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The Accidental Birth of SkinMedica TNS · The Science of Skin

• 0:08
  SPEAKER_01: Hello and welcome to the Science of Skin podcast.
• 0:10
  SPEAKER_01: My name is Dr.
• 0:10
  SPEAKER_01: Ted Lane.
• 0:11
  SPEAKER_01: I'm a board certified dermatologist practicing in Austin, Texas, and we have an incredibly special guest today.
• 0:18
  SPEAKER_01: Uh, Dr.
• 0:19
  SPEAKER_01: Mitch Goldman.
• 0:21
  SPEAKER_01: Dr.
• 0:21
  SPEAKER_01: Goldman, how are you doing?
• 0:23
  SPEAKER_00: I'm having a great day.
• 0:24
  SPEAKER_00: Hope you are too.
• 0:25
  SPEAKER_01: I I am, thank you.
• 0:27
  SPEAKER_01: Dr.
• 0:27
  SPEAKER_01: Goldman is on the board of directors of Platinum Dermatology.
• 0:30
  SPEAKER_01: He's the director for cosmetic and laser surgery at Platinum as well.
• 0:35
  SPEAKER_01: Former now retired professor at UCSD, former president of the ASDS.
• 0:42
  SPEAKER_01: I mean, the list goes on and on, Mitch.
• 0:44
  SPEAKER_01: I I could I could keep going, but it just makes me feel bad about myself.
• 0:47
  SPEAKER_01: So so let's just No, it's it's just because I'm old.
• 0:51
  SPEAKER_00: You know, when you hit 71, you got a lot of accolades you can uh go on.
• 0:56
  SPEAKER_01: Amazing.
• 0:57
  SPEAKER_01: Well, uh, Mitch, we could talk about so many different things.
• 1:00
  SPEAKER_01: You're an incredible entrepreneur, you're you're an incredible dermatologist, especially one of the foremost aesthetic dermatologists that we have in our field.
• 1:09
  SPEAKER_01: But I thought we might start with the Genesis of Skin Medica, uh, which as we all know is one of the preeminent brands uh that are dispensed professionally.
• 1:20
  SPEAKER_01: Uh just celebrated 25 years of existence.
• 1:24
  SPEAKER_01: Um, so just a really long history within our specialty, certainly the first to with the TNS serum, you know, the the uh it's essentially a secretome serum, has exosomes as we all know now.
• 1:35
  SPEAKER_01: I mean, it was so far beyond kind of in advance of the times, and you were at the very beginning.
• 1:42
  SPEAKER_01: Could could you just give us like the founder's story of that?
• 1:46
  SPEAKER_00: So it's a really cool story.
• 1:48
  SPEAKER_00: When I joined uh Dr.
• 1:50
  SPEAKER_00: Richard Fitzpatrick in 1986, you know, we always wanted to be on the cutting edge of whatever we would do.
• 1:57
  SPEAKER_00: And here in San Diego, one of our offices was near uh the La Costa Spa.
• 2:04
  SPEAKER_00: And we knew the one of the people at La Costa Spa, a guy named John Gerudo, who was an amazing formulator.
• 2:12
  SPEAKER_00: And so Fitz and I got together and we said, let's start making skincare products with antioxidants.
• 2:20
  SPEAKER_00: And that was how we started.
• 2:22
  SPEAKER_00: So uh we had hired uh another young dermatologist who's now my age, named Dr.
• 2:28
  SPEAKER_00: Kimberly Butterwick, and she was the one that had all the money.
• 2:32
  SPEAKER_00: And so we basically brought Kim on board, and basic and Fitzpatrick, Dr.
• 2:38
  SPEAKER_00: Butterwick, and I uh basically we started a company, and initially it was called Gioni.
• 2:44
  SPEAKER_00: And how did we come up with this name?
• 2:46
  SPEAKER_00: We were sitting around one night drinking beers, and I said this name and I spelled it wrong, and everyone pronounced it Gioni, and and that that became our initial skincare company, and it was really nice.
• 3:00
  SPEAKER_00: And we sold the products in our office, and again, John Gerudo formulated everything.
• 3:06
  SPEAKER_00: Um, and then, but it never really went anywhere because as we know, it's very difficult to get skincare markets you know going, especially in doctor offices.
• 3:16
  SPEAKER_00: And so I was doing a lot of research on a variety of subjects, but many of you know that one of my passions is the venous uh system and varicose veins and sclerotherapy.
• 3:29
  SPEAKER_00: And because of all of that, I was doing some research on skin ulcers.
