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

If you remove all the things that you use for your acne and stuff like, leave it alone for a few weeks, your skin will wake up and you won't break out as much. You know the skin, you know what makes it youthful, what makes it healthy. But the vast majority of what you talked about was healing the skin from the inside out. It's easy for us to give you thick hair, perfect skin, but on the inside we're actually coming first with mood, concentration, performance, sleep. We're all looking at you on the inside out, rather than the outside in. When you walk into most cosmetic clinics, you can get lost in the programs that they're trying to offer you without really having a fundamental understanding of which one of these is actually going to get me real skin regeneration. The skin is one of the biggest organs and when it does every day, it repairs itself. Let it do the work. God's given it the cells for it to work. We just need to tweak it a little bit. I always say this to my patients, less is more. So what does a good basic skincare routine look like for you? I would go back to basics again and I would say. Hey guys, welcome back to the Ultimate Human Podcast. I'm your host, Human Biologist, Gary Breco, where we go down the road of everything anti-aging, biohacking, longevity, and everything in between. And today's podcast is a double-board certified cosmetic dermatologist that I actually met when, for the first time, face-to-face, when we were in Saudi Arabia speaking at a Zinos Health Summit, I was fascinated by her talk. She was already on my schedule, so I was excited about that. But watching her describe skincare as a dermatologist, as something that happens from the inside out, I found really fascinating. And the plan that she uses to approach her patients to restore healthy, youthful skin really didn't begin with the topical applications. It began with rebuilding from the inside out. So I'm really excited to unpack this. Welcome to the podcast, Dr. Shawanevali. Thank you, Gary. Yeah, you really did a great job in Saudi, I thought. Well, I was put before you, so I couldn't let you down. Right? Why did they put me before Gary, like, the key. Why am I straight before Gary? You should have told me before me then, after me. Yes, exactly. But what I found fascinating was the vast majority of your talk. And obviously, as a double-board certified cosmetic dermatologist, you know skincare, and you know the skin. You know what makes it youthful, what makes it healthy, how it grows, how it ages, and from a medical perspective. But the vast majority of what you talked about was healing the skin from the inside out, youthifying the skin from the inside out. So can we back up a little bit for the people that didn't have the benefit, like I did of attending your talk, which I really found fascinating. And it's so incredible how much of what you do. I not only do with my private clients, but I also deeply identify with. I just never really correlated it to all of these positives, skincare outcomes. Yeah. So I'd love to unpack, you know, what a typical consult with you is like, and where you start with somebody's skincare journey. Yeah, you even talked about different personality profiles of people that come to see you. So yeah, I'd love to unpack that. Well, we have the privilege of meeting all different types of people, and different types of ethnicities, different types of personalities. So I think as practicing physicians, you need to be aware of everything and experience in everything. I specialize in cosmetic dermatology, medical wellness, regenerative medicine, longevity. So we've always looked at everything inside out. We've never been like, oh, you've got some acne, you've got some rosacea, we've always been what's the root cause? Whole person. Whole person, where's the inflammation coming from? So we've always looked at you, you know, it's easy for us to give you sick hair, perfect skin, contour your body to suit your gender, ethnicity, your silhouette. But on the inside, we're actually coming first with mood, concentration, performance, sleep. Labido, gut health, fertility, immune system, musculoskeletal. We're all looking at you on the inside out, rather than the outside in, because the problem I've got is if you've got an inflammatory skin condition and I'm just doing some laser and resurfacing you with some exosomes and some fun stuff on the outside, or topically like you mentioned, I'm not fixing the root cause, it's going to come back, you're going to be unhappy, you're going to be like, it's not a very good doctor. Right, what are the major things in your opinion that cause skin to accelerate? I want to get specific conditions of skin like acne, wrinkles, what have you. But what are some of the just the major offenders of healthy skin that we do to our bodies from the inside out? I think it's just general