The TRUTH About Makeup, Sunscreen and Skin Cancer | Teo Soleymani

23:05I personally haven't found topical estrogen to be any better than the vehicle in which the estrogen is in. So if you smeared one half of the face with, let's say, Aquaphor, no specific brand, but let's say one half is Aquaphor and the other half is estrogen cream, over a month, there isn't much of an appreciable difference. I think the vehicle is doing more than the estrogen itself. And there's a few reasons for that. One is absorption. Two is concentration of estrogen. Our skin on the face is very different than the genital region, which women use this for, you know, different reasons, you know, vaginal dryness, atrophy, you know, what have you.

23:49There, you have a mucosal membrane. The absorption of estrogen is much higher. It's like same thing as putting something under your tongue. The absorption is much higher in mucosal membranes than keratinized skin. So if you want the benefits, oral is the way to go. The way I tend to prescribe it is in the form of birth control. And estrogen-dominant birth control at lowest doses possible does really well to control things that are a result of low estrogen or high testosterone. And this can be PCOS. This can be hormonal acne. This can be postmenopausal skin changes. This can be hair loss. That's pattern hair loss.

24:27So estrogen does a lot of good things. And we use it clinically all the time.

24:32Dr. Gabrielle Lyon:Have you ever considered using the patch, estrogen patch, as opposed to oral? I haven't. I haven't. I don't know. I don't know enough on its effects on skin. I presume the patch has a more steady state release than the pill. I don't know if the patch is purely estrogen based. I know like Depot and the implantable like Implanon are progesterone based. and they tend to make your skin worse. And you're like, what the heck are you talking about? Worse in what way? Generally, it'll break you out. So a lot of young women come in and they have hormonal acne, which we usually call in the beard distribution.

25:05And it's pretty predictable. It's cyclic in the days leading up to their periods. And that tends to be progesterone driven. So as good as estrogen is for your skin, progesterone tends to break you out. So patches, injectables, even the IUD, like the Mirena IUD that is progesterone based, a lot of patients are sensitive to that progesterone spike. So I tend to like estrogen dominant forms of supplementation.

25:28Dr. Gabrielle Lyon:It's really fascinating that estrogen plays a role on the skin. Huge. What would someone expect to see aside from the acne piece? And what I'm really getting is at elasticity and wrinkles. What do they expect to see and over what period of time with the use of estrogen, say for a postmenopausal woman or a woman that is going through menopause and all of a sudden her skin is changing. So the same thing that happens in your skin is the same thing that happens in your muscle, by the way. And we'll talk about that just briefly because it's your area of expertise. But the most common complaint that we get postmenopausal women in their skin is their skin is dry and it lacks luster.

26:06That shine is gone. And that's usually because of the drop in estrogen relative to testosterone. It's not like your testosterone went high. It's just your estrogen went down. So your body senses that there's an imbalance in the level between testosterone and estrogen. So re-supplementing, if you are the right candidate, meaning you don't have a personal history of hormone-sensitive breast cancer or what have you, and that'll be a discussion with you and your doctor. But supplementing usually improves skin hydration, skin turbidity, skin volume. It improves fine lines and wrinkles slightly, but wrinkling is a problem over a decade.

26:44So it's hard to see that correction fast. But usually what women say when they come in is like, my skin looks better. My hair feels a little thicker. I just, I feel good. I look good. And that is perhaps not directly quantifiable, but if they feel great, then we've done our job.

27:02Dr. Gabrielle Lyon:There has been this big influx of topical use of estrogen for the skin. I'm not going to lie. I have tried it. Does it work? What? Does it work? Do you feel like it made a difference? I don't notice a difference. But then again, I'm thinking to myself, well, number one, this is not probably the right dose. Yeah, yeah. And I don't know if there's ever been clinical. Are there clinical studies? I don't know if there's been randomized dose escalation studies. I think it was inferred from literature that's been around for a long time. I see. And what we do in medicine often is we reformulate a drug that was used in another specialty or another indication.

27:38Some women say it works. If it works, great. I'm not saying it's not going to work in everyone. but if you're going to use estrogen as a source of revitalizing your skin for whatever reason, I tend to find the higher concentration from oral forms tend to be better than the topical.

27:54Dr. Gabrielle Lyon:And to be clear, we don't have a dose. Your estrogen, for example, if I'm looking at blood work as a physician and I want the outcome to be obviously subjective, lusterful skin. Yeah, yeah. No dose. No dose. Because it has to be titrated based on titrating, meaning we have to find the dose that fits your skin based on what we see. There are patients who, and I'll use testosterone, it's much more readily measured all the time because people tend to supplement more. There are patients who break out when they are in 6, 700 range. And there are patients who don't break out when they're in 1 ,000, 1 ,100 range.

28:31So your sensitivity to it is very important. And that can be impacted by your genetic metabolism, other medications that you're on, other supplements that you're on that can affect the metabolism or some of the drugs. So there isn't really a level that's correlated to skin the way there is a level correlated to internal organ changes related to hormones.

28:56Dr. Gabrielle Lyon:That makes sense. And also to be clear, skin is not the largest organ in the body. Muscle? It is. 40 % of the body. I mean, And listen, I've never been able to say that to a dermatologist. I believe it. I feel very lucky to just course correct here that it is not the largest organ in the body. It is the skin. Or it is, oh my gosh, it is muscle. It is not the skin. Have you seen anything that was really surprising? You've been in practice. You did two fellowships. Have you seen any trend that just has really surprised you? I don't know if I, I think the rise of social media has taken away the surprise.

29:34I think, I think every day I'm like, what is going on here? And I think that the advent of home, home doctors, like homemade doctors through social media and Google searches is a real big problem that wasn't around when I first started training. I mean, I'm not that old, but people weren't chat GPT-ing their symptoms and coming in with predetermined diagnoses. This makes practice of medicine really hard. It takes more time for you to course correct somebody in clinic than anything else. I think I hate blanket statements. And that's become more and more. I think medicine has become polarized in the U.S.

30:15And you either fall in this camp or you fall in this camp. and if you're in this camp, you're the enemy of this camp. And like, there used to be a lot more middle ground. I'm a dermatologist who focuses primarily on some of the worst skin cancers in the US. It was my area of expertise as a full-time professor at the university. It's what I do in my practice now.

30:33Dr. Gabrielle Lyon:And that was at the UCLA. Yeah. And my career has been dedicated towards treating melanoma and squamous cell carcinoma and basal cells and et cetera. I love the sun. I enjoy it. I go outside and I get a lot of benefit from it. That is blasphemy in our specialty until now. And that's like something I hated when I realized the majority of my field would say, you have to avoid the sun at all costs. I don't think you do. I really don't think you do. And that was really infuriating to me for two reasons. One, this binary good bad is never existent in medicine. And number two, dermatology is probably the last specialty in which the physicians in the field tend to guilt their patients into making them feel like they were the cause of their skin cancer.

31:27The last time we did this was with cigarette smoking and lung cancer. Made total sense. You stopped cigarette smoking. Squamous cell carcinomas of the lung went down. But guess what? The number one cause of lung cancer and lung cancer death in the U.S. now is adenocarcinomas and non-smokers. So that guilting feeling is out. But in dermatology, often what happens is patients come in, they have a skin cancer on their nose and their cheek and people say, you know, the sun you got in your twenties and thirties, you did this to yourself. And don't get me wrong. Blistering sunburns are not good. Constantly getting burns is not good, but there's a lot of factors that we don't have control over that predispose people to skin cancer that I think it sucks to make them feel guilty about this.

32:11Dr. Gabrielle Lyon:You know, I always just wonder, how do newborns get so much energy? They wake up, they cry, they go to the bathroom. Well, they get something that we don't. They get colostrum, the OG energy shot. And I'll tell you what, I'm always looking for ways to improve my energy and gut health since that's where good health starts. And that's why I've added Amra colostrum to my iced coffee. Amra is a whole food supplement packed with over 400 bioactive nutrients, things like prebiotics, peptides that help strengthen immunity, support digestion, optimize performance in case you want another newborn. Onra uses a unique technology to preserve these nutrients in their purest, most bioavailable form, which is why it stands out from nearly everything else that I've seen on the market.

