Dr. Shawana Vali: Healing Skin from the Inside Out, Collagen Degradation & Skin Aging | TUH #239

If you remove all the things that you use for your acne and stuff like that, leave it alone for a few weeks, your skin will wake up and you won't break out as much.

You know, the skin, you know, what makes it youthful, what makes it healthy. But the vast majority of what you talked about was healing the skin from the inside out.

It's easy for us to give you thick hair, perfect skin, but on the inside, we're actually coming first with mood, concentration, performance, sleep. We're looking at you on the inside out rather than the outside in.

When you walk into most cosmetic clinics, you can get lost in the programs that they're trying to offer you without really having a fundamental understanding of which one of these is actually going to give me real skin regeneration.

The skin is one of the biggest organs, and what it does every day, it repairs itself. Let it do the work. God's given it the cells for it to work. We just need to tweak it a little bit. I always say this to my patients, less is more.

So what does a good basic skincare routine look like for you?

I would go back to basics again and I would say. Ultimate human.

Hey, guys, welcome back to the Ultimate Human podcast. I'm your host, human biologist Gary Brecker, where we go down the road of everything, anti aging, biohacking, longevity, and everything in between. And today's podcast guest is a double board certified cosmetic dermatologist that I actually met when, for the first time, face to face, when we were in Saudi Arabia speaking at a Xenos Health summit. I was fascinated by her talk. She was already on my schedule, so I was excited about that. But watching her describe skin care as a dermatologist as something that happens from the inside out, I found really fascinating. And the plan that she uses to approach her patients to restore healthy, youthful skin really didn't begin with the topical applications. It began with rebuilding from the inside out. So I'm really excited to unpack this. Welcome to the podcast, Dr. Shawan Evoli.

Thank you, Gary.

Yeah, you really did a great job in Saudi.

Well, I was put before you, so I couldn't let you down. Why did they put me before Gary like the keen, why am I straight before Gary?

Better before me than after me.

Exactly.

But you know, what I found fascinating was the vast majority of your talk, and obviously as a double board certified cosmetic dermatologist, you know skin care and, you know the skin, you know, what makes it youthful, what makes it healthy, how it grows, how it ages, and from a medical perspective, but the vast majority of what you talked about was healing the skin from the inside out, youthifying the skin from the inside out. So can we back up a little bit for the people that didn't have the benefit like I did of, of attending your talk, which I really found fascinating and it's, it's so incredible how much of what you do, I not only do with my private clients, but I also deeply identify with. I just never really correlated it to all of these positive skincare outcomes. So I'd love to unpack, you know, what a typical consult with you is like and where you start with somebody's skincare journey.

Yeah.

You even talked about different personality profiles of people that come to see you.

Yeah.

So, yeah, I'd love to unpack that.

While we have the privilege of meeting all different types of people and different types of ethnicities, different types of personalities. So I think as practicing physicians, you need to be aware of everything and experience in everything. I specialize in cosmetic dermatology, medical wellness, regenerative medicine, longevity. So we've always looked at everything inside out. We've never been like, oh, you've got some acne or you've got some rosacea. We've always been, what's the root cause? Whole person, whole person. Where's the inflammation coming from? So we, we've always looked at you. You know, it's easy for us to give you thick hair, perfect skin contour your body to suit your gender, ethnicity, your silhouette. But on the inside we're actually coming first with mood, concentration, performance, sleep, libido, gut health, fertility, immune system, musculoskeletal. We're looking at you on the inside out rather than the outside in. Because the problem I've got is if you've got an inflammatory skin condition and I'm just doing some laser and resurfacing you with some exosomes and some fun stuff on the outside or topically like you mentioned. Yeah, I'm not fixing the root cause. It's going to come back, you're going to be unhappy and you're like, she's not very good doctor.

Right. What are the major things in your opinion that cause skin to accelerate? It's, I want to get specific, you know, conditions of skin like acne, wrinkles, what have you. But what are some of the, just the major offenders of healthy skin that we do to our bodies from the inside out?

I think it's just general lifestyle things. Right. So right now we're all living multi hyphenate lives. We've got Multiple roles. Our bodies weren't designed in that manner. So you're a man, you're. You're supposed to be a hunter gatherer, I'm a woman, I'm supposed to be a protective provider. Yet we're both entrepreneurs, we're both burning the candle at both ends. We've got both. Got multiple businesses and multiple roles.

Right.

We're pushing our body to a limit that we've never pushed it, I. E. The ultimate human.

Right, Right.

So. So if our body hasn't caught up with what we're supposed to be doing, then physiologically we have to look at you on the inside and optimize that. And that's why I always say let's. When I take a consultation, the first thing I do is I. Diagnosing your skin is easy. For me, diagnosing what's happening on the outside is easy. And the first three questions I always ask is, who referred you? Because for me it's like, what kind of aesthetic are you looking for? Right.

Ah, right.

What kind?

And you could tell that from their friends.

Yeah. But also, what kind of journey have you had? You know, did your friend refer you to me because you're perimenopause? And so she. That we fix the inside first before we came on the outside.

Wow.

Right. Then I ask, how old are you? If you're in your 20s, you've got social media pressure, you've got lifestyle pressures going on, you're trying to establish yourself. You, if you're in your 30s, you might have had just your babies and you want to return back your body, or, you know, you might be starting a new role, as in the C suite in your late 30s. If you're in your 40s and 50s, you might start your next phase of life. You might have come out of a divorce, you might have, you know, emptiness, survive.

Right.

Something else is happening. So I need to know what stage of life you're in. And third thing I always say is, what do you do? Like, what kind of psychosocial pressures are on you? Explain to me, what role do you have in society? What do you do? Are you a mother of four at home and you're running a small business as well? Are you a CEO of a hedge fund that you have to, like, stay up 18 hours a day about all the time? And then the key thing is we don't move to, let's look at your skin, Gary. The next thing we move to is let's talk about your mood, sleep, energy, immune system, gut health, libido. We Go to the inside immediately.

Love that.

Before we even look on the outside.

Now, are these. Do you do that by. So first you obviously do the console. You get a profile of what the person is like, what stage of life they're in, but after that, what kinds of testing? Because you can't just say mood, mood, hormones, libido. I mean, we need data.

Right.

So where do you get that data? What kind of lab tests are you running? And what do you think are key markers to be looking at that might be markers that would indicate that you have accelerated skin aging?

Yeah. So my patients are seeking me out aesthetically on the outside, because they might have fine lines and wrinkles, folds in their face that they don't suddenly, like loss of definition. They might find that their hair is thinning, they've got receding hairline. They might find that they've got mid abdominal weight gain, which they didn't normally have. So the metabolism has changed. Right. They might find, you know, aesthetically, they've got some cellulite, some stretch marks. They're unhappy in certain places. They're not always taught and tight as they used to be.

Right.

So their body has changed aesthetically on the outside.

Right.

But they haven't identified why it's changed from the inside out. So in terms of markers, we do subjective screening first.

Okay.

And then we. In subjective screen, you can pick up the clinical symptomology quite quickly. In terms of storytelling, is it adrenal fatigue with estrogen dominance? Is it adrenal fatigue with testosterone deficiency? Is it dopamine fatigue? Are you perimenopausal? Is this andropause? Is this dysfunctional gut dysbiosis? Is this just poor sleep or disruptive sleep? So on your wellness screening, we clinically pick up the storytelling, but also, you've already given me signs and symptoms in your past medical history. You already told me in those three pivotal questions, what's happening in your life. I'm recently divorced, I'm dating the world. I'm also CEO of a hedge fund, like, giving me a few key things. And then when I'm asking you about your past surgical history, past medical history, and past non surgical history, like the aesthetic stuff, you've already told me if you're a virgin or non virgin. I like injectables. I actually have only done one laser in my whole life.

