Latest / Skin Anarchy / Dr Amir Karam, Double Board certified, facial plastic, reconstructive, and otolaryngology Surgeon

Transcript

Dr Amir Karam, Double Board certified, facial plastic, reconstructive, and otolaryngology Surgeon · Skin Anarchy

• 0:00
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• 0:31
  SPEAKER_01: Hi guys, welcome back to the show.
• 0:32
  SPEAKER_01: So I really wanted to preface this episode by saying that I am so excited that we made it into the top 100 beauty and fashion podcasts on Apple Podcasts.
• 0:43
  SPEAKER_01: And also our Spotify uh wrapped data is just off the charts good for the last year.
• 0:49
  SPEAKER_01: I mean, I never expected it to be this huge of a growth in just one year, but thanks to you guys, we are really genuinely creating something that is of meaning and of value.
• 1:01
  SPEAKER_01: So I just want to re you know, just say thank you to every single guest, every single person that's uh you know interacted with us, giving us, you know, just the time of day.
• 1:11
  SPEAKER_01: Uh, you know, the most valuable human asset is time, and every single moment that you give us, whether it's through listenership or through coming onto the show or leaving a comment or you know, rating, it's all things that um don't go unnoticed, and they are truly, truly the most valued things that we have that comes from this show.
• 1:33
  SPEAKER_01: So I just want to say thank you, and also I think you're gonna love this episode because Dr.
• 1:37
  SPEAKER_01: Karam is genuinely a brilliant surgeon and he has broken things down in this episode like no other.
• 1:45
  SPEAKER_01: So um enjoy the episode, but it is my truly my humble request um if you could go on to Apple Podcasts or Spotify Podcast, find Skincare Anarchy, and then just leave us a rating of five stars and a written review if you have the time.
• 2:00
  SPEAKER_01: Thank you guys so much, and I really hope you enjoy this episode.
• 2:19
  SPEAKER_01: Hi everyone, welcome back to Skincare Anarchy.
• 2:22
  SPEAKER_01: This is going to be such a great episode today.
• 2:24
  SPEAKER_01: I'm super excited.
• 2:25
  SPEAKER_01: This is a very five-heavy, medically focused, you know, kind of interview and also conversation.
• 2:32
  SPEAKER_01: So, you know, I can't wait to learn.
• 2:33
  SPEAKER_01: I can't wait for you guys to learn with me.
• 2:36
  SPEAKER_01: So without further ado, I want to introduce you guys to Dr.
• 2:40
  SPEAKER_01: Amir Karam, who is a double board certified surgeon in the fields of plastic and facial surgery as well as reconstructive surgery, and also in the field of odolaryncology and the surgical interventions that are utilized in ENT uh medicine.
• 2:56
  SPEAKER_01: So without further ado, I want to welcome you, Dr.
• 2:59
  SPEAKER_01: Karam.
• 3:00
  SPEAKER_01: Um, also, I forgot to mention, guys, he is also the genius and creator behind Karam MD Skin.
• 3:06
  SPEAKER_01: So definitely check that out first and foremost.
• 3:10
  SPEAKER_01: But yes, Dr.
• 3:10
  SPEAKER_01: Karam, thank you so much for coming onto the show.
• 3:12
  SPEAKER_01: It is such an honor, and I am just so humbled and privileged that you made the time for this.
• 3:18
  SPEAKER_01: Yeah, I'm excited.
• 3:19
  SPEAKER_01: I'm excited.
• 3:20
  SPEAKER_02: Let's chat.
• 3:21
  SPEAKER_01: Yeah, um, I want to get started with uh really about you and your journey because I know you know going the route of surgery is uh definitely a very hard path, and I'd love for you to give us some background on why you chose this direction for your career and just how it's been and how the skincare line came to be, all the all the details.
• 3:38
  SPEAKER_02: Yeah, absolutely.
• 3:39
  SPEAKER_02: No, it's definitely been an evolution, and uh um, and I'll kind of take you back to um you know the origins of deciding to be a surgeon, and then you know, much more upstream came the decision to uh to develop a uh uh you know a skincare line that I thought would would sort of change the way um you know people interact with with skincare products and hopefully uh um you know really change the landscape in some ways.
• 4:05
  SPEAKER_02: And we'll talk about that um uh a little bit further.
• 4:07
  SPEAKER_02: But basically, um surgery for me became a um an inspired decision uh when my mom, uh right around the age of my age of around 18 or 19, she ended up having a heart transplant.
• 4:21
  SPEAKER_02: And uh all of her life, basically, she got diagnosed literally at at my um, you know, right when I was born, she got diagnosed with a congenital heart condition.
• 4:29
  SPEAKER_02: And so most of my life I was interacting with uh with um you know hospitals and doctors and in and out of emergency departments and things like that.
• 4:38
  SPEAKER_02: So I had a very, very close relationship with uh with the hospital setting.
• 4:43
  SPEAKER_02: And um, and when she got when we were at the end of high school and beginning of college, she her health really, really deteriorated to the point where um there was really no no option for her, uh, medically speaking.
• 4:55
  SPEAKER_02: And finally the cardiologists uh sent her along to UCSD um to the heart transplant surgeons there and um for an evaluation, and they felt that she would be a good candidate and they you know gave her hope by putting her on the uh the transplant list.
• 5:10
  SPEAKER_02: Now, for me being a single child, that was like a a major, major thing, because obviously, you know, you're you as a young young person and um especially as an only child, I think you're very close to you know to your parents.
• 5:22
  SPEAKER_02: And I was very close to my mom.
• 5:24
  SPEAKER_02: And uh and this opportunity that was given by these surgeons really became kind of a uh um like wow, you know, what an incredibly important um role the these uh this category of of uh professionals have on uh on human life and on families.
• 5:42
  SPEAKER_02: So um finally a year later she uh ended up getting her turn.
• 5:46
  SPEAKER_02: Um I remember her very vividly going into the operating room, basically dusky and purple because of the lack of oxygen and blood flow.
• 5:54
  SPEAKER_02: And she came out um four hours later, bright and and healthy in a way that I had never seen her before, you know, for years.
• 6:02
  SPEAKER_02: I hadn't seen her look like this.
• 6:04
  SPEAKER_02: So um that moment I remember sitting in the ICU uh um waiting room and I decided, you know what, this is what I want to do for my career.
• 6:12
  SPEAKER_02: I want to basically help people, I want to give people an you know the opportunity to have the same, you know, uh renewed, you know, life or quality of life or chance of life, etc.
• 6:23
  SPEAKER_02: And uh so I made my commitment to become a heart surgeon at that time.
• 6:27
  SPEAKER_02: And uh and that was that carried me, you know, I was at UCSD at the time, and that basically became a four-year um, you know, highly, highly dedicated um, you know, um sort of life that I was living, working with the same heart transplant surgeons that were took care of my mom, doing tons of research and in the labs, and I just was obsessed.
• 6:48
  SPEAKER_02: And uh it wasn't until I graduated from college and went to medical school the first year.
• 6:53
  SPEAKER_02: And then I remember I'll never forget the um the cardiac surgeons told me, hey, you know what, the field is changing, it's not what it used to be.
• 7:00
  SPEAKER_02: You might want to consider some other type of surgical specialty because heart surgery is being taken over by cardiologists.
• 7:08
  SPEAKER_02: And I remember how disappointed I was hearing that, and uh, but it did leave a little bit of a of a point in my head where I kind of opened my eyes a little bit more.
• 7:18
  SPEAKER_02: And it was, and I remember in um in medical school, the first class we take is uh is anatomy, and it was at the end of the year, and they were doing the head and neck section on anatomy when the uh um a facial plastic surgeon who had just finished up their fellowship came and did a talk on the uh subject of facial plastic surgery as it relates to the head and neck anatomy that we were studying as medical students.
• 7:40
  SPEAKER_02: And I just remember seeing in the back of the class and my jaw dropped at how um unbelievably complex and how much diversity there was in the field of facial plastic surgery from you know from trauma to reconstruction to cancer to cosmetics to rhinoplasty.