32:59Dr. Gabrielle Lyon:We have a special offer just for my audience. You can get 15 % off your first order. Go to tryamra.com slash Dr. Lion and use the code Dr. Lion at checkout. Does the sun cause skin cancer? Yes, with an asterisk. So there are a whole slew of skin cancers. We talk about the big three in the U.S. because they're the most common basal cell, squamous cell, melanoma. But there are things like dermatofibrosarcoma, protuberans. There are things like Merkel cell carcinoma. There are, you know, there's a ton of skin cancers, a ton of different types of skin cancers. When we say yes, there is a direct correlation with chronic excess sun exposure and the number of blistering sunburns that you've had with our most common types of squamous cell carcinoma and some basal cell carcinomas and melanomas.

34:04However, there was a really interesting randomized study. It was the last randomized study that was ever done on sunscreen. And I'll go into this. I'll go into why this is important. It was published in The Lancet in 1999. This was a study done in Australia that looked at people who used diligent sunscreen versus those who did not. And the incidence of some squamous cell carcinomas came down, but there was no change in the incidence of basal cell carcinomas, which is our most common form of skin cancer in the US. One in four Americans will develop this.

34:37Dr. Gabrielle Lyon:Squamous cell. Basal cell. Basal cell. So no change in basal cells, a decrease in squamous cell and a slight decrease in melanoma, but no change in survival. So you're scratching your head saying, okay, I don't understand. What are you saying? First, sunscreen is a form of sun protection. It's not the only form. sunscreen only works if you apply enough of it to every square inch of sun exposed skin not everybody does that which should be roughly a shot glass yeah shot glass worth which a lot of times people don't put that much that's a ton it is it is and if you're using a spray forget about it you're barely getting anything oh my gosh that's all i use it's all it's all i used as a kid and yeah it's all i used is you know as a kid growing up and adulthood until we learn better so sunscreen is not the only form importantly the strongest predisposing factor for you is your genetic and family history, coupled with your cumulative sun exposure dose.

35:30So if you are from Northern European descent, mom and dad had basal cells, uncles had basal cells, there's a very high chance that you're going to get it in the future.

35:39Dr. Gabrielle Lyon:And is that only two exposed sun areas? No, it can be anywhere. It occurs more in sun exposed areas because the sun is like the second hit. Your first insult is your genetic predisposition. The second is the sun. Do we know the exposure from, for example, lights, fluorescent lights, regular lights, and the effect on the skin? Yes. Published that study as a fellow at NYU. And we showed that visible light, particularly fluorescent light and some halogen light can change the pigment and change the DNA of your skin. That's terrifying. Yeah. So there's proximity is important. Duration of exposure is important.

36:18So LCD, LED screens don't do this.

36:20Dr. Gabrielle Lyon:What about this computer screen? No, that's usually LCD or LED. But fluorescent lights do it. Some halogen lights do it, which is why there's a big movement now towards sunscreens that have visible light shielding and glasses that shield against visible light spectrums in the blue wavelength. So there's a movement to wear stuff or do stuff that'll protect you from indoor light. And this came from, you know, we had a lot of patients at NYU that were on Wall Street. They're like, I'm in these lights all day and night. I'm behind these screens or they're in, you know, private equity or what have you.

36:58They're like, what is this doing for my skin? Nobody really knew the answer. So we did a study for it and we were pretty shocked. You get some pretty significant changes over time.

37:06Dr. Gabrielle Lyon:It's not the same as UV. It's nowhere near the same as UV. If we treat light as a form of a drug or medicine, we can touch base on that in a bit. then everybody should know their dose, right? Your skin and my skin is very different than my Irish patient's skin. I may be able to be outside or be under fluorescent light for an hour and a half before my skin turns red. That's what we call my minimal erythema dose. So that's how much my skin can tolerate. So if I'm gonna enjoy the sun safely, I will go a little bit below that. If you tell me, hey, I'm strawberry blonde, blue-eyed, I burn in 10 minutes, your comfortable dose is five.

37:46So everybody should kind of know their dose. One thing we didn't touch upon earlier in terms of sun and skin cancer, melanoma has historically been our deadliest form of skin cancer. And that's changed in the last five years. It's no longer the case. But for all intents and purposes, melanoma has been our deadliest form of skin cancer because it has the quickest ability to spread. It is the most common cancer in age 25 to 39. Second most common cause of cancer death in women ages 25 to 35.

38:13Dr. Gabrielle Lyon:Melanoma. Melanoma. The majority of lethal melanomas arise in sun-naive skin. Backs and legs are the most common areas. So you're saying, okay, is the sun causing cancer? Is the sun not? Like, what's the message here? A little bit of yes and a little bit of no. Thanks for clearing that up. Yeah, I know. I made more confusion than anything. My point in saying that is you don't have to fear the sun if your sun's smart. You can enjoy the outdoors, get all the benefits that the sun provides. safely, very effectively, while keeping yourself protected from the risks of skin cancer. Now, what is very, very linearly correlated is aging in sun.

38:58So skin cancer has a lot of molecular changes, genetic predispositions, family, you know, heritage, ancestry influences that drive skin cancer formation. Aging is a lot more of a straight line. You get too much sun, you're going to wrinkle like a raisin. So that makes sense. People find that it's still controversial, right? And they find it controversial because they can't account for their genetics. You know, I hear this all the time. My grandma was Greek. She was in the sun all the time. She didn't have a single wrinkle. Maybe if we look back at her photos, maybe she does have a wrinkle. We forgot about it because we loved her.

39:32We also don't know how good her skin genetics was in tolerating UV damage. But the way I describe this analogy is put a grape in the sun, it eventually turns into a raisin. It's pretty predictable. Is that why upstairs on our fourth

39:47Dr. Gabrielle Lyon:floor, I had this beautiful rug and it had green and it had tan and now it looks totally bleached out. Yeah. Yeah. It's exactly right. And it comes through the windows. You think you have protection through the windows and you really don't have much UV guarding. It's why you're not supposed to put nice fine art or whatever you're trying to preserve by a window because the UV will eventually erode it and do we know that it's uv we do because there's been good studies not even in skin but in in worlds not related to medicine like art art preservation where you look at what damages the paint and what age is the paper behind it and it's uv heat also plays an important role but assuming your house is climate controlled you're not not in texas not outside in texas Fair enough.

40:31Touche. It's at least 150 degrees here. 150 will kind of wrinkle you faster.

40:35Dr. Gabrielle Lyon:But that's terrible. If we're talking about aging, premature aging versus skin cancer, wrinkling, the number one cause you would say is UV exposure? Excess. Excess. We didn't define excess and we didn't define a normal amount. Is there such? Yeah, except it's person to person dependent. so if we consider light uv light or sunlight a medicine then there has to be a dose right i give this example all the time take a tylenol or take an advil what happens your headache goes away take 23 of them see what happens you'll be in the ear same thing same thing with uv exposure right every person has a dose the way you kind of know your dose if you came to clinic and you wanted to test it is called the minimal erythema dose where we shine uv light we find the time in which your skin turns red that is the dose that you can tolerate and then anything below that is presumed to be a little safer the way the average person does this is on a summer day they're like hey i 15 minutes later i was burned okay then your tolerance is 10 minutes the problem in making an umbrella statement as to what's safe is everybody's skin is different everybody's skin color is different.

41:48Everybody's UV tolerance is different. So you have to find that dose for yourself. But I think there is absolutely nothing wrong with getting 15 to 20 minutes of sun exposure for most people at low UV index times of the day, every single day. I wouldn't recommend 20 minutes in the desert in California. Most people would burn.

42:09Dr. Gabrielle Lyon:Not everybody. If someone can tolerate it. Yeah. For example, my dad, my dad lives in Ecuador. 74 is outside all the time. would you say that there would be a reason to restrict that exposure if he hasn't had any skin cancer history which actually i think that he has had some skin cancer it's something on his nose you have you have fair you have light colored eyes i do and ironically for some reason that we don't understand very well patients with green or hazel eyes but with dark skin or dark hair roots tend to have a high incidence of pigmented basal cells it's the most common skin cancer i see in south americans the most common skin cancers i see in southeast asians and it's more common in those who have light eyes but all of features so if your dad had one then i would say okay if he i would probably restrict or be careful because everything in the skin and sun is cumulative effect which is why you don't see skin cancers in young kids that frequently almost never unless they have a genetic syndrome most cancers are the same way it's a cumulative effect so if your dad's not bothered if he actually hasn't had a skin cancer and he doesn't really have to ask him yeah but find out if he doesn't if he's not bothered by his aesthetics then no let him have all the fun he wants if he has and you're worried and it's on a sun exposed area his his likelihood of having another one is 50 wow that's high yeah and the out to be clear the outside rays are different you said that light exposure is cumulative it's the cumulative uv that we have to be careful with are we getting any uv from our lights fluorescent lights have uv yeah that's very well known you can you can measure that fluorescent lights have uv most of the lights indoors nowadays are not fluorescent they're either halogen or led and they do not have uv they stop sharply was that why 400 was that why they stopped and the mercury inside fluorescent tubing was a problem so when the fluorescent bulbs would break you're inhaling mercury powder thanks to one of the sponsors of the show, Bond Charge.