• 3:34
  SPEAKER_00: And there was a there was uh an outfit in town called Advanced Tissue Sciences, and they had a product that they asked me to do research on for venous ulceration, and it was a basically a growth factor made by the culture medium from fibroblasts from the founders of Advanced Tissue Sciences, Sons Foreskin.
• 4:00
  SPEAKER_00: So essentially, you know, a rabbi took the foreskin off and then they cultured out the fibroblasts, and the media became what was, I think, the very first line of growth factor serums.
• 4:13
  SPEAKER_00: So here I am treating patients with venous ulcerations with this advanced tissue science growth factor.
• 4:21
  SPEAKER_00: And really, it didn't work that well on the venous ulcers.
• 4:26
  SPEAKER_00: But one day, Fitz is walking by as I'm doing these treatments, and he's like, Oh, what are you doing?
• 4:32
  SPEAKER_00: And I showed him the patient and the ulcer, and he goes, You know, the skin around the ulcer looks really good.
• 4:38
  SPEAKER_00: What are you using?
• 4:39
  SPEAKER_00: And I said, We're using these growth factors.
• 4:42
  SPEAKER_00: And so we went to John Gerudo and we said, John, can you take this serum and formulate it into uh a topical that's a little bit better than at that time it was just basically a liquid.
• 4:56
  SPEAKER_00: Yeah, and so John Gerudo formulated this thing, and then we were saying, okay, what are we gonna call it?
• 5:03
  SPEAKER_00: And we said, okay, let's call it tissue nutrient serum.
• 5:07
  SPEAKER_00: Just a simple name.
• 5:09
  SPEAKER_00: And that became TNS.
• 5:11
  SPEAKER_00: Now we had this product that was really cool, and we had changed the name of the company to Skin Medica, because now we were gonna go, we had a really cool product.
• 5:23
  SPEAKER_00: No one had ever thought of growth factors before.
• 5:26
  SPEAKER_00: Um, and basically, as you just pointed out, it wasn't just growth factors, it was everything, it was a gemish of everything.
• 5:33
  SPEAKER_00: And there were tons of secretomes and exosomes and so many growth factors.
• 5:38
  SPEAKER_00: To this day, we don't know how many are in there.
• 5:41
  SPEAKER_00: Um, and so we started using it as a cream, and John Gerudo made a beautiful formulation.
• 5:48
  SPEAKER_00: All of a sudden, for some reason, it gets to Hollywood.
• 5:52
  SPEAKER_00: And we had had a number of our dermatology friends carrying these products in the office, and we were doing clinical studies, uh, basically putting it on our arms and showing that after we did biopsies, it it thickened the skin, and it and we didn't know enough at the time, but it stimulated fibroblastic function, is what we've uh found out.
• 6:15
  SPEAKER_00: And one of our friends in Hollywood gave it to some actresses and models who then started seeing that their skin was really more beautiful.
• 6:27
  SPEAKER_00: Now, it probably was beautiful to begin with.
• 6:30
  SPEAKER_00: Who knows what the placebo effect was?
• 6:33
  SPEAKER_00: But word got out that we had this brand new product that was growth factor-based.
• 6:38
  SPEAKER_00: Because, again, we didn't say secretomes or exosomes at that time, we just said growth factors, and that became the Skin Medica TNS.
• 6:47
  SPEAKER_00: And that's what launched this product.
• 6:50
  SPEAKER_00: So that's how Skin Medica really started.
• 6:53
  SPEAKER_00: Now, we kept the antioxidants because Fitz was and I and Dr.
• 6:58
  SPEAKER_00: Butterwick really believed in antioxidants.
• 7:02
  SPEAKER_00: But the truth is Sheldon Pinnell is way smarter or was way smarter than us.
• 7:08
  SPEAKER_00: And he started a company, Skin Suiticals, and his growth, his not growth factors, his antioxidants were way better than the antioxidants that we were able to formulate.
• 7:20
  SPEAKER_00: And you so Sheldon Pennell and Skin Puticals probably has better antioxidants than we do, but we had the growth factors, and we had John Gerudo, who made really elegant products, and that's what really started Skin Medica.
• 7:36
  SPEAKER_00: Um, before that process, we were losing tons of money, we had to keep putting money into it, which is a big problem many people have starting skincare companies.
• 7:49
  SPEAKER_00: And then the little caveat is once the once we had something that was really working, then we go to the venture capital people.
• 7:58
  SPEAKER_00: And so they're the people that basically funded us, um, and that's how the company uh really grew.
• 8:05
  SPEAKER_00: Now, along the course of the company, there were a lot of you know pitfalls.