• 7:55
  SPEAKER_02: I mean, it was just an incredible, incredibly um broad and very uh technically uh difficult field, but also very creative.
• 8:02
  SPEAKER_02: And all of those things really um triggered my uh my interest because I always knew I had this kind of creative side to me that uh I knew that wasn't going to be uh expressed in cardiac surgery.
• 8:14
  SPEAKER_02: And uh and and uh so anyhow, so I got interested in in uh facial plastics and I started learning more about it.
• 8:20
  SPEAKER_02: And next thing I knew, um, you know, 11 years later, uh I fell deeper and deeper and deeper in love with it from that moment forward.
• 8:28
  SPEAKER_02: And then uh and I finally got to become a facial plastic surgeon 11 years downstream.
• 8:33
  SPEAKER_01: Well, what do you mean got to?
• 8:34
  SPEAKER_01: You worked your butt off.
• 8:36
  SPEAKER_01: Yeah.
• 8:37
  SPEAKER_02: No, it was it was a it was a it was definitely uh, I think a huge advantage for me to decide that early and uh and start getting really focused on it because you know there are the sooner you start accumulating ideas and um and weighing the different things, it gives you a lot of independence in terms of the way you think.
• 8:55
  SPEAKER_02: Um, unlike I think some some people who decide very late in the game and then they just go into a fellowship and spend a year or two and and basically they're just downloading everything that the mentor tells them.
• 9:06
  SPEAKER_02: I had the opportunity to kind of learn from tons and tons of different uh mentors along that 11-year path that gave me a lot of opportunity to be independent in the way I think about how the you know how the fields should be done and surgery should be done, etc.
• 9:20
  SPEAKER_02: So I I was able to kind of do some innovative things right out of the gates that uh that really set me up nicely in terms of my career path.
• 9:29
  SPEAKER_01: And you know, I'm actually gonna ask you a question because this is something I've never addressed on the podcast before, but I think it's very important for a consumer to understand this.
• 9:37
  SPEAKER_01: Um, actually, you know, surgical programs um in terms of residency for everyone listening, they look very highly towards candidates who have published peer-reviewed journal articles.
• 9:48
  SPEAKER_01: So most of the time when I'm talking to plastic surgeons or surgeons in general, they have this heavy hand in the research side of things as well.
• 9:57
  SPEAKER_01: That's why, like whenever I see a skincare line by a surgeon, I'm more inclined, you know what I mean, to be like, okay, here we go.
• 10:05
  SPEAKER_01: You know, because you've done the research.
• 10:07
  SPEAKER_01: You really do that.
• 10:08
  SPEAKER_01: So that's one thing I want to ask you about and how that journey has been for you throughout the medical, you know, um, academia side of it, because you know, I know it's a lot to balance.
• 10:17
  SPEAKER_01: Um, but I want to I want to hear your perspective.
• 10:20
  SPEAKER_02: Well, no, it you're absolutely right.
• 10:22
  SPEAKER_02: And and I kind of glossed over that just because it's, you know, it was just to me almost like a given.
• 10:27
  SPEAKER_02: But um I, you know, very early from the moment I decided I wanted to be a surgeon back when I was uh you know 18 or so, I did I um very, very strongly decided I was gonna go into academic medicine.
• 10:40
  SPEAKER_02: Um, and uh I was gonna be just like the surgeon who operated on my mom, who's a professor at a at a um teaching hospital and that type of thing.
• 10:47
  SPEAKER_02: So I really groomed from that moment.
• 10:49
  SPEAKER_02: I mean, I was involved in three different research labs as an undergraduate, um, clinical and surgical and you know, bench um science.
• 10:58
  SPEAKER_02: And uh, and that one is again, uh I mean that was like four years of that at UCSD, um published papers, gave talks, et cetera, even as an undergraduate.
• 11:07
  SPEAKER_02: And then when I got to uh UC Irvine, where I did my medical school, right away I joined a facial plastic surgery lab that was doing uh laser research um and uh at the Beckman Laser Institute.
• 11:20
  SPEAKER_02: And basically I spent the next 11 years um, you know, very, very involved, um constantly uh write, you know, researching, writing papers, publishing and and uh and giving talks all over, you know, all over the country and the world.
• 11:35
  SPEAKER_01: You're mastering your craft, you're mastering science.
• 11:37
  SPEAKER_02: No, no, no.
• 11:37
  SPEAKER_02: Science is, I mean, yeah, no, absolutely.
• 11:39
  SPEAKER_02: It's I think the critical thinking that goes along um with the research process and the academic process, I think it really sets sets the tone for for a lot.
• 11:48
  SPEAKER_02: And for me, it was like again, I I anticipated becoming a professor.
• 11:53
  SPEAKER_02: So I mean, it was for me, it was just jumpstarting my academic career by doing that.
• 11:58
  SPEAKER_02: I had a a lot of great opportunities to publish really nice papers and all that stuff.
• 12:02
  SPEAKER_02: So that became um that was a uh a staple of my of my uh um journey that I was balancing between you know doing these type these type of research endeavors and learning surgery and learning medical science and all that stuff all at the same time.
• 12:18
  SPEAKER_02: But but I wouldn't have it any other way.
• 12:19
  SPEAKER_02: I mean, it really, I think, again, to kind of set things up for what came down there.
• 12:23
  SPEAKER_02: And my my current practice and what I do in private practice um today has very much kind of an academic uh approach to things because of that background in training.
• 12:33
  SPEAKER_01: I love that.
• 12:34
  SPEAKER_01: I really you can you don't know, this is music to my ears to hear this because I mean I've expressed it many times on the podcast that I am a huge, huge, you know, supporter of um, you know, MDs that hold on to the side of true bench research, true medical research, you know, whether it's clinical trials or the bench, you know, whichever.
• 12:55
  SPEAKER_01: But as long as it's really looking at a problem and genuinely coming up with solution, I have so much respect, like respect, obviously, but also this uh in my eyes as a consumer, I expect that from a truly notable doctor.
• 13:09
  SPEAKER_01: So I really love what you said, and I love that that you have had this background and this amazing, you know, just kind of take on science and the way that you're looking at it.
• 13:19
  SPEAKER_01: So, you know, my my next question is obviously going to be, you know, so what when you first started, you know, obviously the clinical side of things, I'm sure that was uh, you know, overwhelmingly uh busy.
• 13:30
  SPEAKER_01: So, like, you know, what was what were some of the things that um were hallmarks on your path to like you know, creating your practice and all eventually your skincare line?
• 13:39
  SPEAKER_01: What were some of the hallmarks?
• 13:40
  SPEAKER_02: Well, so as I said, um my um you know, I the that little bit of a uh jump start that I had by discovering facial plastics early gave me um gave me some interesting opportunities to really think through some problems.
• 13:54
  SPEAKER_02: And one of the problems, um you got to remember we're talking about 19, you know, 90, 1997-ish, um, you know, is when when kind of this journey started for me.
• 14:05
  SPEAKER_02: And back then, facial plastic surgery, first of all, was not a uh was not a very popular field, um, both even among students and definitely the public.
• 14:15
  SPEAKER_02: And you know, all the facelifts and different um outcomes that we saw out in the in the real world, everyone looked stretched, they looked pulled, they looked unusual.
• 14:23
  SPEAKER_02: And even when I was watching my um my professors at the university perform these operations, um, you know, the results just looked unusual to me.
• 14:32
  SPEAKER_02: I mean, it just, you know, it's not surprising.
• 14:35
  SPEAKER_02: It's just how the outcomes were.
• 14:37
  SPEAKER_02: Um, and so for me, I said, you know what, there's no way I want to do uh facelifts in my practice.
• 14:42
  SPEAKER_02: These these operations are just really unusual.
• 14:44
  SPEAKER_02: You know, they just they're they're kind of uh yeah.
• 14:47
  SPEAKER_02: I mean, I don't want to say yeah, but they just look terrible, and and I don't want to be associated with it.
• 14:52
  SPEAKER_02: So I really thought I was gonna become a rhinoplasty and a cancer reconstructive uh facial plastic surgeon.