Wow.

So I already know where to move the needle with you.

Right.

And also in that, we ask you a quick medical wellness question. Do you do IVs? Have you taken any? Have you tried peptide. So you've already told me, are you a biohacker or you know.

Yeah.

So all those questions have already got the. I've got there. Before I get to that clinical storytelling. If I want diagnosis, if I want objective diagnosis and quantifiable. Now, my men are driven by data, right?

Yeah.

If I want objective, quantifiable diagnostics, I can run tests, I can do your salivary test, I can do your dhea, I can do your hormone panel testing, I can do all the fun stuff. If I've clinically already explained to you what's going on. And then I'm trying to learn, are you a virgin or non virgin when it comes to treatment modalities?

Yeah.

Am I fixing you on the inside first or am I coming on the outside? Do you understand? Understand me and you understand the storytelling? We don't even treat you on the first day.

Wow.

We won't treat you on the first day. We send you home with an interactive treatment plan. We phase it, phase one, two, three. Because say you're. Say you're a 22 year old female with a bit of acne on the outside, right? And you come in, you're common. Yeah. And yeah, Dr. Valley, this is what I look like on Instagram, right?

Yeah, yeah.

And you know, I want to look like this without the filter. I want this to be like this. I want my acne to be fixed. Also, my body is a bit like. I facetune it with the apps. I'm so. Are you sleeping? You have anxiety? Do you suffer from panic attacks? What's your mood like? Oh, I used to have depression. I used to be on an ssri. I'm not one anymore. I don't, you know, I am overthinking the middle of night. I do check my in like my notifications, right? So we're like, let's think, let's rewire you first on the inside first. Let's work on the inflammatory cause of acne first before we come on the outside and start contouring you unnecessarily.

Now this. How big of a role does stress play in this? Because you're getting to people as lifestyle choices and a lot of us live very stressful lives. You know, we're constantly on the go, but we're also constantly engaged and entertained. We're also always immersed in something and that puts a lot of stress on us. Right? Not just to perform, but to look the way that everyone looks on Instagram. To perform at what everyone expects us, the level they expect us to perform. And. And we talk about, you know, stress being so detrimental, but what is it about stress? What is the link between stress and the skin?

Right, okay, so we can genetically call it stress, but what stress does it cause? Something called oxidative stress. So free radical damage, it causes breakdown of collagen. Okay, so glycation breakdown of collagen turns around and gives you fine lines, wrinkles, open pores, oiliness. It can inflame your acne, rosacea, pigmentation. But if we go back to cellular cause, pathophysiologically, on a cellular level, you've got the beauty layer of the skin, which is the epidermis. You've got the medical layer of the skin, which is the reticular dermis. The reticular dermis. You've got these great things called building blocks called fibroblasts that produce collagen, elastin, hyaluronic acid, gags. All the good stuff stays in the medical layer, the skin, right? By the age of 21, this is degradating. This is already going down with a gift from God. You're already aging.

It's a gift that we don't ever.

Want to open, that we don't want, right? So you've already got that. On top of it, you've got a pigment called melanin, which some of us will get pinky, purpley, and some of us will get brown pigmentation. That comes up with sun trigger, hormonal trigger, environmental trigger. So all these things, when you've got oxidative stress and free radical damage going on, this gets enlightened and inflamed because.

This is in the deep layers of the skin.

Deep layer. So then if you've got fibroblast, the building blocks breaking down, that means you're going to get the collagen breaking down, you're going to get the good stuff. They're like the robust, the architecture of the skin breaking down. So you're going to get the laxity, you're going to get the fold, you're going to get the fine lines and wrinkles. You're going to look dull. Your skin is not going to be glowy, right? Things aren't going to be as tight and taut as they used to be, Right? But then also on the beauty layer, there's something called epidermal cellular turnover. God's given us the best organ, like the human body is the best organ. We both say it, no doubt, but the skin is one of the biggest organs. And what it does every day, it renews and Turns over, it repairs itself.

Right.

But when the beauty layer is a bit broken, then that doesn't happen either. So then suddenly you're exposed to environmental toxins coming in, causing more inflammation.

Yeah.

So that's what happens.

You know, I very often refer to the skin not as a barrier, but as a gateway.

Yeah.

Because it doesn't just keep things out, it lets certain things in.

Yeah.

And there's a big, you know, discussion going on right now about the types of things that we apply to our skin. Phylates, parabens, you know, toxic chemicals that we find in cosmetics and sk. Skincare products. And what kind of damage have you seen over your career? And what do you. How do you advise your patients to go out and select cosmetics, skincare products, makeup lotions? Because I think we sort of go through the process of our day and we don't realize the amount of toxins that we piled on. Was actually at a lecture, this was probably two or three years, two years ago, and this woman was walking through a standard day for a female, from brushing her teeth first thing out of getting out of bed, to removing nail polish at night before she went to bed. And the number of toxins that were applied to the skin, the nails, the hair, the sprays, the things that we're applying to look better and supposedly feel better. As she broke these things down, I was astounded. It was like 180, 190 different chemical compounds in a very average day.

Day. Yep.

Especially for a woman. So what are some must avoids and you know, what do these toxins do? What are some of the toxins and what, what do they do to our skin and what do they do in the, in the female body to the hormonal system.

Yeah. So firstly, you're lucky you're not a woman. So you're not going through, you're not going to.

God.

Yeah. You're not going through all the pressures that we have to go through. But the pressures are coming your way. Don't worry.

Yeah. Trust me, I know.

But here's the thing. So the key thing here is education. I'm quite privileged because we've been educated a certain, with a certain knowledge. So I can look at ingredients and say, this is going to work on my skin or this is not going to work on my skin. Ingredient is going to sit on the beauty layer and do nothing apart from cause a barrier.

Right.

Or it's going to go down to the medical layer, skin, and it's going to upregulate the good stuff.

Right.

Or it's going to cause free radical damage and downregulate the good stuff.

Right.

So that's the key thing here. Anything that's available over the counter sits on the epidermis.

Okay.

If it's available here, goes to the medical. You need a prescription normally.

Right.

For it to work in the reticular dermis, you need a prescription. Does that make sense?

It makes a lot of sense.

So everything you're applying topically, you know, and it used to be a lot of silicon based makeup and silicon gels that could hide the pores and stuff like that. A lot of people have gone green in their environment and they've turned around said green formulation. We want to be natural. The problem you've got is some natural ingredients aren't going to give you the cellular change that you need to work on. The fine lines, the open pores, the laxity, the inflammation, all that kind of fun stuff.

Sure.

So you've got to be careful on the ingredients that you're picking.

Okay.

But what's good in the industry, especially the beauty industry, that they've taken the no nasties out. So there's been a massive movement in the beauty industry in the last decade that the no nasties list has been cleared out.

That's good.

And there has been a clean movement, especially with the likes of brands like Sephora and stuff like that, where they've come in with a clean list. But then there's also a movement where doctors have come in and said, actually these ingredients work really well in the medical leather skin. But if we can get it to penetrate without being broken down up here, then it's amazing.

Right.

It just sits here. It doesn't do anything. I'll give you an example. Hyaluronic acid. Right. Everyone talks about it. Hyaluronic acid naturally found in my body. Oh, my God. Let me put it a serum thousand times its weight.

Water.

You know, it's amazing. Best marketing PR campaign there is. If you have an inflammatory skin condition, if you're acne and you use hyaluronic acid, you're actually causing more dehydration. The molecule was too heavy to get down to the medical layer. The skin, it sits up here and it causes something called trans epidermal water loss. It actually dehydrates your skin. Wow. Whereas beta glucon is tiny, tiny, tiny speck of hyaluronic acid. It can go all the way down to medical skin and reduces inflammation, is anti inflammatory. So ingredients are key.

