The Liz Moody Podcast - The Root Causes Of Hair Loss, Acne & Aging—What's Actually Worth Your Money + What's Total BS

Episode Date: April 22, 2026

Have you spent probably hundreds of dollars over the years on skincare and haircare and wondered why you’re not getting the results you want? Well today, we’re going to change that. I chat with a top dermatologist about every common skincare concern (acne, skin barrier damage, dark spots, pores, aging, hair loss) and we get into the real root causes, what actually works, what's a waste of money, what you're probably doing wrong, and the one thing that you can do tonight that will make your skin look better by tomorrow morning. My expert guest is Dr. Samantha Ellis, a board certified, celebrity dermatologist who teaches at UC Davis. She's become one of the most trusted voices in dermatology with hundreds of thousands of followers online who rely on her deeply science grounded advice. Today, she's going to help all of us get the skin and hair that we deserve. 🎧 What you’ll learn: • Which skincare products and supplements are actually worth your money • Botox, facelifts, and lasers—what’s safe, what works, & what doesn't • What's actually causing your hair loss & how to stop it • Why you're breaking out in your 30s • A surprising new fact about sunscreen • How to know if your skin barrier is damaged • The one unexpected thing you can do to instantly improve your skin’s appearance • The surprising thing that really ages one’s face (it’s not wrinkles) For more from Dr. Samatha Ellis: • Instagram: https://www.instagram.com/drsamanthaellis/?hl=en  • YouTube: https://www.youtube.com/drsamellis  • Her Practice: https://potozkinellis.com/  Ready to uplevel every part of your life? Order Liz’s book 100 Ways to Change Your Life: The Science of Leveling Up Health, Happiness, Relationships & Success now!  Connect with Liz on Instagram @lizmoody or online at www.lizmoody.com. Subscribe to the substack by visiting https://lizmoody.substack.com/welcome.Buy our cute sweatshirts, conversation cards, and more at https://shop.lizmoody.com/. Use our discount codes from our  highly vetted and tested brand partners by visiting https://www.lizmoody.com/codes.  To join The Liz Moody Podcast Club Facebook group, go to www.facebook.com/groups/thelizmoodypodcast. This episode is brought to you completely free thanks to the following podcast sponsors: • AG1: visit DrinkAG1.com/LizMoody and get an AG1 Flavor Sampler and a bottle of Vitamin D3+K2 for FREE in your AG1 Welcome Kit with your first AG1 subscription order. • OneSkin: visit OneSkin.co/Liz and use code LIZ to get 15% OFF for a limited time. • Lumebox: go to TheLumeBox.com/Liz for 40% off anytime.  The Liz Moody Podcast cover art by Zack. The Liz Moody Podcast music by Alex Ruimy. Formerly the Healthier Together Podcast.  This podcast and website represents the opinions of Liz Moody and her guests to the show. The content here should not be taken as medical advice. The content here is for information purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions. The Liz Moody Podcast Episode 424. Learn more about your ad choices. Visit megaphone.fm/adchoices

If you've spent hundreds, maybe even thousands of dollars cumulatively over the years on skin care and hair care and wondered why you are not getting the results that you want, today we are going to change that. We're talking through every common skincare concern. We're talking acne, skin barrier damage, dark spots, pores, aging, hair loss. And we are finding out what the real root causes, what actually works, what's a waste of money, what you're probably doing wrong. And the one thing that you can do to night that will make your skin and your hair look better by tomorrow morning. My guest is Dr. Samantha Ellis, a board certified dermatologist who teaches at UC Davis. She has her own skin care line that is carried at Target. She's become one of the most trusted

voices in dermatology online with hundreds of thousands of followers who rely on her deeply science grounded advice. Her private practice has a six-month wait list. She works with top celebrities. I am lucky enough to call her my personal dermatologist and my friend. And today, she's going to help all of us get these skin and hair that we deserve. Welcome to the Liz Middy podcast where we're not going to add a million things to your life in the name of biohacking or being healthy or doing what you should do. No, we're going to help you figure out the exact levers to pull that are going to make you feel how you want to feel, that are going to get you the results that you want to have. And no matter what you are going through, no matter what you're dealing with, we always, always believe that there is a lever. Dr. Sam Ellis, welcome to the podcast.

Thank you for having me. Welcome back to the podcast. It's true. In person. I know. It's been so long. And like we've become friends since then. I know.

We've come a long way. We've come a long way. Okay. So today we're going to go through a bunch of different skin care concerns, common things. And we're going to kind of say, what are the do's and don'ts? What are people getting wrong here? I would love to start with. What is the number one most common skincare mistake that you see people making?

The number one thing people are getting wrong is how much sunscreen they're applying. I feel like the average person vastly underapplies their sunscreen. So they're not really getting the particular. that they think they should be. What is the right amount to apply? So it's a little bit of an estimate, but we want people using about a quarter teaspoon for their face and ears.

So for a lot of people, that's going to be about two finger lengths on their hand, because when they're assessing the SPF or the sun protection factor of a sunscreen, they're really counting on you using the correct amount. And if you're under applying it, you're not getting that SPF 50 or that SPF 30 that's stated on the bottle.

So I don't reapply my sunscreen. I use a physical, sunscreen and I don't get burnt. Good. And I'm kind of like, I know it gets patchier throughout the day, but I'm sort of like, is that bad? No, it's not. It's a little bit of a nuanced answer, but the reality is most people, including dermatologists, do not reapply throughout the day. And if you are mostly indoors and you're not having tons of sun exposure, reapplication becomes truly less important. But if you are out with lots of UV exposure and you're not wearing a hat, I would prefer you to reapply every couple of hours because exactly, as you said, the sunscreen

breaks up on your face. You get patchy coverage. That doesn't mean it becomes completely ineffective, but it becomes less protective over time. I don't want to like dwell in the sunscreen thing too long because I feel like we all kind of know we should be using sunscreen at this point. But the thing that I always say is if you are using active that you're trying to like clear up dark spots or make your skin look younger or anything like that and you're not using sunscreen. Like what are you doing? Sunscreens is the best thing for all of those things. For all of those. things. And I always tell my patients, protect your investment. If you're getting laser procedures, if you're using actives, there are even studies that show that if you just wear sunscreen and use

no actives, it actually reduces your photo age. So it reduces. Wait, it doesn't just prevent it. No, there's reversal. How? Wait, why? There's just some protective effects that are cumulative over time. And we think it perhaps allows your skin to heal or sort of recover in between those. Because it's not like fighting off the sun. Exactly. Oh, that's so interesting. Exactly. Which is really cool. And that was only with SPF 15 products. Now, I still recommend SPF 30 or higher, but even if someone does nothing else with their skincare, but wears consistent and the right amount of sunscreen, they can do a lot for their skin. Wait, that is fascinating.

I always thought I'm like, I get it. Sunscreens protecting against this future aging, future damage, but the fact that it is letting your cells essentially regroup, repair. Amazing. I love it. Okay. What are the top things that you can do for your skin that are not just skincare? Number one is protecting from the sun in other ways.

So wide-brim hats, sun-protective clothing. I know that it's like skincare adjacent, but I think that's really important. I feel like people lean too much on like, I don't like wearing sunscreen or I don't want to have to reapply, but there's other things you can do to protect your skin from the sun that have a lot of value. And again, I'm not trying to like harp on the sun thing, but it is the number one cause of premature skin aging. So the other thing you can do is exercise, both cardiovascular training and even better resistance training have both been shown to improve the health of your skin and thicken the dermis,

which is the deep layer of your skin that gives it bounce and suppleness and just, health overall. What? Yeah. What is the mechanism there? We think it's because your skin and when your muscles contract, they produce something called myokines, which are signaling molecules that can trigger your skin to reduce inflammatory markers and produce more collagen. Wait, okay. So I have been on a workout journey. I've become a workout girly for the first time in my entire life. Probably. Probably. And now I crave it. I think I really tied it to my mental health in a very strong way this year where I was like, wow, I really sleep better. I really feel less anxious. And so now I don't miss a day. Yes. Do I look glowier? Well, actually, I do think your skin does look good. And I feel like

you're on like this sort of like upswing journey. But this is also talking about making choices for not just your skin, but for like your whole body, your mental health. Anything you're doing to support your entire body is going to be reflected in your skin. But now we just have more data to show that more clearly. So this gets us right into the first thing that I wanted to talk about, which is hormonal acne. I have read quite a bit of research about the connection between stress, speaking of mental health and acne, does stress cause acne? It can. So cortisol, which is your stress hormone, can drive oil production in the skin. And oil production is one of the core things that cause acne. We think of oil production, irregular skin cell turnover that sort of clogs the poor.

And then that leads to an accumulation of acne causing bacteria. And then you have inflammation with that. So anytime you have a cortisol spike in the body, it can lead to increased oil production, which absolutely can drive that acne process forward. Now, I would not say cortisol is the strongest hormone driver of acne, testosterone, DHT, those are the bigger ones, but it absolutely plays a part. Is this the reason potentially? I know a lot of friends where they didn't deal with acne at all in their teens or their early 20s, but now they're in their 30s and they're getting all of this acne all a sudden. Is it because we're more stressed? It's possible. That definitely is one way to think about it. also a lot of people in their 30s are becoming sort of perimenopausal as much as we don't want to

think about that being something that happens in our 30s, it can. And as you start to get those fluctuations in hormones, you get these sort of like surges and then these sort of regressions of hormone. And that absolutely can be stimulatory towards acne. So if you are getting acne all of a sudden and you're in your 30s, where should you start? What should you be looking at? I think you got to look at your skincare. Like what are you using? Are you using any new products that could be clogging your pores? So sometimes that can be a little bit hard to discern. But I usually say go back three months in your skin care and look at what you've been using. What's new? What's changed? Has anything changed in your diet as well? So although the link between diet and acne is not

fully elucidated, there are certain things that can be triggering for some people, whether that's non-fat dairy, whether that's higher glycemic index foods, even sometimes when people incorporate things like extreme intermittent fasting, it can spike your cortisol and that on its own can cause acne. So I look at your diet. I look at what you're using in your skincare, but for a lot of people, there is just a new hormonal surge that's going on or an increased hormonal sensitivity of the oil glands in your skin. At that point, I would start thinking about seeing a dermatologist just to understand if there's things you can be doing to improve it. How can we know if hormones are the underlying cause? Is it just ruling out everything else? Or they're like hormones that we're testing?