• 8:10
  SPEAKER_00: Fitzpatrick at one time he wanted to really be pharmaceutical and go after like the acne market and the hair loss market, and and so we were skinmedica was going from a dispense product to a prescription product line.
• 8:27
  SPEAKER_00: And the truth was I did not like the way it was going.
• 8:31
  SPEAKER_00: And so I resigned as medical director from Skin Medica because it was losing a ton of money when we started to go pharmaceutical, and the VC people kept putting more money in, which diluted everyone out.
• 8:46
  SPEAKER_00: So when Skin Medica became really famous and reached the$100 million mark, I was no longer even involved.
• 8:55
  SPEAKER_00: And then after that happened, and unfortunately Dr.
• 8:59
  SPEAKER_00: Fitzpatrick started to become ill, and we don't need to talk about that.
• 9:04
  SPEAKER_00: The Skin Medica people then invited me back to become medical director again.
• 9:09
  SPEAKER_00: Um, and then I took that position.
• 9:12
  SPEAKER_00: In the interim, I was working with at least a dozen other skincare companies.
• 9:17
  SPEAKER_00: I became medical director of the Obaji company when Zane Obaji was sort of kicked out.
• 9:23
  SPEAKER_00: And so I I've had this crazy career going uh back and forth.
• 9:28
  SPEAKER_00: But I think my my greatest accomplishment was the growth factors.
• 9:33
  SPEAKER_00: And if it wasn't for Fitz telling me that, hey, Mitch, it's not just the wound, it's the skin around the wound, I would have never uh come to that conclusion.
• 9:44
  SPEAKER_00: So it really takes a village, it takes a lot of different people.
• 9:48
  SPEAKER_00: It takes Dr.
• 9:49
  SPEAKER_00: Butterwick and her financial uh acumen and her husband's who we put on the board because he's like a really smart guy.
• 9:57
  SPEAKER_00: So it took a lot of things and it wasn't an easy road, and it it took years to become profitable.
• 10:05
  SPEAKER_01: Yeah, I mean, having a successful skincare company is not for the faint of heart, right?
• 10:10
  SPEAKER_01: It's just you and I have both worked with so many companies now where I've seen founders nearly give up, have to put more money in, you know, change advisors, manage the relationships with their investors, which can be very difficult, especially in the VC or PE world, uh, and then eventually find the right combination of products and marketing strategies to be successful.
• 10:35
  SPEAKER_01: But then again, they also cannot and lose a lot of money.
• 10:39
  SPEAKER_01: And I think when, you know, we have a lot of colleagues who are very excited to start new skincare companies, and certainly celebrities do as well.
• 10:48
  SPEAKER_01: But I think in this day and age, Mitch, you know, without the social media presence and and it's you know, any kind of ability to market yourself because the founder is really the company, without the ability to do that, I would think it'd be very difficult in this day and age just trying to base it all on the science.
• 11:06
  SPEAKER_00: It will.
• 11:07
  SPEAKER_00: Skin physical, it's sort of skin medicine and skin physicals were always on the same track.
• 11:13
  SPEAKER_00: And and Sheldon, you know, had the same problem.
• 11:17
  SPEAKER_00: And what distinguished our two companies from all of the other skincare companies is every time we had any money, we would do research.
• 11:27
  SPEAKER_00: And our products were only sold in dermatology offices because we only wanted people that knew what the heck they were doing to sell it.
• 11:38
  SPEAKER_00: Um, it wasn't, of course, until L'Oreal bought skinticals, and now it's everywhere.
• 11:43
  SPEAKER_00: Um, but Skin Medica has still been a pure physician office dispensed uh product, which I still am very proud of.
• 11:52
  SPEAKER_00: Um and when you look at the the research and the the clinical studies that were done, I'm very proud of both Skin Seuticals as well as Skin Medica for staying in that track.
• 12:04
  SPEAKER_00: And there are some present-day skincare companies that are following that that model.
• 12:10
  SPEAKER_00: And so, you know, there's a number of companies now which are uh I'm really excited about that are advancing the science even more than uh Dr.
• 12:20
  SPEAKER_00: Pinell and and we did.
• 12:23
  SPEAKER_01: You know, just going back to the the TNS and the growth factors in the secretome, yeah, like I said, you were really in in behind the or in front of the times.
• 12:32
  SPEAKER_01: I mean, it's just we didn't know about any of that, right?
• 12:35
  SPEAKER_01: You just knew that that the skin looked better, like Dr.
