Skin Science: Fresh Again w/ Dr. Julius Few

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Welcome to Park Avenue
Plastic Surgery Class,

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a podcast where we explore controversies
and breaking issues in plastic surgery.

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I'm your co-host Doreen Wu,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator, and technology innovator.

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The title of today's episode
is "Customized Skin Science."

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Dr. Bass.

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It sounds like today's episode will be
focused on the science behind skincare.

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Can you tell us what
we're going to discuss?

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Sure.

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There are literally thousands
of skin products on the market,

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and there are many,

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many skin products that are available
from doctors as part of their

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practice or that they've developed
to try to help in the care of their

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patients.

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And so we're going to try to talk
about what's happening in this area

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and some of the latest trends.

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I've been involved in skincare even
though I'm a plastic surgeon since the

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1990s because some of the companies
that were putting together

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panels of doctors to help them
formulate their products decided to

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include a couple of plastic
surgeons along with the usual

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collection of dermatologists.

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And so that got me involved very
early in my career in the science of

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skincare.

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But because there's so many products
out there and it's always changing and

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always improving,

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I've brought someone who's a
true expert on skin science.

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My friend and colleague, Dr. Julius Few,

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who also is a plastic
surgeon in Chicago with a

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very busy and successful practice.

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He is a clinical professor of plastic
surgery at the University of Chicago,

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as well as a health science
clinician at Northwestern University.

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In addition to that,

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he's one of the associate editors
of the Aesthetic Surgery Journal,

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which is the number one
aesthetic publication in the

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world,

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and he's in charge of editing the
aesthetic medicine portion of that

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journal. So Dr. Few, welcome
and thank you for joining us.

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Larry,

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I'm truly excited and
congratulations for a great podcast.

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I am somewhat jealous that Michael
Kane beat me out to being first

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on this, but you know what,
listen, since he and I actually,

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we just talked at the aesthetic
meeting recently and is one of the

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main reasons I kind of got
into the non-surgical space,

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I guess he deserves it.

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I am truly excited to be here. Larry,

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you've been a visionary in the
space of non-surgical aesthetic

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medicine for more than two decades.

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I feel very lucky to have
known you for that long,

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and it just helps to show that we're
getting old. Well, I'm happy to be here.

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We're getting old,

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but we still have a few tricks and
contributions left up our sleeves.

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I know you do for sure.

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Absolutely.

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Exactly. So let's jump right in. Dr. Few,

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you're a plastic surgeon like Dr. Bass.

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Maybe you can tell us a little bit
about how you got involved in skincare.

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Well, Doreen, hi to you as well.

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I got involved in skincare initially,

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much like Larry came from a background,

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really kind of a diverse perspective
in that my major in college

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was biochemistry. I've always
been interested in skin science.

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When I was part of the core
faculty at Northwestern,

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I worked on a couple of projects very
closely with the dermatologic department.

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They actually were our next door
neighbor for our administrative offices.

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And we in fact developed a couple of
applications for dermal delivery that

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are to this day still patent protected.

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And so when I started to look
at in particular, skin science,

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the honest answer, and this is one of
the things I love about Larry's podcast,

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is that we kind of try to
put the BS aside. So for me,

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it really was a vanity project at first.

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I had, when I was younger,

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had so much trouble with different
skin products even into my

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adult life. I would try something, I
looked at a neat package, I said, "oh,

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this would be great.

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Let me get this." And I would put it on
and then I would be broken out for weeks

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and then I would spend the time
trying to chase it using applied

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science to deal with the side
effects. But as most know,

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one of the challenges in skin of
color is if you get a breakout,

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you're left with
hyperpigmentation. So for me,

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I wanted to come up with a
solution initially that would,

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to be quite honest,

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just help me and relatives
and people who were

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challenged by the same types of things.

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And then as I kind of moved along,

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the patient feedback became
more and more specific

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that there was a true following.

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People were giving it to their friends.

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I had given patients that

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were fairly well-known
individuals who I would

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periodically see a picture of them in
some post and I'd see my product in the

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background.

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So it kind of became this
very organic thing that

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led to where we are now.

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Awesome.

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And so what are some of the key features
or key products in the skincare line?

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So I, like anybody who's been in the
skincare game, they have gone through,

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so I've been at this now on a
commercial level for about a decade,

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lots of iteration.

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I've worked with lots of different
manufacturers in the US that tried to keep

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everything on domestic soil,

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but along the way you learn a lot.

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And so now I'm very happy with
the chemistry team that I work

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with. They're in Southern California,
everything is sourced there.

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And we kind of all come together,

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the three of us in core that
come up with different kind of,

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if you will,

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formal ingredients that then
we try to center around kind of

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a botanical approach. So using
things like gren tea extracts,

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the polyphenols that go
with that using hyaluronans

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on a topical level. And most lately,

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and I think the thing that really
catapulted or differentiated us

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was the use of CBD.

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So CBD and skincare has been dabbled
with, you typically have to go to,

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especially if you're in
California or New York,

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you have to go to a health food store
to find different forms of CBD that are

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used topically. The problem is

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they're infiltrated with other
impurities such as various forms

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of CBM that are not as effective
and other forms of cannabidiol

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that really get lost on
the surface of the skin.