We don't typically test the hormones because for the vast majority of people who get acne, if you test a hormone panel for them, it will be totally normal. And that's because they don't have irregular hormones, but they've increased sensitivity to their hormones. So the oil glands in their skin just respond more actively or bind more strongly. And the other thing is this is not true across the board, but a lot of people, when they have quote unquote hormonal acne, which most acne is driven my hormones, to be honest, but they get a lot of like lower facial acne. So it can be on like the jaw line, the chin, even the neck area can be more indicative of a stronger hormonal trigger.

PCOS, that's a big thing with acne, right? Yes, definitely. So is the idea that kind of until you treat your PCOS, you can't just treat the acne, you need to treat the PCOS at that point? And with people who have polycystic ovarian syndrome PCOS, they have higher circulating levels of androgens. So they do actually have those increased hormones in their body. But when you're getting treated for PCOS, a lot of that will help your skin.

For example, going on birth control or spronolactone. These are medications that can be leveraged not just by dermatologists, but by endocrinologists who are helping with PCOS overall. If somebody comes to you and they have hormonal breakouts, let's say they're breaking out right before when they're on their period, what would be your Dr. Sam plan for them? It might be slightly different from person to person depending on. on what medications they might be on or what other medical problems they have. But for most people, I will make sure they are on Tretnoan,

which is a topical medication that helps regulate their skin cell turnover. So it helps unclog their pores. It's anti-inflammatory. It's also anti-aging, so most people aren't mad about that. And then I will also often talk to them about the medication, spronylactone. It's a really effective medication at reducing how your androgens interact with your oil glands. and for most women, like over 85% of women who go on that medication, they will see a reduction in their hormonal acne.

Oh, wow. Yeah, so it's very effective. And of course, like I say, for every medication, it's not for everyone and not everyone can tolerate it. But it tends to be quite well tolerated. Yeah, what are the downsides? Number one, it is a diuretic, meaning that it makes you pee out more fluid. When people be like, oh, yeah, I'm not bloated.

So this is the thing. So it was initially used for blood pressure to reduce your blood pressure by peeing out extra fluid. It also can be part of some birth control pills. but yes, it can make you lose some water weight, which is great, but also if you tend to have low blood pressure. Like if you feel fainty when you say that. Exactly. You have to make sure you're staying really hydrated on the medication.

So if you easily get dehydrated or you're not good about staying up on your water intake, that can be really important. And then some people will get breast tenderness, some people can get headaches. But it's really uncommon. I would say for every hundred people that I prescribe spronal lactone to, there's just a handful that might have an issue with it. And sometimes we just reduce the dose or we adjust how they're taking their medication and they are able to tolerate it.

And that makes a world of difference in terms of how confident they are in their skin on a day-to-day basis. So for PCOS, we know like, okay, you need to figure out a way to manage your PCOS to help this acne go away. Is that true for other hormone stuff? Like, do you need to get your perimenopause under control? Do you need to get your other hormonal fluctuations under control from an internal standpoint almost if you want the acne to go away? To some degree, but I would say that PCOS is a little bit different because it directly impacts the hormones that are most triggering to acne. So whether you have like other hormone issues, whether it's thigh. thyroid, things like that, those are less important or less well associated with acne. So it wouldn't

be something that I would necessarily do as a dermatologist. But sure, it helps to have all aspects of your health aligned when you're trying to treat any skin disorder, including acne. What do you think about blue light therapy? I'm okay with blue light therapy. I think the devices you use in an office are usually more powerful or potent than what you could do at home. But blue light kills acne causing bacteria. So anytime you're reducing at least one arm of sort of the acne-causing quad, that's going to be helpful. What do you think people get wrong when treating their acne? I think people assume that just one intervention or one modality will be completely

curative. And typically the goal with acne is to reduce the intensity and frequency of breakouts. But we can't always get someone to never break out again. And I also think that there's not always an alternative. Sometimes people come in and they say, I don't want to do antibiotics, I don't want to do birth control. I don't want to use high-strength retinoids topically. And there's only so much we can do when we have certain.

restrictions on how we can treat it. Yeah, I don't know what the right way to say this is, but I came across the stat that 62% of women have some sort of breakout around their period. And then I was like, is this something we should be treating? Like, is this a problem? Or is this just like a normal part of life and we need to normalize having some acne, looking at some acne, not having acne mean anything about you as a person or how you're perceived? Do you know what I mean? Absolutely. It's kind of a deeply stigmatizing skin condition. And I think that's why people feel so strongly that they shouldn't have it. We associate it with being a teenager. Some people associate it with poor hygiene, which it has nothing to do with hygiene. I totally understand that, but also I understand

being a grown adult and being like, hey, I'm out of my acne phase. There's no reason I should have pimples on my chin. And just being confident in your skin and what you're putting forward to the world every day, I understand why people are bothered by it. What's the Dr. Sam protocol for acne scarring? I would say it really depends on how intense someone's acne scarring is. If it's just discoloration, like redness and brown spots, a lot of people will call. acne scarring, but to me a scar is something more permanent. That pigment is transient. It will fade no matter what you do, but wearing consistent sunscreen is going to be really helpful. Because then our cells have the time and energy to repair. This is my phone back to the day. I love it. So yes, you want to

protect your skin from the sun. You also can do things to help speed up cell turnover, whether that's using your Tretanoin, which we use as an acne treatment, but also an acne scar treatment. For even ingredients like azaleic acid that speed up that skin cell turnover, that help with brown spots, that can be really helpful. But when you have true textural scarring, which is what I think of as true scarring, where you get in bad lighting and you think, not my best angle, that typically involves in office treatments. And depending on what someone's budget is, how many sessions they want to do, it kind of depends. But we usually do some combination of either microneedling or more aggressively or resurfacing. And the thing with acne scars is it can take many, many sessions to reduce them. And the goal usually

is a 50% reduction in scarring. It's not to have complete clearance, which is why I'm such a proponent of treating acne more aggressively when someone is younger or at a point in their life when their acne is more severe. And we're just starting to see scarring because I cannot tell you how many adults that come in in their 30s and 40s and they're like, why didn't I just treat my acne when I was younger? A lot of times when someone comes in and they have a lot of active breakouts, we're thinking about aggressive treatment in the beginning. And then we can taper off things. So it's sort of like a kitchen sink approach in the beginning to get the inflammation down and to just stop new breakouts, and then we can start tapering off things. So just because someone starts with maybe a more

intense routine, they don't have to stay there, but it really helps just, like, quiet everything down so that they don't get this permanent scarring that can be so stigmatizing as they get older and causes a lot of people to be unnecessarily self-conscious. Can we pop our pimples? The dermatologist in me wants to say no, but the human in me wants to say yes. I think the key, if you're going to release a pimple, is to wait until it is very, very, very, very. white at the top. So a lot of people try to pop pimples when they're red or sort of that deep cystic acne. And that's not going to pop well because you don't actually have a little pocket of pus. But if you have that like really superficial white bump with clean hands, warm compress ahead

of time, it's not my preferred thing. But I think if you're going to do it, wait until it's at that point because otherwise you're just going to give yourself a world of hurt. It is so satisfying, though. It's so satisfying. And a lot of us in dermatology will also talk about this sort of like triangle of death around the nose and the mouth area that you really shouldn't pop your pimples because bacteria can travel retrograde into the veins that communicate directly with your brain and people can get like deep infections. So anything around the nose, like those deep ones there, we generally say like, please don't touch. Wait, how often does that happen? Very, very rarely. But enough that I wouldn't pop a pimple there. I've heard that for filler too. Like it's

quite dangerous to get filler in your nose. Is that because the filler goes to your brain? That's almost. So you have vessels throughout your face, but the vessels around your nose area and that run through the center of your face can communicate directly with the blood vessels that supply oxygen to the back of your eye. So if you were to get filler, which can clog a blood vessel and stop blood flow into the vessel that supplies your eye, you could go blind, which is why it's so important that you go to a reputable injector, that they're taking all the right precautions, because these are very rare complications, but obviously completely life-altering. I had happened to a friend, not the nose, but she had, I forget, you'll probably know what it's called, it blocked her vein in her chin. Yes. And it was turning like black. And it was the most pain she had ever been in her life. And it took them like days to figure it out and then to dissolve it. And if it had gone much further, it could have been like really, really, really bad.

And then her dermatologist who ended up treating it, not the person who did initially, was like, unless they can describe in detail what's happening underneath your face, like the structure of the muscles and where the veins are and all that, like, do. not have them inject you? Absolutely. If they don't have a really sound understanding of that anatomy, there's no reason they should be blindly placing a needle or product into your face. And that is the problem here. We've gotten so casual about it too. So casual. I think because we talk about it casually, and in some ways I'm happy with that, that people are less. Like self-conscious? Yeah. And they are okay with talking about what they've had done. But I feel like it's also empowered a group of people to inject that really shouldn't be injecting people. Would you go to a non-derm? Depends. But yes, there are some that I would go to because they either do a lot of teaching, they've clearly done a lot of training.

There are great non-derm injectors, but there's less sort of structured education that happens around it. So, for example, in a couple of days, I'm going up to C. Davis to lecture the residents about how to do safe injections. We're going to do hands-on stuff. If you haven't done that in your training, how can you expect to be safe with a patient? So how can we know if we're like scrolling on Yelp or Google, how do you know that somebody is reputable and good? This is tough because one thing with your injectors, you want them to be safe. But also you want to have a good aesthetic outcome. And those are both important. I would say safety always is going to take the priority, but there's no point in having

the procedure if you're not going to be happy with how it looks as well. Number one, I would say look at their credentials to see where they trained. Are they an MD, a DO, a nurse practitioner, a physician assistant, because that gives you a little bit of an idea about their training background. You can see if they do education, if they publish in the area of aesthetics. But ultimately, I also say go to someone who a friend or family member has gone to because that also can just give you a sense of like what the vibe is. I made a whole YouTube video about how to find a good injector because I do think so many

people struggle with this. The other thing that I hear about all the time with acne is like you over-treated it and it made it worse. Like you dried out your skin, you damaged your barrier, layer, et cetera. How often do you see that as playing a part in the equation? I used to see it more because I think people would try to start too many actives at one time or they'd be given a big regimen by their dermatologist and no one really explained to them how to use this or how to start incorporating things. I feel like in my practice, I spend a lot of time

educating the patient not just on what they should be using, but how to kind of ramp up because a lot of things with acne, especially topicals, cause dryness, cause irritation. And so although they might have three things that they're getting prescribed, I don't always have them start all those things simultaneously so that they can have less irritation. Because for sure, the number one reason people's acne doesn't get better is not because they weren't prescribed the right things, but the patient wasn't able to be compliant, whether it's because the regimen was too complicated or the regimen was too irritating. So we always try to make sure it's something that the patient can actually find success with

if they do it slowly over time. Okay, we're going to move into dryness and skin barrier damage in a second. But just final thoughts on acne, if somebody was dealing with acne, what's the first thing you would sort of have them do? Would it be adding in trinineau with their sunscreen? Like, what would be to step one? The first thing I would have them do is call and make a dermatology appointment because it's going to be months before they can get into most dermatologists. So they can have that appointment

on the books. And in the meantime, they can go to a drugstore and buy a dappoline gel, which is essentially an over-the-counter retinet that helps regulate your skin cell turnover, helps with oil control, it's anti-inflammatory. And I would have someone start using that because it works for all types of acne two nights a week after washing their face and then slowly working themselves up to every other night and then nightly. because even just using that before they see a dermatologist will help start regulating everything. And then by the time you get to a dermatologist, if they want to prescribe something stronger, you've now been sort of like working towards that. Actually, I have two more questions. I lied.