• 14:57
  SPEAKER_02: Those are gonna be my two subspecialties.
• 14:59
  SPEAKER_02: But then something really unusual happened, um, just kind of serendipitously, that I was in I was in a conference in 2004, um, and I was sitting in the crowd, and what happened was um some lecturer was giving a talk on eye rejuvenation.
• 15:14
  SPEAKER_02: I was honestly hardly listening because all the talks were always the same.
• 15:17
  SPEAKER_02: They were just you know taking out fat and skin from the eyes, and it just every eye looked the same, and they looked hollow and and gaunt and all this kind of stuff.
• 15:23
  SPEAKER_02: And again, never really appealed to me.
• 15:25
  SPEAKER_02: But I think I was like, as I'm scouring through what would be the next uh talk that I'm gonna go listen to as I'm sitting in the crowd, I look up and there's this guy showing these set of eyes that are very old looking.
• 15:34
  SPEAKER_02: And then next thing I know, there's another set of eyes that are really young looking.
• 15:38
  SPEAKER_02: And I really didn't even think they had anything to do with each other, but then he put them next to each other and said, you know, this is a before and after.
• 15:43
  SPEAKER_02: And how we achieved that was with fat transfer um by re-volumizing the eyes.
• 15:49
  SPEAKER_02: And again, 2004, this is far beyond.
• 15:52
  SPEAKER_02: You gotta remember, this is not even the term volume didn't even exist.
• 15:56
  SPEAKER_01: There was no fillers for volume, and we're still I don't think it's still, I don't think it still exists in the real general population.
• 16:02
  SPEAKER_02: Yeah, yeah, yeah.
• 16:02
  SPEAKER_02: No, I agree, I agree with you.
• 16:04
  SPEAKER_02: And so I I remember sitting there, it was like maybe 400 people in this uh in this lecture, and it just a light went off in my head.
• 16:10
  SPEAKER_02: And I said, Oh my god, that's what's what's you know, a big part of the aging process is this volume loss piece.
• 16:17
  SPEAKER_02: You know, people are losing fat in their face.
• 16:19
  SPEAKER_02: And then I started really looking everywhere, like everywhere I would be sitting in an airport, in a you know, restaurant, whatever, and just studying and looking at faces.
• 16:26
  SPEAKER_02: And I realized, yeah, indeed, that's what's happening.
• 16:28
  SPEAKER_02: People are losing volume as part of aging.
• 16:31
  SPEAKER_02: And uh, and so that kind of got me interested again in in the facial rejuvenation.
• 16:35
  SPEAKER_02: But the problem was that again, the surgical aspect of it was was uh um not great.
• 16:39
  SPEAKER_02: And so what I as I dug in a little bit deeper, I realized that surgeons um historically, literally from the turn of the night of the century, were lifting faces by pulling them sideways.
• 16:49
  SPEAKER_02: And that was our classic SMAS facelift as a sideways pull.
• 16:53
  SPEAKER_02: And um, and what I recognized from from that uh um realization was that's not the way a face ages.
• 17:01
  SPEAKER_02: A face ages from top to bottom, it goes you know downward.
• 17:05
  SPEAKER_02: And why are we pulling it sideways if we know it comes downward?
• 17:08
  SPEAKER_02: So I started um looking for other surgeons who are doing things differently than what was the 95 or 99 percent way of doing facelifts.
• 17:16
  SPEAKER_02: And I discovered that there are there are a handful of surgeons starting in the mid-90s that were starting to um do things in a vertical direction.
• 17:24
  SPEAKER_02: And when I looked at those outcomes, they totally looked natural.
• 17:27
  SPEAKER_02: So when I recognized that there was a vertically oriented lift that you could be done and a opportunity to add volume, and remember at that time it was either you're you're at it, you're a surgeon lifting faces or occasional fat transfer people.
• 17:42
  SPEAKER_02: They were trying to take, they were trying to use fat to fill the faces and avoid surgery.
• 17:46
  SPEAKER_02: I thought the real reality sort of sat in the compromise between the two, where you do a little bit of volume and you know the in the surgery, and then you have a truly rejuvenated face.
• 17:56
  SPEAKER_02: So when I finished my my uh uh residency and I became a fellow in 2005, I bought myself a set of fat transfer um, you know, cannulas, and I went uh on in my very first patient, which was just a few weeks after I finished, um, was a uh, you know, it was a my first fat transfer uh combined case.
• 18:15
  SPEAKER_02: And the result from that moment on was like unbelievably natural and beautiful.
• 18:20
  SPEAKER_02: And and uh and I was like, wow, you know, this is this is the the key.
• 18:24
  SPEAKER_02: You gotta re you gotta rejuvenate by adding a little volume and going vertical.
• 18:28
  SPEAKER_02: And uh and so from that point forward, I I think I did like 150 facelifts during my fellowship, which was a huge number.
• 18:34
  SPEAKER_02: Um, and all of them included fat transfer, and all of them looked natural, and all of them were, you know, and then I came out in private practice, and the reason I chose not to go academics was because all my academic uh colleagues were telling me that there's no way to really build a good facial plastic surgery practice in an academic setting because there's so much service involved in dealing with those customers that you can't do that when you don't uh have control over the employees that you hire, et cetera.
• 18:58
  SPEAKER_02: And and I and it turned out to be a very good set of uh recommendations.
• 19:01
  SPEAKER_02: So once I got into private practice, um I started really focusing on being a facial rejuvenation surgeon and a rhinoplasty surgeon.
• 19:10
  SPEAKER_02: And uh and I did that for you know, you know, from 2006 basically all the way um to about uh 10 10 plus years later.
• 19:19
  SPEAKER_02: And then I had kind of this moment where I was like, I had 10 years worth of outcomes to look at, and a lot of things were becoming clear to me.
• 19:27
  SPEAKER_02: And one of the things that became super clear to me was that um, you know, the skin is an incredibly important part of what makes somebody look young.
• 19:38
  SPEAKER_02: Because when you think about what what a 30-year-old looks like, when you think about what a 20-year-old looks like, there's two commonalities that never um there's no exception to this.
• 19:49
  SPEAKER_02: Number one is they have very young looking skin, right?
• 19:52
  SPEAKER_02: Young by their skin is is uh clear, there's there's very little blemishes in terms of sun damage, there's no fine lines and wrinkles, there's supple, there's thickness to it, um, and there's a brightness in general.
• 20:04
  SPEAKER_02: And then their facial shape, they have, you know, this kind of firm jawline, firm neck, you know, a heart-shaped or v na V-shaped uh jawline.
• 20:12
  SPEAKER_02: And when you put those two things together, that's what a young person looks like.
• 20:17
  SPEAKER_02: So now all of a sudden I became enamored and obsessed with finding ways to make skin better at the same time as I was doing the surgery.
• 20:27
  SPEAKER_02: So I was I was uh really getting involved in in uh you know TCA peels, laser resurfacing.
• 20:32
  SPEAKER_02: And then I would try to put all my patients on these really, really fundamentally sound um skincare regimens.
• 20:40
  SPEAKER_02: And uh and basically um, you know, I recognize that number one, it's when it comes to skin, people not only have no clue what they should be doing, but also once you get them on the right stuff, it's so complicated, it's so um so many steps involved, so expensive and and all this.
• 21:01
  SPEAKER_02: The very few people are able to do the right things for their skin um continuously over time.
• 21:06
  SPEAKER_02: I mean, I would put them through this whole process and then I follow up with them a few months later, and they had dropped like three other four things just arbitrarily, or they said it was too expensive, they can't continue with it, and all this kind of stuff.
• 21:17
  SPEAKER_02: And um, and so from that moment it became um again another one of those like obsessive moments where I try to solve this particular problem by you know finding ways to make skincare um very easy for for the uh for my patients to use so that they can use it on a regular basis.
• 21:36
  SPEAKER_02: Because at the end of the day, and you know as well as anyone, um what it takes is it takes you know sun protection, it takes the right products consistently over time.
• 21:44
  SPEAKER_02: And then you supplement with in office treatments and things like that for specific problems.