Called beta glucan.

Beta glucan? Yeah. Beta Glucon, which is preferential, especially for my acne patients. My rosacea patients would turn around and said, my skin is so dry. I'm like, you're oily. My skin is so dry. I'm using all these emollients and moisture, like, please stop using them.

Yeah, yeah, please don't.

You're. You're definitely. You have an inflammatory skin condition. You have cellular turnover, which increases your aging faster. Inflammation causes cellular turnover. That causes your cells to break down faster. If I take you and your twin sister, if you don't have acne and your twin sister has acne, she will age faster. She will see folds in her skin a lot more easily than you.

Wow.

So when you have an inflammatory skin condition, we have to dry you up. We have to override your inflammation. So if you're using emollients and moisturizers, you're making my job much harder. Ah. So I think there is a massive key piece needed in education and where whoever you're going to, your practitioner, your physician, your makeup artist, your beautician, they really need to understand skin care ingredients or makeup ingredients. Does is this lipophilic? Does is it lipid soluble? Is it hydrophilic? Is it water soluble? Does it actually get to the right endpoint to give us the change we want? Or is it just sitting there doing nothing?

Listen, there's what I share on this podcast and then there's what I share with my inner circle. If you've been following me for a while, you know how I hold nothing back here but my VIP community. That's where the real magic happens. Picture this. You're struggling with energy crashes, brain fog, or just feeling like you're not operating at your peak and you don't know where to get real answers. But here's what really sets this apart. You're not just getting my insights. When I have incredible guests on the podcast, VIP members get to submit questions for a private podcast segment. So that world renowned expert we just interviewed, you get exclusive access to their knowledge tailored to your specific situation. This section is under the private podcast section in the ultimate human community. And speaking of exclusive, you're getting my personal protocols, the exact tools I use for water fasting, gut optimization, and morning routines that have taken me decades to perfect. This isn't theory. This is what works in the real world. The community launches challenges throughout the year where you get direct access to me and my network of experts. It's like having a personal health advisory board for less than a hundred dollars a month, your health is your wealth. And this investment pays dividends for Life. Join the VIP community at theultimatehuman.com VIP and step into your ultimate potential. Now let's get back to the ultimate human podcast. Right. Yeah. Now, what are some. You refer to inflammatory skin conditions. What are inflammatory skin conditions? You're talking sunburns or, or are you talking about actual skin reactions like a topical dermatitis?

Yeah. So most skin conditions are inflammatory based. And we, you know, this notion of inflammation has only happened in the last five years where everything's inflammatory based. Every condition, everything in medicine is inflammation based now. Right. Every diagnosis. Actually, skin conditions are inflammatory based. Inflammation per se, just in a general term is cellular turnover. Rapid, fast and cellular turnover, that's all it is. So for me, when I'm looking at skin conditions, is this a skin condition with accelerated cellular turnover and damage or is it not? So things like pigmentation, acne, rosacea, eczema, psoriasis, despite it having environmental genetic autoimmune predisposition, there's also an inflammatory predisposition. So I have to understand what aspect or modality am I working on? Am I working on the sebum? Am I working on the inflammation? Am I working on the oiliness? What am I working on before I can give you a treatment plan?

Sure, yeah. And people that have, you see that there are certain races like Latinos, African American, generally more olive and darker complected populations where they have a blessing and a curse. Right. More oily skin which doesn't age, but it's probably more prone to different things like breakouts and acne and things like that. And you see that.

Or pigmentation or. Or.

Yeah, or pigmentation. So it's not a one size fits all because obviously you're treating lighter skin differently than you're treating, you're treating darker skin. But what are some of the lifestyle choices that people are, you know, doing every day that are accelerating their skin loss? I mean, their skin age?

I think in the world we work in, I think the key things that we see is poor sleep. So sleep hygiene, disturbed sleep, not getting to deep restore sleep, that's causing that, that's causing accelerated aging.

About this all the time.

And you. Exactly, you say it all the time. Your body repairs itself at night. Growth hormones produced at night, happy hormones produced another microbiome, the gut microbiome. And the skin microbiome is repaired at night. Right. Then we've got cortisol, we've got stresses, daily stresses. We have more stresses now than we've ever had. We've just mentioned that in the beginning. So that's causing accelerated aging. Your free radical damage of glycination, all the fun stuff that's happening. So that's causing us accelerated aging then. I always say this to my patients, less is more, I always said. Did your grandmother have this, like, does.

She have that 14 stage skincare routine?

Yeah. All right. Your grandmother had Nivea. She didn't have eight to 12 steps.

Right, exactly.

So like less is more. Like sometimes you want to, you want to let the body, the human organ is so amazing. Let it do the work. God's given it the cells for it to work. We just need to tweak it a little bit. So my thing is to distill things and remove things a little bit and say, no, take this away. You don't need this. No. An antibiotic will only fix the bacterial element in your acne. Rock 10 will only fix a sebum. It's not going to fix the inflammation, it's not going to fix the scarring, it's not going to fix the cellular turnover.

Right.

There isn't a one pill for a magic cure.

Yeah.

And it's actually educating that patient in that way.

Now, where do you fall on sun exposure? Because, you know, I'm, I'm Gary, look at me.

Yeah, I. Come on. I think I've answered your question. I'm a vampire.

Well, I hope you're taking vitamin D3 then.

Okay. Yeah.

Okay, good. You know, I, I've always been a fan of morning sunlight because there's no UVA and UVB rays. And I tell people if they want to get sunlight first, 45 minutes of the day is a great time to just.

Blue light is less as well, right?

Yes. And the blue light is less as well. And you know, it's the UVA and UVBs that really kind of damage our skin. But it's still okay to be out in sunlight first thing in the morning. I, I actually make a practice of it. You know, I just expose my skin to sunlight in the morning. You can tell I don't get a lot of sun. I'm not, I'm not red and I'm certainly not tan. I'm, I'm. I' white boy. Like you're a white girl. But so where do you fall on, on sun exposure? And even more importantly, where do you fall on sunscreen? Because, you know, a lot of sunscreens, I mean, there have been what, 18 brands or so pulled from the market in the last 12 years for having some Kind of indirect cause either to skin cancer or some other carcinogen. Yeah, yeah, carcinogen. So where do you fall in that realm of sun exposure and. And sunscreen?

Well, the first thing I say to my patients is this skin has to match this skin, which has to match this skin. If you're gonna have a Birkin bag here and you're gonna go like, Allahu Akbar to the sun, you're gonna sit there and, like, get the sun raising. You're creating. You're gonna cause wrinkling, fine lines, wrinkle pigmentation. You're gonna get that crocodile Birkin you've always wanted. You don't need to put people. But you're not gonna. You're not gonna be put on a weightlift.

Put a handle on it.

Yeah, that's what I said. You know, I'm like, are you gonna make a Birkin bag out of your decolletage?

Right, yeah.

So the key thing, the problem with sun is. Exactly. It causes inflammation. It causes a cascade of glycation, oxidative stress, cellular turnover, aging. All the things we said before. Fine lines, wrinkles, it deflates you and can age you. Your skin is like an organ. It holds everything in place. If I'm burning it, it's burning it down.

Yes, yeah. Burning everything.

Literally, it goes down here. The other key thing we need to remember is you mentioned Latinos versus Caucasians or Afro Caribbeans versus Caucasians. We've got. And I'm Indian African, by the way, as you're pale as I am.

Indian, Indian, African African.

Yeah, as pale as I am.

Practice in London, live part time. Okay.

Everywhere around the world.

Yeah.

You got all the bases covered, basically. But here's the thing, right? I have melanin in me. So if you and I went into the sun, you'd burn quite quickly. I wouldn't. I have a protective melon in me. So African skin. And remember, there's 28 different types of collagen. Wow. Right. So we've got. All of us have different types of. We have collagen. One in three.