44:09Dr. Gabrielle Lyon:Man, if you're a mom out there and you've been carrying the whole team, I got a different form of therapy for you, and that is red light therapy. And listen, good light impacts sleep, hormones, mood, and even your ability to recover and focus. Bond Charge has created science-backed tools to help me live in better alignment with my circadian biology. Artificial light is overloading us. They have blue light blocking glasses that are a staple in our house. They have red light. They have red light light bulbs. They also have infrared PMF mats to help chill my body, relax my muscles and support full body recovery.

44:52Dr. Gabrielle Lyon:If you've never tried red light therapy, this is the time to do it. They have some of the best devices that I've ever seen. great for skin, mitochondrial health, and overall resilience. If you care about your skin, if you care about your sleep, if you care about your body and want to try something new, check out bondcharge.com slash Dr. Lion. Use the code Dr. Lion to get 15 % off your entire order. Simple, proven, designed to support your biology. We covered the number one way to prevent wrinkles. Would you say that that's fair? That is exposure? Yeah, excess sun protection or excess sun exposure protection.

45:31What about diet?

45:33Dr. Gabrielle Lyon:Some people, for example, individuals that are extremely low in protein, animal protein, they seem to age really poorly. Tell me. Diet is massive. And I trained at Stanford and this was a really great forward thinking institution in which we incorporated dietary changes to treat skin disease. Diet is medicine. Food is medicine and should be treated as such. Absolutely, the amount of protein that you get correlates to the amount of collagen substrate that you have to build. Collagen's a triple helix, proline, lysine, hydroxyproline, hydroxylysine. You make that triple helix with some vitamin C.

46:17Animal-based proteins are much higher bioavailability, a greater density of protein per, you know, plate of food you eat. So protein for certain. Anti-inflammatory diets tend to protect the skin from premature aging and a myriad of skin conditions, eczema, psoriasis, certain rashes, things like that. I tend to be very pro in the anti-inflammatory diet. And generally diet is also correlated with lifestyle habits. If you're eating a shitty diet, you're probably not controlling your sleep and exercise and hydration. I don't know anybody who has Cheetos for dinner, but it's maintaining.

46:56Dr. Gabrielle Lyon:I know my son was doing a pretty good job. Yeah, he's pretty jacked. He's not eating Cheetos for dinner. But you get the point. It's unlikely for you to have a flawless diet and then have everything else out of whack. If you're controlling that, you're concerned about your health. Everything else falls in sync. So diet, absolutely important. I tend not to like foods that spike insulin levels fast or have a high surge in the glycemic load. We see that as a problem in our skin in a myriad of things. The most common complication is just breakouts. Everybody used to think dairy was a culprit until a really good study out of Penn State came out that showed that full fat dairy products cause no acne.

47:38Skim and non-fat dairy products in the U.S. cause acne. And they looked into this saying, what the heck, where'd this come from? Skim and nonfat dairy products in the U.S. tend to have emulsifiers added to them to give them the mouthfeel of full fat. Those emulsifiers are sugar substitutes. They spike your insulin. Insulin drives the breakout. So if you're worried about dairy causing breakouts, avoid the skim or nonfat stuff. Go full fat. It's really the sugar that's a problem.

48:07Dr. Gabrielle Lyon:And that's well documented. Yeah, yeah, very well. Skin is definitely an extremely well-studied area, right? And I want to go back to collagen. Yeah. We know that collagen, to the best of our knowledge, has no impact on skeletal muscle because it's the amino acid profile. Yeah. What do we know about oral collagen in skin? So the same reason a lot of people didn't believe in collagen supplementation for muscle is the same reason people didn't believe in collagen supplementation for skin. because you can make that three amino acid triple helix from other foods that you eat. It doesn't have to be, it's not an essential amino acid.

48:45And you know this better than anybody else. What we have found though, is especially in the US and especially in certain cities, patients have very restrictive dietary habits, whether that's medically indicated or it's for aesthetic purposes. People have a variety of very restrictive diets, vegans, vegetarians, et cetera, in which the amount of overall protein and collagen content that they're consuming is very low. So we see a benefit overall for two reasons. And several studies have suggested, and these are subjective assessments of skin health. So there's always some bias to it, whether your skin looks better after supplementing, but there's two reasons.

49:27One, people who have dietary restrictions benefit from supplementation. And number two, when you consume collagen powder, just like whey or any other protein form, you have a measurable spike in the protein content of your blood plasma. In your plasma, you can measure, you know, albumin is the common one we measure, but when you consume it, you can see a spike of protein in the plasma component. With that spike draws water. Oncotic pressure in your blood increases slightly. That gives that appearance of a little bit more hydrated skin. You can actually measure it in patients who are sensitive to protein supplements and their blood pressure goes up as well.

50:08So there's a little bit of a water draw effect with collagen supplements. I think in my opinion, it's a net neutral to slightly positive. I think at, you know, not high doses in lower doses, I think it's okay to beneficial, especially for people who are dieting a lot, who have restrictive diets, who aren't eating everything that they should. It helps. For people like yourself who are spot on with their diet, their health, I don't think adding collagen to the mix is going to make or break your skin.

50:39Dr. Gabrielle Lyon:You know, I use collagen and I will tell you, I first started using collagen sitting on, you know we're talking about new york city yeah i had a practice on fifth avenue across from central park and this which it was awesome and this girl came in and this was before anybody was taking collagen it was 10 years ago and man this girl came in with glowing skin i swear to god and i just said i i need to know and she was well uh i don't know if this works but i've been taking collagen and vitamin c and after that i was absolutely sold i don't know if the data is because I've looked and it looks like there is some data.

51:19The majority of the studies are subjective evaluations, but there is some improvement. Like you can see it in the photos. You can see an improvement in the photos. Now, the question exists twofold. When they start supplementing, are they also changing things about their daily routine that will improve their skin and overall health? Because now you know you're part of a study. You're going to be a little bit healthier. You're going to sleep a little bit more. You're going to wash your makeup off. You're going to do all the additional things, these biases. I tend to recommend it in patients who want an additional thing that they can do that's easy and low-hanging fruit.

51:52Or they've noticed a change in the dullness or the volume or the luster in their skin. It's an easy thing to add. I don't think it's a negative. Anecdotally, I have one, I found one benefit in my patients. And I don't know if this is true across the United States. But a lot of older patients come in complaining about easy bruising on their arms and stuff. We call that Bateman's purpura. We used to call it senile purpura. that's not appropriate anymore. A little offensive, senile. Yeah, but we call it Bateman's Purpore. It's basically bruising in the skin because of thinning skin and UV changes.

52:22Sometimes patients are on blood thinners like aspirin and Plavix, what have you. Collagen supplementation for those patients reduces their likelihood of bruising as much. And that's been really interesting.

52:32Dr. Gabrielle Lyon:I am going to get back to you. I'm going to pick up some studies and I'm going to send them to you. And maybe you can tell me, again, I'm not a dermatologist. Yeah. So maybe there is something out there with benefit. Yeah. And also, I think you talked about something important, vitamin C. You can't make the triple helix without vitamin C. So again, if you're not getting a source of vitamin C from your diet and you're not supplementing, that collagen you're consuming is less beneficial. Hydrolyzed collagen absorbs better. We found that patients have a better result with hydrolyzed collagen anecdotally than just bulk collagen powders.

53:06And again, there is - Is it something that you've looked into?

53:08Dr. Gabrielle Lyon:We have. We've looked at, yeah, for sure. Absolutely. From, from variety of reasons. One, we want to know where the data lies because patients ask about it all the time. Two, we're always looking for things that we can do for patients' skin besides prescriptions that is easy, safe, won't interact with other medicines that will improve their overall health and their skin health. And in formulating a product ourselves that we have, we added collagen at a low dose for the very reasons that you describe. We're going to come back to this product because it blew my mind. And we're going to spend a little time talking about it because I think you're genius.

53:44Dr. Gabrielle Lyon:I don't know about that. Well, let's ask your wife. We'll ask Andrew, our friend Kuberman. I think we would all agree you are extremely well-trained as a physician. Thank you. The better the training of the physician, the more open-minded they can be. I agree with that. And I think the less you know, the more patients you see, the more questions you have than anything else. I think the Dunning-Kruger effect is real. This is absolutely true. I have a couple questions in terms of, you mentioned bruising. Yeah. As people age, there is this creepiness that happens. Yeah. Do you know what I'm talking about?