• 21:49
  SPEAKER_02: And you know, but without that foundation, it's very, very difficult to get um you know, get to the the point of having great skin or to preserve your skin from aging.
• 22:00
  SPEAKER_02: So that was kind of where where um my uh my interest in skin began and and it and it led me to uh a lot of lot of research in terms of being able to finally develop a product that uh that you know was able to become you know fully, fully uh comprehensive, very effective, very simple to use and literally just in one or two bottles and that's it.
• 22:24
  SPEAKER_02: You know, and I love that.
• 22:25
  SPEAKER_01: And I want to actually I want to uh devote like uh you know a good chunk of the the interview to really talking about the skincare line.
• 22:32
  SPEAKER_01: But I really want your opinion on one big question.
• 22:35
  SPEAKER_01: Sure.
• 22:36
  SPEAKER_01: Or really just uh an observation I've had.
• 22:38
  SPEAKER_01: So when we talk about, you know, facial anatomy, right?
• 22:41
  SPEAKER_01: I mean, right now in social media, as I'm sure you know, like there's so many posts out there, people are finding images, anatomical images of the face, the muscles, and you know, just posting them up.
• 22:51
  SPEAKER_01: But one thing that no one talks about is when you look at the facial structure in terms of just muscles, right?
• 22:58
  SPEAKER_01: Or just like the fascia and the muscles, you are looking at um, you know, a design, you could say, of, you know, parts of your body that are like the the way the fibers run is almost like a much more organized system in muscle than it is in something like skin, which is a multi-layered, not as organized in the sense that it's not like one fiber lines up with another, another, another.
• 23:22
  SPEAKER_01: It's not like that.
• 23:22
  SPEAKER_01: It's a very diverse environment that the skin deals with.
• 23:26
  SPEAKER_01: So, like it's really something I wonder about in terms of your philosophy around that when it comes to plastic surgery.
• 23:33
  SPEAKER_01: And you know, because the thing is when you were talking about the facelift, it really made it brought this up for me because I'm like, thing horizontal.
• 23:41
  SPEAKER_01: Like, how does that work with the actual fibers of the muscles?
• 23:44
  SPEAKER_01: Because you've got, I mean, I mean, if for everyone listening, you have a lot of facial muscles FYI.
• 23:49
  SPEAKER_01: Some of them, the fibers are running around, they're creating a full circle, you know what I mean?
• 23:53
  SPEAKER_01: Like your eye muscle, for example, and then some are running like diagonally.
• 23:57
  SPEAKER_01: So, yeah, it's a very complicated thing, right?
• 23:59
  SPEAKER_01: I mean, I I'm really dumbing it down for I guess myself and the listeners, but I I want to get your take on that.
• 24:05
  SPEAKER_01: How does plastic surgery approach this issue of skin versus muscle versus you know what I mean?
• 24:12
  SPEAKER_01: That that's it.
• 24:13
  SPEAKER_01: No, no, absolutely.
• 24:14
  SPEAKER_02: Uh yeah, so let me uh and I actually have some some good thoughts on that.
• 24:18
  SPEAKER_02: I'm glad you brought that up.
• 24:19
  SPEAKER_02: So so basically, um so again, when you become when you're hyper-focused, hyper-specialized in a particular area, you start to understand the anatomy better than like, you know, if you're doing it um occasionally.
• 24:34
  SPEAKER_02: And so again, in my in my world, in my daily world, all I do is rejuvenate faces.
• 24:39
  SPEAKER_02: And um right around that time that I was telling you about, 10 years in, that became clear to me, another thing that became clear to me is that the the fascia that you're describing is literally in the shape that I mentioned earlier, that young shape, that that's the fascia is responsible for the shape.
• 24:58
  SPEAKER_02: The fascia is the girdle that holds the face up.
• 25:01
  SPEAKER_02: And the fascia attaches up in the temporal region, attaches up into the uh the temple, and then you know, in this area it's a superficial temporal fascia, then it turns into the SMAS and the deep uh deep fascia of the face down through here, which intertwines with a lot of the facial muscles that you're describing.
• 25:19
  SPEAKER_02: And then it comes down into the neck, it it uh inter intertwines with the platisma muscle, which then finally has its attachments to the bone of the clavicle.
• 25:31
  SPEAKER_02: So this entire this entire this entire region, I looked at it.
• 25:35
  SPEAKER_02: Um I began, I should say, I began to look at it as one fascial network that's that's you know, basically, if you again simple terms, it's it's buttoned up down the center, it's attached down into the uh the uh clavicles, and then it's held together here up at the temporal, the bone.
• 25:52
  SPEAKER_01: Well, it's like saran wrap, right?
• 25:54
  SPEAKER_01: Just to give people on an appeal like it's the saran wrap over the muscles that's holding everything in place in that structure, which is what you just said.
• 26:01
  SPEAKER_02: Yeah, exactly.
• 26:02
  SPEAKER_02: And then what happens during aging is, and this typically happens right in the late 40s.
• 26:07
  SPEAKER_02: You know, again, we're being generalistic here, but you know, somewhere in the late 40s, that fascia starts to loosen and it starts to loosen instead of being this tight net that's holding everything up, it starts to loosen.
• 26:18
  SPEAKER_02: And when that happens, what we start to see is a very predictable organized direction of aging, which is the lateral, the corners of the brow starts to come down, the midface starts to come down, the nasal labial folds as a result get a little deeper, the jawline starts to come down, creating jowling.
• 26:36
  SPEAKER_02: And then finally, the platisma muscle, which is actually intervenes and attaches into the facial fascia.
• 26:45
  SPEAKER_02: Once the face starts to droop down, the neck then starts to hang, and you start to see the the uh heaviness starting to happen in the neck, the looseness in the neck.
• 26:55
  SPEAKER_02: So all of this is one fascia.
• 26:57
  SPEAKER_02: So and the skin is attached to the fascia.
• 27:01
  SPEAKER_02: So that and as you know, skin is literally a passenger in the whole body.
• 27:07
  SPEAKER_02: So, for example, in pregnancy, the platisma gets big with the with the baby, the skin you know stretches around it.
• 27:13
  SPEAKER_02: Bodybuilders get big, gain weight, lose weight, it stretches and contracts according to what's happening in the deeper tissues.
• 27:20
  SPEAKER_02: And in the fascia, as the fascia gets elongated, the skin gets elongated with it, and as a result becomes redundant.
• 27:27
  SPEAKER_02: So the technique that I I basically um trademarked and developed to address this problem um directly was a technique called the vertical restore.
• 27:36
  SPEAKER_02: And I um in the uh um in 2018, this you know the I kind of made a big switch into the way I do um my my uh facial rejuvenation by doing a procedure that addresses the fascia, the temporal region, the midface, the jawline, and the neck, all in one, in one setting.
• 27:56
  SPEAKER_02: So all of it is brought up together at the fascia level by releasing those deeper um ligaments.
• 28:02
  SPEAKER_02: So you're not pulling against anything.
• 28:03
  SPEAKER_02: Again, one of the reasons why people look stretched and pulled is because things are are uh tethered down to bone.
• 28:09
  SPEAKER_02: And when you release them, then you're able to get everything to go in the direction of those organized fibers that you're describing, kind of that that that that uh same sort of vector.
• 28:18
  SPEAKER_02: Uniform, yeah, uniform hybrid.
• 28:20
  SPEAKER_02: Yeah, exactly.
• 28:21
  SPEAKER_02: Bringing it all up together, and then it has harmony and it has balance, and everything looks like it belongs together.
• 28:26
  SPEAKER_02: And that's a huge reason why my outcomes have such a natural look to them, is because it's it's like pieces of a puzzle coming back together.
• 28:35
  SPEAKER_02: Once you reposition things back to where they were, it looks like it's where they belong.
• 28:39
  SPEAKER_02: No one looks different, they don't look like they've had work done, they don't look like a different person, they just look like them minus aging, which is at the end of the day, what I think people uh you know obviously want when it comes to to the facial rejuvenation.
• 28:52
  SPEAKER_01: Absolutely.