One, I want to clarify trinotinoin because I talk about it online all the time and people like, wait, what is that? It's kind of like the more fancy version of retinal, right? Yes, exactly. Tretanin retinol, they're both vitamin A derivatives. Retinal in your skin needs to be converted to... retinoc acid, which is tretanoin. So retinol is sort of like a much, much weaker form of Tretnoan. And all of the studies when it comes to acne and when it comes to anti-aging are more

robust when it comes to Tretnoan. Okay. I say fancy. It's not really. It comes in like a little medical tube. It doesn't look very fancy, but it's expensive. It can be. I mean, with a coupon and buying it generic, it shouldn't be more than 50 bucks for a tube. So that's which lasts for forever. Yes, like six months. Because you are using a pea-sized amount. So it lasts for a very, very large. time. But there's also a million like retinol products on the market. What's the difference? How do we know if we should be using one of those versus using tritonoin? First of all, retinal, not good for acne. It just doesn't work enough and as potently as we need it to. So you should either be using prescription or a dappoline gel, which used to be prescription, but is also retinoric acid. It's the active

molecule. It's just a third generation retinoid instead of trinone, which is a first generation retinoid, but they're essentially working on the same receptors and as directly as either one. And then retinol, is that good for aging? Yes. So retinol can be good for aging. So it's not quite potent enough to have consistent effects on acne but can help with fine lines, collagen production. But if someone was tolerating retinol really well, there's more data to support that using

Tretnawan regularly will offer more benefits in the skin. Yeah, this is always my question. Like, why would anybody buy, especially there's ones over the counter that are like $200? I'm like, why are we buying this when we could get the prescription tube of the stuff that is actually more potent. Yes. So one, not everyone has access to prescriptions, but more so I would say there are a subset of people who just can't tolerate Tretanoan. Like no matter how they layer it or how slowly they try to introduce it, it will just always cause irritation in their skin. And those are the cases where I would say investing in a good retinol that's sort of tailored for sensitive skin can be valuable,

but that's kind of the only exception. And can I share a Dr. Sam fact that I share with a lot of people and you can tell me if I'm completely misrepresenting you. Okay, so I heard from you that stronger tritanoan does not necessarily get you better results. So if you're doing like, I'm so bad of the math, I think it's like 0.05, you can drop down to 0.025 and get the same results with less irritation. Like there's no, we have this idea societally that like more is better and try, but like the results aren't actually better. The irritation is just more. Yes. When you're looking at photo aging, so fine lines, wrinkles, hyperpigmentation. 0.025 Tretnoan has been shown to be as effective as 0.1% Tretnoan. When it comes to acne, the strong.

stronger or higher strengths can be better if you can tolerate them. But there's no reason you should be suffering with 0.05 Tretanoan when you could be using 0.025. When people are trying to like work through the Tretanoan uglies and they're like two weeks of skin peeling, I'm like drop it down, like drop it down. Oh, I have so many people who come in and in their consultation, I can see their skin is like visibly peeling off. And I'm like, let me guess. You're using Tretnoan. They're like, yes, how can you tell? And then I ask what strength they're using and they're using like 0.1, which is so potent, unless you have really resilient or sometimes very oily skin, 0.1% is just going to be overpowering.

Okay. And then my second acne thing that I wanted to get into before we move on to dryness and barrier stuff is how much of this is about pores? Like, do we need to be like taking our black heads out, unclogging our pores? How much do pores play a role in acne? When it comes to acne, it's not about the pore.

It's about what's going on inside the pore. And for people who are prone to acne, they're getting too much oil production or the cells that are turning over inside the pore are stickier. And so they're a better environment for bacteria and inflammation to build up. So we are thinking about clearing out the pores

with either regular use of topicals like Tretnoan or oral medications, and that can help regulate that. So you don't have to regularly be clearing out your pores. It's better to just be on a topical that helps regulate the way the skin cells in your pores turnover. What do we think about like extractions and the masks that you rip off

and you see your little black things from your pores? So those can be helpful for like a very temporary improvement. I find that if you're getting extraction, but you're not on a regular skin care regimen to normalize that skin cell turnover. It's a bit of a waste of time. That's like a very fleeting improvement. There are cases where extractions are indicated when someone has like a very clogged pore or I can see that the skin has sort of like closed up over the pore.

There's a low chance that that's going to clear on its own and an extraction can be helpful. But I feel like extractions are generally overdone and not always needed. And then the little pore strips and stuff, that's like fun. But there's some concern that you're causing physical trauma to the pores, which can stretch them out more in the long run. So I'm not the biggest fan. I'm not completely anti, but I wouldn't use one. Like you don't need to go to a facialist once a month to get extractions.

Generally, no, don't hate me facials. But I feel like facials to me usually are something that like make you feel good, but they're not going to lead to. It's like a massage. For some people, they can be truly therapeutic and sort of like life changing and a really important part of their regimen. And I don't want to say that they're horrible. But I feel like it's more just like a feel good thing and something that keeps you accountable. Yeah, I feel like I don't want to pay. $150, $200, $200 to have something like rub products on my face.

Yes, everyone's different. But I feel like you could take the several hundred dollars that you invest in a facialist and get laser treatment one to two times a year and do so much more for your skin overall. But not everyone will agree with me on that and I respect that. Did you know that the average half life of caffeine is five hours? Meaning if you drink a coffee or match at 3 p.m., you still have half of that caffeine in your system five hours later when you try to go to bed, which delays your melatonin release and it makes it harder to fall asleep and get deep sleep. But I also get slumpy in the afternoon, which is why it's a

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Go to drinkag1.com slash Liz Moody. I very rarely get genuinely excited about skincare, but this is one of the most innovative products that I have come across in years, and I'm so obsessed with it. I've been telling all of my friends to get it, so now I need to tell you guys. Here's some science first. Your skin isn't just getting older. It's being actively broken down by something called senescent cells. These are cells that have stopped functioning but refuse to die.

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mine with moisturizers. I hate that like sticky feeling when you go to put your clothes on. This does not do that. But it does moisturize really, really well. And then again, I'm reducing my skin's biological age. I am not making it just look younger. I am making it actually younger. OneSkin has four peer-reviewed clinical studies and over 10,000 five-star reviews. The data backs everything up. For a limited time, get 15% off with code Liz at oneskin.c.co slash Liz. Again, that's 15% off at oneskin.co with code Liz. You guys ask me constantly if the hype around red light is real. And the answer is yes, but with one huge caveat. Most of the devices on the market

aren't actually powerful enough to make a difference. But if you get one that is, it can transform your skin, your pain, your energy, your hair, even your mood. I know it sounds too good to be true. So here's the science in the nuttiest of nutshell. Red light targets your mitochondria, the powerhouses of your cells,

giving them more energy to repair, regenerate, and function better. That's why you get the local benefits wherever you're using the red light, so you get less knee pain or cramps or better skin or thicker hair. but also because you are helping your mitochondria, you get general benefits like more energy and less anxiety. There are literally thousands of studies spanning everything from faster recovery

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It is a lightweight portable panel. You can hold it in your hand. So you can use it for your face. You can use it for your scalp. You can use it anywhere that you need it. It's really easy to travel with, which is so nice. I love putting it on my head for headaches. and it is a god send for cramps. And of course, I use it every single day on my skin.

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Loombox may qualify as a medical expense through TrueMed and qualified customers save about 30% on average. You can head to trumed.com slash loombox to check your eligibility before you buy. TrueMed is for qualified customers. HSA, FSA tax savings vary. Again, though, go to the loombox.com slash Liz for that 40% off. When people talk about having glass skin, Are they essentially talking about reducing the appearance of their pores?

Yes, pores and texture overall. But usually glass skin is just highly reflective of light. So the pores, you don't have these undulations or these microscopic texture in the skin that prevents light from bouncing off of it well. So yes, glass skin is mostly genetic, whether you have big pores or not. But there are certain ingredients that can help tighten up your pores temporarily, like, nice into mine. Do you think I have big pores? I had a 12-year-old tell me once that I had really big pores. That's rough.

That was, I think, like 15 years ago. And I've thought about it often. Well, the kids just are the worst. I would say that you have average-sized pores. Like, there are people who have much bigger pores than you, and there are people who have more refined pores. I feel like you have a special camera in my office that, like, looks at your pores and tells you sort of where you, like, rank against the general population.