lifestyle things, right? So right now, we're all living multi-hyphenate lives. We've got multiple roles, our bodies weren't designed in that manner. So you're a man, you're supposed to be a hunter-gatherer. I'm a woman, I'm supposed to be a protector provider. Yet we're both entrepreneurs, we're both burning the candle at both ends. We've both got multiple businesses and multiple roles. Right. We're pushing our body to a limit that we've never pushed it. I.e. the ultimate human. Right, right. So if our body hasn't caught up with what we're supposed to be doing, then physiologically we have to look at you on the inside and optimize that. And that's why I always say let's, when I take a consultation, the first thing I do is I diagnosis your skin is easy for me. Diagnosing what's happening on the outside is easy. And the first three questions I always ask is who referred you. Because for me, it's like what kind of aesthetic are you looking for, right? What kind of. And you could tell that from their friends? Yeah, but also what kind of journey do you have? You know, did your friend refer you to me because your parent meant a portion and so she? And we fixed it inside first before we came on the outside. Wow. Then I ask, how old are you? If you're in your 20s, you've got social media pressure, you've got lifestyle pressures going on, you're trying to establish yourself. If you're in your 30s, you might have had just your babies and you're going to return back to your body, or you know, you might be starting a new role as in the C suite in your late 30s. If you're in your 40s and 50s, you might start your next phase of life. You might have come out of a divorce. You might have, you know, earlyness, emptiness, right? Something else is happening. So I need to know what stage of life you're in. And the third thing I always says, what do you do? Like what kind of psychosocial pressures are on you? It's been to me what role do you have in society? What do you do? Are you your mother or four at home and you're running a small business as well? Are you a CEO of a hedge fund that you have to like stay up 18 hours late by all the time? And then the key thing is we don't move to it. Let's look at your skin. Gary, the next thing we move to is let's talk about your mood, sleep, energy, immune system, gut health, levita. We go to the inside immediately. Love that. Before we even look on the outside. Now are these, do you do that by, so first you obviously do the console. You get a profile of what the person is like with stage of life they're in. But after that, what kinds of testing? Because you can't just say mood, mood, hormones, libido. I mean, we need data, right? So where do you get that data? What kind of lab tests are you running? And what do you think are key markers to be looking at that might be markers that would indicate that you have accelerated skin aging? Yeah. So my patients are seeking me out aesthetically on the outside because they might have fine lines and wrinkles, folds in their face that they don't suddenly like loss of definition. They might find that their hair is thinning. They've got receding hair line. They might find that they've got mid-dublominal weight gain, which they didn't normally have. So the metabolism has changed, right? They might find that, you know, they've aesthetically they've got some cellulite, some stretch marks around happy and certain places. They're not always taught and tight as they used to be. Right. So their body has changed aesthetically on the outside. Right. But they haven't identified why it's changed from the inside out. So in terms of markers, we do subjective screening first. Okay. And then we, and subjective screening, you can pick up the clinical symptom one as you quite quickly in terms of storytelling. Is it adrenal fatigue with estrogen dominant? Is it adrenal fatigue with testosterone deficiency? Is it dopamine fatigue? Are you parabenopausal? Is this andropause? Is this dysfunctional gut dyspiosis? Is this just poor sleep or disruptor sleep? So on your wellness screening, we clinically pick up the storytelling. But also, you've already given me signs and symptoms in your past medical history. You've already told me in those three pivotal questions what's happening in your life. I'm recently divorced. I'm dating the world. I'm also a CEO of a hedge fund. Like, you've given me a few key things. And then when I'm asking you about your past surgical history, past medical history and past non-surgical history, like the aesthetic stuff, you've already told me if you're a virgin or non-vergine, I like injectables. I actually have only done one laser in my whole life. So I already know where to move the needle with you. Right. And also in that, we ask you quick medical question. Your wellness question, you do IVs. Have you taken an ED? Have you tried peptides? So you've already told me, are you a biohacker or you