54:19Dr. Gabrielle Lyon:Yeah. Ladies, do you know what I'm talking about? Tell me there's something to do about that. I wish I had an easy answer. There are things that you can do that will improve it over time. For sure. And what is it? So the creepiness is usually from a loss of collagen and elastin. When you look under the microscope, if you biopsy the skin, you see a tangled web of broken collagen and elastin fibers. We call it solar elastosis. UV has basically chewed them up and left the epidermis hanging from the fat. And that's the creepiness you see. There's no buoyancy in the skin. And that's a result of age, genetics, and some medications accelerate that.

55:00Dr. Gabrielle Lyon:And for everyone knows, Matt, my producer, you know what I'm talking about, right? Where skin is really crepey and you see it. It looks like wet newspaper. It looks like wet newspaper. It looks really thin. And I operate on those patients all the time. It's really hard to stitch. It's really, really hard to stitch. What can people do about that? So first is prevention. But that can't just be sun exposure. A lot of it is sun. A lot of it is genetic, which is why you see creepier skin on the hands. than you do the back or chest, unless you go to like nudist beaches or, you know, beach towns where you see the same creepiness on the...

55:36They're just last week. Me too. But you see the creepiness on the arms the most because they're the most sun exposed. Also, the amount of oil glands are an important factor in skin elasticity, skin thickness. So you don't see it as much on the face because we have oil glands on our face where we don't... That's actually true. Where we don't on the hands and arms. Things that you can do to prevent that. Number one, sun protection. Obviously, we talk about this all the time.

56:01Dr. Gabrielle Lyon:But a lot of sun protection. And we're going to come back to, again, we're talking about two things. We're talking about vanity, wrinkles, and then we're also talking about skin cancer. From the vanity standpoint, mitigate sun exposure. Sun protection, for sure. Number two, there are laser resurfacing devices that we use all the time to stimulate collagen synthesis and elastin synthesis. that 100 % anybody who cares about their skin should do some sort of laser procedure for two reasons. One, we know it improves the appearance. And now we know it also cuts your cancer risk. It does? Our new Harvard study came out last year, like a 20-year study that showed that it reduces keratinocyte carcinoma.

56:46Dr. Gabrielle Lyon:What kind of laser? The laser that we studied the most, the brand name is called the Fraxel laser. It's the workhorse in my practice and many derms practices. but any fractionated non-ablative resurfacing device the fraxel fraxel love it love it i love it too and i did it to my face and i look like the mask do you remember that movie or was it the elephant man where his mat where his face was completely blown yeah yeah yeah how that happened to my wife happened to my nurse practitioners happened to everybody ladies you should guys you should definitely do this but you want to know something if you do it again it'll be less If you do it again, it'll be less because there's less of a damage target to hit.

57:28There's less things that the laser is targeting to erase. So the first time anybody does it. Terrible. Yeah, yeah, for sure. But that's a good thing.

57:36Dr. Gabrielle Lyon:How the Fraxel. I'm so glad that we're talking about this. I love this device. This episode is brought to you by something sweet. And it's not me. It's Manacora. Let's talk carbs. Specifically, honey. And no, it's not another nickname for my husband. I usually call him something else. People have this idea that carbs are bad. And that is simply not true. I use Manokura honey daily. Well-positioned carbs like Manokura honey, they have been amazing for my personal training. I think of Manuka honey, which is what it is, is a functional carbohydrate, not just a sugar. It's serving a purpose. It's not just adding empty carbs.

58:09Dr. Gabrielle Lyon:Honestly, we use it anytime we need a natural sweetener. The bees collect the nectar from the Manuka tea tree in New Zealand. It's very complicated. The nectar is then packed with bioactive ingredients and the honey that is produced has three times more antioxidants than your average honey if you are looking for good honey and you're looking for something sweet you can check out their website to learn more head to manicora.com dr lion for 25 off your starter kit we're talking about it in the domain of prevention as well not just treatment no no prevention for sure when should somebody start doing it and should they do it on their body Yeah, we do.

58:48So when you should start is when you start to worry about the way you look. If you ask my dad, he would never do it. If you ask my patients... 18, 19 years old? No, because your skin hasn't matured yet. You're still in the... Your hormone milieu is peaking. You're still probably breaking out, things like that. But I think starting in your late 20s, early 30s is not unreasonable as prevention. In terms of treatment, we start to treat creepiness, volume loss, collagen loss, elastin loss somewhere in our mid thirties, because that's when we first start to notice it usually. And unfortunately, social media has accelerated perceived aging faster now than ever before.

59:26People are coming in, asking for it younger and younger. But in reality, when we look at faces, the first decade that we start to notice appreciable changes is in our thirties. So that's where I start to convert from prevention to treatment. But honestly, you can do it at any age and it's very safe. How often should someone do it? if you're treating then what are we treating wrinkles elasticity sun damage sun spots if we are using it as treatment then it'll be based on how much of that thing we're treating is left

59:57Dr. Gabrielle Lyon:so every six months but i'm not gonna for example for me and i use the fraxel laser um i had my girlfriend christy hamilton she's a plastic surgeon and amazing i i trust her the laser I had her do it the first time I did it my face looked terrible I did it six months later it looked better and then I got really busy and all this other stuff happened but I'm never gonna erase the wrinkles on my face no and that's it's not it's not meant to to reverse decades of aging it's to slow down that natural progression everybody will age we're not going to make out of this race a lot, right? So if your slope is like this - Brian Johnson might, you never know.

1:00:38Or that guy on the boat in Greece,

1:00:40Dr. Gabrielle Lyon:you know, loving life just - Yeah, for sure, he definitely is making it up. Yeah, that guy's gonna be 125. Never have any wrinkles, yeah. If your slope is like this for aging, the goal of everything we're doing is to make it like this. I see. So you get there slower. You extend the duration of the perceived effect. So it's not like you're gonna get a facelift result from a non-invasive procedure. And even facelifts don't erase your wrinkles forever. But the goal is to help push that aging process down and help prevent any cancer along that. Fraxel is not the only device that does this. CO2 resurfacing lasers.

1:01:14Dr. Gabrielle Lyon:So that's actually the one I did. Yeah. I did this CO2. So you were probably pretty messed up. I was. But was it Fraxel? Was the brand name Fraxel? I think so. These names, so there's an older Fraxel that has like a CO2 wavelength component. Interesting. There's a newer Fraxel that has a wavelength. that's 1927 or thulium tipped. It gets really nuanced in the technicalities. It all depends on what you're targeting. So CO2 is not necessarily a Fraxel laser. It's like saying tissue paper and Kleenex. Okay. Or petrolatum and Vaseline. So Fraxel is the brand of the device. And then CO2 is the lasing medium and the wavelength target.

1:01:52There's a lot of companies that make CO2 lasers. And the more important thing is whether it's fractionated or not, meaning you don't burn the entire square of the skin, but you have little skip areas to allow the skin to heal faster. I love fractionated lasers because it helps patients heal faster.

1:02:08Dr. Gabrielle Lyon:The kind of laser, the brand. So we hear about Morpheus. Yeah, yeah. There's a lot. Those are all brands. Those are all brands. Those are all brands. Of a Fraxel laser. Those are all brands of different lasers. Morpheus isn't even a laser. It's radio frequency. So it gets really... But this is important. Yeah, it gets really technically nuanced. Yeah. I want to walk away from this episode knowing what I can take orderly to prevent skin cancer, which you guys, it blew my mind. It really blew my mind. I also want to know, as a dermatologist who's done two fellowships and was a professor at UCLA, what am I going to do to age better?

1:02:47Dr. Gabrielle Lyon:So you got to tell me, you got to lay it off for me. If I were to have like my favorite things. Yeah, I'm taking notes. Let's say you have your perfect regimen for anti-aging and essentially skin cancer prevention. Some good form of sun protection. Do you care if it's... It doesn't have to be a sunscreen. Okay. You don't care if it's a sunscreen? Do you prefer... In fact, in head-to-head studies, sun protection from shade, shelter, covering outperformed any sunscreen on the market because you cannot burn if you're in shade. It's impossible. But you can burn if you don't put on enough sunscreen.

1:03:23That being said, not everybody's going to cover up because life. So some form of sun protection, sunscreen, SPF clothing, shade, shelter, what have you.