• 28:53
  SPEAKER_01: And I think thank you so much.
• 28:54
  SPEAKER_01: That was such an amazing explanation, and I really hope everyone caught that because that's a huge, huge topic.
• 29:00
  SPEAKER_01: It's very um it's very, you know, intriguing to me, you know, and I think to a lot of people because you you know, what you said, it really feeds into that point of um what I was trying to make about the skin is like, okay, now that we've learned that the skin is attached to the fascia, and now, you know, say we were going into the next step.
• 29:18
  SPEAKER_01: So you've you know, you've gone ahead and done the um like the the work with the fascia and and the deeper layers like that, and you've lifted them upwards, right?
• 29:27
  SPEAKER_01: And now we have to work on skin.
• 29:28
  SPEAKER_01: And you were talking about volume, right?
• 29:31
  SPEAKER_01: So that's a whole different conversation.
• 29:33
  SPEAKER_01: And I think it it's important to kind of categorize these, like, you know, steps that are involved in the process of quote unquote aging, because that's when people will start to understand what do skincare products really do?
• 29:45
  SPEAKER_01: You know what I mean?
• 29:46
  SPEAKER_01: Your skincare product.
• 29:48
  SPEAKER_01: Yeah, you're they're not working on your fashion, your um they're working on the like I said, the loose connective tissue in your skin that helps it be so pliable and flexible.
• 29:58
  SPEAKER_01: So you that's where I I think, you know, that's where I was really trying to go too was this idea that there's a huge differentiation between the type of tissue you're dealing with and how you're approaching it, you know, medically.
• 30:10
  SPEAKER_01: So, you know, that that's the segue I wanted to use to kind of talk about your line, you know, and your skin care, uh your viewpoints.
• 30:18
  SPEAKER_02: Well, no, I I really appreciate it.
• 30:20
  SPEAKER_02: You actually you brought up a point I'm just gonna emphasize on, and that is um, you know, it's so important for people to understand that laxity, you know, when we talk about real laxity with the kind of misshapes the face, that's a fascia problem, right?
• 30:37
  SPEAKER_02: So that is not a topical skin care solution.
• 30:42
  SPEAKER_02: It's not a laser solution.
• 30:44
  SPEAKER_02: That's not, you know, unless you physically manually move that fascia back up to where it was surgically, there's nothing that's gonna deliver that type of a result.
• 30:54
  SPEAKER_02: And unfortunately, when you have creams and and lotions and potions with terms like, you know, lifting, you know, full whatever, you know, they're trying to imply that they're somehow going to neck, you know, firm and lift the neck and all these different things, you're all you're doing is unfortunately misleading the the public.
• 31:14
  SPEAKER_02: And you talk about a uh, you know, um something that I absolutely hate about our industry is the type of misinformation and misleading for marketing purposes that ultimately lead to people just to to waste money on things that uh that are you're gonna leave them disappointed and uh and chasing the wrong you know wrong things.
• 31:35
  SPEAKER_02: I've always been extremely, extremely um a big advocate of of transparency and honesty when it comes to to the this this type of work.
• 31:43
  SPEAKER_02: Um, you know, talk about the the realities of what can be done and what can't be done, um, and uh let people know in realistic ways what the expectations are.
• 31:53
  SPEAKER_02: And so so the and to speak to that, I mean, specifically about skin, and we you know, we talked about our facial rejuvenation sort of triad, it's it's uh addressing the volume loss, which is fat loss, addressing the fascia repositioning, um, and uh now really addressing the actual skin.
• 32:13
  SPEAKER_02: And that's that's a whole interesting biology in of itself because you know, when we're when we're young and we think about it from an evolutionary biology point of view, there's a reason why when we get to perimenopausal age, for example, for women, um, there is a complete transition that happens into the skin.
• 32:32
  SPEAKER_02: There's a massive reduction in the production of collagen, elastin, all those kind of things that give the skin that thickness and suppleness, right?
• 32:39
  SPEAKER_02: And as a result, you said, and you also see that in patients who have had Oophorectomies, um, you know, at age 30, something they they're being pushed into menopause.
• 32:50
  SPEAKER_02: Their skin is on a completely different trajectory than somebody who's a normal 30-year-old with with normal hormones and all this stuff.
• 32:58
  SPEAKER_02: So one of the things that I think is really important to point out is I mean, this is how I think about it, and and I'm sure you have your your own perspective on this, but the way I look at it in my mind is the skin, let's let's say it starts off at you know, this thick, an inch thick or whatever, just obviously not an inch, but we're just using kind of round numbers.
• 33:18
  SPEAKER_02: By the time you're in your your 50s, now it's like a half an inch thick, right?
• 33:21
  SPEAKER_02: So the question then becomes how do we keep our skin thicker over time?
• 33:25
  SPEAKER_02: Because that's one of the important qualities of skin.
• 33:28
  SPEAKER_02: Why do you why does somebody who gets older need Botox as opposed to somebody younger?
• 33:32
  SPEAKER_02: I mean, they're still moving their deep facial muscles, right?
• 33:35
  SPEAKER_02: I mean, everyone's raising their foreheads, et cetera, but they have such thicker skin when you're younger.
• 33:40
  SPEAKER_02: Your skin starts to thin as we age, and then all of a sudden, every one of those little motions starts to leave a little line on the rink on the skin, and lines get deeper and deeper, and you end up with fine lines and wrinkles as you age because of the loss of organization of that collagen and thickness and production.
• 33:55
  SPEAKER_02: So that's one aspect of it.
• 33:57
  SPEAKER_02: The other aspect of it is from an evolutionary biology point of view, I think the skin just sort of gives up on itself once we get to that age range, because all of a sudden it's like maybe it's better to use that metabolic energy towards something else as opposed to trying to keep the skin clear and try to keep the skin free of uh pigments and all that other stuff that that uh again give it a youthful context and look.
• 34:18
  SPEAKER_02: So what you end up seeing is is those three things, I mean, those changes having thinning, fine lines and wrinkles, dullness, the epidermis becomes thicker, um, stratum corneum gets thicker, and then you get all these like pigments that kind of go unchecked, and you have uh you have sun damage and both reds and brown spots that start to show.
• 34:37
  SPEAKER_02: So that story, if you look at it that way, is like, okay, these are our targets: pigmentation, dullness, thinning.
• 34:45
  SPEAKER_02: And yeah, so how are you going to address these three things in a in a very deliberate, thought-out, you know, scientifically oriented way to help a person, whether they're young, to avoid that from happening, or if they're older, to gain on this, on this uh sort of you know, this direction.
• 35:05
  SPEAKER_02: And so it really comes down, you got to address all three of those things.
• 35:08
  SPEAKER_02: And how do you address collagen?
• 35:09
  SPEAKER_02: Well, you know, topically, you know, you have products that can do that.
• 35:13
  SPEAKER_02: You have retinols, vitamin C, certain um growth factors, etc., that can stimulate um collagen production.
• 35:19
  SPEAKER_02: And then you have mechanical things, laser resurfacing, chemical peels, uh, microneedling, all those different things that create injury and the injury response leading to collagen production.
• 35:29
  SPEAKER_02: Clarity comes down to stifling the you know the pigments, all you know, with with uh whether whether it's hydroquinone, if it's prescription-based or non-hydroquinone uh type things, but you want to do something to keep those those pigments from developing.
• 35:43
  SPEAKER_02: And then the surface of the skin, you need to exfoliate it, you need to um turn it over, you need to kind of bring that brightness and lightness back.
• 35:50
  SPEAKER_02: So that was really when I looked at all these things, I would sit down with patients and I would put them on a treatment prep program using um, you know, all the all the really um known and great uh product lines like uh ZO and Skin Medica, etc.
• 36:04
  SPEAKER_02: medical-based stuff.
• 36:05
  SPEAKER_02: And there's a few things that became very clear to me.
• 36:07
  SPEAKER_02: Number one, no one um could handle, with the exception of maybe my wife and a few other patients, could handle like a multi-multi-step program.
• 36:17
  SPEAKER_02: Two, very, very few people can handle retin A or retinol in its full dose.