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And so we were able to not
only come up with a 99%

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pure form of cannabidiol,

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but also a water soluble version of it,

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which for somebody like me who I
deal with kind of challenged skin,

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even as an adult, you're
talking to somebody, by the way,

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who will travel with my own body
soap just because I'm so afraid

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a hotel cleanser will make
me break out on my body.

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So it is a situation where with the

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CBD that is water soluble,

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we've really come up with
something that is quite special.

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And in fact, what we did is
we did a controlled blinded

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study that ultimately not
only showed clinical efficacy,

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which we can get it to
later if we have time,

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but also it was published in
the Aesthetic Surgery Journal.

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And again, for the sake of time,

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I won't go into what all the metrics mean,

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but in terms of looking at the viral

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nature of that publication,

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it is the record setting publication
for metrics for the Aesthetic

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Surgery Journal.

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So it's a subject that has
been referenced extensively,

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including by the FDA,

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even though it doesn't technically fall
under the purview of the FDA because it

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a nutraceutical, whereas the
Cosmoceutical. But nonetheless,

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big,

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big pharma has actually taken
note of our research and have

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proposed actually the use of it
in the treatment of psoriasis.

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So it's literally taken
a series of turns that

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had I not gone to California,

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I did open a clinical
practice in Los Angeles.

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That's when I really became
curious about the cannabinoid.

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That is certainly very interesting.

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So let's shift gears for a moment and
discuss some important points about

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skincare that patients may
not necessarily realize.

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Well, I think the biggest
one is more is not better.

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I think there are lots of products
out there. As you initially said,

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there are thousands of options.
But at the end of the day,

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it's about finding compatibility.

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It's about finding a
routine that is easy to do.

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Like the three of us,
I mean, we're all busy.

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We don't have an hour every night
to spend or an hour every day

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during the morning to spend on skincare
or these very complicated elaborate

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routines that may have
diminishing returns. So again,

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as in full disclosure of vanity project,

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I wanted to come up with something
that I knew I could be compliant with.

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And so I do think the key essence
of skincare is good cleansing,

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but not over cleansing,

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good hydration and
protection of that hydration.

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And then something that facilitates
cell turnover and elimination,

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again, not stripping, but
enhancing that process.

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And so I think if you look at the approach

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to really skincare circa the

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seventies and eighties,

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it was very much so geared towards
stripping and then replacing.

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And that is, it had its place. But
in reality, if we look at the big,

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big picture,

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really there should be no
role for the stripping or

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removing of the protective barriers
of the skin just to try to use a

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replacement with the
synthetic alternative.

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I think you raised a number
of really important points.

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And in my practice,

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I have always pursued the same
approach with the skincare program.

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It's got to be a limited
number of products that you can

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keep up with on a practical
basis without naming

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names.

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A very famous product line based Southern

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California would often have
patients on seven or more

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products.

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And it was almost impossible for anybody
who had less than three hours a day to

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play with their skin,

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which is basically a hundred
percent of people to do that regimen

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correctly.

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And I'm not sure it was necessary,

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but it was impossible to be
compliant. So that's critical.

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And exfoliating,

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which was the mainstay of
skincare in the early nineties

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is okay,

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but as you said,

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beating up the skin is never productive.

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Teenagers do this when they have acne,

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they're frustrated and they want to
punish the skin in the hope that the skin

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will behave. Adults are seeing dryness,

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scaling wrinkles, rough texture,

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and they want to again,

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force the skin to behave
the way they want.

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And by stripping the protective barrier,

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the skin needs to defend itself.

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It's like putting the skin out in winter
or in summer sun without any clothing

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on. It's very damaging.

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So gently cajoling the
skin in the direction

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you want to go is probably
the productive pathway

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for all skincare. And we're Americans,

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we'd always like it more and faster,

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but sometimes we actually
lose the game by taking that

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approach.

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I couldn't agree more.
And at the end of the day,

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it really is,

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we have to remember that the
skin is just engineered to

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do all the things. I mean,

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their skin actually on
the surface has powerful,

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powerful factors even included in sebum,

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which smells awful if you have
overproduction of it. But sebum as

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an agent on the surface of the
skin is actually the most studied

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component or one of the most studied
components in science because it is a

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natural antifungal,
antibacterial, antiviral,

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and it's one of the most potent, I mean,

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even there are antibiotic resistant
strains of bacteria that cannot survive

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see them in its pure concentration.

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So I think that if you start to
realize that that is not you,

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Larry, but in general, if your
audience, people are listening,

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start to realize that the skin itself
has its own barrier, its own factors.

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So then it becomes much
easier to think about, okay,

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well then I want to then
structure my skincare

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program not only around not overdoing it,

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but also thinking about the important
variable which is hydration.

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If you're hydrating internally,

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ultimately all these things work better.

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So if somebody hasn't adequately
taken care of their internal health,

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systemic health as we call it,

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then ultimately what we're doing
on the outside the skin is its,

242
00:15:14,450 --> 00:15:18,650
it really is our largest organ, then
we're not going to see the benefit either.

243
00:15:19,580 --> 00:15:21,770
Dr. Few, you mentioned this earlier,

244
00:15:21,771 --> 00:15:26,120
but if we could go back to another
important focus for people of color

245
00:15:26,240 --> 00:15:28,880
tackling hyperpigmentation and dyschromia,

246
00:15:28,910 --> 00:15:30,740
if you could both talk
a little bit about that.