not? Yeah. So all those questions are really good that I've got there before I get to that clinical storytelling. Great. If I want diagnosis, if I want objective diagnosis and quantifiable, now my men are driven by data, right? Yeah. If I want objective quantifiable diagnostics, I can run tests. I can do your saliva retest. I can do your DHEA. I can do your hormone panel testing. I can do all the fun stuff. If I've clinically already explained to you what's going on. And then I'm trying to learn, are you a virgin or non-vergine when it comes to treatment and modalities? Yeah. Am I fixing you on the inside first or am I coming on the outside? Do you understand me? Do you understand the storytelling? We don't even treat you on the first day. Wow. We won't treat you on the first day. We send you home with an interactive treatment plan. We phase it, phase one, two, three, because say you're a 22-year-old female with a bit of acne on the outside, right? And you come in, you're like. Common. Yeah. And you're like, "Dotswali, this is what I look like on Instagram." Right. Yeah. And you know, I want to look like this. I want my jawline to this. Without the filter. I want this to be like this. I want my acne to be fixed. Also, my body is a bit like, I face tune it with the abs. And I'm like, "Are you sleeping?" You have anxiety. Do you suffer from panic attacks? What's your mood? Like, "Oh, I used to have depression. I used to be on an SSRI. I'm not on one any more." I don't, you know, I am overthinking the middle of the night. I do check my in, like, my notifications, do do do do do do do do do do do. Right. So we're like, let's think, let's rewire you first on the inside first. Let's work on the inflammatory cause of your acne first before we come on the outside and it's not contouring when you're unnecessarily. Now, there's how big of a role does stress play in this, because you're getting to people's lifestyle choices and a lot of us live very stressful lives, you know, we're constantly on the go, but we're also constantly engaged and entertained. We're also always immersed in something. And that puts a lot of stress on us, right? Not just to perform, but to look the way that everyone looks on Instagram, to perform, and what everyone expects us to level it, expect us to perform. And we talk about, you know, stress being so detrimental, but what is it about stress? What is the link between stress and the skin? Right, okay. So we can generally call it stress, but what stress does it cause is something called oxidative stress, so free radical damage. It causes breakdown of collagen, okay? So glycation, breakdown of collagen, turns around as you finalize wrinkles, open pores, awareness. It can inflame your acneurization pigmentation. But if we go back to cellular cause pathophysiologically on a cellular level, you've got the beauty layer of the skin, which is the epidermis. You've got the medical layer of the skin, which is the reticular dermis. In reticular dermis, you've got these great things called building blocks, called fibroblasts, which is collagen, last in high lonic acid, gads, all the good stuff stays in the medical layer of the skin. Right. By the age of 21, this is degradative. This is really going down with, by a gift from God. You're already aging. It's the gift that we don't ever want to open yet. It's the gift that we don't want, right? So you've already got that. On top of it, you've got a pigment called melanin, which some of us will get pinky-purpley, and some of us will get brown pigmentation in face. So that comes up with sun, trigger, hormonal trigger, environmental trigger. So all these things, when you've got oxidative stress and free radical damage going on, this gets enlightened and inflamed. Because this is in the deep layers of the skin. In the deep layer. So then, if you've got fibroblasts, the building blocks breaking down, that means you're going to get the collagen breaking down. You're going to get the good stuff. They're like the robust, the architecture of the skin breaking down. So you're going to get the laxity. You're going to get the fold. You're going to get the fine lines and wrinkles. You're going to look dull. This skin's not going to be glowy, right? Things aren't going to be as tight and talk as they used to be. Right. But then also on the beauty layer, there's something called epidermal cellular turnover. God's given us the best organ, like the human body is the best organ. We both say it. Right. No doubt. But the skin is one of the biggest organs, and what it does every day, it renews and turns over. It repairs itself. Right. But when the beauty layer is a bit broken, then that doesn't happen either. So then suddenly, you're exposed to environmental toxins coming in. And of course, in more inflammation. Yeah. So that's what happens. You know, I very often refer to the skin, not as a barrier, but as a gateway. Yeah. Because it