1:03:32Dr. Gabrielle Lyon:Do you care if it's mineral-based or non-mineral-based? Oh, I'm going to get so much heat for this. I tend not to like chemical sunscreens. I treat, as a skin cancer surgeon, I treat sunscreen as a drug. And it's classified as an over-the-counter drug by the FDA. But I treat it as a mechanism to prevent cancer for my patients. So I don't really give a shit, excuse my French, whether it looks great or not on the skin. Because my job is to prevent something where I have to take a scalpel to it. Not everybody thinks that way. And rightfully so. So for me, I tend to like mineral sunscreens for two reasons.

1:04:10Number one, it tends to have better visible light coverage and broad spectrum coverage than chemical sunscreens. More importantly, there's a lot of smoldering talk in the literature suggesting that chemical sunscreens are not as innocent as they may be played out to seem. Meaning, some of the chemicals and their breakdown products can be questionably carcinogenic, can be questionably hormone disrupting. We didn't know this stuff when it came out. Chemical sunscreens came out in the cosmeceutical industry as a way to allow women and men to put on makeup without the chalky white residue of minerals.

1:04:52Because what would bother people is they would put on sunscreen and then makeup and you got this white cast or you got this grainy sandy texture. So minerals started becoming annoying to people who were wearing makeup. So cosmeceutical industry say, hey, can we find a chemical that will shield us from the sun? That goes on elegantly, goes on nicely. You don't have a white cast and you don't have that chalky feel. The way chemical sunscreens and mineral sunscreens work are a little bit different. Mineral sunscreens tend to absorb and deflect or refract the light. They sit on the surface of your skin.

1:05:26Chemical sunscreens tend to absorb, undergo a chemical reaction in the skin, release that energy as heat, and then get a breakdown product. So there's a chemical reaction going on on your skin when you apply chemical sunscreen. That's how it protects you from UV.

1:05:41Dr. Gabrielle Lyon:A chemical reaction. There's been enough data in animal studies and an interesting paper that was in JAMA that showed that even with a single application of a chemical sunscreen, we could detect that product in our plasma, meaning in a blood draw, at levels that were above what we considered safe and normal. Now, a lot of people are going to come after me, especially those who are in the cosmeceutical industry right now. Would that be zinc oxide? What is a... Mineral is zinc and titanium. I see. Chemicals are things like oxybenzone, avobenzone, octocrylene, a bunch of... If you can't really pronounce the name, it's probably a chemical sunscreen.

1:06:17And a lot of people are going to come after me for this. But if I have enough data that says maybe this class is not as safe as we think, whereas this class is generally recognized as safe, I'm going to pick this one. Of course. Especially for my kids. In fact, the American Academy of Pediatrics and the American Academy of Dermatology do not recommend applying chemical sunscreens to infants six months and younger. So if we have that already, and now I'm sure in the comments people are going to say, well, no, the amount of chemical you need to put on is 500 times what you put on. There's enough data for me to say, you know, if I'm going to...

1:06:53Dr. Gabrielle Lyon:I don't think you're going to get pushback. You know, you'd be surprised. I've gotten some remarkable pushback from a lot of industry. And I get it. Like skincare is a$200 billion global industry. People have to push product. And they say, oh, my mineral, my chemical sunscreen is this and there's no absorption. I don't know. There's a lot of basic science and some translational science that suggests chemicals aren't that safe. We're taking chemicals. So you would avoid, so you would use mineral sunscreen? I recommend mineral sunscreens. It's the majority of what we carry in our practice. mineral sunscreen and a retinoid are the two single best things you can do for your skin.

1:07:32And this would be retin-A or something like that. Prescription grade is always better than over-the-counter. The reason for that is the over-the-counter retinols are not active. They are inactive pro-drugs that need to be converted into the active form by your body. The conversion varies person to person based on the enzymes that they have, which is why somebody will use this product from Sephora and say, oh my God, I'm like flaking and dry. I'm having the effects. And the other person will use it. I'm not, I didn't get any of that effect. Prescription strength, always better.

1:08:06Dr. Gabrielle Lyon:And that's generic. It can be generic. Yeah. Generic. What percent? Start at the lowest because it'll irritate your skin. Tretinoin 0.025%. Now there is one prescription that is now available over the counter. It was a prescription it up until a few years ago adapalene the brand name is different that is a prescription strength not not an inactive retinoid it's called adapalene it's 20 bucks at target and do people put it everywhere if someone and what is it gonna do yeah so retinoids should go on at night you put a pea sized amount to the full face you go one two three four and massage it in including under your eyes and above your eyes you don't have to go right up to the eyelids because the eyelid skin is thin it will get really irritated, but it'll diffuse naturally.

1:08:49So if you get it to your cheekbones, you're fine. You start once a week at night. And if you're not dry and peely, you'll go to two times a week at night. If you're not dry and peely, you'll go to three times. And the goal is to get to nightly. But if I told you, go get retinoids, start them at night and you start peeling, you're going to say, this guy's an idiot. So start slowly.

1:09:07Dr. Gabrielle Lyon:And this is for wrinkles? It is for wrinkles. It was, it's indication is acne has been since the eighties, but it has the only medicine that we know, topical or otherwise, that grows new collagen. And that's been studied for 30 years. You can biopsy the skin and see changes in collagen density, increase, and elastin. So it prevents wrinkles, it prevents sunspots, it prevents fine lines, it prevents sun damage, it prevents pre-cancers, it prevents acne. It's the best topical medicine you can use. I'm sold. Why am I just putting it on my face? You could put it on everywhere. One, you'll probably run out of the tube.

1:09:45And really the area we're concerned about if we're thinking aesthetics is face and it responds, it affects and modulates the pylosebaceous unit, which is the hair follicle and oil glands. So if you don't have that on your like arms, legs, it's not going to be as effective.

1:09:59Dr. Gabrielle Lyon:But what about for that creepiness of the skin? It can help. It's not great. It's not great. And it may just irritate your skin a little bit more, but for the face, it does help long-term for the creepiness. Okay. So those are the two single topical products that you should, everybody should be on. Sunscreen in the morning and any time you have excess sun exposure and a retinoid at night. Got it. If you want to ice the cake, you've built your cake. If you want to ice the cake. Everybody wants to, and we want a cherry on top of all of it. You can add a vitamin C serum. The way vitamin C works, if you think about this is, you know, cut an apple, put some lemon on one side, leave the other side unexposed, leave the apple out in the sun.

1:10:36The unexposed side will brown. The side with the lemon will not brown. That's the vitamin C preventing oxidative stress and oxidation from the environment. The theory is you put that on your skin in the mornings and you help prevent oxidative stress and changes from the environment when you're out and about. Now, don't go rubbing lemon on your face or oranges on your face because that's going to create a whole slew of other problems. But vitamin C is an added thing that you can do once your cake is built. So if you're not using sunscreen, you're not using a retinoid, I don't think spending a lot of money on vitamin C is helpful.

1:11:10Dr. Gabrielle Lyon:What about the Kojic Acid? And there's a whole bunch of other products. So there's a lot of products depending on what you're targeting. Usually the acids are to help improve dispigmentation, melasma, sunspots. Acids are basically abrasive things that burn the top layer of skin off, either gently or very aggressively. There's acids that are over the counter, lactic, Kojic, glycolic, etc. Then there's acids that we do in the office, like higher strength TCA, trichloroacetic acid, glycolic acid, phenol peels. These chemical peels are acids. I caution people into doing too many things because a lot of what we're putting on are caustic.

1:11:50They burn the skin. Vitamin C is an acid, ascorbic acid. So if you're putting vitamin C acid on, if you're adding kojic acid, if you're having a lactic acid wash and you're putting on a retinoid, your skin's going to really be irritated. You got to build into these things slowly. So I bring this cake frame again, but once your cake is built, then you can frost it. Once the frosting set in, then you can put the sprinkles and the cherry on top, but it takes some time for your skin to get used to it, or you're going to have a bad reaction.

1:12:16Dr. Gabrielle Lyon:What about, and you really are building the foundation of the things that you should for wrinkles, anti-aging sunscreen, retinol, vitamin C. Yeah. What, and it sounds like it's a give or take vitamin C for you. Look, I love it. I don't want people to throw everything at their skin right away. If you've been using sunscreen and a retinoid, for sure add a vitamin C. And if you're at the age where you're starting to see the changes, I like vitamin C late thirties, forties, fifties. It does help prevent oxidative stress and it is an antioxidant by definition as well as a vitamin, but you have to be careful with it.