I'm only aware of nine, but, yeah, there's 28.

So there's one in three that we really work on in aesthetics that we really upregulate. That gives your strength, your volume, the tightness. Right. And then there's 4, 7, and 14 that work on the anchors between the beauty level skin and the medical leather skin to hold it in place. Right. But African mean people have different distribution to Caucasian people. African people have more melanin, so they're protected from the sun.

Right.

Whereas you're not. If you, if the UV damages your cells, you get the aging, you get the glycation, you get the fine lines and wrinkles, you get the sunburn. Right. But then on the other hand, Afro Caribbean skin pigments easily. Keloids easily. So I think God's been fair to.

All of us, right?

Yeah, he's been fair in his distribution. Sun protection is key whether you're indoor, outdoor. I wear SPF all the time now. There's different types of SPF. SPF 30, I wear SPF 50. And I also wear sunblock, especially in heat like this. So you know, I do tend to put the sunblock especially on the tips of my nose. Right. Zinc oxide base.

Yes.

It blocks it completely. Has the industry come out with something better? Not yet. Yet.

Right.

Are we waiting for it? Watch and wait.

Right. But the non nano zinc doesn't actually absorb into the bloodstream, which I'm a big fan of because you know, if you are going to wear sun block, it should be exactly that, a sun block. It shouldn't be something that actually passes into the bloodstream and starts our, you know, to disrupt our hormones. And there is a lot of links between different parabens and phthalates and fragrances and, and things that actually do.

Hormone disruptors.

Yeah. That are, that are hormone disruptors. And so when you talk about into this reticular layer of the skin and actually feeding the fibroblasts or helping the fibroblast do their job.

Yeah.

One of the things I've heard you talk about that I am an enormous fan of are exosomes because these are, these are little vesicles. They're, they're about the size of a virus. They're about 1-800 the size of a cell. They do penetrate deeply just because of their micron size. Some of them carry high molecular weight hyaluronic acid, some carry growth factors. So these I'm starting to see slowly. And I think you even have a skincare line that contains exosomes. And why did you choose exosomes? And for somebody that's not familiar with what they are, how do they work in the skin? Why should it be something they consider in a skincare routine?

Yeah. So I want to step back a little bit.

Yeah, Step as far back as you want.

You're not in my industry. You're not someone who's seeking me out. Right. So in terms of aesthetic treatments or treating things, you've got virgin and non virgin.

Okay.

So virgin treatments are things you might be comfortable with. You don't want needles near your face, you don't want anything external put into you. Right. And that could be things like prescription grade skin care with great formulation, vitamin A, your retinoids, your exosomes, your epigenetic formulations. It could be lasers, ablative, non ablative lasers. It can be skin tightening modalities, radio frequency ultrasound. This is all you're comfortable with because you're not putting a needle in your face.

Right. And those are looking to do the same thing to provide either micro damage to that layer so that when it repairs, it repairs itself in a healthier way. Right. I would probably call that a hormetic stress like micro trauma which in a controlled environment done by someone like yourself that understands what they're doing can be a good thing. You know, I also know people that have over derma roller themselves scarring and stuff like that and gotten scarring. Yeah. Because those, those needles puncture on the way in, they kind of tear on the way out with a lot of rollers. Okay, good. Yeah. You know, because we, we, Sage and I, when we first started our, our, our business, we, we had a girl working with us, beautiful early 20s and she discovered derma rolling. And I'm not kidding you, in three years she had completely destroyed her skin. It looked absolutely terrible and she was actually developing these, these scars.

Yeah.

But I want to go back to some of these topicals. I mean you have a skincare line but, but I want to go back to some of these topicals and what exosomes are doing in the skin.

Yeah.

And why these biologics?

So I'm going to come to the bottom.

Oh yeah.

So you've got, you've got the virgin style treatments and then you've got the non virgin style treatments and on the verges like you said, it's a controlled inflammation. It upregulates the medical of the skin. It tightens you, it cleans up any pigmentation, stuff like that. It works on different modalities. Then you've got non virgin, where we might do intradermal exosomes, where you might inject hyaluronic acid mixed with exosomes where you might say biologics such as prf, prp, your own growth factors or we might use biostimulants such as PLLA or calcium hydroxyapatite to regenerate the dermis or even the bone on the periosteal level to tighten you. So these are non virgin because I'm using a foreign body into You, Right. So when it came to skincare and skin care formulation, you are. There are only certain things that are licensed at a certain prescription strength that we were allowed to use. But the key thing is here, when you look at an ingredient, you want to look at bioavailability, does this amount actually get to the end point or does it go to first pass metazin, because it just sit on my skin. Does it actually get to that? So we're talking about the fiberglass or the melanin or the keratin side. What cell does it get to? And how much of the bioavailability actually gets there? And then what does it actually do? What was the outcome of it? And I think that's the key thing. I can name exosomes through the extracellular vesicles. They pre. You know, I love them. You love them, right? We love them in longevity medicine intravenously. We love them in our hair into intra scapulae to get hair growth from the effluvium phase, the shedding phases.

You're talking about exosomes exercise.

Right. We love them introderminate to cellular regeneration and grow. Right. But what exosomes in formulations do is they create, they give signals to different cells to give you the output that you want.

Wow.

So they can take growth factors, DNA, mRNA, RNA and they can say, okay, produce more collagen, really make more fibers.

They can literally send this signal to that. Wow, that's fantastic.

And that's why, and, and that's why it's really, it's going to be going anywhere, as you can tell. And that's why it's really important in epigenetic skincare that if you are using exomic formulation that the bioavailability is actually there.

Yeah. Now also the, and by bioavailability you mean that that exosome is still viable enough to perform its function. Right. They're not really living things, but they can also be inert because they're destroyed by heat or, or, or what have you.

Or their delivery system is inept.

You know, and I hear the terms collagen, elastin and fibrin.

Yeah.

You know, obviously these are all involved in the scaffolding of the skin. The structure of the skin would, for, for someone that's not familiar, you know, what is the difference between collagen, elastin and fibrin in the skin? And are there different ways to stimulate each of them? And why are they each important in having youthful looking skin?

I think collagen's the main player okay. Okay. So you've got the building blocks of fibroblast. And collagen is actually the main pair.

It's a protein, right?

Yeah, yeah. And in the dermis, it's collagen fiber one. About 80 of your dermis is collagen fiber one. Right.

Okay.

There's one in three, but it's more one than anything. And then fibrin and elastin. Fibrin helps give your fiber in terms of the fibers. So if I stimulate fibrin, you can actually get fibrosis as well. It can go the other way. Wow. Right. And then elastin is that, you know, that tensile. Do you want it to be loose and lax or do you want to be tight? And you actually want things to bounce back? You want it to be, you want to bounce back with age. You get the laxity. It's not going back up. So can you remember those days when you used to put on weight and lose weight?

Yeah.

And the skin never expanded.

Right.

Or used to. I don't know if you, you know, if you body train in weight and you debulk.

Yeah, yeah. You would either get, you know, lots of guys would get those stretch marks, stretch marks around their shoulders and their pecs and stuff. Because the muscle grew too fast.

Exactly. Yeah. So I say to patients after the age of 35, be very careful of weight gain and loss or muscle gain and muscle loss. Because once you, after the age of 35, you've got, got, you've got significant fibroblast degradation. And your fibrin, elastin is not as strong as it used to be. So it doesn't bounce back. Whereas your collagen, you can keep up regulating it with different treatments that I have.

Okay.

Most modalities in my industry work on collagen fibers 1 and 3. We don't really concentrate on fiber and elastin.