And it does tell me that my pores are on the smaller side. So that's important when you're seeing these people on social media and they're like, look at my poreless skin. A lot of that is genetic. Most of that is genetic. And it's really hard when you see someone who's like 15, 18, 20 coming in. with this beautiful glass skin. They also have so much collagen, that sort of structural protein in the skin that's squeezing on their pores and keeping it nice and tight. Everyone's pores get bigger

as they get older because their collagen breaks down and everything sort of like widens out. But yes, all of that is genetic. And I definitely have people who come into my office who have the most beautiful glass skin and they're doing nothing for it. They're just blessed. But you also said niacinamide. Yeah. So if I want to get closer to glass skin, is that the product I should be looking at the ingredient I should be looking at? Yes. I mean, niacinamide. is one of them. Now, niacinamide is included in a lot of skincare. So, like, a lot of sunscreens, a lot of moisturizers, a lot of serums already have niacinamide in them. So you don't necessarily need a separate niacinamide step. But if I have a patient who's really oily, who has very prominent

pores, I often will recommend a separate niacinamide step at a higher concentration, like 10 to 15%, which is really high. But if they don't get irritated from it, it really can reduce the appearance of their pores when they use it consistently. Is it okay to use trinone and niacinamide? Yes, nicinamide is nice because it basically plays nice. with everything. Now, like all ingredients, not everyone's skin is going to get along with that ingredient, but if it does, it can be leveraged well. If you're going to look at one ingredient to try to, like, look more poreless, more textureless, that's it? I would say my order of that would be like retinol or some type of retinoid for sure. But yes, that can really help. And then also just thinking about

skin cell turnover, because sometimes the glass skin is also due to the fact that there's not a lot of buildup of dead skin cells on the surface. And so exfoliating acids like glycolic acid, lactic acid, mandelic acid, these are all things that also help with that skin cell turnover and can make things just look smooth and reflective. Are there in-office treatments that help with that? Oh, yeah. Like, what's the best one? If I was just like, I want that like porous, texture-free look. I would say for your age and stage of life, like a fraxil laser, so a non-oblative but fairly aggressive laser to sort of tighten things up and sort of remove that surface dead skin cell layer would be appropriate.

Is a fraxil laser the same thing as a CO2 laser? Is that different? Fraxel is a brand of laser. And a lot of people when they're talking about Fraxel, including myself, we're talking about the Fraxel dual laser, which is a non-oblative laser that is essentially heating columns of skin and then you extrude those columns of skin and everything tightens and smooths around it. Fraxel does have a CO2 version of their laser, but there are lots of other brands of CO2 laser. And that is an ablative laser, meaning that instead of heating columns of skin, it is truly vaporizing columns of skin. Is that why people look like, people look so scary. online after they do. I feel like CO2 lasers are having like a moment online and everybody's saying it's the single best treatment you can get for your skin, but then people look so scary after and it's really scared. I'm like I want to try it and I'm terrified. Yes, it's really intense. So always with cosmetics, it's usually like more downtime, more intensity is more impact per treatment. It's also more cost and

risk per treatment. But CO2 does have that really intense downtime and you can have bleeding, oozing. You've got to be on antiviral medication, sometimes antibiotics. And it's like a true solid week or more of downtime. So it's a very intense treatment. We often refer to it as laser surgery. Yeah, I was going to say it feels more like that's surgery. Yeah, in my office, we do like a pre-op visit. They get a little bit of sedation. It's a big deal. Can they drive home? Generally no, because they've been, they've taken like a little zanny or something. Do you agree that it's like the most effective thing you can do, though? Yes. I do. But I feel like sometimes people assume that because they had a CO2 laser and because they're going through the downtime and they paid these many thousands of

dollars, which is usually what a CO2 costs, that they're going to have complete erasing of all the aging that their skin has done. And even though it's the most powerful, that doesn't mean that it's all treating. How long does it last? Usually four to six years is like a good CO2 result. It's really intense, but I feel like it's worth it for a lot of people. It really is about expectation management because a lot of people are seeing a lot of CO2s done online on younger patients. And so they're expecting their skin to look like a younger patient skin when they're done and that doesn't always happen. Have you had one? No. When would you decide to get one and why? I would have a CO2 done once the crepiness under my eyes starts to really bug me once I have a full 10 days where I don't have to go

to work. But there are real risks that come with a CO2 like infections, like scarring, like prolonged redness. And so someone has to really understand that that is a possibility, although rare and why you should be treated by an expert. Are you in pain the whole 10 days? No, it's not actually uncomfortable. You're really well numbed for the procedure and you feel kind of tight and itchy is the biggest thing that people complain about when they're healing is like all the little nerves are sort of like coming back to life. You have a lot of dry skin that you're managing. We have you do vinegar soaks every couple of hours for the first few days. You're covered in aquifor. So by the end, people are just really not happy with the fact that they're so greasy.

And then your skin continues to get better for about six months after the procedure. So you'll have some immediate visible results, but then it continues for a while. We're going to get into this more later when we talk about aging. But at a certain point, I'm like, why? Why? Like, literally, wouldn't it be easier if we just societally accepted that we will look older as we get older and that's okay? Absolutely. I feel a lot of internal conflict about this because I want people to feel confident in their own skin.

But we also live in a society where people are heavily judged by their appearance. I know. That's where we all have to like get together. I know. It's a collective action problem. have to decide together. But like I'm just like the amount of like time and energy and money we could get back. If we all grouped up and we just said, no, it's cool.

Like you're like, crepiness is fine. Oh. Like those are all super cool things. I would love that for hair. I would love that for all of us to get together and be like we don't wear makeup anymore. I mean, there are so many plates. We don't do thongs. So many things could be.

Thongs are like, things are like literally like I'm going to take something and rub it on my butt hole. Which doesn't feel sanitary. My four-year-old son saw one on the four. floor of our room recently. And he goes, when do I wear that underwear? I want to get into dryness and skin barrier damage. Can you explain in the simplest terms what our skin barrier is and how we can know if it's damaged? Your skin barrier is the outermost layer of your skin. It's called the stratum corneum. It's the dead skin cells that are built up on the skin surface. And right below that, you have

the epidermis, which is sort of the top layer of living skin cells. And when you have a damaged skin barrier, that stratum corneum has cracks in it and environmental allergens or irritants are able to get in and water is able to get out. We call that transepidermal water loss or tool. Like it's evaporating out? Yes, it's evaporating out. So we are constantly in this state of trying to get water into our skin and water is constantly trying to get out of our skin. And if you have a damaged skin barrier that's happening at a more rapid rate and that can lead to inflammation in the skin, which can lead to redness, premature skin aging, et cetera. So how do we know if this is happening to us? How do we know if our redness is because our skin barrier is damage or dryness is because our skin barrier is damage versus some other factor?

I think the easiest way to know if your skin barrier is damaged is when you feel any type of stinging, burning, or discomfort when you apply a regular kind of bland moisturizer. If you're using a product that doesn't have actives in it, like vitamin C or acids and you're still having stinging when you apply it, that is a really good indicator that your barrier is not fully intact. Okay, so what do we do if our barrier is not intact? The first thing I have people do is look at their skincare regimen and take out anything that isn't an essential, which is essentially you're going to do cleanser, moisturizer, sunscreen. Everything else you just put on pause. And you're basically going to use those really consistently until your skin feels better again. And you can do things

to support your skin barrier like using a really occlusive ointment, like aquifer or even basaline. A lot of people are nervous to use those types of thicker ointments on their skin, but they can be incredibly helpful with repairing your skin barrier. It's why we have people use it after a CO2 laser, for example, because it really prevents that transepidermal water loss, and it kind of is a comfort to your skin. But you need to put that over moisturizer, right? Because it's not going to moisturize unto itself. It actually is. Or it is. Yeah, it's independent. There's a huge misconception that, like, Vaseline and Aquafor aren't moisturizers. They are. They are not the most optimal moisturizers. So you could use cream style moisturizer. Is it actually moisturizing,

though? Is it like just, I mean, maybe this doesn't even matter. But like, if your skin's always trying to lose water and it's sealing that water in so it can't get out, is it providing more moisters or just keeping the moisture from leaving? None of the moisturizers really work by providing more moisture. They are really all working by preventing that transepidermal water loss. Moistrizers also help draw water to the skin surface. Those are humectins within a moisturizer. Which is like hyaloronic acid. Hylaronic acid, polyglutamic acid, glycerin are all great humectins. And then there's amolions, which is another category of ingredients within moisturizers like seramides that helps smooth the skin. And so like a great moisturizer should have humectins

to draw water, emolents to smooth, and then occlusives to seal. If our skin is super, super dry, should we be looking for a better moisturizer? Should we be looking to repair our skin barrier? Should we be doing something else entirely? I would say both. I think looking at your environment, so if you live in a more arid or dry climate, we have lots of people who struggle with dryness here in California. So doing things like adding a humidifier.

Girl, I'm like California. Go to Colorado. Yeah, that's true. I did my intern year in Colorado. And there's actually something called Colorado Face because it's so dry there and you live at such a high altitude that there's so much sun and wind damage that it's a very premature sort of weathering of the skin that happens when you live in Colorado. Okay, so sure, the California babies can listen to this, but let's say you're in Colorado

or you're in New York in the winter. I'm sorry, I just, I've lived in these other places. So I'm like, California is balmy. Yeah, fair enough. We live a nice life out here. It's pretty good. But if you live in one of these other places, what can you do to prevent that? One is using a moisturizer really consistently.

So I feel like one of the biggest issues I see with people and skin care is they don't use it very consistently or they don't use one product very consistently. We're constantly bombarded with newness and you're constantly kind of trading things out. And so finding a moisturizer that feels good on your skin that when you sort of think about your skin 15 minutes after you've put it on, you can still sense that the moisturizer is there. I call that having presence. And I like a moisturizer that has presence on the skin and doesn't sort of disappear, which could be good if you're oily, but is generally not good if you have dry skin. And then if you still feel dry after that, I really like a hydrating serum. So something that either has hylornic acid,

polyglutamic acid that you're layering underneath your moisturizer to help draw more water to the skin surface. And it also gives like an instant plumping effect to the skin. There's not a lot in skincare that gives you that instant gratification. Is it drawing it from the air? It can draw it either from the air or from the deeper layers of the skin. So humectins draw from both directions. Yeah. That's how it gets. You know, you drink the water. It goes through all their organs. It makes its way out. Wait, okay. So how much is dehydration showing up in my skin? Oh, dehydration can make your skin look horrible. Yes. There's a bit of a myth like, oh, if you drink a ton of water, your skin's going to look so much better. Yeah, that's what every Hollywood actress does, right?