1:12:52It can irritate your skin. It can cause some perioral dermatitis, but I do love it. It does brighten complexion. It does help with dispigmentation and sunspots. It's a great add-on.

1:13:02Dr. Gabrielle Lyon:What about lotions, things of that nature, and red light therapy? Yes. Everybody should have a good moisturizer. There's three big forms, ointments, creams, lotions. What are the differences? Ointments are basically oil with some water droplets mixed in. The most classic ointment is Vaseline or petrolatum. Aquaphor is an equivalent. Creams are much broader. They tend to be white. They can be thick. They can be not so thick. Creams are water emulsions with a little bit of oil mixed in. So creams are lighter than ointments. Lotions are powders mixed with water. They are the least moisturizing. So I generally say, how dry is your skin?

1:13:45How irritated is your skin? The drier, the more irritated, the more moisturizing properties you want. You want to go towards thicker things, given that you're not breaking out. You know, if you're 18 years old, don't put Vaseline on your face. You're going to break out. But put it on your feet. It will definitely help your feet. That actually brings up another point. This whole like beef tallow. I was going to ask you that.

1:14:05Dr. Gabrielle Lyon:That's exactly what I was going to ask you. So my entire, unfortunately, my entire field has put this umbrella term on beef tallow is horrible for your skin. I cannot believe you bring this up. That is exactly my next question. Because we're talking, you know, ointments, creams, lotions. So I am neither for or against beef tallow. In my culture, I'm ethnically Armenian. There is an equivalent homemade remedy that is like a beef tallow equivalent that everybody in my culture knows about that we use to treat burns and scrapes and injuries. If you are using beef tallow and you are not having any issues like acne, breakouts, clog pores, by all means, use it.

1:14:47Who am I to say otherwise?

1:14:48Dr. Gabrielle Lyon:Are they saying not to use it? Because doesn't it have fat-soluble vitamins in it as well? People are saying it does, not enough for it to be appreciable in your skin. You're probably not absorbing it enough for it to even make a difference. But it does. It has a lot of bioactives that you don't get from petrolatum. What is a problem with beef tallow is in young individuals, those who are actively getting their medical information from social media. And they're 23 years old. They have a lot of acne or they have hormonal acne or they have congested pores. and they're smearing the stuff on their skin.

1:15:20It would be the same as if you smeared Vaseline on your skin. It's not really much different. But I have older patients who have dry skin. They're like, you know, I've been using beef tallow. My skin looks great. Who am I? To say anything else, you know, your skin looks great. Continue using it. So in the right patient, it's fine. The other problem with beef tallow is where you source it from and quality. Like backyard beef tallow, I probably wouldn't recommend it. I don't know where it's coming from. I don't know if it's sterile. I don't know what else you're getting in there. But, you know, good brands, you know, trusted brands that make beef towel.

1:15:55I'm not against it. Go ahead, by all means. But if you start to notice your skin's reacting to it, back off and let's figure out why. It's good advice. It makes sense. Yeah, I hate like being umbrella one or the other way. I think every person responds differently. Now, you bring up red light. Actually, before we transition to red light, you asked moisturizer. I think everybody needs a moisturizer if they're using a retinoid or an acid. your skin's going to be dry pick the moisturizer that works with your skin is there one you use i don't have any brand affiliations i tend to like neutrogena's hydro boost or cera vay's pm moisturizer or vani cream you know anyone that is non-comedogenic so you want to look for that label that says non-comedogenic meaning it's been tested not to clog your pores but neutrogena is great anyone that you like that you will use and it won't be a glorified paperweight on your desk use.

1:16:44If you have issues with it, then figure out why. Maybe there's a preservative that your skin doesn't agree with. Maybe there's an ingredient that is breaking you out. In terms of red light, a lot of talk about red light. I tend to like it. I have it in my practice. We have one that we use post-procedure. We also use it post-procedure for hair treatment. I love it. It is not a game changer device. Game changer devices are devices that can completely change your skin's biology. Full face ablative resurfacing. Which is like the CO2. Yeah. Devices that peel your entire skin off and it regrows beautifully.

1:17:25Those are game changer devices. I think red light does a few things that is awesome. It increases blood flow to the skin. It helps promote some wound healing. It helps improve post-procedure healing, you know, after laser resurfacing, what have you. I think that's great. I don't think there's a negative to it. I think the only thing people should be aware of is whether their red light device is powered enough to see a clinical benefit. The way you kind of know is if anything is battery powered, forget about it. Probably is not powered enough to get the joules or the energy output, the fluence to see the effects we see in studies.

1:18:03Most of the time, the ones that are effective are usually clinical grade or medical grade, and they plug into a wall and you can see an energy output.

1:18:12Dr. Gabrielle Lyon:Do we know why, what the mechanism for hair growth is from the red light? Yeah, it's thought. So hair loss, the most common type of hair loss that everybody seeks, most people seek medical attention for is androgenetic or androgenic alopecia. And that's male or female pattern hair loss. And that's hair miniaturization and dormancy due to sensitivity to DHT, testosterone's byproduct. The hair is not gone. You may look bald, but when you biopsy the scalp, the hair follicles are there. They're miniaturized and they're shrinking. They go into resting phase. The way the red light is thought to work is it increases the blood flow to the dermal papilla cells, basically the stem cell region of the hair follicle to provide more fertilizer.

1:19:01Imagine turning up the hose in your garden and you can now provide more water to your plants. Your plants are going to grow again, so long as the plants are there. And most of the time it is. Its effect is slow. Person to person, you get a variability depending on how thick your scalp is and how deep the hair follicle sits in the scalp. Those are things you can't really measure, but some people get great response, 10 to 15 % increase in hair density. That's a lot. With red light alone, some people don't. I tend to use it post-procedure. So if you get hair transplant, microneedling, microneedling with PRP, PRP injections alone, we use it immediately post-procedure when the skin is already a little bit more inflamed to increase that circulatory flow.

1:19:44Dr. Gabrielle Lyon:You mentioned PRP. We didn't really talk about it, but I do want to talk about PRP exosomes. Yeah, yeah. But before we do that, what is the mechanism for the skin, for the red light therapy on the face? Is it just increased blood flow? It's thought to be increased blood flow. And in doing that, you can get a lot more fibroblast recruitment and a lot more stem cell regeneration from post-procedure. And increased blood flow allows us to turn the skin over appropriately. You know, it allows your skin has stem cells that go down the hair follicles and they live in the basement membrane. increasing flow to our pylosebaceous unit allows our skin to be a little bit more vitalized.

1:20:23Dr. Gabrielle Lyon:You know, this has me thinking, and I've used a red light cap for hair growth. I've used it for years. I actually have kind of fallen off the bandwagon of recent, but if it increases hair growth on the head, would it increase hair growth on the face? In theory, potentially, but you have to have those types of hairs on the face that respond to that. So generally terminal hairs, which are the dark, thick, or the thick blonde or thick brown hairs that come out of our head. Those are terminal hairs. Whereas the hairs we have on our face, men tend to have terminal hair in their beard area. Women tend to have what's called vellus hairs, which is that peach fuzz hair.

1:21:01That is not so responsive to things like red light or even hormones, unless you shift them from vellus to terminal. You won't be able to do that with the red light.

1:21:10Dr. Gabrielle Lyon:Okay, that's good. Good question. So you're not going to grow, but you actually bring up a point. People use Rogaine, minoxidil, topically and now orally to help improve hair vitality. That will grow peach fuzz as well. Do you use that in your practice? We do. Minoxidil? We use it orally more than topically, mostly because guys hate putting on topical minoxidil. Women will be a little bit more compliant, but the efficacy of the oral version, in my opinion, is a lot better than the topical. We use oral minoxidil as well. What dose do you happen to use? For women, usually 1.25, and then we'll go up to 2.5.

1:21:45For men, we start around 2.5. Yeah. As long as they have no issues, no heart palpitations, things like that.

1:21:51Dr. Gabrielle Lyon:And you find that they seem to lose hair first? So there's a shedding phase. 30 % to 50 % of patients will have an initial shedding phase in the first four to six weeks. That's a good thing because it means you're a responder. We see it with the topical, and we see it with the oral. So if you don't counsel patients about that, they'll come in and say, I'm losing my hair more. You're crazy. What the heck did you give me? Yeah, it does work. So the only thing is you will grow peach fuzz. Your body hair may increase a little bit. That's the downside to minoxidil, but it is safe, effective, doesn't modulate hormones the way finasteride or dutasteride do.