247
00:15:31,550 --> 00:15:35,330
Absolutely. So that's
what led to the genesis

248
00:15:37,340 --> 00:15:42,050
for a beauty line or skincare line is

249
00:15:42,060 --> 00:15:46,880
also around hyperpigmentation,
dyspigmentation and dyschromia,

250
00:15:49,580 --> 00:15:54,140
coming up with medical grade
options that did not require our

251
00:15:54,150 --> 00:15:57,710
patients to go to a pharmacy to
get their needs because frankly,

252
00:15:57,711 --> 00:16:00,050
I think most of, or not most,

253
00:16:00,051 --> 00:16:04,130
but many of the options
that are pharmacy derived

254
00:16:04,910 --> 00:16:08,390
have disadvantages because again, they
may have components that are harsh.

255
00:16:09,860 --> 00:16:14,690
And so we have a product that
does require physician oversight.

256
00:16:14,940 --> 00:16:18,470
It does have a component
of hydroquinone, however,

257
00:16:19,220 --> 00:16:24,110
it has a lot of other components
that are nurturing to the skin that

258
00:16:24,111 --> 00:16:28,760
have free radical scavenge
capability and so on that

259
00:16:29,150 --> 00:16:33,980
then allow for a delivery
of a pigment cell or

260
00:16:33,981 --> 00:16:38,150
melanocyte friendly solution.
And at the end of the day,

261
00:16:38,420 --> 00:16:40,250
the most important factor,

262
00:16:40,670 --> 00:16:44,990
especially if you're treating any
kind of dyspigmentation hyper, hypo,

263
00:16:45,440 --> 00:16:47,930
is sun protection or prevention.

264
00:16:48,950 --> 00:16:52,280
We can't even in my skin
tone, darker skin tone,

265
00:16:52,730 --> 00:16:57,440
which my skin tone because I
have a dark brown hue to my

266
00:16:57,441 --> 00:17:02,300
skin, has a natural sun protective
factor of anywhere from 12 to 15,

267
00:17:02,570 --> 00:17:04,610
just innate. However,

268
00:17:04,880 --> 00:17:08,270
if you're treating a dyschromia
or a hyperpigmentation,

269
00:17:08,330 --> 00:17:11,060
especially if it's my skin
or somebody's skin is darker,

270
00:17:12,510 --> 00:17:17,330
you even more so need protection because
the melanocyte activity is going to be

271
00:17:17,331 --> 00:17:20,000
hyperactive. And if you're
putting an agent on,

272
00:17:20,001 --> 00:17:22,850
especially a skin lightning agent,

273
00:17:23,240 --> 00:17:27,050
it tends to also by definition
photosensitize because it actually

274
00:17:27,060 --> 00:17:30,710
destabilizes the melanocyte
production process.

275
00:17:30,830 --> 00:17:34,910
That's how it works actually by
preventing more deposition of pigment.

276
00:17:35,600 --> 00:17:39,500
But at the same time, because
modulating the melanocyte activity,

277
00:17:39,830 --> 00:17:41,600
it also makes that melanocyte irritable.

278
00:17:42,200 --> 00:17:46,190
And so then you can have a situation
where ironically, sun exposure,

279
00:17:46,191 --> 00:17:47,390
or for that matter,

280
00:17:47,870 --> 00:17:52,410
if you have a patient who's a picker or
is playing with things or what have you,

281
00:17:52,860 --> 00:17:57,390
like so many of our patients do, they
actually can make the issue worse.

282
00:17:57,960 --> 00:18:01,380
And so one of the most common
causes that I see in my practice,

283
00:18:01,500 --> 00:18:06,120
we deal with a lot of skin of all
types, whether it's African, Asian,

284
00:18:06,510 --> 00:18:08,940
Latin or Caucasian skin,

285
00:18:09,360 --> 00:18:13,890
is really this idea of occasionally
people will come back and say, well,

286
00:18:14,190 --> 00:18:18,090
I feel like it's not working fast enough.
And then if you really drill down,

287
00:18:18,091 --> 00:18:22,080
it's either lack of sun protection
or they're picking at it,

288
00:18:22,140 --> 00:18:26,520
or the worst of all is
they're not using it.

289
00:18:26,880 --> 00:18:28,470
They have it, but they don't use it.

290
00:18:30,450 --> 00:18:34,350
And the easiest way to smooth that
out is to say, "you know what,

291
00:18:34,530 --> 00:18:37,530
do you mind bringing it back?"
And because we've done a lot of,

292
00:18:38,100 --> 00:18:40,980
because it comes in a pump,
it comes in an airless pump,

293
00:18:41,610 --> 00:18:43,110
and so we'll have them bring it back.

294
00:18:43,200 --> 00:18:47,910
And we have the ability to weigh
the container because we do

295
00:18:48,090 --> 00:18:51,330
so many clinical studies, we've
clinically studied most of our stuff,

296
00:18:52,290 --> 00:18:56,610
so we can ascertain literally how
much of the product they've used.

297
00:18:56,940 --> 00:19:01,920
And if we do the math, and it's not
hard math, you can say, well, honestly,

298
00:19:02,820 --> 00:19:05,460
using it once a month doesn't quite work.

299
00:19:07,110 --> 00:19:08,760
So I think these are the things,

300
00:19:09,240 --> 00:19:14,220
it's slow and steady wins
the race and using these

301
00:19:14,221 --> 00:19:17,940
products, any of the products
I would tell any given person,

302
00:19:17,941 --> 00:19:21,360
even if they want maintenance
to get beautiful skin,

303
00:19:21,750 --> 00:19:26,100
it's a minimum of six weeks
of doing a hopefully very easy

304
00:19:27,120 --> 00:19:29,880
process to get to their stated goal.