• 36:22
  SPEAKER_02: I mean, I'm talking like Yes, thank you.
• 36:25
  SPEAKER_02: Very few, very few people can do it.
• 36:28
  SPEAKER_02: So it's like I and I we all know, you know, we all know that that's good for your skin, but and with the best of intentions, you put somebody on it and then they they and then you come back again and they're like either doing it like once a week or they're doing it like you know uh twice a week, and then or they stopped it altogether, and it just becomes like this this non-starter.
• 36:47
  SPEAKER_02: So there's so when I went, so finally, anyways, I went through several years of being super committed to putting people on products um that were available, and uh, and to no avail.
• 36:57
  SPEAKER_02: No, I couldn't get anyone to do it the right way, or at least a very small portion of them.
• 37:01
  SPEAKER_02: So then what happened is my my inspiration, I guess, was you know, I said, listen, let's let's uh figure out a way that we can do this that um allows everyone to at least get on the right stuff, allow them to do it consistently, let it be as least expensive as possible, um, as easy to use as possible.
• 37:20
  SPEAKER_02: And and that was it.
• 37:22
  SPEAKER_02: And then so what what you know, obviously it's a chemistry problem at that point because we already know what those ingredients are.
• 37:28
  SPEAKER_02: I mean, anyone who's in the world of of uh of skin and skin science and all that stuff, they all I mean, all the all the named um ingredients, we all know those things, retinols and isinamides, and you know, growth factors and peptides and um moisturizing and all those kind of important uh things that a skincare product or skincare routine needs, it's just how do you get these things to marry together and and function well together?
• 37:51
  SPEAKER_02: That's a that's a chemist issue, right?
• 37:52
  SPEAKER_01: So you obviously well I think it's more of I think it's more of a molecular molecular biology issue more than anything, if you ask me, because I think it's you know, it's not just about like what products can we put on the skin, what are the ingredients that we can put on the skin, but it's more so about the you know, the quantif the quantification of results based on dosages, which is not there right now in skin health.
• 38:18
  SPEAKER_01: It's just not there.
• 38:19
  SPEAKER_01: For example, let me let me just give you, you know, my train of thought.
• 38:22
  SPEAKER_01: We were talking about flash end muscles earlier.
• 38:24
  SPEAKER_01: Well, when you learn about them, there's a very easy way to quantify the um, you know, I guess the viability, or you could say, you know, how good everything is, right?
• 38:35
  SPEAKER_01: But because you mentioned you can measure things like tension, which is a direct quantifiable measurement that describes a lot about the any kind of pathology you're looking at, any kind of problem you're looking at.
• 38:46
  SPEAKER_01: I mean, you had just talked about, you know, sagging, right, of the fascia and stuff.
• 38:50
  SPEAKER_01: So there's a very, I think, um, easier way to like quantify that kind of data on the deeper, deeper um parts of our body, like muscles.
• 38:59
  SPEAKER_01: But with the skin, like we talked about earlier, because these layers are so um, there are so many of them and they're so diverse in their composition, you have this idea of immunology coming into play, molecular genetics, you have molecular biology, obviously, cell signaling, uh, obviously the chemistry component that you mentioned, immunology being one of the biggest ones, because let's be honest, what a lot of people hate talking about, and I'm surprised derms don't even mention this, is there's this thing called the internal milieu of your body.
• 39:33
  SPEAKER_01: And each organ has its own internal milieu.
• 39:35
  SPEAKER_01: And what that means is there's an environment that exists within this organ system or this tissue structure.
• 39:41
  SPEAKER_01: And what that's doing, that all of those components combined are contributing to how your skin will react to what you put on it topically, because like I said, it's that signaling cascade.
• 39:53
  SPEAKER_01: And we can't quantify, it's very hard to quantify that.
• 39:55
  SPEAKER_01: So, you know, that's something I think I I just wanted to put that out there because there's a really a lack of understanding of true, I think, um, science, like you know, what we talked about, like from that academia standpoint, there's really a lack of understanding there because you have to, if you have, you know, if you're somebody who's really into skin health, you need to do the homework and look into the science because there's nothing more transparent than the science that's published and the facts.
• 40:20
  SPEAKER_01: You know what I mean?
• 40:21
  SPEAKER_01: So yeah.
• 40:22
  SPEAKER_01: So I, you know, I just wanted to say that, but I want to actually talk about the trifecta routine that you have established and and let's go through that and let's talk about the ingredients and what you think is really required for good skin health.
• 40:33
  SPEAKER_02: Yeah.
• 40:33
  SPEAKER_02: Well, I think that, you know, I look at it as layers of of what's required.
• 40:38
  SPEAKER_02: So what I think is required in good skin health in general, um, it starts with sun protection, right?
• 40:44
  SPEAKER_02: That's that's one foundational piece to it.
• 40:46
  SPEAKER_02: I mean, we don't have to be um we don't have to overthink it.
• 40:50
  SPEAKER_02: You look at people who have gotten very little sun over their life because of geographically where they live, um, man, their skin, even at age 70, looks remarkable.
• 40:59
  SPEAKER_02: Um, you look at Southern California generation and like my generation, where everyone was sunbathing by the time they're in their 40s and 50s, I mean, it's a whole different skin story, right?
• 41:08
  SPEAKER_02: So sun is an, you know, the UVA is a is a huge component of that.
• 41:12
  SPEAKER_02: So sun protection um with using a broad spectrum is a is in my opinion, uh it's kind of like don't even bother with anything after that if you don't if you don't start with that.
• 41:23
  SPEAKER_02: The other aspect is, and I think this is not talked about enough, is the proper diet and hydration, right?
• 41:29
  SPEAKER_02: I mean, the foods we eat, the the amount of hydration, the types of you know, um, all that's of eating, being clean, you know, um, all of those things have a major, major impact on the quality of the skin before you even put a single ingredient on your skin, right?
• 41:46
  SPEAKER_02: I mean, all that's of stress, sleep, uh, electrolyte hydration, uh, everything, right?
• 41:52
  SPEAKER_02: And then once you've got like your your your basis covered with that type of stuff, then I think the next layer, I mean, in my my opinion, it really comes down to um, I mean, I would say the two sort of more foundational long-term.
• 42:05
  SPEAKER_02: Again, we're talking about long-term um uh benefit, beneficiary type products is like retinols and vitamin C.
• 42:11
  SPEAKER_02: I think those are really, really good for long-term um collagen production.
• 42:16
  SPEAKER_02: You know, it's caught, you know, we're talking about uh signaling and all those different things that that stimulate fibroblasts to develop uh you know more collagen over time.
• 42:24
  SPEAKER_02: And there's been tons and tons of study in the in the category of retin A showing, you know, punch biopsies of skin getting thicker as you know after 10 years of use and all that kind of stuff.
• 42:34
  SPEAKER_02: So I think I mean that's a 40, 50 years worth of data on on that particular product.
• 42:39
  SPEAKER_02: Um, so so that's great, but as we talked about, it's hard for people to get on it.
• 42:44
  SPEAKER_02: And then you have net the next generation of stuff that's really important.
• 42:47
  SPEAKER_02: I mean, you know, the the and this is another thing that it's not talked about quite often enough is how do you get the tissues to properly hydrate um, you know, between what you obviously consume, but also at the at the level um of the actual tissue to keep the oil production at in a in a certain level where where it's uh um optimized.
• 43:06
  SPEAKER_02: And then next next generation of stuff is things like um you know growth factors and and uh peptides and different different things like that we all you know have have known that added these sort of extra benefit of niacinamides and all those kind of things that can improve um skin.
• 43:22
  SPEAKER_02: So when I set out to do set up the trifecta, this is how this is was my exact thinking.
• 43:26
  SPEAKER_02: I wanted to have a reduced level of of uh of retinol in there, a reduced level to the point where um, and I should back up for a second.
• 43:34
  SPEAKER_02: I wanted every single human being on the planet to be able to use the trifecta.
• 43:40
  SPEAKER_02: Like I did not want there to be one person to say, oh, it's my skin is it's too sensitive for this, or you know, I don't, you know, this makes me react this way or that way.