1:22:25Dr. Gabrielle Lyon:Yes. And for the record, we never recommend finasteride. You know, we were talking about big time out of favor. Thank goodness for those. And that's Propecia. If anyone is taking that, I strongly recommend you go and you see your physician and really talk about coming off of that. That was, I think, a medical failure. Yeah, especially in young patients. Yes. You know, if you're post the age of deciding to want children, you know, you're 40s, 50s older, maybe it can be a discussion because it'll provide some prostate protection as well in men. But for young guys, especially they come in like 18, 19, like, dude, you don't need this.

1:23:00They're way, way better. Your hair has probably not even reached its state where we need to treat it anyway.

1:23:05Dr. Gabrielle Lyon:The circling back to the PRP and exosomes, that's a big, really hot topic. Okay. Talk to me about what that is and how effective that is. PRP is great. Platelet rich plasma. We basically draw all the concentrated growth factors from the plasma portion of your blood, concentrate it, and then re-inject it in an area of concern. It was popular in orthopedics, still is popular in orthopedics and regenerating, you know, tendons, ligaments, what have you. had it done. Yeah, it's great. In skin and hair, we use it to reintroduce either growth factors, stimulate hair growth, or wound healing post-procedure.

1:23:40So let's say you have laser resurfacing done and the skin is injured, you can apply PRP. That'll speed up the healing process. Theoretically, increase the amount of collagen and elastin you'll produce. Does it work? I think it works. Yeah, we use it. I use it a lot post microneedling. So we will microneedle the skin. Microneedled skin is basically bloodied. And we take a concentrated form of PRP and apply it to the skin and hope that it absorbs it because those microneedling channels are open. The patients that I've used it, the ones that benefit the most are the ones that tend to have like acne scars or traumatic scars in which we are trying to get rid of the scars.

1:24:22PRP seems to improve the density of collagen and speed up the healing more than if we just did microneedling or laser alone.

1:24:30Dr. Gabrielle Lyon:And there's various modalities that you're talking about, but could someone skip all that and just go right to laser? Yeah, for sure. Or do they do different things? And we blend them together. They do different things. We usually use them in synchrony. So laser and PRP at the same time, it depends on all what we're targeting. So if we're targeting like sunspots or melasma or dispigmentation, the PRP is not going to provide you much benefit. Wrinkles. We care about wrinkles and elasticity. If we're treating wrinkles, elasticity, PRP at the same time. For sure. If you're treating hair loss, PRP injections, red light therapy, things like that are all simpler procedures.

1:25:06There are bigger procedures you can do, hair transplant, facelift, and they're very effective. But most people are not diving straight into a facelift. No.

1:25:15Dr. Gabrielle Lyon:Exosomes. Yes. Exosomes. What's that? These are thought to be messaging signal molecules. I don't like that you just took that big sigh because I just bought exosome under eye cream and I am afraid I just wasted cash. You may have. Oh, come on. Yeah. Unlike internal organ mechanisms, exosomes, and they fall in the category of peptides as well, in the skin, except maybe two or three companies that use exosomes that are shelf stable and verified in terms of having the exosomes they claim they have, the majority of the stuff sold hogwash. No. Hogwash. But would if I happen to have purchased, which I'm going to go look and I'm going to find out.

1:26:03Dr. Gabrielle Lyon:Well, I'm definitely using it because it was expensive. Yeah, it is very expensive. There are some great brands that have some good exosomes. Okay. And the exosome itself is a signaling mechanism? It is. Usually it's a combination of peptides or amino acids. Sometimes there's a metal attached to it, like a copper moiety. Those are really popular in the skin, copper-based exosomes. Some are derived from stem cells, either human stem cells or plant-based stem cells. The plant ones don't really do much because our body works differently. It's theorized to send signals to increase your fibroblast ability to grow new collagen and elastin.

1:26:41Dr. Gabrielle Lyon:You're not a fan. I have yet to see a difference in which the vehicle is used and the vehicle plus the exosome is used and see an appreciable difference. Nobody really likes to do that study, which is why a lot of times in that realm, like scar healing products, you won't see many companies do a split scar study where they use standard petrolatum aquaphor for one half of the scar elantoin for one half of the scar and their scar healing product on the other half because it looks the same what they will do is show you an untreated scar no nothing on it and then a scar that's treated with their product well of course that product's going to work better because you're doing something to protect it okay well if you're going to spend the money for exosomes my opinion is hold it and get a procedure that really provides skin health, some sort of resurfacing laser, microneedling, something.

1:27:38We touched upon what we can do for anti-aging in terms of topicals. There's a lot of things we can do in the office that will help you in terms of anti-aging from a procedure standpoint. I love, there's three, if I had three magic devices, and those are the only devices I can use, it would be Fraxel, or some sort of fractionated non-ablative laser. Fraxel is my favorite. Some sort of vascular laser that targets blood vessels. I like the V-beam or the pulse dye laser. I like it because it gets rid of all the broken blood vessels, gets rid of rosacea, and it helps reduce the likelihood of basal cells.

1:28:17It gives you that really nice, even tone.

1:28:19Dr. Gabrielle Lyon:How often can someone do that? They can do it every month if they'd like, especially for fair skin patients who have a lot of redness, who flush in the sun or with hot beverages or with spicy foods or with emotion, you know, that rosacea flush, this is the gold standard for getting rid of that. Broken blood vessels around the corners of the nose. I'm going, signing up. And then a microneedling device. Simple, effective and stimulating collagen synthesis. You can do it in all skin tones. One of the biggest challenges in the US is we can't use every device on every skin type because of the risk of dispigmentation and consequences with changing their skin tone.

1:28:54So a lot of what we can use in very fair skin individuals is not safe in very olive or ethnic skin or dark skin.

1:29:01Dr. Gabrielle Lyon:The laser and the microneedling, do they do different things? The Fraxel, the fractionated laser. It depends on if you're targeting fractionation for sun damage, then yes. That targets a higher level of the skin, gets rid of freckling, sunspots, etc. If you're targeting fine lines and wrinkles, depending on the depth, they do similar things. But I use them in conjunction all the time. And then probably the third thing that you can do is utilize a daily supplement that will protect your skin from the harmful effects of the sun. Now, everybody's like, what the hell are you talking about? Yeah, say it again, please.

1:29:35Yeah, the third thing. So topicals, a sunscreen, a retinoid, and a vitamin C. And then you can add all the other things that you'd like, you know, kojic acid, azelaic acid, what have you, after the fact. the retinoid at night laser resurfacing procedures that will stimulate collagen and elastin growth get rid of sun damage prevent skin cancer those are excellent and then the third thing which i recommend to all my patients is to take supplements that protect your skin from the sun there are three well four three really big supplements that i like one is a plant called polypodium leucotomas which is from a fern in the Amazon.

1:30:15It's a fern that when you consume, lets you be out in the sun longer before you burn.

1:30:20Dr. Gabrielle Lyon:Yeah, where did you even, were you in Peru somewhere? And this is a jungle, which, you know, with a machete. I don't understand what happened. It's well known in a niche of dermatology, this plant. You mean like five people? Yeah, like seven, yeah. And it's a readily available plant that went consumed at the right dose, lets you be out double the time before your skin burns. It's not a replacement to sunscreen. That is so cool. Yeah, it's awesome. Wait, it's a fern? It's a fern. It's like a naturally growing fern in the Amazon. Polypodium leucotomas. Of course. And where, what, who is, were they eating it?

1:30:58Dr. Gabrielle Lyon:Yeah. Was it indigenous? The way they found out is indigenous people would go out on fishing expeditions on the Amazon and they'd be out for three days. So the way they'd protect themselves is they'd crush up the leaves and eat it. Wow. And they wouldn't get a sunburn. That's really cool. So this came out, you know, this like data came out about 10, 15 years ago saying, hey, there's a supplement that you can eat, that you can consume that will protect your skin from head to toe from burning. And it helps prevent things like flaring of your melasma, helps prevent sunspots. It's basically an internal shield for your skin against UV and sun damage.

1:31:32Dr. Gabrielle Lyon:You know, I'm going to have to ask, do they know the mechanism of action? There is a myriad. It's thought to decrease our skin's dimerization from UV exposure. Meaning? Meaning it's thought to prevent our skin cells ability from causing UV mutations from the sun. That's one. The next supplement is a supplement called nicotinamide. Now, not NMN, not NAD. These are commonly mistaken or confused. NAD is nicotinamide, adenine dinucleotide, NMN is the mononucleotide. They have different functions in the body. They have no relevance in the skin. But pure nicotinamide, when given at the right dose, has been shown to reduce our skin cancer risk, our non-melanoma skin cancer risk, by up to 30%.