305
00:19:30,960 --> 00:19:35,940
And again, you've raised some
really, really critical points there.

306
00:19:36,870 --> 00:19:38,430
Every skin product,

307
00:19:38,730 --> 00:19:43,410
it's six to eight weeks to really judge
if it's working or if it's the right fit

308
00:19:43,411 --> 00:19:46,500
for you. And a lot of people,

309
00:19:46,501 --> 00:19:51,390
if they either react to a
product as they initiated

310
00:19:51,400 --> 00:19:56,100
or if they look after a few days or a

311
00:19:56,101 --> 00:19:59,610
week and don't see an effect
or ready to switch it up again,

312
00:19:59,611 --> 00:20:00,990
and that's a mistake.

313
00:20:02,370 --> 00:20:06,150
But pigment issues in

314
00:20:06,240 --> 00:20:10,320
certainly darker skin tones,

315
00:20:10,321 --> 00:20:15,000
but even in fair skin
people are one of the

316
00:20:15,150 --> 00:20:19,980
major aging changes that
occur as decades start

317
00:20:19,981 --> 00:20:20,970
piling up.

318
00:20:21,390 --> 00:20:25,620
And it's something that
historical products have not done

319
00:20:25,680 --> 00:20:30,030
amazingly well with and have
really done quite poorly with

320
00:20:30,630 --> 00:20:33,840
in people with darker
skin tones. And in fact,

321
00:20:33,841 --> 00:20:38,700
a lot of the treatments in my
view that were widely endorsed

322
00:20:38,940 --> 00:20:42,750
for clearing pigment are

323
00:20:43,110 --> 00:20:46,020
problematic in people
with darker skin tones,

324
00:20:46,050 --> 00:20:50,590
alpha and beta hydroxy acid
peels and products are big

325
00:20:50,591 --> 00:20:55,540
promoters of hyperpigmentation
in people who are olive skin

326
00:20:55,550 --> 00:20:56,383
or darker.

327
00:20:56,860 --> 00:21:01,330
And they may work very
nicely in someone who's very

328
00:21:01,331 --> 00:21:05,140
fair-skinned, but it's
the wrong treatment for,

329
00:21:05,170 --> 00:21:10,000
you can't just apply that to the
entire human spectrum and expect

330
00:21:10,001 --> 00:21:11,590
it's going to work equally well.

331
00:21:12,490 --> 00:21:16,420
A hundred percent. And this is having,

332
00:21:17,710 --> 00:21:22,270
even going to medical school
in the eighties and certainly

333
00:21:22,280 --> 00:21:23,113
before that,

334
00:21:23,830 --> 00:21:28,750
there really were not any
good viable options if you

335
00:21:28,751 --> 00:21:33,370
had skin of color or you had
combination really significant

336
00:21:33,400 --> 00:21:36,520
ethnically combined skin,
there just wasn't, I mean,

337
00:21:38,710 --> 00:21:39,910
this didn't exist.

338
00:21:39,911 --> 00:21:43,750
And I think that probably to go
back to the original question,

339
00:21:44,170 --> 00:21:49,090
that probably heavily
affected my choice to go into

340
00:21:49,091 --> 00:21:51,250
skincare because at the end of the day,

341
00:21:52,390 --> 00:21:55,540
I think that so much
of what we do, I mean,

342
00:21:55,930 --> 00:22:00,250
Larry is probably one of the most
gifted thinkers in our space,

343
00:22:01,330 --> 00:22:05,380
and you have to be passionate about
what you're doing. And I think

344
00:22:07,090 --> 00:22:11,590
from my viewpoint, I'm passionate
about it because it was a need,

345
00:22:11,591 --> 00:22:13,870
it was an unmet need in my mind that then

346
00:22:15,430 --> 00:22:20,170
combined with an area of expertise
led to this evolution that

347
00:22:20,620 --> 00:22:25,540
now we have our product being
sold commercially and very visible

348
00:22:25,550 --> 00:22:28,420
outlets. So it's Larry,

349
00:22:28,421 --> 00:22:32,980
you timed this interview
and subject very well.

350
00:22:33,190 --> 00:22:35,110
We just launched,

351
00:22:35,410 --> 00:22:39,310
we have a clean version of a product
that we just launched on Gwyneth

352
00:22:40,870 --> 00:22:45,820
Paltrow's site Sunday. So in all of our,

353
00:22:45,910 --> 00:22:50,200
like I said, our products, we
back with clinical studies.

354
00:22:50,201 --> 00:22:55,030
So I think it's been
quite a journey in our

355
00:22:55,031 --> 00:22:55,864
process.

356
00:22:56,680 --> 00:23:01,240
Well, but again, it sounds
like a very rational journey.

357
00:23:01,241 --> 00:23:05,470
It was need-based, not a me too product,

358
00:23:05,890 --> 00:23:09,070
it was data-driven, which is

359
00:23:10,990 --> 00:23:15,490
still not as common as
it ought to be in the

360
00:23:15,491 --> 00:23:20,350
actual medical side of things and is

361
00:23:20,740 --> 00:23:24,070
really not as commonplace in

362
00:23:24,670 --> 00:23:28,240
product-based items.