• 43:49
  SPEAKER_02: That was my challenge.
• 43:50
  SPEAKER_02: I wanted it to be universally used by all skin types and all skin sort of conditions.
• 43:56
  SPEAKER_02: And so it went through four years, four to five years of kind of like.
• 44:00
  SPEAKER_02: Testing, retesting this and that.
• 44:01
  SPEAKER_02: And I and I had my kind of like handful of extremely sensitive, uh, known uh people that they said they can never even use a single product on their skin whatsoever.
• 44:13
  SPEAKER_02: Um, period.
• 44:14
  SPEAKER_02: And so those were sort of my my final test group and see if they could they could handle the the level of retinols and the vitamin C absorption, you know, because that those are things that typically give people some uh some you know issues.
• 44:26
  SPEAKER_02: So um so I wanted this to be universal.
• 44:29
  SPEAKER_02: So anyway, so we started with that the big picture, and then we I wanted it to have all those foundational ingredients, um, retinol, vitamin C, you know, uh other types of antioxidants, and then all the other stuff that we talked about, the stuff that we know that are important.
• 44:42
  SPEAKER_02: We need to proper moisture to the skin, we need to, you know, hopefully stimulate in as many different ways as we can.
• 44:48
  SPEAKER_02: And then the other thing I think is really important for people in all situations, like when you have high blood pressure, you know down the road you're gonna end up with a stroke or heart, heart attack or something like that.
• 44:57
  SPEAKER_02: So you take your you take your blood pressure medicine, but you know what?
• 45:02
  SPEAKER_02: It's hard to to be compliant sometimes with something that is like downstream.
• 45:07
  SPEAKER_02: You don't see the benefit of it, right?
• 45:09
  SPEAKER_02: But if you have a headache, you take an aspirin, the headache goes away.
• 45:11
  SPEAKER_02: It's very immediate.
• 45:12
  SPEAKER_02: So there's a there's a um a very positive relationship with with the drugs that help you with immediate changes.
• 45:18
  SPEAKER_02: So I wanted I wanted the trifecta to give both immediate changes and to give long-term changes.
• 45:26
  SPEAKER_02: Because the long-term stuff I wanted to work in the background to help the skin just get better and better and better over time, all the things that we we talked about originally.
• 45:33
  SPEAKER_02: But I wanted somebody to use it within a couple weeks and all of a sudden see, yes, my skin looks more supple, looks more bright, looks more fresh, um, has a uh has a better glow to it, all those type of things.
• 45:45
  SPEAKER_02: And so that was that was kind of the the dual sort of challenge of it to create something that has that.
• 45:51
  SPEAKER_02: And you know, it it's been very, very um interesting for me to see the the people's responses and reactions to even a short period of time.
• 46:01
  SPEAKER_02: And we were talking about my longest um outside of like the test groups, um, which by the way, we all tested them through like VIZIA and all that kind of stuff to see see changes, um, VISI skin analysis, but just three months worth of of three to four months worth of consumer use, it's been remarkable how much of exactly that they've they've you know that's given them a stickiness, that immediate improvement that they see in their skin, and how simple the process is.
• 46:28
  SPEAKER_02: Because the what what what the trifecta basically is, is it's a combination of a step one rinse, which is um a uh um a cleanser, plus like some anti-inflammatory and uh and uh you know things that calm the skin, soothe the skin, decrease kind of poor inflammation, etc.
• 46:44
  SPEAKER_02: Um, so that's rinse and not a very mildly uh foaming uh cleanser.
• 46:49
  SPEAKER_02: Then the second is a combination of of um uh vitamin C's and a compound, plus again more anti-inflammatories uh built into it.
• 46:59
  SPEAKER_02: And then um the uh the aluminae, which was the original inspiration, has like 14 different active ingredients um in it.
• 47:08
  SPEAKER_02: Um it has a mild retinol, it has more vitamin C, it has a bunch of other um antioxidants, and then down the road of uh you know moisturizers, hyaluronic acid, lipid complex, um, niacinamide, swalene, you know, da-da-da-da-da.
• 47:23
  SPEAKER_02: 14 different actives all put together um to basically give the skin what it needs in the short term, but also the long term.
• 47:31
  SPEAKER_02: So my feeling was if I could get people to to do this, but do it consistently, man, we've we've really gotten ahead of the of the story because it's kind of like the idea of you know, you could go in and do hardcore boot camp exercises every day, but you're probably not gonna be able to sustain that for you know too long.
• 47:50
  SPEAKER_02: But if you can work out 30 to 35 minutes, 40 minutes a day for the rest of your life, you're gonna be in some pretty amazing shape.
• 47:57
  SPEAKER_02: And that's the idea with with consistency in skincare that I thought was really important to be able to do.
• 48:02
  SPEAKER_02: Make it super easy, make it you know, short in terms of the time it takes.
• 48:06
  SPEAKER_02: It takes like two minutes to do to do the entire uh regimen.
• 48:09
  SPEAKER_02: And sometimes I'm doing it, I'm like, oh my god, I'm putting on all these ingredients in just like a minute and a half, two minutes worth of time.
• 48:16
  SPEAKER_01: But it's not about see, here's the thing here's the thing, and I really want to say this like about your approach, because I think it it's genuinely brilliant.
• 48:24
  SPEAKER_01: It's like it reminds me of the best analogy I can give anyone listening is to think about the prep stage of creating a painting, okay?
• 48:35
  SPEAKER_01: Because you don't want your canvas to be all messed up and have like, you know, things that are just not gonna like the paint's not gonna go on in its true form or something's gonna right.
• 48:45
  SPEAKER_01: So you need that those anti-inflammatory steps that you described, the cleanser and the second step.
• 48:51
  SPEAKER_01: What they're doing is they're telling your immune system just to be like, okay, just chill out, okay?
• 48:56
  SPEAKER_01: And then whatever you and then, yeah, so it's ready.
• 48:59
  SPEAKER_01: Your skin's like, okay, cool, I'm good, I'm relaxed, I'm I'm feeling good, normal, you know.
• 49:03
  SPEAKER_01: Then you put the other stuff on, it's not gonna go, oh my God, what the hell is this?
• 49:07
  SPEAKER_01: Because your immune system is really the part of your body that goes, oh my god, what the hell is this?
• 49:12
  SPEAKER_01: So that's where I anti-inflammation really comes in, is to stop those, you know, factors in skin that are going to like disallow this priming of the skin so that whatever you do put it on it next that is the richest product in your routine, it now has the highest chance of really doing and binding to receptors it's supposed to bind to, going into the skin as it's supposed to, you know, um, in terms of just like making sure that, you know, yeah, okay, you can formulate something that's within that, you know, 500 uh, you know, kilodalton, whatever, you know, measurement there is, but is it gonna go in or not?
• 49:49
  SPEAKER_01: There's a lot of factors there, right?
• 49:50
  SPEAKER_01: And inflammation is one of them.
• 49:52
  SPEAKER_01: So that's that's what I'm really thinking.
• 49:54
  SPEAKER_01: And I wanted to tell you that I think you are absolutely brilliant because I'm not gonna lie, um early on in my, you know, I've loved medicine my whole life.
• 50:02
  SPEAKER_01: And so um, you know, I've done a lot of uh reading into like microdosing and to keep this very pharmaceutical, I mean, why not, right?
• 50:11
  SPEAKER_01: Like to keep it pharmaceutical.
• 50:13
  SPEAKER_01: There have been so many studies that have been done across so many different organ systems that really promote this idea of microdosing whatever pharmaceutical agent you're utilizing to completely change a pathway or to regulate a pathway.
• 50:30
  SPEAKER_01: And that is really what your skin is is a lot of different pathways that are working all the time.
• 50:35
  SPEAKER_01: And you need to, they need time to regulate.
• 50:38
  SPEAKER_01: Just like your hormones, you can't inject someone with a bunch of estrogen and then expect them to act normal.
• 50:44
  SPEAKER_01: There you're gonna start seeing, you know, like psychological impacts and you know, physical response and all this.