Just a gallon of water a day. They just drink so much water and that's why they look so beautiful. Nailed it. But it really is about preventing dehydration. Because when you're dehydrated, your cells are sort of like shriveled down. I think of it like taking your skin from a grape to a raisin. And we really want our skin cells to be at grape status. I'm going to go through some things, rapid fire. And you're going to tell me if they're damaging my skin barrier layer and what I should do instead. Okay. Physical exfoliation. technically is damaging your barrier, but in a controlled way. So it really just depends on how aggressively you're rubbing, how often you're doing something like that. So I love a physical exfoliant

maybe once a week to just sort of like buff things out, but don't need to be using that every day. And so that to be clear something with like the little beads or something where you actually feel texture on your skin. And I didn't realize this counted as physical exfoliation, but a washcloth. Oh, totally. Yeah. Or even like rubbing with a towel, that is physically exfoliating. Oh yeah. When I see some people like drying their face off after doing a skincare routine and they're like scrubbing at their face. That is deep exfoliation and can be very irritating. So limit, yeah, pat it in. Okay, chemical exfoliation. Also intentionally sort of damaging the skin barrier. Now, if you have a excess buildup of dead skin cells, that's what a chemical exfoliant is really meant for. But there are people

who will reach sort of the optimal dead skin cell layer on the top of their skin, and then they will continue to exfoliate. And then you start breaking down the deeper layers of the skin, which is not helpful. So if you're using a chemical exfoliant, it really depends on what strength and how frequently you're using it. But yes, you absolutely can wreck your skin barrier if you over exfoliate physically or chemically. And does retinol or tritanoin count as a chemical exfoliant because it's doing the cell turnover thing? It's not technically put in that category, but it has a similar effect with that skin cell turnover. So if we're doing that, would we not want to also do like an acid type thing? Often not, although I will say some people like a chemical exfoliant because it just gives an extra boost and that really sort of glass.

skin we were talking about earlier. So I have a lot of patients who will do a retinoid five to six nights a week and then have one exfoliation night. But I don't usually have the same night. Yeah, I wouldn't. Okay. Layering active ingredients, which ones together would damage our skin barrier layer? I think if you're doing tritnoan or a retinoid with acids at the same time, not ideal, that's the biggest one. Everything else, it's really about what your skin can handle. There are lots of people who can do some physical exfoliation in the morning and do a trotenoin at night. and be just fine. There are people who, if they put vitamin C on in the morning

and they use Tretano and at night, that's too irritating. So it's really about listening to your skin. And if you're having stinging or irritation, the thing I would say is to prioritize the retinoid. It is the most powerful thing in your routine and does the heaviest of lifting. So I wouldn't sacrifice nights of that to use other types of actives in your routine.

Why do you use physical exfoliators? Like, what's better about it versus chemical? They're not better. It's just... Is it fun? Yeah, it can be fun. It can feel good. You get that like sort of immediate,

satisfaction. So I like it just for the experiential aspect of it. But it's like I've like heard that it rips up your skin more than like chemicals. I don't know more like gently dissolving. Yeah. Right. And people talk about physical exfoliation causing micro tears. And I think like the same thing like ruined it for everybody else. Yeah. Maybe not with like apricot kernels. Yes. But I do think that physical exfoliation can be helpful for some people. And there's lots of people who don't like chemical exfoliation because it can sting or feel irritating on their skin or for people who have rosacea, they might find that chemical exfolients are just too much. And some very gentle physical would be fine for them. And then harsh cleansers is my last thing. Is that damaging my skin barrier layer? And how do I know if my cleanser is harsh? Any cleanser that you're probably

using or like buying at the drugstore or from your dermatologist or esthetician nowadays is probably not going to be too harsh as long as it doesn't have a ton of acids in it. They're called sindets or synthetic detergents. They're different than like old school. soaps that were super basic. I mean, like, acid versus base. And those used to really disrupt the lipids in your skin barrier. But now the cleansers that we use generally don't tend to be too harsh. Is there anything else that you feel like we get wrong about the skin barrier or that you want people to understand about it? I feel like it is just this thing that's like, it's become such a hot topic online that there's so much misinformation about it. Absolutely. I think the other thing

to understand is that it takes a solid four to six weeks for your skin barrier to repair. So sometimes people will go, okay, change my routine. I use moisturizer for a couple. of weeks and that didn't do it. And sometimes that won't do it. You need more time for your skin to recover and you have to really respect what your barrier is doing. All of these active and other things you're trying to do for your skin are really not going to serve you well if your skin barrier is in a constant state of being dysregulated or inflamed. You also kind of disrupt the natural microbiome of your skin when your barrier is disrupted. And so there's more data coming out on that, but also really important to think about maintaining. That's interesting. Okay. Next up is aging.

We've already sort of discussed some of my complicated thoughts on aging. We're going to get together our quorum. And just decide we're doing it. We're aging, baby. We're doing it. I mean, especially because of the differences between, like, I think men are having more pressure now than they've maybe historically had. Men are getting plastic surgery in ways that they haven't historically, stuff like that. But because there still is such a difference there, it does feel like, let's distract the women so we can maintain power in a way.

You know what I mean? I just think of like the hour that it takes for us to get ready sometimes to go out. If we had that extra hour every day. Or this. I think out constantly, I am performing beauty so that people will listen to my messages more. Yes. And the men are rolling out of bed. They're putting on their black t-shirt.

They're not touching their little buzz cut of hair. And then they just go on camera, you know? It's an unfortunate place to be. It's why I think what I do is so valuable to people, but also I feel conflicted about it. It's holding both in your mind at the same time, for me at least. It's holding this like, I think we should make changes. I think we should have these conversations. And it's okay for me to acknowledge that I live inside this system.

I don't need to self-flageulate about feeling that I need to perform beauty within a system that rewards beauty. Absolutely. It's a little bit of like, don't hate the player, hate the game. Yeah. That's a much more concise way. Like, I don't need to self-flage. I don't know you were saying it. Okay.

So when we say I look older, what are we actually perceiving? It will depend on each person. A lot of what we're noticing is the shape of our face. So generally noticing that we call it this like inverted triangle of youth, where we usually have more volume towards the top of our face and the temples, and it sort of tapers down. And as we age, that triangle inverts where you get more heaviness and sagging in the lower face and around the jawline.

So a lot of it is just the shape of the face and where the tissues sit on the face. Next is things like discoloration, whether it's brown spots or redness, and unevenness of skin tone automatically makes people, clock you as looking older. And then fine lines and wrinkles, but I actually think fine lines and wrinkles contribute less to it than general facial shape and discoloration, at least based on what the study show. That's so interesting because I feel like if you ask the average person on the street, they'd be like, more wrinkles equals older. For sure. But when you look at studies where people are given faces to look at and they have to decide how old that person is, the number one predictors

are things like how long someone's upper lip is because that descent of the upper lip or the lengthening between the base of the nose and the upper lip. It's like a dead giveaway and they care less about like wrinkles on the forehead. Wait, so I don't love that because I feel like that means there's not as much skincare-wise you can do to reduce the perception of aging. This is the toughest thing, and I actually think that's why facelifts are on such an uprise right now is because a lot of people are realizing I need to surgically lift or reduce this laxity in the skin, and you can't do that with skincare and you can't do that with non-invasive things. There's still a ton you can do to make your skin look more youthful and to feel better. But ultimately, sometimes people are hoping for

changes that are really only achievable through surgical interventions. And that's a reality that I have to review with my patients all the time. I'm not going to ask you to comment on any individual people, but in general, when the internet is speculating about whether or not people have had a facelift, is the answer probably yes? Yes. Usually it is. I think it's really hard because people hold themselves to the standard of celebrities, and they're hoping to have that level of improvement when these celebrities have had multi-hundred thousand dollar facelifts. Sometimes it's not a full facelift, but they've had eyelid surgery, they've had a brow lift, they've had a slight reduction in their nasal tip, they've had a little bit of lip filler, and all of those things together

can read as a facelift if they didn't have like a full facelift, but most of them have had a facelift. Even like younger. Yeah, like, yeah, late 30s, early 40s, really common. And the reason that's becoming more common is because it's less of a shift. It still leaves you in the like, did she, didn't she kind of thing. Whereas if you have someone like Chris Jenner, who's been very forthcoming about her facelift, she obviously had like a massive visible improvement. And when you do it when you're younger, it's like, oh, is she just wearing like a super tight ponytail and got a new makeup artist? If somebody gets a facelift in their 30s or 40s, are they probably going to need to get, is it like getting breast implants or if do you like get them changed out every 10 to 15 years?

Generally, a good facelift will last you depending on your tissue and what was used like eight to 15 years. It really kind of depends. And need is a bit of a generous word. But yes, if you have a facelift when you're in your early 40s, there's a good chance that by the time you're in your 60s, you're going to potentially want another one because it doesn't stop you from aging. It just sort of like resets the clock. But if it resets a clock, so like if when you're 40, you reset to 30, then when you're 50, do you look 40? When you're 60, it doesn't, it, the clock is reset forever. And it's not necessarily linear. And, you know, your aging really does speed up quite a bit as you get older. But yes, I have patients who got facelifts 30 years ago and they've never done a

facelift since, but they still look much more pulled back. Their jaw lines are much sharper. Their neck is much more refined than my patients who are the same age that never had that surgery done. How scary is that surgery? Like, is it super painful? I've seen like the blood drains that that come out of your, that freaks me out a lot. It's a big deal. I feel like a facelift is very casually talked about, but it's a really big deal. I mean, you want to put under general anesthesia. So you always have to think about the risks of being under general anesthesia. You're cutting near facial nerves, vasculature. I mean, it's very common to have prolonged numbness on the sides of your face and on your forehead for years after a facelift. So I don't say that to make people

scared of them, but just to understand that there's true risk. It's deep surgery. And I would say most surgeons will quote you at about like three weeks of recovery to become restaurant ready. But that doesn't mean you feel fully recovered at that point. You just might be able to go out and hide your scars and feel like you can reenter society successfully. So barring facelifts and barring your really bummer news that it's like not our skin making us look older. What are the three biggest needle movers when it comes to reducing visible signs of aging? A solid resurfacing procedure to remove discoloration and even out the skin tone. So depending on how much discoloration someone has, that can be something like IPL or intense pulse light, also marketed as BBL or broadband light or a fraxal laser to kind of do that. And how many times you need to

do this or with what regularity really depends on how much cumulative damage you have at that point and what your goals are. Well, and you told me, so we did an IPL and I was like, is this going to get rid of my brown spots forever? And you were like, no, because they, I don't know, what did you say? Well, essentially, like, your skin essentially has memory. So the damage, the DNA damage that you incurred when you were younger still sits in sort of the basal layer or the deep layers of your skin, that damage can continue to replicate and resurface over time. That's so annoying. It's somewhat of a temporary thing, but it's not completely temporary.

Like if someone does a series of IPL treatments, if you look at them in five years versus you look at their face if they had never done anything, it's still significantly better. But for a lot of these things, we are doing some degree of maintenance with any laser just to ensure that things stay where someone wants them to be. Okay. So that's needle mover one. Yes. I will say Botox is really helpful.