Okay. So fibrimin and elastin, they're going to be, they're, they're secondary being lost at a rate that's commensurate with aging. But the collagen can make up for that because you're going to increase this protein. So what are some of the ways that you increase collagen in the skin? And then I want to get into some of the topical modalities that people use because I believe some of these are short term benefit for long term loss. You know, people are borrowing from their future, if you will. Too much burning of the skin, scraping of the skin, and maybe you get this youthful rebound, but temporarily Temporarily. But then you're literally borrowing from your future. You know, we. My wife has friends like this that were just laser and dermabrasion and microneedling freaks and. And skin looked great for a period of time, and now it really looks terrible and it's hard to get it back. If you want protein to build lean muscle, but without the caloric impact or need to cut, you need perfect amino. It's pure essential amino acids, the building blocks of proteins in a precise form and ratio that allows for near 100 utilization in building lean muscle, no caloric impact. So we build protein six times as much as whey, but without the excess body fat we normally get during bulking. This is the new era of protein supplementation, and it's real. If you want to build lean muscle without having to cut, you need perfect amino. Now let's get back to the ultimate human podcast.

I think the first thing you said about me was the inside, right?

Yeah.

So for me, I don't diagnose collagen degradation because. Because it doesn't present like that. You're presenting with adrenal fatigue or you're presenting with other features. Right. And then it's a byproduct of the stress that you're going through.

Yeah.

So I'm not focused on collagen. Collagen, collagen. I'm focused on getting the inside correct first.

I love that.

So if we've got adrenal fatigue, then I'm working on that. Is it nad? Is it peptide program? Can I move the needle?

What? Do you find some ways that people recover from adrenal fatigue? Because we do see women whose cortisol is floored out.

Yeah.

They're just not producing twice in my career. Have you really?

Yeah, I've had significant burnout twice in my career.

So how did you get your cortisol back?

Yes, I've been completely flawed. I was eastern dominant with adrenal fatigues.

Oh, dude.

The worst I had to go through, I had to go through rewiring myself. I had to do my routine nad. I had to turn around. I went on peptide programs. I didn't just go on ACTH139 and your Adrenal fatigue ones. I went on sema concellang as well to optimize my mood.

Yeah, yeah. So I went an anti anxiolytic. That's a peptide.

Yeah. So I went on those and then I went on microdose on estrogen as well.

Okay.

But now I'm coming to perimenopause, so I'm now changing that up a little bit so we work on the inside first. Before I'd work on the outside of your collagen degradation. On the outside, like I've said before, it's always virgin or non virgin tools. What are you happy with? In my industry everything is inflammatory inflammation basis me causing micro trauma, right. To upregulate the cells to wake them up. So it's either that, that. But there's a new area of medicine which we spoke about in the Saudi conference called regenerative aesthetics.

Love that.

That's where your biologics come in. That's where your exosomes are coming in. That's where things like polynucleotides are coming in. That's where profilo is coming in. That's where your biostimulants have now come back again. They used to be out of a fadish fashion because like calcium hydroxy appetite or PLA used to grow your face uncontrolled by stimulation so you'd get that look and you're like no, no, I haven't had any treatment, I promise you for two years. It's still growing, still going. But they've changed the mechanism in action. They've told us to inject more much deeper and over dilute and you know, they've changed the molecule, right. So they've worked on it to change the mechanism action. So we've got different modalities now in terms of regenerative aesthetics and cellular regeneration that are not focused on just micro trauma but work on a biological front. On the front end, on the outside, but also on the inside we've got regenerative modalities such as your exosomes, your mesenchymal stem cells such as your peptides or just, just natural things like therapeutic plasma exchange or Eboo Ivo zone.

You're saying all these things. It's great because you know these toxins build up not just in our bloodstream and but in our tissues, in our. Our skin is also a secondary route of waste elimination. Lots of waste is sort of excreted through the skin and if you're full of toxins they're going to come out that way, you know.

And what happens? Do you remember the days when. I don't. You do. You must do intermittent fasting. You must be. You do 24 hour fasting from 2472. Sometimes you're like a legend in fasting and you notice is that your skin just glows.

Oh, it's unbelievable. The whites of your eyes, bing. They're bright. And your skin changes in three days.

Yeah.

You know, which is fascinating to me.

And that's why sometimes I say to patients, you know, you can't get access to me, but you can get access to my knowledge. You can go. You can go on intermittent fasting. You can go into autophagy. Your body can start repairing itself. It can start reducing the inflammation on the inside. Your skin will start glowing and repairing itself.

Yes.

You can do a. You can do a detoxification. Remove all these creams that you're putting in for the next seven days, and you'll notice that your skin barrier function will start waking up again.

Wow.

And your skin will start repairing itself. If you remove all the things that you use for your acne and stuff like leave it alone for a few weeks, your skin will wake up.

Yeah.

And you won't break out as much stopping even if you don't come and see me.

Yeah. You know, it's funny, I had. Well, I have one teenager now, but I have one that just recently turned 21. Both of them struggled severely with. With acne. One went on a very short course of Accutane. We took him right off. But one of the interesting things, much to your point, was in both of their cases, when we applied the less is more theory, not over scrubbing their face, not always. Not always. Using these facial cleansers and a lot of those benzoyl peroxide and all those pads and yeah, the acids, you know, I found that it really inflamed the skin. They would go from having acne to really red and. And inflamed acne. You could tell the skin was super, super irritated. But in both of their cases, both my youngest son and my youngest daughter, their skin changed dramatically when we started skipping days, washing it when they just used warm water, when they actually didn't use any. And they had a little bit of sun exposure. Not a lot, but just a mild amount of sun exposure. It actually really started and we focused on hydration and good nutrition. It really.

Internal.

Yeah, internal. Really started to change them. Well, my wife, who's been very public about this, you know, just recently went through menopause. And on the way in, we noticed dramatic changes. Mood, emotion, typical hot flashes, but also to her skin almost overnight.

Yeah.

And, you know, I've been deep down the rabbit hole of female hormones and their relationship to, you know, estrogen's relationship to skin elasticity. You know, and when these hormones floor out, the. The skin very rapidly loses its elasticity. But what was fascinating is after hormone therapy, her skin bounced right back. It was unbelievable. I mean, I think menopause is like, if you could. If you could sort of design the perfect torture chamber for a woman. You know, it's like weight gain, water retention, loss of skin elasticity, no libido, sleep disruption, brain fog and mood swings. There you go.

Yeah.

And by the way, we're going to toss in a little frozen shoulder decline. Just. Yeah, cognitive decline. And we're gonna maybe toss in some frozen shoulder. Just really complicated. Exactly.

Fun times.

And you know, as we really. I mean, when I got this test back on her, which called a Dutch test.

Yeah.

It really gave me so much insight into how so much could go so wrong so fast, because these things floored out. And I really would implore women to, to really, if you're perimenopausal, you're going through menopause, you know, get a functional medicine doctor to do a hormonal evaluation on you. So what have you seen with hormone replacement therapy in. In men and women?

Yeah.

And having effects on their skin?

Yeah. So my. So men again, never come for. I look tired. Can you. I've got folds, wrinkles. Can you fix that? They don't come. Men come. And my wife sent me to get refreshed.

Yeah, that's it.

So men never come to me because I've got wrinkles on my face or folds here.

Yeah, we're fine with it.

You're quite chilled. Right.

You throw some jergens, you know, 299CVS moisturizer.

I'm like, I don't care what I put on my face. It's the wife that pushes the man.

So true.

And then when you take the history from. And like I said, we always, always do inside out. And then I'll find out you're wide and tired, bed, you're running on empty, you're not sleeping, you've got loss of libido, you've got mid abdominal weight gain. You don't have that drive that used to have. I'm like, okay, let's do a testosterone test. We've got a little bit of testosterone deficiency. Are we in andropause? Do we even have adrenal fatigue on top or we just. In andropause.

Right.

