:17:18
SPEAKER_05: I am on social media.
1:17:19
SPEAKER_05: You can follow me on Instagram at drumming.
1:17:22
SPEAKER_05: Sorry, gone.
1:17:23
SPEAKER_01: Say it again.
1:17:24
SPEAKER_05: DrWiles.derm.
1:17:25
SPEAKER_01: Okay.
1:17:25
SPEAKER_01: All right.
1:17:26
SPEAKER_01: I'm gonna put that in the show notes.
1:17:27
SPEAKER_01: Lots of show notes here.
1:17:29
SPEAKER_01: Thank you so much.
1:17:30
SPEAKER_01: It has been a pleasure and a privilege.
1:17:33
SPEAKER_01: I could have asked you a hundred more questions, but um you kept tapping your watch when the camera was on me.
1:17:39
SPEAKER_05: Thank you, Chris.
1:17:40
SPEAKER_05: This was fun.