To me, that is the most easy way to see, like, not improved to improve. Like, you smooth outlines, you can do things like lift brows. I do a lot of facial balancing where we do it in the jaw line, in the neck, and around the mouth to just sort of reproportion. And some of that's for aging. And some of that is for beautification. And beautification, that's a tough word to say because I feel like some, it's a standard of beauty that we're trying to reach with that.

But I can do it to make someone more symmetrical or to just sort of enhance things that sometimes we can't enhance other ways. There's been an entire like no Botox movement online. There's been influencers who have been pretty public about having negative reactions to Botox. What do you think about when you hear about those things? I think that that's totally valid. They're allowed to say those things. And even though that type of complication from Botox is exceedingly rare, I mean,

millions and millions of people get Botox throughout the world. And it's one of the most well-studied drugs that exists. And we can use it for things like anti-aging, but they can also be used for bladder spasms and overly sweaty people. Or my friend has that vocal thing that RFK has. Yes. And he gets Botox in his vocal cords. Yeah, to relax the vocal cords.

It has so many uses. And when you're using it, aesthetically, you're using it at such low doses compared to when it's used medically. It is safe. But that doesn't mean that some people can't have an adverse effect. But I've never had a patient have an adverse effect. And I know that's just my experience. But that's thousands and thousands of patients over a decade. The best hypothesis I've been able to find online is that essentially,

your body's at this like tipping place and the Botox kind of like tips you and then you have a reaction. So maybe you're fighting off a long-term virus or your body is not really in this state of health. And so this thing like tips you over. Do you think there's any validity to that? I do think there is some to say that you're sort of on like the precipice of something going awry. And sometimes it's hard to understand did the Botox tip you over or were you heading in that direction anyway. But it's often, I will say if I've had a patient come in and say I don't do Botox because they've had a bad reaction, which is rare but happens. They use. They use. You usually do have some type of autoimmune condition or an inflammatory condition, and that often aligns. We know that Botox wears off after a number of weeks or months or whatever. When it's wearing off, everybody like online is like, Botox is a toxin. Like if you put a drop of this in the drinking water, we would all die. Like, is it wearing off by going through your body being processed by your liver in some way and then exiting in a way that you're kind of like low-grade poisoning your body with this toxin?

Your Botox does bind at this junction between your muscles and your nerves, and that's where it enacts its force. And then your body, over time, will slowly break down that Botox protein into little chunks called amino acids, just like fragments that no longer have that activity. And then you naturally clear them through generally your kidneys. Wait, so this thing that would have been poison was technically like you could put a drop of it in our water supply and we'd all die. Yes. Gets broken down into amino acids, like what we had got in our protein powder? Basically, I mean, different amino acid composition, but yes, it's just a protein. And when you break a protein into tiny chains, it doesn't do what it used to do anymore. So is it taxing your liver in any way, shape, or form to process the Botox through your body?

None, because at that point, it's already been sort of broken down at the site. And so it's already pre-processed and then goes through your kidneys. Okay. Wait, that was number two. What thing number three? I think a little bit of a biostimulatory filler can go a really long way. So that's different than hyluronic acid-based fill. which add shape and structure to your skin or to your face like voluma or rostolin or juvaderm, these are things people have heard. But something like Sculptra, which uses poly-allactic acid to stimulate collagen production in the skin, can be a really nice way to, in my opinion, more naturally, in some cases, make the face look more youthful without having to do anything that's like a big lift.

I think I'm just going to become like an old lady with good skin. I think that's what I'm going to aim for. I actually love that look and I actually think it looks really good. I always tell my patients, it is better. to look old than weird. And there are a lot of people out there who their age is kind of up for interpretation, but you know that they don't look fully human. And that's not a good look. Yeah. And I think that really comes from picking the wrong intervention. A lot of people get overfilled. So they try to use fillers to lift their face. And it's a gel. It's not very good at

holding your features in place. And instead of having surgery, which is really the way you need to reduce lax tissue and put things back where they used to be, if you use fillers or you try to use the wrong interventions, it's just going to inflate the face without making it look more youthful. Or some of the surgeries are making people look kind of weird these days. Oh, absolutely. Essentially, I'm thinking about there's been a few men who've gotten, what's it called, bleph.

Oh, upper blest. Yeah. Which is you take, I believe, a little bit of upper skin. Yeah, like a crescent skin. I had a person tell me I needed this. It's fun. But like you take a little crescent of skin and you like get rid of that. But it makes them look kind of weird.

Oh, it can really change the look of your eye. It can make you look more hollow. can make the eyes look more severe. So surgery isn't a perfect solution and you absolutely need to be going to a good surgeon who's going to be conservative, but there's plenty of risk that comes with that as well. And so I always tell people it's better to make the right decision than the easy decision. And a lot of people want to take the easy way out by doing some like non-invasive things for their skin. And when it comes to resurfacing and Botox and stuff, that can be great. But if they really have a loose skin problem where they're in my office and they're holding the sides of their face

and they're pulling things back up or they're looking at their under eyes and they don't like it, that is almost always a surgical intervention. And it's okay to not have a surgical intervention, but you also then have to be okay with not fixing that aspect of your appearance. Like, don't be spending hundreds and thousands of dollars in products and being like, this is going to fix this thing. I think eye cream is like the perfect example of that. Like a good eye cream can be helpful, but it's not going to change the deep anatomy around your eye. And so many people are disappointed in their eye cream. And that's because that was a surgical job. Can it be helpful? I think eye creams are kind of bullshit.

Yeah, someone who's consulted for a lot of skincare companies over the years. Sometimes eye cream is just repackaged moisturizer for sure. But there are some eye creams that have like some special ingredients. And usually they have, they have like a better ingredient story, like a couple extra peptides or caffeine or some other things that can help tighten the skin or help with depuffing to a degree. Yeah. To me, an eye cream is not an essential. But for some people, I think it's nice because it makes them focus on that area and treating that skin. But you can bring most skincare up under your eye, right? Oh, yeah, for sure. And I think if you do that, like the role of eye cream then is diminishing returns. Can you bring Tret up under your eyes, or is that scary, dangerous? It can be helpful.

Not everyone's going to be able to tolerate it under their eyes because it's just really thin, sensitive skin. The other thing that Tretnoan can do is it can cause the oil glands that sit on the eyelid margin to die off permanently and lead to something called Mobomian gland dysfunction. Okay, so just don't do that. I wouldn't. I try to keep it outside my orbital bone. There are some people who have no issue with it, but it's something where I would just prefer to use really good sun protection in that area and understand that that area is going to age faster no matter what because it's the thinness skin on your body. This episode is brought to you by IQ Bar, our exclusive snack sponsor. One of the easiest micro habits to change your diet is to stop giving yourself the

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You can just make an appointment online and the clinicians are so good. I'm often really frustrated when I meet with doctors in real life because I have access to these amazing people on the podcast. And then when I meet people in real life, I'm like, oh, that's actually outdated information or new research shows this. And I'm like that really annoying patient that everybody hates. But every single person that I have talked to at MIDI is up to date on the most recent information, the information that the biggest experts in the world are sharing on

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And then what is one thing you wish everybody understood about aging better? I think one of the best things you can do is like an in-office resurfacing procedure once a year, like a fraxil, like a like an IPL, like microneedling, something that goes deeper than skin care to really... But we don't have to do CO2. You don't have to do CO2. And if you are someone who's in your 20s or 30s and you're starting regular microneedling or IPL or a fraxil once a year now, the chance that you want a CO2 later in life is really low. You can very much protect against those changes.

The people who I do CO2 on now didn't wear sunscreen when they were younger. Sometimes it's their first foray into resurfacing. So there's a lot that can be done to essentially collagen bank and help build things up. What's one thing that you wish people understood about aging? I think having a realistic expectation of what's possible with skin care with in-office interventions is really important. I think because we see so much on social media and people sort of broadcasting their aging journey, we expect that we are going to age exactly like our peers.

And you're different than your friend or even your sister. And you're not going to age the same way. And you have to accept that to some degree. I know it's so annoying because I don't feel that celebrities owe us an explanation of what they're doing in their private time, including things like surgery. And I hate the idea that people are spending so much money, so much time and essentially like thinking something's wrong with them, that they're not getting these types of results. Yeah, I don't think they owe us anything. But I do think that if you are selling other products and sort of suggesting that these are the things that

give you the benefit, that's where it becomes sort of tricky. Murky. Okay, the last thing that I want to get into is hair thinning and hair loss. To start off, I found it fascinating that this is something that you're trained in. I think when a lot of people experience hair thinning and hair loss, they don't know that there's a doctor trained in that. They don't know who to go to. And the fact that that was part of dermatology training was surprising to me. Yes, dermatology is hair, skin, and nails. And depending on where you trained, how much hair training you get can differ. But it was a huge part of my training. Every single week, we had a hair clinic. The only people in that clinic were people who are suffering from various types of hair loss. And I learned a lot. It's actually a really hard

clinic because hair loss is so emotional and so to have every patient so deeply affected, more so than when I would tell people you have skin cancer or any other thing about their skin, hair loss brings up a lot of emotions in people. Are more people losing their hair these days? Are we just more aware of it? There's probably a little bit of both going on. We certainly see more hair loss now that the GLP ones are everywhere because they cause hair loss in a lot of people. There's a lot of confusion about this online. There's a lot of disagreement. Does rapid weight loss just cause hair loss, or is there something specific to the GLP-1s that cause hair loss? So we know that rapid weight loss causes hair loss. No matter how you're doing it with a GLP-1, whether you're on diet and exercise,

we don't fully understand whether the GLP-1 itself does. A lot of the mechanisms of GLP-1, we would expect it not to because it's anti-inflammatory. So we do think most of this has to do with the weight loss itself. Okay. And I feel like men are experiencing hair loss at unprecedented. levels. Is that true? It's probably a little bit of both, but I think people just have way more awareness around it. Even when I was doing my general dermatology clinic 10 plus years ago, I would see hair loss on a lot of people, but no one would really bring it up. And I think people just really understand and they know to look for it now, which is good because it gives us opportunities to intervene earlier. But I do think there's just like so much more chatter about it. What's the single most important

change that somebody experiencing hair loss could do to their routine? Because hair loss is a symptom of something, the single most important thing to do is get a diagnosis of what type of hair loss you have. Do you have female or male pattern hair loss, which is the most common kind, which is sort of progressive and slow over someone's lifetime? But you can have things like alopecia Ariata, which is immune mediated. You can have scarring types of hair loss. And so until you have a diagnosis of what type of hair loss you have, it's really hard to pick what intervention would be the most helpful. So you would treat different types differently? Absolutely, very differently. And also, there's a workup that happens with hair loss. So because it's a symptom, we also want to make sure that your

thyroid works well. You're not iron deficient. Your vitamin D levels are appropriate. So there are other things we will also screen people for. And things like female and male pattern hair loss are a bit of a diagnosis of exclusion. You have to rule out other nutritional deficiencies or medical issues before you can call it that. Are there common nutritional deficiencies that you often see in your practice? For women, iron deficiency all the time, all the time. So an iron supplement might be like if that is, It can be helpful. You can get your iron levels tested. You could get your iron levels tested.