363
00:23:28,360 --> 00:23:33,160
So that's really important
that you're doing it in a way

364
00:23:33,161 --> 00:23:38,020
that sets the bar at a
new height rather than

365
00:23:38,021 --> 00:23:42,190
just following along
into the marketplace with

366
00:23:42,191 --> 00:23:45,320
something with your name on the front.

367
00:23:45,350 --> 00:23:49,520
You don't want to put your name on the
front unless you know there's science,

368
00:23:49,521 --> 00:23:52,160
there's data, there's an unmet need.

369
00:23:52,161 --> 00:23:56,930
And congratulations on getting listed on

370
00:23:56,931 --> 00:23:59,360
goop, and I'm sure you'll
have great success with it.

371
00:24:00,380 --> 00:24:01,160
So Dr. Few,

372
00:24:01,160 --> 00:24:05,060
what kinds of things can happen if you
pick the wrong skin products for your

373
00:24:05,061 --> 00:24:05,894
skin type?

374
00:24:06,440 --> 00:24:09,830
Well, this is Doreen, a
really, really important

375
00:24:11,390 --> 00:24:12,710
point and question.

376
00:24:13,280 --> 00:24:18,080
Picking the wrong topical
agent for skincare

377
00:24:19,310 --> 00:24:24,290
can lead to significant
inflammation or in a worst

378
00:24:24,590 --> 00:24:28,610
case scenario, a reactive dermatitis.

379
00:24:30,200 --> 00:24:34,160
And so dermatitis is just a
catch or grab bag term for

380
00:24:34,580 --> 00:24:38,180
inflammation of the skin. The
problem is if you have skin of color,

381
00:24:38,600 --> 00:24:43,190
the inflammation will often
manifest dist pigmentation or discr,

382
00:24:44,420 --> 00:24:49,190
and it's much easier to get
pigment than to get rid of it.

383
00:24:50,150 --> 00:24:52,370
So you can so many things,

384
00:24:53,740 --> 00:24:56,800
you get the issue and
then you will spend easily

385
00:24:58,340 --> 00:25:01,190
five or 10 times the amount of
time trying to get rid of it.

386
00:25:02,750 --> 00:25:07,400
So this is probably the first and
foremost thing. I think the other,

387
00:25:07,880 --> 00:25:08,211
which again,

388
00:25:08,211 --> 00:25:13,010
a lot of times people don't realize is
that what you put on your skin and the

389
00:25:13,011 --> 00:25:17,990
sequencing of how you put it
on the skin does matter because

390
00:25:18,170 --> 00:25:19,003
again,

391
00:25:19,430 --> 00:25:23,480
the skin behaves differently
at night compared to the day.

392
00:25:24,020 --> 00:25:28,130
And so anytime that I
want to, for example,

393
00:25:28,190 --> 00:25:32,000
do a restorative treatment on my face,

394
00:25:32,750 --> 00:25:36,830
I tend to do it at nighttime
because that is the time when

395
00:25:37,100 --> 00:25:42,000
actually our body's not
just repairing things on a

396
00:25:42,170 --> 00:25:47,000
neurologic level, but it actually is
repairing on a systemic level as well.

397
00:25:47,660 --> 00:25:52,460
And so in general, if you
want to optimize kind of,

398
00:25:52,730 --> 00:25:53,660
for example,

399
00:25:53,690 --> 00:25:58,580
a hypersensitivity or if you have a
low grade dermatologic issue that's

400
00:25:58,581 --> 00:26:01,730
going, the best time to
treat it is at nighttime.

401
00:26:03,140 --> 00:26:04,670
And certainly when you're sleeping.

402
00:26:05,930 --> 00:26:10,580
I think also the other thing to
remember is know your skin depending

403
00:26:10,581 --> 00:26:11,600
on the season.

404
00:26:11,930 --> 00:26:16,700
So if you're in the middle of the winter
in a cold climate like Northeast or in

405
00:26:16,701 --> 00:26:17,534
the Midwest,

406
00:26:18,770 --> 00:26:23,120
you will easily run into a situation
where the skin is dynamically

407
00:26:23,450 --> 00:26:24,283
very different.

408
00:26:25,790 --> 00:26:30,500
And so what tends to happen is because
of the skin having a tendency when it's

409
00:26:30,501 --> 00:26:32,600
colder to be drier,

410
00:26:33,020 --> 00:26:37,640
you may only have to wash the face
once a day instead of twice a day.

411
00:26:38,750 --> 00:26:40,010
And that's one of the things, I mean,

412
00:26:40,020 --> 00:26:42,380
it won't mean that you're
selling more skincare product,

413
00:26:42,390 --> 00:26:47,370
but the truth is it's better for
the skin if your skin tends towards

414
00:26:47,371 --> 00:26:48,780
being very, very dry.

415
00:26:48,781 --> 00:26:53,340
I'd rather have a situation
where I strategically once a week

416
00:26:53,341 --> 00:26:55,290
lightly exfoliate the skin,

417
00:26:55,710 --> 00:26:58,620
but then during the balance of
the week and when it's really,

418
00:26:58,630 --> 00:27:01,620
really cold for my friend's, family,

419
00:27:02,250 --> 00:27:04,290
patients that have very dry skin,

420
00:27:05,670 --> 00:27:10,140
to have them just wash their face at
nighttime before they put on their

421
00:27:10,150 --> 00:27:14,670
actives. And again, this
should be no more than a five,

422
00:27:14,671 --> 00:27:18,030
10 minute process. And then when they
wake up in the morning, think about it,

423
00:27:18,031 --> 00:27:22,650
you've done anything that requires
a stripping of the skin that's

424
00:27:22,710 --> 00:27:27,210
purely to get whatever active
residue you have, which by the way,

425
00:27:27,211 --> 00:27:30,420
typically has been reabsorbed by
the skin. What really matters?