So what happens in men is that the testosterone declines over a long time.

Right.

And then with the collagen and with. In terms of skin, you notice you get the bony resorption. So you get loss of definition of your jawline, you said. Yeah, that sharp jawline used to have that.

Right.

You also get folds and wrinkles in your face. That doesn't really bother you because, you know, men should look like they've lived.

Right. Right.

It doesn't really bother you, but you look a bit weathered. Right. You might get recession of your hairline and you get the middle abdominal weight gain. And like men again, are always metric driven. If I change you on the inside, outside is five minutes, you're like, done. You're like, thank you, it's goodbye, I'm off. Right. And, and, and I've got different modalities again. Is it virgin, non virgin? Do I stick to, to just peptides? Do I stick to iv nad, simple stuff? Do I do tp, ubi, all that kind of fun stuff or do I go on testosterone replacement?

Sure.

Are you ready for that?

Yeah.

My women will literally take the pencil and they will consult themselves.

I need this titan. I've got this more. I've got this part.

I literally woke up this morning and this is a classic line in perimenopause. I woke up this morning and my, like, my jowls were here. They weren't there yesterday. And they're suddenly down here.

Yeah.

I suddenly look like I've aged 10 years overnight.

This is what happens.

So women, they'll take their pencil and they'll mark it all day and I just sit back and relax and, you know, I check my, my whatsapps and stuff.

You're like, I've been here before.

Yeah, here's your charge for the consultation.

Yeah.

You've diagnosed yourself. But the good thing about women is they'll tell you everything and the picture is a lot easier. And they're very transparent.

Yeah.

So the picture is a lot easier. So again, on the inside, are they sleeping? What's their mood like? So we can diagnose perimenopause just on clinical symptomology. Like you mentioned the symptoms. Yeah. And they already had that inkling because they've spoken to their friends. We talked to each other all day long.

Oh, yeah, yeah. Women just. They're flat out with their friends.

And they'll come in, yeah, they'll come in going, I'm perimenopausal. Right. And you're like, you're 38. I'm perimenopausal. It starts early in Dr. Valley. Did you not know? Okay, no, start as early as 38. Did you not know? I was like, okay, cool. Not a problem. Estrogen decline in women just happens overnight over the cliff.

Right.

And it just drops by 30, 40% overnight collagen degradation happens. Fine lines, wrinkles, open pores, oiliness, more inflamed conditions. So say you had moderate rosacea, you just drank a glass of wine in your 30s. Now in your 40s, you're noticing broken capillaries.

Yes.

Skin thickening, you've got pores, your face looks a little bit grubbier. The solidness is there. It doesn't look as bright as it used to be. Right?

Yes.

So you're noticing changes that you didn't see before. Your skin's thinner, the ceramides have gone. Because the estrogen drives the ceramides. The ceramides have gone. So you're feeling dry everywhere. You've got hair thinning. So this is what's happening. And then suddenly you're getting the mid abdominal weight gain, you are not eating at all, but you're still putting on weight. You metabolize retaining water, you're retaining water. So women will come in. And again, do you want to say in the virgin lane or non virgin lane? So my women are still not HRT ready. They're not identical hormone replacement ready either. So I have to, still, I just have to use the tools I have, whether it's peptides, nads, whatever it is, just to optimize their mood, get them to sleep with a delta sleep induced peptide. What is it that I can do in a natural way that they're comfortable with? Yeah, right. And on the outside is easy. I've got loads of modalities to thicken their skin, tighten their skin, you know, do they want a biostimulant to lift on the bony level so they jawline definition back? Do you want, do they want an ablative laser with exosomes to continue regeneration?

Yes.

But if I can convince them to go and buy identical hormone replacement therapy or hrt, A lot of women are now going on it much younger because the positive outcomes, I think so many.

Women are suffering unnecessarily because they have this fear of getting on a bioidentical hormone therapy. And I've seen miracles happen for women that are suffering overnight. My wife being one of them and I'm a big fan and I've been deep down the rabbit hole in the research and some of the studies that link, you know, hormone therapy to breast cancer actually debunked that link in the very same study, just after it was carried on for a longer period of time. I think it was the Women's Health Initiative was the big one that really got a lot of it's Been debunked, right? Yeah, it's been debunked by the Women's Health Initiative. So, you know, if you, if you are listening to this podcast and you're one of those women, you know, don't be scared of seeing a functional medicine doctor and getting on bioidentical hormones.

I would say go on it. Yeah, yeah.

Because it can be. So you've mentioned peptides a number of times. What are some of your favorites for skin? I mean, like the ghkc, you copper peptides. Do you like BBC? What are your. What are your.

So I don't really, I don't use peptides for skin because I've got so many different modalities already.

Gotcha.

So I don't really need to use peptides. I've got better things that can work for it.

Okay.

The GHKCU is a popular one. Thymosin beat is a popular one. You can, you can do subdermal injections or you can just microneedle it in. It's up to you how you want to take it. For me, I use peptides for the internal stuff.

Yes.

I don't use peptides for skin. I don't use peptides for hair either. I use exosomes for hair because.

Yeah.

Is much stronger. Right. So the outcome is there for my patient because if, if I promise you something, I don't deliver, game over.

Yeah.

Like again, I'm the worst doctor in the world.

Dermatology.

Yeah.

Yeah.

So your reputation matters, but also you have to do good by the patient. So I have to say these are the modalities you've got. If it was my hair and my hair follicle, this is what I would use.

So I want to talk about the new breed skin technology. Tell me about that. How are you using that for your.

So for me, like I've always mentioned, and probably for you as well, bioavailability is important, formulation is important. And one thing I didn't understand, I'm a practicing doctor. Yes, I'm practicing doctor. But what I didn't understand is how one skincare brand can work on all of us the same way.

I couldn't agree with you more.

We're 8 or 9 billion different types of people. If we're doing personalized medicine, why are we not doing a personalized approach? Approach. So then I was looking at formulation. I'm like, what do I like in practice? That is prescription grade strength and can I get it over the counter? So I was like, okay, most of the skin products sit on the beauty layer. So it's not even going where we need it to go.

Right.

How do I get my 12 favorite ingredients to go to the medical of the skin without you needing a prescription?

Yes.

And then how does it treat open pores or in those fine lines, wrinkles, pigmentation, rosacea, acne, all common things we suffer from. Right. Inflammation. But it works on you differently. To me, because we're different ages, we're different sexes, we do have different skin conditions.

Right.

So then I wanted an epigenetic formulation. So I took the 12 prescription reactives, I shrink wrapped it in Japanese technology. I spent about seven years and with lab and formulation and clinical trials and studies, and we proved that it goes to medical level. The skin, the reticular dermis.

Wow.

And it upregulates your fibroblasts or your melanin or your inflammatory cytokines or whatever it needs to differently to mine.

Wow.

If my problem is pigmentation and yours is rosacea, it acts on you differently to me.

Wow. Regardless of gender, uses cell signaling or.

Something, Epigenetics formulation, that kind of thing.

Wow.

So we've done that in our painted molecule, biometric biomimetic adaptive complex 12. So that's in our adaptive skin care.

Okay. And then that's why you call it adaptive skincare.

Adaptive skin. It adapts to you.

You. Okay.

And then the reason why we call it new breed skin 10 was just because I wanted something fun, you know, like Rihanna, Fenty. I wanted something fun. I wanted to be just as cool.

Yeah. Yeah. Well, you are pretty cool. I mean, look at your boots.

Yeah.

Thank you.

Cool. I got styled. Yeah. And then on the other side, devices, over the counter devices. So, you know, your LED masks, your microcurrent devices, you know, does it actually lift and tighten?

Right.

How do I get my hands on you over the counter without you having to come to me? So I was like, well, microcurrent only goes to the beauty layer and the dermis. It doesn't go to the muscle, it doesn't go to the bone, it doesn't go to where we restructure and we age from the bone. Do you remember grandma used to have these big wide eyes.