• 12:38
  SPEAKER_01: Fitzpatrick said.
• 12:39
  SPEAKER_01: But now we think of that as like longevity products, right?
• 12:42
  SPEAKER_01: It's all being rebranded and renamed as longevity.
• 12:45
  SPEAKER_01: You had the first longevity product.
• 12:47
  SPEAKER_00: Yeah, you know, and that was like almost 25, as you said, 30 years ago, but we didn't really realize it.
• 12:55
  SPEAKER_00: Just like we didn't realize that it wasn't us just TGF beta or one growth factor that would do things, because I was with another company called Topics, where we we decided we were going to just put the TGF beta in the liposomal encapsulation to have it penetrate through the skin.
• 13:15
  SPEAKER_00: And even though that product worked very well, it tends it's the sort of the gamish, it's the interaction of all the growth factors and the exosomes and the secretomes, which in the olden days we thought were just byproducts and garbage.
• 13:32
  SPEAKER_00: Like that's why we didn't even look at the exosomes because we figured, oh, that was all the junk.
• 13:38
  SPEAKER_00: It's really the growth factors that do for everything.
• 13:41
  SPEAKER_00: And now, of course, uh we've learned from people way smarter than us that or me that uh it's it's a combination.
• 13:49
  SPEAKER_00: And so I like the physiologic combination of the of the different growth factors from cell culture media.
• 13:57
  SPEAKER_00: Now, with that in mind, there are other companies that don't use just fibroblastic uh growth factors or media.
• 14:06
  SPEAKER_00: There's a company in Singapore called Cell Research Corporation, which uses uh actually umbilical cord lining mesenchymal stem cell from New Zealand Red Deer for some reason.
• 14:19
  SPEAKER_00: Um, and so there's there's a lot of other companies that are getting into this as well.
• 14:26
  SPEAKER_00: And, you know, they're all pretty good.
• 14:29
  SPEAKER_00: And and there's never been like a head-to-head, like which one's better.
• 14:33
  SPEAKER_00: And the reason is I don't think we're gonna be able to tell a significant difference.
• 14:39
  SPEAKER_00: I think one might give you like a 30% improvement, one might give you a 40% improvement, but is it really statistically significant?
• 14:47
  SPEAKER_00: I don't know.
• 14:48
  SPEAKER_00: And so for my patients that come in wanting growth factors, exosomes, secretatomes, sometimes I'll I'll say, okay, let's start with the skin medicine, let's change over to plated, let's change over to callusum, which is cell research corporation.
• 15:06
  SPEAKER_00: I sort of mix things around and I allow the patient to basically tell me what they think is best.
• 15:13
  SPEAKER_00: And sometimes it's the feel, sometimes it's the smell, and oftentimes they've they've look at the difference in appearance.
• 15:23
  SPEAKER_00: So one product may not be great for everyone, and I think it's okay to have a number of different products, and that's why even in my own office, we sell probably eight different skincare lines uh in our retail center in our office, because you can't just go with one.
• 15:42
  SPEAKER_00: You got to go with the one that's best for the patient.
• 15:46
  SPEAKER_01: At that point in time, right?
• 15:48
  SPEAKER_01: And as you said, it could change with season, with age, stress, hormones.
• 15:52
  SPEAKER_01: Many different things can affect the skin and its ability to be receptive to different skincare uh ingredients and formulations.
• 15:59
  SPEAKER_01: I think, you know, it's everything right now is talking about integrated skincare.
• 16:04
  SPEAKER_01: How do we incorporate skincare along with procedures?
• 16:06
  SPEAKER_01: And initially it was just post-procedure.
• 16:08
  SPEAKER_01: How do we maybe augment the outcome of the procedure?
• 16:12
  SPEAKER_01: But really, initially we were talking about decreasing downtime.
• 16:15
  SPEAKER_01: And now we're starting to talk about pre-procedure preparation, post immediate post-procedure, and then you know, delayed post-procedure.
• 16:23
  SPEAKER_01: Um, are you using the growth factor products that you just mentioned both pre and post, or are you really just doing post?
• 16:30
  SPEAKER_00: Well, Ted, that's a phenomenal topic that we can spend uh, you know, a long time on.
• 16:37
  SPEAKER_00: You know, when we first started doing laser resurfacing, called because Fitzpatrick and I actually developed the Ultrapulse CO2 laser to start laser resurfacing.
• 16:48
  SPEAKER_00: The key thing at that time was how are we going to get patients to heal more quickly?
• 16:52
  SPEAKER_00: Um, one of the biggest advances we originally had was to use a silicone dressing called Cylon, which basically kept the patient's own growth factors in contact with the skin, and that really speeded up healing.