426
00:27:30,780 --> 00:27:33,480
And it's just the carrier of the
vehicle that's on the surface,

427
00:27:33,481 --> 00:27:37,920
which frankly very easily
comes off the skin.

428
00:27:38,040 --> 00:27:38,873
And in fact,

429
00:27:39,360 --> 00:27:44,310
the natural oil of our skin is
actually that cleansing agent.

430
00:27:45,940 --> 00:27:50,610
You don't need to apply a cleanser on
top of that if you tend towards dry skin

431
00:27:51,180 --> 00:27:52,320
because again,

432
00:27:52,590 --> 00:27:56,610
there's no reason to strip only to try
to protect or replace the oil that you

433
00:27:56,611 --> 00:28:00,360
stripped off the skin. And in
fact, if you go back in time,

434
00:28:01,800 --> 00:28:03,450
certainly to Egyptian times,

435
00:28:03,540 --> 00:28:07,170
oil was used as the primary
cleanser of the skin

436
00:28:08,400 --> 00:28:11,820
in times when you couldn't
predict clean water supply.

437
00:28:12,510 --> 00:28:14,580
Actually oil was the bathing agent.

438
00:28:15,090 --> 00:28:19,890
You used the various forms
of botanical oils that were

439
00:28:19,891 --> 00:28:24,270
non stripping to clean the
skin. So again, everything,

440
00:28:25,050 --> 00:28:26,670
if you go back far enough in time,

441
00:28:26,671 --> 00:28:31,590
you can find examples
historically of how and why a lot

442
00:28:31,620 --> 00:28:36,090
of old application were frankly
some of the most effective

443
00:28:36,091 --> 00:28:40,920
application because what's
the mother of invention?

444
00:28:41,370 --> 00:28:44,940
So I think that's one thing.

445
00:28:44,970 --> 00:28:49,240
I think the other is that we also
should know that as the skin gets older,

446
00:28:50,610 --> 00:28:53,100
like all things, it becomes less reactive.

447
00:28:54,330 --> 00:28:57,030
So when you're dealing
with skin that is older,

448
00:28:58,140 --> 00:29:02,940
you have to change your gears
perhaps a little bit in terms of

449
00:29:02,941 --> 00:29:07,200
skincare from the standpoint
of protection of moisture,

450
00:29:07,201 --> 00:29:11,730
because older skin tends not to be
as effective at hydrating itself or

451
00:29:11,850 --> 00:29:12,780
maintaining

452
00:29:15,020 --> 00:29:17,280
the intracellular matrix of fluid.

453
00:29:18,060 --> 00:29:22,830
And so doing things that are focused
more on hydration and older skin

454
00:29:23,250 --> 00:29:27,780
can often yield a much better
result just in terms of outward

455
00:29:27,870 --> 00:29:32,760
visual appearance of the skin as compared
to just hammering it with a bunch of

456
00:29:33,210 --> 00:29:37,800
different agents that are trying
to strip the skin. So again,

457
00:29:38,310 --> 00:29:43,000
it's these things that
philosophically use common sense

458
00:29:43,390 --> 00:29:45,820
and really the skincare should match.

459
00:29:46,900 --> 00:29:50,800
And that's very important.
Skin is individual,

460
00:29:50,801 --> 00:29:54,370
so the product your friend
used and worked well on them,

461
00:29:54,371 --> 00:29:58,990
unless you're genetically
identical, your twin,

462
00:29:59,290 --> 00:30:03,480
your twin sibling maybe
is a good example of

463
00:30:03,730 --> 00:30:07,390
someone you should try their
product if it worked well on them,

464
00:30:07,400 --> 00:30:11,560
but not maybe for your friends,
even if you're roughly the same age,

465
00:30:11,561 --> 00:30:15,160
because everyone's skin is
going to age differently,

466
00:30:15,161 --> 00:30:17,920
it's going to react differently
to different things,

467
00:30:18,100 --> 00:30:22,420
and it's going to have different needs
in terms of what the problem areas are.

468
00:30:23,170 --> 00:30:27,820
And I love the idea of the
seasonality because I've

469
00:30:28,570 --> 00:30:30,760
always done that with my patients,

470
00:30:30,940 --> 00:30:35,680
cycled their products in different
seasons, which is efficient.

471
00:30:35,681 --> 00:30:39,190
Usually they'll use up a product and
then they can move on to something

472
00:30:39,191 --> 00:30:44,050
different in a new season that's
matched for what their needs are

473
00:30:44,051 --> 00:30:49,030
going to look like in that season.
And certainly where you live,

474
00:30:49,180 --> 00:30:50,590
Julius, and where I live,

475
00:30:51,940 --> 00:30:54,490
weather is really different
at different times of year.

476
00:30:55,180 --> 00:30:59,830
We're not sunny and warm 12 months out
of the year or 10 months out of the year.