1:32:20And that data was published in the New England Journal of Medicine, one of our most prestigious medical journals, in a phase three study. So this is a great supplement that is over the counter.

1:32:29Dr. Gabrielle Lyon:Where would you find it in food? Yes. Nicotinamide you won't find. It's a derivative of niacin. So niacin is vitamin B3, but the amide derivative that has the amide moiety attached to it is nicotinamide, also known as niacinamide. You can find that in supplements. You won't really find it naturally occurring in foods. That is another excellent supplement. And the third is astaxanthin. I am really big into this. Yes. It's not well-known in dermatology, but it is well-known in the anti-aging, wellness, longevity world. It is a powerhouse antioxidant and has been shown now in several studies to prevent premature aging of the skin.

1:33:11Helps prevent fine lines and wrinkles. Helps prevent sun damage. These are excellent supplements that everybody should be on.

1:33:19Dr. Gabrielle Lyon:Where would you find anthocyanins? In terms of food, you'll find it in shrimp, salmon. you'll find it if you eat a lot of marine algae you'll find in the marine algae the bioavailability in shrimp and salmon and crustaceans that are have that orange hue that's where the orange hue is from is higher bioavailability than the marine form but if you don't eat you know and it's also difficult to get the dose yeah yeah yeah a precision dose i've actually am starting to take 12 milligrams which is high so two milligrams i've been reading about is great for eye health Yeah, and the skin is around four.

1:33:55Dr. Gabrielle Lyon:Around four. Yeah. So because of all this, we put together, me and my two partners put together a product called Sun Powder. It's very cool. It's the world's first daily drinkable supplement that you can take to protect your skin against sunburns, to help reduce the likelihood of non-melanoma skin cancers, and to prevent premature aging from the sun. In my practice, I have a lot of patients who are sun damage heavy, meaning they have skin cancers. They have life-threatening skin cancers. There's a lot of patients that come in for, hey, what happened to my skin? Like, why is it all wrinkled? And, you know, I lived at the beach.

1:34:28I'm like, okay, let's figure this out. My partner, who's a Harvard-trained laser dermatologist, sees a ton of patients every day for laser resurfacing, mostly for aesthetic purposes. And aside from the standard sunscreen, avoid the sun, wear your retinoid, there has to

1:34:44Dr. Gabrielle Lyon:be something. And dermatology never really looked into the supplementation world because in medicine, unfortunately, it was taboo for a long time. If it wasn't a prescription, it didn't work. Remember Perricone back in the day? Yeah, yeah, yeah. I remember that very well. He must have been the first. And I don't know, is he still alive? I don't know. Okay. I don't know. So this guy, Dr. Perricone, was the OJ. I remember reading this in my grandmother's bathroom while she was, I don't know, watching Jane Fonda. And he was talking about food and skin. There's a lot that we can do that we don't look at that can improve skin vitality from the inside out.

1:35:19Dr. Gabrielle Lyon:How did you come up with this and this sun powder? So originally, like eight years ago or what have you, when I was doing my training at Stanford, we had a high-risk clinic. We had a high-risk skin cancer clinic, patients who had a lot of tumors and a lot of burden of disease, those who had a high chance of metastatic disease or death. And we looked for things that we can do to reduce their skin cancer burden. And ironically, oral retinoids are one thing that you can do, and that's a prescription that has to be talked about with your dermatologist. But we found that nicotinamide also helped reduce their skin cancer burden.

1:35:56What do you mean their burden?

1:35:57Dr. Gabrielle Lyon:Meaning how much you were finding? If you had a high likelihood of making five of these next year, squamous cell, basal cell, what have you, when you supplement it with nicotinamide, your risk reduced by 30%. And it's a lot because all of the majority of the skin cancers tend to occur on the face. So then we said, okay, if this food supplement or if this oral supplement does this, is there anything else that can improve skin appearance resistance to uv so that's where the dive began and we did a lot disappointed collagen didn't make it in there it's in there it's in there not a lot not a lot but enough for those and there's vitamin c in there for that reason how much vitamin c is 250 milligrams okay and then we have hyaluronic acid which is the same thing that you know filler cosmetic fillers are made of this helps hydrate your skin we have glutathione in there, which is, I think we're the only oral supplement that has reduced glutathione in there.

1:36:51Really popular product, Korea, really popular in Asia, both as supplement and as infusion to lighten and even out the skin from sun. And then we have astaxanthin, we have nicotinamide, polypodium. So we put all of these ingredients into one supplement called sun powder. And all of my patients, they take a single scoop, mix it into water and drink.

1:37:11Dr. Gabrielle Lyon:How long till they see, obviously there's the cancer yeah good question good question how long till you anticipate a cancer prevention versus how long till they can see it in their skin so if you're using it for sunburn protection if you're using it to reduce the likelihood of you burning within two hours of consumption we see that change that's unbelievable how that's awesome i know it's really really cool how it the polypodium is amazing the astaxanthin works together but how does it get into the skin that fast well usually if you consume something you can measure an uptake in your plasma of whatever you're consuming somewhere around 30 minutes to an hour depending on gastric emptying and how much food you've eaten what have you ideally it works better if you know you're going to go on a trip and you start a week before there's a cumulative measurable change in your skin so if you know you're going to hawaii next week start a week have a scoop a day it preps your skin for UV.

1:38:08Amazing. So if you know, so if you're using it for sun protection, two hours before sun exposure or daily just as a preventive. If you're using it for skin cancer reduction, our data point inflection was nine months. You had to be on it for at least nine months to start to see the changes. And not just skin cancer, we see a reduction in what's called AKs, actinic keratosis, pre-cancers. Patients who supplemented had a lower number of them when they would return. This is without any other treatment. So if you're using it for skin cancer somewhere in nine months or so, if you're using it for primary anti-aging prevention, you just want your skin to look good.

1:38:43Think of this as, and I have no brand affiliation, but think of this as like AG1 for your skin. If you're using it for that, the time point is hard to see a specific inflection point, but most of our customers, my patients, will come in around three months and say, hey, I'm noticing my skin looks a little bit brighter. I feel a little bit more hydrated. I'm in the sun and I'm not burning. We've had a lot of patients from across the US message and say, this is the first summer I've been able to go outside without either getting a sun allergy, which we call PMLE or polymorphous light eruption, or they've gone to Disneyland, Florida, Hawaii, where have you on vacation and they haven't burned.

1:39:23Now it's not a replacement for sunscreen. Got to make that clear. Sunscreen does a different thing. It works from the outside in. Sun powder works from the inside out.

1:39:29Dr. Gabrielle Lyon:It is really amazing. I'm going to try it. You brought me four bags. Two follow-up questions. Can kids take it? Six and older. Six and older. Six and older. Generally, it should be weight-based. So six to 12, I say take half a scoop. 12 and older, if they're of normal body weight, they can take a scoop. Very cool. Everything is water-soluble. It doesn't interact with medications. You don't have to worry about it being a drug or a prescription. Pregnancy? Run it by your OB. Theoretically, every ingredient in there is safe for pregnancy, but every pregnancy is very sacred. Every person is different.

1:40:05I would hate for something that is like this to affect it, so run it by your OB.

1:40:09Dr. Gabrielle Lyon:This is a random question, and this is because my best friend's sister has, I don't know, she has some polymorphism that every time she goes out into the sun, she gets, it's like very painful. What is that called? It's either PMLE, polymorphous light eruption. Okay, so that was right. Or the more severe version is actinic pirigo. Okay. Serious. But they tend to get better with what's called sun hardening. So as the summer goes on, their skin tends to tolerate the UV more and more. There's actually a medical indication for our supplement for that. That's what I was, I'm going to send for one of my bags.

1:40:44Yeah, it's used for PMLE. It protects your skin from the inside. It's really effective because it's miserable for patients. They get this itchy, blistery rash on their forearms.

1:40:52Dr. Gabrielle Lyon:Dr. Teo Soleimani, thank you so much. This was such a fun conversation. This was a blast. And we'll have to do it again. Yeah, there's so many things we haven't even touched upon. We didn't even touch upon Botox, which is the quintessential neuromodulator. So not for another episode. Yes. I'm one, I'm a fan of it, but it's been an honor to be here. It's been a pleasure. I've had a lot of fun chatting about all the things I love to do. And hopefully this provided some information for people to find the right direction and how to make their skin look good and stay healthy. Thank you so much. .