• 17:07
  SPEAKER_00: And that's in the olden days when we were doing fully ablative CO2 lasers under general anesthesia.
• 17:14
  SPEAKER_00: And that, and so that worked incredible.
• 17:17
  SPEAKER_00: So then we would, of course, have patients that would develop a lot of post-inflammatory pigmentation and erythema.
• 17:24
  SPEAKER_00: So we started with this pre-treatment.
• 17:26
  SPEAKER_00: In the olden days, when we did wire brush derm abrasion, uh, we and others, like John Yarburrow, who is one of the greatest derms of all time, figured out, and Steve Mandy figured out that if you pre-treated the skin with tretinoin, that would heal things faster after derm abrasion.
• 17:47
  SPEAKER_00: So we tried that with uh ultrapulse CO2 laser resurfacing, and it really didn't make any difference.
• 17:54
  SPEAKER_00: And then we thought, okay, let's try to down-regulate the melanosomes by using hydroquinone before.
• 18:02
  SPEAKER_00: And Fitzpatrick and I published a paper saying, no, that really didn't do anything either.
• 18:07
  SPEAKER_00: It just basically showed us which patients could tolerate hydroquinones and which couldn't.
• 18:14
  SPEAKER_00: And so we've started doing now a number of studies on a topical rapamycin uh from a company called Rapalogics, or the product is called RECU, because it's really my firm belief at this point that what we're doing to our skin, everything we're doing, is stimulating fibroblastic function.
• 18:37
  SPEAKER_00: And if you can prime the fibroblasts with uh something like a topical rapamycin, which acts through the mTOR pathway to sort of wake up the senescent fibroblasts, then when you stimulate and or injure the fibroblasts, you get a more robust wound healing response.
• 18:56
  SPEAKER_00: So we're doing uh that study actually right now.
• 18:59
  SPEAKER_00: Um we're doing other studies with different, like diamond core technology from a company called Pavis to try to uh increase and speed wound healing.
• 19:09
  SPEAKER_00: We've done studies with um a botanical anti-inflammatory uh called Pomega that decreases the erythema and speeds up wound healing.
• 19:19
  SPEAKER_00: So there's many different products out there.
• 19:22
  SPEAKER_00: Uh, and I could go on for probably 10 different products that we've studied in our office and other people have also studied, which shows that we can potentiate and stimulate wound healing and more importantly, sort of upregulate the fibroblast so that when we do stimulate them to make collagen elastic fibers and hyaluronidase uh primarily, that they will make more of it.
• 19:49
  SPEAKER_00: And so I think we still have a ways to go.
• 19:53
  SPEAKER_00: But as you said, it's not just the laser or intense pulse light or radio frequency microneedling or focused ultrasound.
• 20:02
  SPEAKER_00: It's using it in conjunction with skincare products that stimulate fibroblastic function both pre and post, that makes the procedure work better.
• 20:14
  SPEAKER_00: And that's why it's so wonderful to be a dermatologist, because not only do we know how to do the procedures, we're we're best able to know what how the skin will react and how to stimulate the skin.
• 20:29
  SPEAKER_00: So even though virtually any doctor, retired proctologist can do these procedures, I think as dermatologists and dermatologic surgeons, we we're the best.
• 20:41
  SPEAKER_00: You know, we know all stages of wound healing in order to potentiate our our uh results.
• 20:48
  SPEAKER_01: It's so interesting.
• 20:49
  SPEAKER_01: I totally agree with you.
• 20:50
  SPEAKER_01: It's so interesting now to focus on the fibroblast, right?
• 20:54
  SPEAKER_01: Because I would say probably five years ago, and everybody was focused on the keratinocyte proliferation and migration.
• 20:59
  SPEAKER_01: How do we close that wound up more quickly?
• 21:02
  SPEAKER_01: It's going to you know allow patients to recover better.
• 21:05
  SPEAKER_01: But in essence, that's the wrong cell to target, isn't it?
• 21:08
  SPEAKER_01: It's the it's the fibroblast, which is the workhorse of the dermis to to produce the glycosaminog glycans and the collagens that we need to increase the thickness and and also to rejuvenate that layer.
• 21:20
  SPEAKER_01: And we know that fibroblasts and keratinocytes talk to each other.
• 21:24
  SPEAKER_01: So even more important to target not only the fibroblasts, but maybe also the keratinocytes, and we're doing that with these products.