477
00:31:00,160 --> 00:31:03,820
We're hitting very different seasons
in terms of the amount of sun,

478
00:31:04,240 --> 00:31:08,830
the amount of moisture in the air and the

479
00:31:08,831 --> 00:31:09,664
temperature.

480
00:31:10,120 --> 00:31:14,890
So that's a really important
thing to build into the approach.

481
00:31:15,700 --> 00:31:16,720
Absolutely.

482
00:31:16,870 --> 00:31:21,490
And I think also the truth
is just like we would

483
00:31:21,491 --> 00:31:22,600
for our diet,

484
00:31:22,630 --> 00:31:27,400
we all know as we get older what agrees
with us and what doesn't agree with us.

485
00:31:27,610 --> 00:31:32,440
And so typically how I approach
skincare is very much so

486
00:31:32,441 --> 00:31:33,880
from that vantage point,

487
00:31:33,881 --> 00:31:38,080
which is there are basics that frame good

488
00:31:38,081 --> 00:31:41,650
skincare and then you build from there.

489
00:31:43,870 --> 00:31:48,100
And again, being science-based. So I think

490
00:31:49,750 --> 00:31:53,530
that's really where things are. And
especially being out in California,

491
00:31:54,790 --> 00:31:58,450
there are skincare products that
come out literally every day,

492
00:31:59,860 --> 00:32:04,390
and they may be hyped in different
ways. And at the end of the day,

493
00:32:05,290 --> 00:32:08,140
with all due respect, it
becomes a question of, okay,

494
00:32:08,150 --> 00:32:11,470
well what is this really doing? And then

495
00:32:13,420 --> 00:32:17,710
can your claims be backed
by scientific study?

496
00:32:18,840 --> 00:32:20,620
And I guess that at the end of the day,

497
00:32:21,100 --> 00:32:25,660
it's really the biggest eyeopener
I've had in this space now that I'm

498
00:32:26,560 --> 00:32:31,330
kind of playing with some of the
big boys and girls is just the

499
00:32:31,331 --> 00:32:32,470
idea of

500
00:32:34,540 --> 00:32:38,620
have you subjected your
product to scientific study?

501
00:32:38,740 --> 00:32:40,070
And I was just on a panel

502
00:32:41,840 --> 00:32:44,390
with two other skincare companies.

503
00:32:45,410 --> 00:32:47,570
One was based in Switzerland,

504
00:32:48,680 --> 00:32:53,180
and I mean really interesting
products, interesting conceptual ideas.

505
00:32:53,210 --> 00:32:54,043
However,

506
00:32:54,500 --> 00:32:58,550
when I asked can I see the data,

507
00:32:58,910 --> 00:33:01,970
basically I said it the nicest
way, and I did this offline.

508
00:33:01,971 --> 00:33:02,870
It wasn't on the interview.

509
00:33:04,190 --> 00:33:08,570
And so their chief scientist had
promised that they would send links to

510
00:33:08,571 --> 00:33:10,460
different things and so on,

511
00:33:11,090 --> 00:33:13,310
because there was no published
literature I could find.

512
00:33:14,690 --> 00:33:17,990
There was nothing to share.
There was nothing to share.

513
00:33:18,470 --> 00:33:23,420
So I think that, and I understand,
and Larry certainly you do too.

514
00:33:23,421 --> 00:33:27,050
I mean, to do a clinical study
takes a lot of time, energy,

515
00:33:27,060 --> 00:33:30,920
and money to do it and
then to orchestrate it.

516
00:33:31,310 --> 00:33:34,670
And so for me, I feel fortunate that

517
00:33:36,410 --> 00:33:39,020
I've been involved in a lot
of different clinical studies.

518
00:33:39,021 --> 00:33:43,580
So we have an apparatus at our
institute where we can do the

519
00:33:43,760 --> 00:33:48,150
formal process an IRB, FDA level,
even though it doesn't go to the FDA,

520
00:33:48,740 --> 00:33:53,690
but an FDA level study that would stand
up to just about any kind of clinical

521
00:33:53,691 --> 00:33:54,524
trial.

522
00:33:55,580 --> 00:34:00,230
And I would challenge most
skincare manufacturers to

523
00:34:00,231 --> 00:34:04,070
say that they've done the same
because that's not common.

524
00:34:04,880 --> 00:34:08,840
Yeah, I mean, they often don't do it
because they simply don't have to.

525
00:34:09,890 --> 00:34:14,840
But a point that I make
very often to my patients

526
00:34:14,841 --> 00:34:19,550
is you may have a really good idea of what

527
00:34:19,551 --> 00:34:22,520
ingredient might be useful in a product,

528
00:34:22,760 --> 00:34:27,170
but unless you've done a study, how
do you know you've dosed it correctly?

529
00:34:28,130 --> 00:34:31,310
If I give you five milligrams of aspirin,

530
00:34:31,400 --> 00:34:34,550
it's not going to get rid of your
headache. You're a full grown man.

531
00:34:35,150 --> 00:34:38,720
If I give you 500 milligrams or 325,

532
00:34:39,260 --> 00:34:43,970
probably your headache's going to go
away. But skin products are like that.

533
00:34:43,971 --> 00:34:47,210
Sometimes. They've got a great
ingredient, but not very much of it.