And really, when you're getting your iron levels tested, you need to get your ferretin tested. So that's the test. I have patients all the time that come in and say, I don't know why I'm losing my hair. I got my labs done. My iron was normal. And I'm like, well, let me just see your lab tests. And they never had a ferretin done, which is really the indication of what are your iron stores.

And if those are low, not only are we talking about an iron supplement, but also we need to understand why they're low. Are you not getting enough through your diet? Are you malabsorbing? Are you bleeding somewhere that we don't know about or do you just get heavy periods? So it's really important to understand. why the iron deficiency happened and not just blanket treated with a supplement. I was also wondering because I know that there can be, if you have a virus or a viral infection,

you can experience some hair loss after that. I was wondering if it's a long COVID situation. We do know that COVID causes hair loss. When people have had an acute infection, they can often get hair loss months later. And I think we will need more time to understand if there's like a long COVID aspect to this hair loss because there's been some immune dysregulation that's happened because of it. What do you do with somebody who's had a virus or something like that? that's why they're experiencing hair less. How do you treat that? Typically, it's just supportive. So

helping them understand that this is a brief loss in hair due to an intense trauma to the body, the same way women after childbirth will shed a lot of hair. Wait, is that why? Yeah. It's because you've had sort of like a trauma to your body. It's like a big shock to the body. After people run marathons, if you've had a high fever, if you've had surgery, like even after like, I've had a patient recently who had her breast implants removed and then is shedding a ton of hair were four months out. So any type of big hit to the body can cause some pretty indebted. intense hair loss, and it can be shocking for people, and it can last many, many months. The move isn't to necessarily do anything during that time. It's just to ride it out, or can we do

stuff to shorten those months? You can do things, but I usually say, hey, like, you just have to know that this is not a forever thing. Things you can do are like topical monoxidil or rogain, which we use long term in people who have female and male pattern hair loss. It can be used short term when people have this stress-induced hair loss, which we call telogen effluvium. But I really just try to encourage people that this is a temporary thing. You want to make sure that your nutrition is right, that you're not having ongoing stress in the body. But other than that, I just try to give some emotional support. And I think once people understand that this is not going to be a forever thing, they're able to

sort of accept it and realize, okay, my body's going to move on from this in a short period of time. I always look at women who are like postpartum, they're like, oh, here's what I'm doing to get my hair back postpartum. And I'm like, wouldn't it just like grow back in a few months anyway? Yes, it totally would. The thing that can happen, though, is telogen, effluvium or any stress to the body that causes that immediate and sort of semi-pronged shedding can unmask underlying male or female pattern hair loss. So you might have been prone to this female or male pattern hair loss,

but it might not have really shown up in you until five to ten years from now. And when you have that shed from the telogen ophluvia, it sort of reveals that you have female or male pattern hair loss underneath. And for a lot of people, then, that's when we start talking about more long-term solutions for their hair loss or ways to maintain. And is that just rogain? There's lots of things you can do. Rogaine is really helpful. There's a medication called finasteride. There's a medication spronalotone that we use for acne, but can also be helpful for female hair loss because of its similar effect on androgens. And then there's like topical hair serums that can be somewhat helpful because they have certain peptides or they change the milieu

around the hair follicle. Okay, I want to play a game called helpful, harmful doesn't matter. And these are all hair care things. And I want to know if these things are helpful, harmful, or they don't matter. Rosemary oil. Doesn't matter. There's one randomized control trial that I found is from 2015. And it showed that rosemary oil is comparable to 2% monoxidil for alopecia. That's true. If you look at the details of the study, it's a really poorly designed RCT. So that's the issue with a lot of the trials is like, even if it's an RCT, it might not be a well-conducted one. And also that's 2% monoxide. Is that not a normal? We're basically never recommending that unless someone can't tolerate 5%. So that wouldn't really even be something we would recommend. Now, anecdotally, whenever I post on like my Instagram, don't bother with rosemary oil, people will tell me like, well, it worked for me. Totally fine. So to me, it's like, doesn't matter. You could try it, but I think temporary expectations. Rice water rinses. Doesn't matter. What's the purported mechanism there?

The thought is maybe the proteins there help fortify the hair. But in terms of it making your hair grow better, I think you're really just trying to fortify the hair so it doesn't break off in the middle. So is it like K-18 kind of? I would just thought to leap. So olipox and K-18 are things you put in your hair. They're bond builders. Okay. And that's kind of a protein.

Yes. Yeah, that is a protein. But when you're thinking of rice water, those are like little proteins that act almost like glue that fill up the gaps on the cuticle or the outer portion of the hair. Do you like a K-18 or an oliplex? Sure do. I love them. I love. I use K-18. Do I need to be using both? No. I would say one or the other. They work slightly differently. I would say oliplex is probably better for like severely damaged hair. It has like more comprehensive bond building and it's sort of the OG. But K-18 is also very good and just works through its kind of single patented peptide. But I love it. I like it because I'm

much pickier about products than I know that you are. But I like. But I like it. like it because you're not putting on your scalp, so I'll get like the K-18 cream. I'll rub it my hands, and then I'll put it through the lengths of my hair. It's great. Yeah, I'm a big fan. If you color your hair, you heat style it regularly. I think having a bond builder in your routine, at least with some degree of regularity can be very helpful. Scalps scrubs or scalp exclamation? Helpful if you struggle with a lot of dead skin cell build up on your scalp. Now, generally when people have a scaly scalp, it's usually due to yeast overgrowth and having a little bit of dandruff. And so really what I would rather someone do is use like an anti-dandruff

shampoo, but if you're doing that regularly and you still feel like product is building up, or often for people who have really thick hair, they just feel like they can't get a good rinse of their scalp, which is what your shampoo is doing. I do not think of shampoo as a hair wash. It is a scalp wash. You could use something like an exfoliant to sort of like help break that down. And if I have patients who have these like thicker plaques or yellowish gunk, for lack of a better word, stuck on their scalp, we can use exfolients to help sort of break up that debris. Biotin supplements. Harmful. Harmful. For hair loss, So biotin has never been shown to be helpful for hair loss if you are not biotin deficient, which is incredibly rare in the Western world. And oral biotene can do a lot of things. It can break you

out so it can cause acne. It can also mess with your lab values. So although it doesn't change the function of your thyroid, it can make your thyroid test read inaccurately. It can make your cardiac markers read inaccurately. So if you think you're having a heart attack and you go to the ER and you're taking biotin, it can mess with your, what we call your troponin levels, and it can make you make it look like you're not having a heart attack when you are. So it's one of those things where I always have patients who are on biotin, maybe as part of their prenatal or they're doing it for nail health, which there is some evidence that can help with nail health, stop their supplemental biotin at least 72 hours before any type of lab test.

Oh, wow. Are there any supplements that you think are very helpful for hair loss or hair regrowth? There are the more studied ones like viviscal and neutroful. and often they contain some ingredients that are like androgen blockers. So things like Saw Palmetto that essentially help DHT not negatively impact your hair follicle. And those are things that are going to work for some people and not work for other people, but can be helpful. And I think are worth a trial.

You just have to understand that if you have one of these chronic or long-term hair loss conditions, if you do find it helpful, that is going to mean you're going to stay on that medication or on that supplement indefinitely. Sleeping on a silk pillowcase. Love that one. Helpful. When we're thinking about optimizing hair growth, we're thinking about it in two ways from the follicle, like what's coming out at the root, but also how are you treating your strands? And using a silk pillowcase really does reduce friction. Some people will do a pillowcase. Some people will do like a silk bonnet. But just creating some type of like silkyer buffer on the hair can be really helpful. Washing your hair less often. Depends. Doesn't matter. I think washing your hair as frequently as your hair requires washing. So for a lot of people, what we're trying to do is just keep their scalp clean. And for some people, they only need to wash once a week to keep their scalp clean. And for some people, they need to wash every day to keep their scalp clean. And as long as you are

rinsing thoroughly, you're conditioning, you're fine to wash it more frequently. So the like no shampoo thing or decreasing washes really shouldn't have an effect, unless every time you're washing, you're also heat styling afterward. And in that case, going longer between washes can be helpful so you're not putting heat as frequently on your hair. What about the idea that when your hair is wet, it's most prone to breakage? So you're like putting your hair into this fragile state more frequently. That's true. It is more prone to breakage. But just because something is prone to breakage, but just because something is prone to breakage doesn't mean it's going to break. You have to also put it through some discomfort, whether that's you're pulling on it, you're letting it sort of bop around with your blow dryer

too much or it's getting buffeted. But just because it's more fragile, it just means you need to treat it with care. But if you're doing that, then it being wet more frequently isn't really a problem. Microneedling the scalp. Helpful. There's good studies to show that it can help increase blood flow to the scalp and help with hair growth. More helpful when you combine it with things like monocidil, but definitely if someone's open to it, microneedling can be helpful and you can do it at home. Red light therapy. Helpful, for sure.

There's lots of good data that shows that red light therapy can be very helpful for multiple types of hair loss. It's anti-inflammatory. And it's nice because you can use it, whether you're pregnant, all phases of life, I just think red light is very, very good when it comes to hair, even more so for sure than when it comes to skin. Is there something that you're looking for in red light, like the irradiens or the types of red light or stuff like that?