doesn't just keep things out. It lets certain things in. Yeah. And there's a big, you know, discussion going on right now about the types of things that we apply to our skin, filates, parabins, you know, toxic chemicals that we find in cosmetics and skin care products. And what kind of damage have you seen over your career? And what do you, how do you advise your patients to go out and select cosmetics, skincare products, makeup, lotions? Because I think we sort of go through the process of our day. And we don't realize the amount of toxins that we piled on was actually had a lecture. This was probably two or three years ago. And this woman was walking through a standard day for a female from brushing her teeth first thing out of getting out of bed to removing nail polish at night before she went to bed. And the number of toxins that were applied to the skin, the nails, the hair, the sprays, the things that we're applying to look better and supposedly feel better. As she broke these things down, I was astounded. It was like 180, 190 different chemical compounds in a very average day. Yeah. Especially for a woman. So what are some must-of-voids? And what do these toxins do? What are some of the toxins? And what do they do to our skin? And what do they do in the female body to the hormonal system? Yeah. So let firstly, you're lucky you're not a woman. So you're not going through all the pressures that we have to go through. But the pressures are coming your way, don't worry. Yeah, trust me, I know. But here's the thing. So the key thing here is education. I'm quite privileged because we've been educated with a certain knowledge. So I can look at ingredients and say, this is going to work on my skin and this is not going to work on my skin. Because ingredients are going to sit on the beauty layer and do nothing apart from cause of barrier. Right. Or it's going to go down to the medical layer of skin and it's going to up-regulate the good stuff. Right. Or it's going to cause free radical damage and down-regulate the good stuff. Right. So that's the key thing here. Anything that's available over the counter sits on the epidermis. OK. If it's available here, go to the medical, you need a prescription normally. Right. To work in the reticular damage, you need a prescription. Does that make sense? He makes a lot of sense. So everything you're applying topically, you know, and it used to be a lot of silicon-based makeup and silicon gels that could hide the pores and stuff like that. And a lot of people have gone green in the environment and they've turned around, so it's green formulation. And we want to be natural. But the problem you've got is some natural ingredients aren't going to give you the cellular change that you need to work on the fine lines. You open pores, the laxity, the inflammation, all that kind of fun stuff. Sure. So you've got to be careful on the ingredients that you're picking. OK. But what's good with the industry, especially the beauty industry, that they've taken the no-nasties out. So there's been a massive movement in the beauty industry in the last decade that the no-nasties list has been cleared out. That's good. And there has been a clean movement, especially with the likes of brands like Sephora and stuff for that where they've come in with a clean list. But then there's also a movement where doctors have come in. And so, actually, these ingredients work really well in the medical area of the skin. But if we can get it to penetrate without being broken down up here, then it's amazing. So just sits here, it doesn't do anything. I'll give you an example, hyaluronic acid. Everyone talks about it. Hyaluronic acid naturally found in my body. Oh, my God. Let me put it in a syringe. A thousand times, it's weird. Water, it's amazing. Best marketing PR campaign, there is. If you have an inflammatory skin condition, if you're acne and you use hyaluronic acid, you're actually causing more dehydration. The molecule was too heavy to get down to the medical layer of the skin. It sits up here and it causes something called transepidermal water loss. It actually dehydrates your skin. Wow. Whereas beta glucone is tiny, tiny, tiny, tiny spec of hyaluronic acid, it can go all the way down to the medical layer of skin and reduce its inflammation is anti-inflammatory. So ingredients are key-- Called beta glucone. Beta glucone, yeah. Beta glucone. Which is preferential, especially for my acne patients. My rosacea patients will turn around and say, my skin is so dry, I'm like, you're oily. My skin is so dry, I'm using all these emolients and moisture like, please stop using that. Yeah, yeah. Please stop. You're definitely having an inflammatory skin condition. You have cellular turnover, which increases your aging faster. Inflammation causes cellular turnover, causes your cells to break down faster. If I take you and your twin sister, if you don't have acne and your