534
00:34:47,480 --> 00:34:51,380
And unless you've demonstrated that the

535
00:34:51,381 --> 00:34:56,210
formulation has the desired
effect that the product is

536
00:34:56,211 --> 00:35:00,590
there inadequate amounts
by gauging clinical

537
00:35:00,591 --> 00:35:03,950
response, you're just
shooting in the dark.

538
00:35:05,360 --> 00:35:08,120
Could not agree more,
could not agree more.

539
00:35:08,900 --> 00:35:12,740
Now, Dr. Few, to wrap things up
toward the end of our episode,

540
00:35:13,010 --> 00:35:17,900
can you share your overall philosophy
about the role of skin products in

541
00:35:18,200 --> 00:35:21,320
an individual's beauty plan
or their skincare regimen?

542
00:35:21,980 --> 00:35:22,813
Well,

543
00:35:22,890 --> 00:35:27,530
I think that overall
skincare is the low hanging

544
00:35:27,531 --> 00:35:32,030
fruit and beauty care, especially
in the nonsurgical space.

545
00:35:32,090 --> 00:35:36,500
It can be the most cost
effective solution to

546
00:35:36,501 --> 00:35:40,800
anyone's beauty regimen or
beauty care self-care approach.

547
00:35:41,430 --> 00:35:43,710
I think that it's often overlooked.

548
00:35:44,250 --> 00:35:49,200
I think people will jump
to even surgery faster than

549
00:35:49,201 --> 00:35:54,000
they do looking at a
good balanced skincare

550
00:35:54,001 --> 00:35:54,834
routine.

551
00:35:56,070 --> 00:35:59,550
And so I think that's the biggest
takeaway is that remember,

552
00:36:00,510 --> 00:36:04,920
good skincare especially ideally
medical grade skincare is a

553
00:36:05,730 --> 00:36:07,860
necessary adjunct to plastic surgery,

554
00:36:08,550 --> 00:36:13,020
to non-surgical injectable
care and to beauty as a

555
00:36:13,620 --> 00:36:17,340
whole, both as a preservation
tool, a restorative tool,

556
00:36:17,670 --> 00:36:22,470
but ultimately as well can facilitate
outcomes in a synergistic way.

557
00:36:23,370 --> 00:36:25,950
Dr. Bass, any parting takeaways
you would like to add?

558
00:36:26,670 --> 00:36:31,500
I think it's important for people
to realize the skin is like a

559
00:36:31,501 --> 00:36:35,220
puzzle. That's how I think of
it, because everyone's different.

560
00:36:35,221 --> 00:36:39,840
So it's figuring out in as few steps as

561
00:36:39,841 --> 00:36:44,340
possible, which products are
going to be most effective

562
00:36:45,060 --> 00:36:49,050
to address the prevention and

563
00:36:49,980 --> 00:36:53,520
restoration needs that
you have in your skin.

564
00:36:54,900 --> 00:36:59,070
It's ideal if you can do that with your

565
00:36:59,670 --> 00:37:04,470
beauty doctor who has extensive
experience and can gauge with

566
00:37:04,480 --> 00:37:06,900
you if the products are being effective.

567
00:37:07,410 --> 00:37:10,020
But if you're doing it on your own, again,

568
00:37:10,021 --> 00:37:14,520
you have to look at least six or eight
weeks down the line and assess the

569
00:37:14,521 --> 00:37:16,500
effect of what a product has.

570
00:37:19,980 --> 00:37:24,390
And we said early in the episode
that product overload is a mistake,

571
00:37:25,260 --> 00:37:28,200
and constant changing is also a mistake.

572
00:37:28,230 --> 00:37:31,860
That's the grasses greener
fallacy that, oh, there's always,

573
00:37:32,340 --> 00:37:34,020
if I just switched to this product,

574
00:37:34,021 --> 00:37:37,380
suddenly magically the
skin will transform.

575
00:37:37,830 --> 00:37:42,150
And it is a process, but it's a
process that's very worthwhile.

576
00:37:44,490 --> 00:37:48,000
So Dr. Few, I'd like to
thank you for joining us.

577
00:37:48,180 --> 00:37:50,400
It was a really engaging discussion,

578
00:37:50,550 --> 00:37:55,440
and I think you have such a well

579
00:37:56,550 --> 00:38:01,230
formulated and productive perspective on
how to think about these things that I

580
00:38:01,290 --> 00:38:05,820
think will be really informative for
the listeners when they tune into this

581
00:38:05,821 --> 00:38:06,654
episode.

582
00:38:07,470 --> 00:38:07,561
Thank you,

583
00:38:07,561 --> 00:38:11,370
Dr. Few for joining us today
and for sharing your insight
and expertise with all

584
00:38:11,371 --> 00:38:12,060
of us.

585
00:38:12,060 --> 00:38:13,830
This was a lot of fun. Thanks a lot.

586
00:38:15,240 --> 00:38:18,930
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

587
00:38:19,380 --> 00:38:20,820
Follow us on Apple Podcasts,

588
00:38:20,880 --> 00:38:22,920
write a review and share
the show with your friends.

589
00:38:23,340 --> 00:38:26,460
Be sure to join us next time to avoid
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590
00:38:26,461 --> 00:38:30,000
coming your way. If you want to
contact us with comments or questions,

591
00:38:30,001 --> 00:38:30,900
we'd love to hear from you.

592
00:38:31,380 --> 00:38:35,670
Send us an email at podcast@drbass.net
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593
00:38:36,510 --> 00:38:36,600
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