Yeah.

Pictures. And now they're like tiny beady, rhomboidy. And like the cartilage of the nose is growing and the ears are growing. The jawlines move forward or backwards. The eyes are beady.

Yeah.

That's your skull absorbing as you age.

Age. Wow.

We age from the skull and everything else slips off.

Wow.

That's why you get the fact coming here.

Thought about it that way.

Yeah. And then the balloon deflates. The skin deflates. It doesn't hold it as much. So you've got the periostein, the skull resorbing and the balloon resorbing. So in between, everything slips.

Right.

So I wanted a technology that doesn't need a transducer gel that doesn't need. You don't need to be like, use my creams. Yeah, it doesn't need a current. It doesn't. And I don't need to be. You might not like my cream, so don't. Yeah, don't use my greens.

Right.

But it's also. I wanted you to be able to take a technology that goes to the bone and it lifts and contours, that goes to the fat pads and repositions them, that goes to the lymph nodes and decongest you.

Right.

Goes to the frontalis muscle here and releases tension and gets rid of headache. Or goes to the masseters and your teeth grinding tension. It releases it. So this is called transon oscillations. It's vibration technology. So everyone's like, oh, you're based on a sexton. No, we did clinical studies and we made different sonic wave patterns to go to different anatomical planes to give you different outputs. So we made cutis, which gives you the perfect bone structure, but each sonic wave pattern gives you different outputs.

What does this look like? Like a handheld device.

Yeah, it's a handheld device. It looks a little bit like a sex toy.

Oh, it does.

But it's in a really cool.

Scared of those. Let's just be honest.

But it's in beautiful colors. It's like your Hermes orange and your bone and electronic.

Can you use it in public?

You can use it in public and no one's going to say anything to you.

Okay, good.

Like, that looks cool.

Yeah, that's cool. She just whipped that thing out on a bus. So awesome.

Exactly. On the plane. You're de puffing and it's great.

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But actually, but what it actually does, the studies show that it changes the cells. There's no point. It's not temporary. With use you can read. It's like going to the gym. And the muscle, right. So it reposition re educates your cells. So what you've got is some. It's a horseshoe shaped and it's got a connecting wire and some people really putting force in it. So the connecting wire breaks and you're like, dude, it's not going to give you a facelift. Just like, like calm down with the tension at the. Let the device do its own work.

Right.

Lifts and contours your face. Repositions of fat pad. It can relieve tension. It can depuff your face depending on the protocol.

And is this, is it using microcurrent or is it using sound wave?

What is using sonic waves?

Sonic wave and we.

And it's called trans anatomical. So each anatomical plane oscillation technology. Ah.

So, so some you, you know, the different tissues respond to different, different wavelengths. So muscle is going to respond differently than connective tissue, than bone. So you actually provide different wavelengths to stimulate those different areas. And we basically heard of somebody starting with skincare from the bone out. But that really makes a lot of sense. I never really thought about, you know, skull resorption because you are having, you know, osteopenia, osteoporosis. These are, these are, you know, demineralization of the bone. Why would you not have it in the, in the skull? Makes perfect sense.

But it's just like when we assess you in the face and you know, you want contouring or anything like that. Some people want their lips done or they want their cheeks done. Something like that. The first thing someone looks at is your eyes.

Yeah.

Next thing is your teeth.

Yeah.

Fix that first.

Yeah.

Forget your lips.

Yeah.

Your cheeks. No one's looking at them.

So true.

So it's, it's, it's understanding. And the reason why we went in and out is because of the journey that we've both been on, we understand internally what's happening pathophysiologically and Histopathologically on each cell that we can now understand what happens on the outside.

Yeah, yeah. And so is this used in conjunction with a skincare routine? Because I have seen as many as 14 steps in a skincare routine. And I'm like, how can anyone stick to that kind of program where you literally have 14 things? You have an enzyme cleanser, then you have a cleanser, then you have killing me. You know, dermatology, you know, the. What do you call it? The. What's the sandy things? Microdermabrasion, you know, exfoliation. That's the word I was looking for, Exfoliation. Then you have something you put on right after that, then you have a toner. So what is a good basic skincare routine?

Okay, so let's go back to basics.

Yeah, let's go back to basics.

Regardless of gender. And I always do this regardless of gender, heritage, age, regardless if they were like, you know, the 21 year old sitting in the room, there's 16 year olds in the room. Then there's me, there's you, right? 30s, 40s, 50s, whatever it is, Regardless of gender and ethnicity, there's something going on our skin for all of us, the same thing. There's only two things that are happening that we're synonymously feeling the same. We all have fibroblast degradation from the age of 20s, early 20s. Collagen, elastin, your hyaluronic acid, your gags are all going down. Okay, that gives you fine lines, wrinkles, open pores, oiliness. Okay, then all of us, regardless of ethnicity, have some form of pigmentation. So in me it's going to be brown. And you it's going to be pinky, purpley or vascular. So fair hair, fair skin, pinky, purpley, vascular, brown hair, darker skin types, brown. So if I'm only just treating those two things, I'm gonna. Together with that, I'm gonna give you the perfect canvas. That's just two creams. Okay, obviously they're my creams, but they're just two creams. Right. With my patented formulation. But if I was going to say to you that you're not going to bother with my skin care and you're going to go and use just two, three products, the only thing I would say to you is use an spf, use a beta glucan based serum glucan base. And I'd actually say to you, wash your face with water. Better. Yeah, that's why, really? And if you can tolerate a retin A or retinol or something, Vitamin A derivative based. Because that's the strongest ingredient, has the massive amount of studies. There isn't anything that's been studied more in our industry in Retin. Yeah. Retina. Retinol. Retinal. Whichever one you can tolerate. Right. Once a week, twice a week, just to upregulate the fiberglass. Ah. And that's it. That's all I would start with really.

So, so washing your face with water, applying one of these creams. So just wash and then apply the cream. There's not a multi step. You're not a big believer in taking those abrasive things and scrubbing off the layers of this.

You just gave me the stories of not just your kids but also one of your ex employees or colleagues.

Oh, yeah, she, she, derma rolled herself. It was terrible. I mean she started at 24. By the time she was 20, last time we saw her, she was 27, maybe 28 years old. And, and there was a noticeable.

Yeah.

You know, scarring on her skin and she was actually going for laser to try to correct.

Less is more. Derma rolled because once you've done it, once you've damaged certain cells, you know when you've got the stretch marks.

Yeah.

Gang muscle. Right. We can't get it back together. We can't get these borders back together. Have you ever seen anyone fix stretch marks properly? Even if we do CO2 Blazer, if we do carboxy therapy, even if you've got exosomes, Right.

You can, you can lighten them a little bit. Yeah.

You can take, change the pigmentation, but that's about it. And you can bring the border slightly together, but it doesn't go back to new basking.

Never.

So once you've damaged certain skin, it's really hard to bring back.

Yeah.

So you've got to be careful. And that's why I talk about the Birkin bag. Never. This skin is thin. The skin under the eye is super thin. The skin around this area is thin and the next skin is thin. These are the areas you don't want to damage.

Yeah, very true. So are there any different, I mean, are there any topical modalities that you think are a great practice? Are there any particular lasers that you're a huge fan of? Because I know there's CO2 lasers, there's ablation lasers, there's, there's class one, class two lasers. There's so much that when you walk into most cosmetic clinics, you can get paralysis of analysis. You can also get lost in the programs that they're trying to offer you without really having a fundamental understanding of, okay, which one of these is going to borrow from my future? Which one of these is actually going to give me real skin regeneration and changes. Yeah, and real changes.

So I would go back to basics again and I would say, say let's first put you on a skin prescription based skin program.