Yes. both of those things. You want to look at sort of the power of the device. You want to make sure you're using the right wavelengths, which are red light, which is like around 630 nanometers and near infrared light, which is around 830 nanometer, 810 to 850. And you want to make sure you have both of those, that you have enough power. I don't expect the average consumer to be able to look at all those things individually. So I usually look to device companies to talk about, you know, whether their product is clinically tested, whether it's shown safety or result. I know, but they all want to like, we're the best. We're so great. I know. And this is one of those things where you kind of have to

look to the germs and be like, yeah, we've vetted these things. The biggest thing is you're never going to find, like, a cheap red light device for your scalp. If it's cheap, that usually is a sign that it doesn't have the right bulbs, the right power, et cetera. What's your favorite for hair? Gosh, there's a few. I like current body. They make a really good one. Disclosure, I have worked with them in the past, but also Therodome is very good. I restore. And then there's one called Capelis. That's more of like a baseball cap. Can you speak to the person who is dealing with some hair thinning hair loss and they're just like, I'm really overwhelmed. I don't have a lot of time and money to treat this and I'm really depressed about this. Like, where would you start with them? How would

you speak to them about, you know, how to find hope in the situation? Yeah, I think understanding that lots of people go through this, so over 50% of the population is going to have hair thinning over the course of their life and understanding that it's sort of like one small step at a time. So monoxideal is something that's very affordable. It comes down to like $10 a month. So that's a really evidence-backed way that you can start intervening. I also think if it's affecting you emotionally, it's not bad to see a therapist about this. Like being hung up on a very prominent physical feature that you feel like is not optimized is a big deal. And I think having those kinds of conversations and being really honest with yourself can be very helpful. Also, lots of people wear hair pieces,

wigs, hair transplants. There's so many things you could do if you wanted to feel more confident in your hair. This is another thing that I feel like we should talk about more. I have hair extensions in and I like like to talk about them because my hair never looked this thick before I had my hair extensions in. And I feel like, have you seen that woman online and she's like points out when people are wearing wigs? Oh, no. And she's like, that's a wig, that's a wig, that's wig. And it's almost every Hollywood celebrity. And almost because, and why wouldn't you? It's so much easier than damaging and styling your own hair. Absolutely. I think it's very freeing. And I think it wasn't something that I even realized and still I started working with more celebrities

and just like realizing how many of them have fake hair. And that's not a knock to them. It's just a way that they get a confidence boost and obviously they're very heavily judged on their appearance. So why wouldn't you want to do something to optimize it? But I tried to talk about that with my patients too and say, hey, you can wear a wig if you want to. And initially, I feel like people are a little bit hesitant about it. But once they get into it, if they find a good wig and you get confident, I mean, gosh, you never have to do your hair. Yeah, it's like five minutes to get ready. Yeah. Absolutely. That's why like people say that Sabrina Carpenter does it for her tour. And I'm like, why would you not do that for your tour? I'm wig curious for sure. I wish a hairstylist had told me sooner when I was

coming in with my Pinterest pictures of what I wanted my haircut to look like. It was never going to happen. It wasn't going to happen. The picture I was showing them from Pinterest had extensions and nobody told me. They had twice as many hair follicles. Yes, exactly. Yeah, it really bummed me out. And I will say if you're listening and you liked hearing us, go through all the different

things you're hearing on social media for hair. We're going to do that in a separate episode. We're going to have you rate all of the skincare advice from social media. So make sure you're following the podcast because we're going to have a whole episode about that. I want to know, though, right now, if somebody is listening and they're just feeling really overwhelmed. And they're just like, Dr. Sam, I just want to have good skin. I don't want to think about it that much. I don't want to spend a bunch of time or money. Like, what should I be doing?

Finalizing a morning and nighttime routine that are locking in on the most effective skincare ingredients can be the first thing. And we're talking a cleanser in the morning, vitamin C, if you can tolerate vitamin C on your skin and a good antioxidant that's going to help you fight oxidative stress, moisturizer, if you feel like you need it, and sunscreen. And then in the evening, cleansing your face, using a topical retinoid, whether that's over-the-counter retin, retinoldehyde, adapoline, or prescription, trinan, and a moisturizer. If you do just that extremely consistently for three months, you will notice a change in your skin. What's one thing that we should stop doing right now for good skin? I think if you smoke, you absolutely shouldn't be smoking in any capacity, whether it's

cigarettes, marijuana, anything that's being sort of inhaled, all of those carcinogens are going into your lungs and then getting distributed throughout your body, including your skin, and it causes a lot of oxidative stress on your skin. And I would put this in a slightly lesser category, but also reducing your alcohol intake. These are also really big things that impact the skin, and sorry to take away people's fun, but it makes a huge, huge difference. Do you drink? I don't. At all? Maybe like fewer than five drinks a year. Like maybe on a couple occasions, but I stopped drinking a few years ago, and I just, I don't miss it. So I think if it was like a really big part of my life, I would. But there are very few things that we know are so cancer-causing and alcohol is one of

them. And so because I have that- I quit after that JAMA study. And I was like, that jamma study is really powerful and very accurate and a very good study. And I found it incredibly compelling. And I do all these other great things for my health. But none would have the same impact as like drastically reducing alcohol. It was the number two or number three cause of cancer, preventable cause of cancer? Yes, preventable cause of cancer. Was drink. Which is crazy. Yes, exactly. If you've heard that about basically any other thing in your life, you would say, of course

I'll make that switch. And I get it. Alcohol is like a big social component and all of that. But if you're looking to make really impactful changes in your life, you don't have to go cold turkey and you don't have to stop completely. But I think it would be something I would highly recommend for your health in general and certainly for your skin. You know what I love and I didn't notice it until somebody pointed out? So we're in book club together? Yes.

We never drink. Like every other book club I've ever been in. It's like wine night. It's wine night. Yes. And I don't know. if we started drinking or like we and it went away or what, but like everybody always has like, here's your selection of spin drifts and stuff, but almost nobody drinks and nobody even offers

drinks anymore. That's true. I feel like drinks are not even like on the table, which I think is nice because I feel like sometimes people feel social pressure to drink and so the fact that that's not there is kind of lovely. And it's equally fun. Like I do think that that is like important. People are so, I was so afraid before I stopped before I stopped. I call myself an intentional drinker Yes, I agree with that. Before I stopped, I was like, am I ever going to be able to laugh and be silly and have fun again? And, like, we definitely do. Give yourself some credit.

I know. That's the thing. I feel like your alcohol is not your personality. And if it is, that's like some deeper work to do. But we have a great time in really good discussions and we remember them. Yeah. This can be in the realm of skin care, hair care, or something else entirely. But what's one habit that's changed your life?

Probably one that I've noticed the biggest change in is just like really optimizing my sleep. Like I wear earplugs. I use a white noise machine. I just really like to be completely in a sort of like sensory deprivation situation. But that one has really helped for me. Sleep has an impact on skin too. Huge. Oh my gosh, huge.

When you asked earlier about things that can like impact your skin that aren't skin care, getting enough sleep for sure. There are little studies that show that if you don't get enough sleep, it drastically ages you. You're perceived as older. So whatever you need to do to get more sleep, like I used to wake up early to exercise and I realized I was sacrificing sleep because of that. And now sleep is like my number one health priority.

Wait, so do you not work out anymore? I work out. I become more efficient with my workouts. And I feel like I do more strength training now, which I don't feel like I have to sort of like hype myself up for like I used to for cardio. Like cardio I had to find like the perfect. Did I just eat? Did I not eat?

That kind of thing. Whereas with strength, I feel like I can even do like a 20 minute lifting video after my son goes to sleep and I can get it done. Sleep, though, to me is even more important than exercise for me. But I try to do both. Can you leave us with just one thing that we could all do the second that we turn off this podcast to begin to see a noticeable difference in our hair or our skin? I would say shave your face. Oh, I feel like there's no better way to

make your skin look better faster than to do a little, we call it dermaplanning. It sounds fancy, but essentially you're just shaving all the little baby hairs off your face. It makes your skin glow. Like if you want Insta Glass skin, do that. Wait, what about my barrier layer? Is that okay? Totally fine. I mean, you don't want to like rough shave. I'm not like shaving off my barrier. No, I have like a very, I think it's my most popular YouTube video ever is teaching people how to shave their face because people are kind of intimidated by it. But it's, it's, so glorious. And a lot of the texture or sort of like irregular light bouncing off our skin is due to the little baby hairs that are on there. And again, it's like not one more thing I want to demonize

about the female body. They're like, oh my gosh, now you're telling me to shave my face. But if you want to make your skin look better fast, do that. Does it have long term benefits? Or is it just like right away you look better? More right away. I mean, you were doing some gentle exfolation when you do that. So I suppose you could call it that. But it's really more for that, like, immediate effect. And it's so impactful. And it doesn't make your hair grow back like thicker or faster or anything like that. Okay, Dr. Sam, I know that there's like a million things that you do online. People can find advice from you on YouTube, on Instagram. You have your own skincare line. Like, tell us about everything in your world. Okay. Let's see here. Okay, so I have my own skincare line.

It's called Prequel Skin. You can get it at Target. You can get it on Amazon. You can buy it at Prequelskin.com. And the real goal of Prequel is to make accessible products. So everything in the line is generally under $30. Most of it is under $20. And a lot of it is huge. Huge. Huge, like lots of value. and also just very supportive of the skin barrier. So a lot of things we talked about today was about optimizing your skin barrier and prequel products are really meant to lean into that. We have a lot of support from like the National Exma Association,

the National Sorriasis Foundation, all of that. Super cool. And then the other things that are you can find me on YouTube at Dr. Sam Ellis and then on TikTok and Instagram at Dr. Samantha Ellis where I give lots of advice on how to take care of your skin, but also what is good about certain beauty procedures, cosmetic stuff, all the stuff that I think your dermatology best friend should tell you. Amazing. Well, we're going to do a whole other episode. We're going to rank social media skincare advice, which I'm very excited about. I have so many thoughts. But thank you so much for all this information. Oh, thank you for having me. That is all for this episode of the Liz Moody podcast. If you enjoyed this episode, I would so appreciate if you would share it with somebody that you think would love it too. It is my goal to get as much life-changing information out to as many people as possible. And you sharing episodes with people is 100% the thing that makes that happen.

I would also love to hear from you in the comments, any thoughts or questions or opinions that you have on this episode. Make sure that you're subscribed to the podcast on Spotify, on Apple Podcasts, on YouTube, wherever you like to listen. You can find every single discount code that you heard in this episode and tons more at Liz Moody.com slash codes. It is the best way to save money on amazing vetted products. Truly, our brand partners make the best products in the world. That is why they're our beloved brand partners. And it's the best way to support the show and keep it completely free for you. and we so appreciate it.

Okay, I love you, and I will see you on the next episode of the Liz Moody podcast. Oh, just one more thing. It's the legal language. This podcast is presented solely for educational and entertainment purposes. It is not intended as a substitute for the advice of a physician, a psychotherapist, or any other qualified professional. This is genuinely one of the most innovative things that I have heard of in a long time. So here's the deal.

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