• 21:32
  SPEAKER_01: You know, Mitch, one question for you is as I've learned a little bit more about the hallmarks of aging and and just thought about targeting these for skin rejuvenation and skin longevity, it seems to me that targeting one hallmark of aging at a time may not be the best approach.
• 21:51
  SPEAKER_01: That we should really focus, you know, mTOR pathway plus the epigenome, plus the mitochondrial DNA or mitochondrial dysfunction.
• 22:00
  SPEAKER_01: Plus, plus, plus.
• 22:01
  SPEAKER_01: And so do you think that in the future, and this is really a question because I ponder this quite a bit.
• 22:07
  SPEAKER_01: Do you think in the future we will be having these kind of products that are so targeted, like you were talking about with a rapamycin, in addition, like multiple targeted products, or will we come back to a TNS serum which has so many different ingredients that probably target multiple aspects of the hallmarks of aging?
• 22:25
  SPEAKER_00: Boy, Ted, those that's that's a great question.
• 22:28
  SPEAKER_00: Obviously, I I don't know the answer, yeah, but I think as so many of us has have found through the years, everything is multifactorial.
• 22:39
  SPEAKER_00: And there and the more we can do to stimulate a variety of pathways, the more we can get into this rejuvenation uh medicine that everyone's getting into now.
• 22:51
  SPEAKER_00: Again, as dermatologists, I love topical.
• 22:55
  SPEAKER_00: Um, I'm a little bit afraid of systemic treatments that are so popular now with growth hormones and peptides and all this other stuff that people are injecting into themselves.
• 23:09
  SPEAKER_00: Because, you know, I actually had a problem.
• 23:13
  SPEAKER_00: Um, when I was in my early 40s, anti-aging, so that's now 30 something years ago, started really taking off in San Diego.
• 23:22
  SPEAKER_00: And there was a doctor who was a friend of mine, he was an ER doctor, so actually a smart person, and he had this anti-aging clinic.
• 23:31
  SPEAKER_00: He says, Mitch, you got to get on growth hormone.
• 23:34
  SPEAKER_00: And so, like an idiot, I started injecting myself with growth hormone until I developed thyroid cancer.
• 23:41
  SPEAKER_00: And then my oncologist was like, What the fuck are you doing, excuse me, what the heck are you doing?
• 23:47
  SPEAKER_00: It's like, you know, you shouldn't be having that much growth hormone at this, at this age.
• 23:52
  SPEAKER_00: And my wife at the time, of course, was also doing it, and she developed uterine cancer.
• 23:58
  SPEAKER_00: And so, and and so I'm I'm really reluctant to do a lot of the systemic therapies that so many of our colleagues, um, especially outside of dermatology, are pushing now.
• 24:13
  SPEAKER_00: Um, I don't know if it there it's just for the money or they really believe that that's possible.
• 24:18
  SPEAKER_00: And one day it may be, but I don't think we as science physicians just know enough yet uh to do that.
• 24:28
  SPEAKER_00: Because, you know, I and and my wife are some of the guinea pigs that that and a number of my other friends that were doing this that that went through these problems.
• 24:38
  SPEAKER_00: So uh caution is really, you know, we we gotta have be cautious.
• 24:43
  SPEAKER_00: But that's why topical to me is so much of a better way to go at this point.
• 24:51
  SPEAKER_01: Oh gosh, we could talk about so many things right now because I completely agree with you.
• 24:56
  SPEAKER_01: I know my my business partner, Patty Ferris, doc absolutely believes in this as well.
• 25:01
  SPEAKER_01: We have to be so careful with these unregulated peptides that haven't gone through rigorous double-blind placebo controlled trials.
• 25:08
  SPEAKER_01: And I don't know if they ever will.
• 25:10
  SPEAKER_01: The FDA just today is pondering whether they're going to allow compounding of these peptides and take them off the Schedule II list.
• 25:16
  SPEAKER_00: So Ted, I think they actually did.
• 25:19
  SPEAKER_00: I just read that the FDA approved it.
• 25:22
  SPEAKER_00: And and and where does the raw product come from?
• 25:25
  SPEAKER_00: It all comes from China.
• 25:27
  SPEAKER_00: And as we know from other medicinals that come from China, it may not be as pure as people think.
• 25:34
  SPEAKER_00: And so it's we've we've got to be careful.
• 25:39
  SPEAKER_00: We've got to be careful.
• 25:40
  SPEAKER_01: It makes me so nervous, Mitch, because it's buyer beware when the consumer is at an education deficit or a knowledge deficit, um, and you really won't be able to know what's in there.