• 50:50
  SPEAKER_01: So, you know, what I really want to say to the listeners is that the only time in medicine that I personally, from my experience, have seen this like bombardment um, you know, uh approach when it comes to pharmaceutical or like chemical agents is in the treatment of infectious diseases.
• 51:06
  SPEAKER_01: Because obviously, when you have an infection, we bombard you with IV antibiotics, right?
• 51:10
  SPEAKER_01: Yeah, we bombard your system because we have to nuke it.
• 51:13
  SPEAKER_01: But that can't be applied to something like skin.
• 51:17
  SPEAKER_01: That's a very living, versatile, moving in so many different directions all the time.
• 51:22
  SPEAKER_01: We can't use that same system.
• 51:23
  SPEAKER_01: So, what you're really doing here is you're modulating, you're allowing the skin to modulate the response in a more like sophisticated and optimized way because you're giving it what it needs, but it's not being, you know what I mean?
• 51:37
  SPEAKER_01: It's not being brought.
• 51:38
  SPEAKER_02: Yeah, no, absolutely.
• 51:39
  SPEAKER_02: I appreciate that.
• 51:40
  SPEAKER_02: You're right, because that I mean the trifecta is it's AMPM.
• 51:43
  SPEAKER_02: You use the same regimen in the morning and the night.
• 51:46
  SPEAKER_02: And uh, and by cutting down those dosages, the skin tolerates it better.
• 51:50
  SPEAKER_02: But also, like you said, it it allows it to be in perpetual sort of positive motion in that way.
• 51:56
  SPEAKER_01: Yes, absolutely.
• 51:57
  SPEAKER_01: And I and I really love that you've kept it at three steps, to be honest with you, because you know, they always talk about all those uh trends, right?
• 52:03
  SPEAKER_01: There's always some data coming out about uh, oh, it takes this long to form a habit or you know what, all those little things.
• 52:09
  SPEAKER_01: But I think it's really um right now, more than ever, you know, especially with all of the buzz around minimal uh skincare routines and what is minimalism.
• 52:18
  SPEAKER_01: This is minimalism, yeah.
• 52:20
  SPEAKER_01: Science, it's really good science.
• 52:22
  SPEAKER_01: Honestly, everyone listening out there, uh like if you ever read a paper about somebody finding a cure for something or a new medicine or something, one trend you're always gonna notice is really good science is simple.
• 52:33
  SPEAKER_02: Exactly.
• 52:33
  SPEAKER_02: It's so true.
• 52:34
  SPEAKER_02: It's so true.
• 52:35
  SPEAKER_01: Everything's it's the most like beautiful, you know what I mean?
• 52:38
  SPEAKER_01: It's the most beautiful and like just elegant way of like accomplishing a goal that's happening in our bodies, and every single thing is doing that.
• 52:47
  SPEAKER_01: So that's that's where I'm sitting here.
• 52:49
  SPEAKER_01: And I'm like, if you're someone listening and you need to know what to do with your skin, you don't know anything about it, then go to professionals like you know, Dr.
• 52:59
  SPEAKER_01: Karam, because this is the amount of science it takes, this is the amount of studying and work and experience it takes to really understand the body and to really understand how science works.
• 53:11
  SPEAKER_01: So, you know, I I'm I'm a huge fan of your approach.
• 53:13
  SPEAKER_01: This that's amazing.
• 53:14
  SPEAKER_02: I love it.
• 53:15
  SPEAKER_02: That's awesome.
• 53:16
  SPEAKER_02: I really appreciate that.
• 53:16
  SPEAKER_02: Means a lot to me.
• 53:17
  SPEAKER_02: Yeah, no, I I kind of feel like you know, there's been several aha moments for me, you know, throughout my career, um, surgically and and now this.
• 53:24
  SPEAKER_02: And really at the end of the day, I feel this is the one way I can actually touch even more lives.
• 53:30
  SPEAKER_02: Um, because I mean, surgically, I only have X number of spots per week, per month that I can I can do for people.
• 53:36
  SPEAKER_02: And and our surgical schedule gets, you know, it's filled out for like a year and a half or so.
• 53:41
  SPEAKER_02: Um so it's it's uh, but I think this is something that you know it just it's part of the continuum of anti-aging.
• 53:49
  SPEAKER_02: Um, the one really important part is obviously the skin.
• 53:52
  SPEAKER_02: And for me to be able to help people um navigate and find a solution that's easy and predictable and reliable, and it's not filled with BS and overpromising.
• 54:01
  SPEAKER_02: It's just again scientifically sound and and uh appropriate.
• 54:05
  SPEAKER_02: And um, you know, I I feel good about it.
• 54:07
  SPEAKER_02: And I feel like you know, I I'd love to to help people with this because I know how many people have struggled with a drawer full of of products that they've tried and and stopped using and the confusion that goes along with it and all the other things.
• 54:21
  SPEAKER_01: So as you know, and then people start mixing in things like Ayurveda and like Eastern medicine, and I'm just like, oh my god, yeah, like okay, how many how many articles do you want me to read to tell you about this?
• 54:32
  SPEAKER_01: Like I'm gonna have to, you know, so yeah, I I agree with you.
• 54:36
  SPEAKER_01: I think you know, here's the thing, you know, to be fully transparent, and maybe you know, you can call me bias, I'm also in the medical field, but I I'm not.
• 54:43
  SPEAKER_01: I really believe that you know, science is a field that requires true curiosity in a human being to the most like utmost level.
• 54:53
  SPEAKER_01: Because if you're not that curious, you're never going to come up with anything interesting.
• 54:57
  SPEAKER_01: You're just gonna be following a bunch of protocols and doing the same thing for the rest of your life.
• 55:00
  SPEAKER_01: So the fact that you have done so much and you've you've dedicated your life to true science is that this is very rare to see.
• 55:08
  SPEAKER_01: And everyone listening, um, you know, at the very least, you right now, you need to go check out Karam MD Skin.
• 55:16
  SPEAKER_01: Uh, go to the website, check it out.
• 55:18
  SPEAKER_01: It's a very easy routine, like um Doc mentioned, it's just three steps.
• 55:23
  SPEAKER_01: Look into that and look into this line before you even go anywhere else.
• 55:27
  SPEAKER_01: Because here's the thing if you don't know the science, then you need to start trusting the people that do, you know?
• 55:32
  SPEAKER_01: And and and it's like you can't you can't argue with like, you know, 11, 20, some years of experience, you know, like learning uh uh uh something that's so so hard to understand.
• 55:42
  SPEAKER_01: So yeah, Dr.
• 55:43
  SPEAKER_01: Karam, thank you so much.
• 55:45
  SPEAKER_01: This has been such an immense honor hosting.
• 55:48
  SPEAKER_02: Oh, thank you very much.
• 55:49
  SPEAKER_02: My pleasure.
• 55:49
  SPEAKER_02: It's an absolute pleasure, and thank you so much for inviting me.
• 55:52
  SPEAKER_02: It's been a lot of fun.
• 55:53
  SPEAKER_02: I mean, you have a lot of great, great uh insights and and thoughts, and uh, it's been fun sharing and discussing them with you.
• 56:00
  SPEAKER_01: Thank you so much.
• 56:01
  SPEAKER_01: And everyone listening, definitely give uh this episode a huge like.
• 56:05
  SPEAKER_01: Leave your reviews, leave your comments if you have any questions for Dr.
• 56:09
  SPEAKER_01: Karam.
• 56:09
  SPEAKER_01: Um, I'm sure I can pass them along to his team.
• 56:12
  SPEAKER_01: But again, like I said, go to karammdskin.com and check out the line.
• 56:18
  SPEAKER_01: And I will link everything in the um concept art for this episode.
• 56:22
  SPEAKER_01: Thank you, Dr.
• 56:22
  SPEAKER_01: Karam, and everyone, I will be back next time.
• 56:25
  SPEAKER_02: My pleasure.
• 56:25
  SPEAKER_02: Thank you.
• 56:26
  SPEAKER_02: Have a great day.
• 56:27
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• 57:34
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