Okay.

Let's re educate the cells. You've had your skin your whole life is not going to happen overnight. It's going to take me three to four months to give you good skin. And I always promise you 70 improvement and we aim for 90.

Wow.

So what we do is we re educate. We, we might resurface you. We might use a partial ablative, not full ablative. A full ablative laser such as CO2. I'd only do my 40s up.

Okay.

Post like a facelift or something like that. But I do a non ablative laser such as fraxel, which is, which is less damage. But I, I'd combine it with exosomes for regeneration. Right.

How would you apply the exosomes? Intravenously or topically?

No, topically or interdermally. Right. One or the other. And then because that will cause cellular regeneration.

Okay.

So you either do microneedling like your colleague did, prescriptionary microneedling or you can do a partial laser such as a fraxel, which is a baby laser. Right. But not an ablative.

Fraxel's a light laser. Right.

It's a light, it's not ablative, it's lighter version. Not a CO2. You don't need that yet.

Okay.

And then what happens? We put you in a prescription grade skin program, just creams the next six to eight weeks, morning and evening, two minutes in the morning, a couple of minutes in the evening, you yourself within four weeks, you're not wearing as much makeup, pores have gone away, the skin feels tighter. Because we're working on the reticular dermis. We're getting your cells to start behaving again, stop up regulating to regenerate again. Right?

Yeah.

And if you need another, if you need another booster, we might do another booster. And the first phase of the skin changing, it takes skin cells six to eight weeks, the keratinocytes, eight weeks to change their behavior.

Wow.

To 12. So the first eight weeks is I call transformation. The second phase, and this is the most important phase, I call permanence. We want the skin to permanently behave like that.

Wow.

Six to eight weeks. And in this program we increase the active, so we might increase the dose of the retin A, we might increase the dose of the prescription rate actives and they're just creams. Cream. By the end of it, you have perfect skin.

Wow.

You turn around and you continue it and say you started with inflammatory acne, you had some scarring, you used to breakouts. I say to you, you know what, in three to four months you're gonna have, you're gonna tell me off and you're gonna complain about one or two spots. It's like your whole face. Because literally if you can go on a steady level and retrain the cells slowly rather than attacking them and blasting them. Because you don't want to borrow from your future in your own words.

Yes.

You want to re educate them slowly and you want them to behave in that way for the rest of their lives. And, and that's the key thing. Slow and steady wins the race.

I totally agree with that. Is there anything that you know of to actually increase the density of these fibroblasts?

Yeah. So the neocolagenesis, that's most collagenesis. Most. Most modalities are based on something called neocolagenesis. New collagen formation. Right. And. And what we call it, it's a fibroblast upregulator that increases the density of the fibroblast. Perfect. If we're increasing the density of the fibroblast, we're increasing everything el else.

And what increases the density? These.

So it depends. Is it we can do inflammatory based modalities or we can do biologics or we can do virgin or non virgin, or we could just do prescription grade ingredients. It just depends what you're comfortable with.

That's. That's phenomenal. And then just winding things out, you know, you, you. I won't take you deep down the rabbit hole of peptides, but I'm a huge fan of peptides and we use them internally for lots.

What do you use?

BPC157 for wound healing and repair. Something called TB500 for wound healing and repair.

There.

So like post surgical recovery, anytime someone has like a knee, hip, shoulder, rotator cuff injury, low back, especially if it's chronic and persistent. Yeah, yeah, you can do it. Sub Q BPC is probably one of the few peptides that's tolerated well orally because it's a gastric peptide. But we find the combination of those two works really well. GHKCU copper peptide. NAD. I know you're a fan of NAD. Two 50 milligrams a day in sub Q injection or transdermal patch. In full disclosure, I'm a, I'm a partner in a peptide manufacturer called Peptool by Visalius Lab Sciences. And, and I chose these guys because they, they manufacture in a CGMP certified lab.

Right.

They don't source ingredients from China. And the peptides really work. A lot of the overcounter peptides have all kinds of nasty things in them. Heavy metals, fillers, binders, and very often they're not even peptides. And it's hard for a consumer to know because, I mean, how are you going to evaluate whether or not this white capsule is, you know, rice bran or a peptide, other than by the fact that it either worked for you or didn't work? But, you know, not being a dermatologist, but having seen the. I would say the greatest shift in what we see by treating the inside showing up on the outside is when we balance hormones. You know, you see a noticeable youthful appearance in both men and women that get their hormones balanced. You know, when they're estrogen dominant or their progesterone is deficient, or the cortisol is floored out, or like you said, stress and inflammation has just fatigued their adrenals. You know, we see it. You, you, you see it in the skin. They just look and feel tired, and in a few weeks, weeks, you know, they seem to really, really bounce back. So. Dr. Valley, I, I, first of all, I'm so appreciative that you came on the podcast because. And it's, it's, it's so interesting that we saw each other in Saudi and now we're, we're here in the Middle East. I think this is one of the most fascinating regions of the world because they are growing so fast and they're.

So hungry as well.

So hungry.

Yeah.

And, and they, and they're innovating and they're there. It's like they want the brightest minds, they want the best food. They want the most educated population. They, you know, they're really thirsty for knowledge in this area of longevity, anti aging. You must be a very popular human being walking around here. I saw you get mobbed after your, after your.

You got mobbed too. We both got loved. Yeah.

Yeah, we sure did. So I wind down all of my podcasts before we go into the vip and we have a. Some questions from my VIP community by asking all my guests the same question. What does it mean to you to be an ultimate human?

For me, for me, I'm perimenopause at the moment. So, so for me, full disclosure. Full disclosure. If you ask me in two weeks time, it'd be a different answer.

Right? Yeah.

So for me at the moment, you might be angry. Yeah, I might be completely different. For me it's just contentment. For me, the ultimate human. Because I've got access to everything and like you're like, you're on a peptide stacking program. I'm on a peptide stacking program. I have access to everything. As soon as I see the first red flag of like, I mean, cause the overdrive, I know what to do. So I'm quite privileged in the industry to have that access.

Yeah.

So for me at the moment it's just contentment. I want to get to that phase where the highs are high, but I don't feel it high. And the lows are low, but I don't feel them low. I'm just streamlining and you know, just getting through life content and happy.

Yeah.

What, what will be, will be and what won't be, won't be.

Yeah. You know, I think, I think there's a lot of genius in that, you know, letting go of the things that we can't control.

Yeah.

You know, I've, I've focused a lot on that as I've gotten older or more mature, whatever you want to call it, you know, frustrating yourself with the things that you have no control over.

Yeah.

Is just, that's only on you, you know, but getting frustrated about the things you can control, it's, you know, a little different. But with so often things just, just knocked us off our stride during the day that we have zero control over. I don't get frustrated in traffic anymore.

Yeah.

I'm just like, well, that's what it is. You know, going to be late.

I feel like, especially because you're an entrepreneur like me, we go through such high highs and we go through such low lows that you have to get to a point where you're just like, nothing. Nothing.

Our emotion is so tied to our outside environment. How well did this meeting go? How bad did that meaning go? What are they saying about?

Was I not? Yeah, well, it is. And that's why I say I'm perimenopause at the moment. So ask me on another day. I'll give you a different answer. Yeah, it depends on my cognitive resilience.

All right, Dr. Valley, we're going to go into the VIP room. For those of you that are interested in becoming a VIP, you can head over to the ultimate human.com forward slash VIP. This is the community that I am pouring myself into. We do private podcasts, we do live Q&As. I have a Gary AI in there that you can ask anything to. You can feed it your labs, you can feed it your genetic testing. You can ask it questions about supplementation, diet, lifestyle, travel hacks, anything you'd like. I think you'll find it fascinating to interact with the Gary AI but for the rest of you guys, until next time, that's just science.