• 25:50
  SPEAKER_01: I mean, you can send for testing, I suppose, but that gets so expensive.
• 25:53
  SPEAKER_01: I mean, there's batch testing, but there's not single product testing.
• 25:56
  SPEAKER_01: So it's um it makes me incredibly nervous to your point.
• 26:00
  SPEAKER_01: And uh I'm really sorry to hear that that you experience such such horrible effects of the growth hormone, but it is like no scar.
• 26:09
  SPEAKER_00: You know, that's the beauty of lasers.
• 26:12
  SPEAKER_00: Yeah.
• 26:13
  SPEAKER_00: I had a great surgeon, and you know, and basically Kim took away my scar, Dr.
• 26:18
  SPEAKER_00: Butterwick.
• 26:19
  SPEAKER_00: So, you know, everything's good.
• 26:22
  SPEAKER_00: And I learned a lot from that experience.
• 26:24
  SPEAKER_01: Yeah, and I hope we can all learn from your experience then that we just have to be careful and jumping on the latest and greatest may not be the best idea.
• 26:33
  SPEAKER_01: Uh, and and if we as dermatologists, who as to your point before, just to reiterate, we understand the skin, we understand the biology, the physiology of the skin, and you know, we can everybody can learn a little bit more about formulation and understand penetration and and really educate yourself to to make sure that you are working with the companies that have the best formulation.
• 26:54
  SPEAKER_01: I mean, John Gerudo is is just an absolute legend uh as a formulator.
• 26:58
  SPEAKER_01: So um, you know, has worked on Skin Medica, but many other brands since then.
• 27:03
  SPEAKER_01: And, you know, we just have these incredible formulators that are able to get some of these products into the skin at safe levels.
• 27:09
  SPEAKER_01: And so we are able to effect incredible change because of that without the need for systemic exposure to some of these products that may not do well systemically, to your point.
• 27:20
  SPEAKER_01: And I think it's to the point where, you know, we're at the point now in in formulation science and and just skincare science where we can really rely on these products to make amazing differences in our skin, both acutely and then longitudinally, that that will probably extend skin span.
• 27:39
  SPEAKER_01: And and I know we need more studies, and I'm saying this just from a knowledge base that's limited, but I don't know, Mitch.
• 27:46
  SPEAKER_01: Maybe you agree.
• 27:46
  SPEAKER_01: I I think that we probably are extending skin span at this point.
• 27:50
  SPEAKER_00: Yeah, I agree.
• 27:51
  SPEAKER_00: But it but it there it even goes beyond that.
• 27:53
  SPEAKER_00: Like I've been involved with a company called Dive, D Y V E.
• 27:58
  SPEAKER_00: And I became involved with this company because they had a technology that pushed products through the skin, because that is the most difficult thing to do.
• 28:08
  SPEAKER_00: And they had a product actually called uh AMPHC, um, which is basically a topical sodium bicarbonate.
• 28:18
  SPEAKER_00: And I started using it because I'm an athlete that is a cyclist.
• 28:24
  SPEAKER_00: And as you know, if when you're doing prolonged physical activity, you build up a lot of lactic acid and other byproducts.
• 28:32
  SPEAKER_00: And so in the olden days, we were actually drinking sodium bicarbonate solutions because we thought that that was going to you know get better muscle recovery and allow us to go a little bit farther.
• 28:43
  SPEAKER_00: And then when this company, it's uh it's actually called Momentous, um, actually came up with this sodium uh bicarbonate, I thought that was great.
• 28:53
  SPEAKER_00: Fast forward 10 years later, they're now doing clinical studies in City of Hope and other areas on changing the acidic environment of tumors.
• 29:05
  SPEAKER_00: Because if you if you get rid of the acidity of the environment of tumors, it's going to be more susceptible to damage through chemotherapeutic uh agents and radiation.
• 29:17
  SPEAKER_00: And so what started as a product for triathletes to use and and old people thinking they're triathletes, um, is now it's now looks like it's going to be a product that's going to help, you know, superficial skin cancers.
• 29:34
  SPEAKER_00: And so, you know, in the dermatology world, we can affect a number of different things, not just getting rid of wrinkles, you know, just like Botox.
• 29:44
  SPEAKER_00: It helps with the wrinkles, but shoot, it's phenomenal for patients with cerebral palsy and a whole host of other medical things to do.
• 29:54
  SPEAKER_00: So, you know, we cross over.
• 29:56
  SPEAKER_00: And that's why I wrote an article a number of years ago in Derm Surgery about why aesthetic dermatology is so important to medical dermatology.
• 30:08
  SPEAKER_00: You know, for so long, you know, the academic dermatologists were like, no, we're not going to do any aesthetics.
• 30:15
  SPEAKER_00: That's that's BS, that's just for people making money.
• 30:18
  SPEAKER_00: But it's the aesthetic dermatologists that are actually helping with the medical problems as well.
• 30:25
  SPEAKER_00: And I really wish the academic dermatologists would pay more time or give more respect to the aesthetic dermatologists because there's such a good overlap between our two specialties.
• 30:39
  SPEAKER_00: Um, and some some area some departments do that, but the majority, 90% of dermatology residency programs, do not teach any aesthetics.
• 30:50
  SPEAKER_01: Is that still the case?
• 30:51
  SPEAKER_01: I didn't realize that.
• 30:52
  SPEAKER_00: Oh, absolutely.
• 30:53
  SPEAKER_00: And I know this because when I was ASDS president, we established the cosmetic surgery fellowship program, and you know, we get applications from all over.
• 31:04
  SPEAKER_00: So let's pretend there's uh 550 dermatologists that graduate a year.
• 31:10
  SPEAKER_00: There are probably a hundred dermatologists that apply to fellowship programs, and that just tells you, everyone that comes in to interview, why are you why do you want to take another year to do cosmetic dermatology?
• 31:24
  SPEAKER_00: Because it was not taught and in fact frowned upon by their residency programs.
• 31:30
  SPEAKER_00: And so we've got to change that message around too.
• 31:35
  SPEAKER_00: And again, I don't know how we're how we're gonna do that because the medical derms think the aesthetic derms are just in it for the money, and they don't really understand that it's not just about making people look better and having better self-esteem, but preventing a lot of the dermatologic problems and cancers that we all see as physicians.
• 32:02
  SPEAKER_01: You know, Mitch, I couldn't agree with you more.
• 32:03
  SPEAKER_01: We started this meeting, Science of Skin Care Summit, and it was basically basically to highlight all the great data that these companies were producing to support the use of their products, which kind of goes back to our conversation earlier.
• 32:15
  SPEAKER_01: And then we rebranded to science of skin because we were I wanted to bring more medical into the meeting and show people that they're they're complementary.
• 32:24
  SPEAKER_01: Um, skincare science, aesthetic science, medical science, now longevity science.
• 32:29
  SPEAKER_01: It's all complementary and part of our practice, part of part of dermatology writ large.
• 32:34
  SPEAKER_01: So I completely agree with you.
• 32:36
  SPEAKER_01: I think that I love skincare in particular because the science that starts in skincare, the new biomarker technology, the new pathways that are being elicited and taken advantage of to improve skin quality and health, are pathways that are oftentimes later targeted by by pharmaceutical companies.
• 32:55
  SPEAKER_01: And so what happens in medicine, you know, medical dermatology often starts in aesthetic or skincare.
• 33:01
  SPEAKER_01: So completely agree with you.
• 33:03
  SPEAKER_01: You have to pay attention to all of it in order to truly understand how we can kind of practice the best we possibly can, practice at the very top of our license.
• 33:11
  SPEAKER_01: And so um, thank you, Mitch.
• 33:13
  SPEAKER_01: I can't, we've already run out of time.
• 33:14
  SPEAKER_01: I we've gone over time.
• 33:16
  SPEAKER_01: Thank you so much, Dr.
• 33:17
  SPEAKER_01: Goldman.
• 33:17
  SPEAKER_01: I truly appreciate your time.
• 33:19
  SPEAKER_01: Hopefully, we can have you back.
• 33:20
  SPEAKER_01: I mean, there's so much more to talk about, if that's okay with you.
• 33:23
  SPEAKER_00: Well, I I tell you, I feel privileged to be part of the program.
• 33:27
  SPEAKER_00: And Ted, thank you so much for the opportunity to share my views.
• 33:30
  SPEAKER_01: Oh, amazing.
• 33:31
  SPEAKER_01: Guys, thank you so much for listening to the Science of Skin Podcast.
• 33:34
  SPEAKER_01: If you have any questions, thoughts for for future episodes, please shoot us an email.
• 33:39
  SPEAKER_01: Inquiry at science of skinsummit.com.
• 33:41
  SPEAKER_01: That's inquiry at science of skinsummit.com.
• 33:44
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• 33:46
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• 33:47
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• 33:49
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• 33:50
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• 33:59
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• 34:00
  SPEAKER_01: Dr.
• 34:01
  SPEAKER_01: Goldman, thank you again, and uh have a great day, everybody.