twin sister has acne, she will age faster. She will see folds in her skin a lot more easily than you. Wow. So when you have an inflammatory skin condition, we have to dry you up. We have to override your inflammation. So if you're using emolients and moisture relays, you're making my job much harder. So I think there's a massive key piece needed in education. And whoever you're going to, your practitioner, your physician, your makeup artist, your beautician, they really need to understand skin care ingredients or makeup ingredients. Is this lipophilic? Is it lipid-soluble? Is it hydrophilic? Is it water-soluble? Does it actually get to the right endpoint to give us the change we want? Is it just sitting there doing nothing? Listen, there's what I share on this podcast, and then there's what I share with my inner circle. If you've been following me for a while, you know how I hold nothing back here. But my VIP community, that's where the real magic happens. Picture this. You're struggling with energy crashes, brain fog, or just feeling like you're not operating at your peak, and you don't know where to get real answers. But here's what really sets this apart. 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Now let's get back to the ultimate human podcast. - Right, yeah, now what are some, you refer to inflammatory skin conditions? What are inflammatory skin conditions? Are you talking about sunburned or are you talking about actual skin reactions like a topical dermatitis? - Yeah, so most skin conditions are inflammatory base. And we, you know, this notion of inflammation is only happening in the last five years where we're everything's inflammatory base. - Right. Every condition-- - It's not your buzzword. - You know, everything in medicine is inflammation base. Right, every diagnosis. But actually skin conditions are inflammatory base. Inflammation, per se, just in a general term, is cellular turnover, rapid fast and cellular turnover. That's all it is. So for me, when I'm looking at skin conditions, is this a skin condition with accelerated cellular turnover and damage? Or is it not? So things like pigmentation, acne, rosacea, exma, psoriasis, despite it having environmental genetic auto and marine predisposition, there's also an inflammatory predisposition. So I have to understand what aspect or modality am I working on? Am I working on the sebum? Am I working on the inflammation? Am I working on the awareness? What am I working on before I can give you a treatment plan? - Sure. And people that have, you see that there's certain races like Latinos, African-American. Generally, more olive and darker, complex populations where they have a blessing in a curse, more oily skin, which does an age, but it's probably more prone to different things like breakouts and acne and things like that. And you see that-- - Or pigmentation. - Yeah, or pigmentation. So it's not a one size fits all because obviously you're treating lighter skin differently than you're treating darker skin. But what are some of the lifestyle choices that people are doing every day that are accelerating their skin loss? I mean, their skin age. - I think in the world we work in, I think the key things that we see is poor sleep. So sleep hygiene, disturb sleep, not getting to deep start to sleep. That's causing that's causing accelerated aging. - Reach about this all the time. - And exactly, you say it all the time, your body repairs itself at night. Growth hormone is produced at night. Happy hormone is produced at night. Microbiome, the gut microbiome, and the skin microbiome is repaired at night, right? Then we've got cortisol. We've got stresses, daily stresses. We have more stresses now than we've ever had. We've just mentioned that in the beginning. So that's causing accelerated aging, your free radical damage, your glycination, all the fun stuff that's happening. So that's causing us accelerated aging. Then I always say this to my patients, less is more. I always say, "Did your grandmother have this?" Like, does she have access to? - 14 states, skin care routine, yeah. - All right, your grandmother had Nivia. She didn't have eight to 12 steps, right? - Exactly. - So like, less is more. Like, sometimes you wanna let the body, the human organ is so amazing, let it do the work. We just need to tweak a little bit. So my thing is to distill things and remove things a little bit and say, "No, take this away, you don't need this." - No, an antibiotic will only fix the bacterial element you're actually. Racketane will only fix the sebum. It's not gonna fix the inflammation, it's not gonna fix the scarring, it's not gonna fix the cellular turnover. There isn't a one pill for a magic cure. And it's actually educating that patient in that way. - Now, where do you fall on sun exposure? Because, you know, I'm. - Gary, look at me. - Yeah. - Hey, I come on. I think I've answered your question. I'm a vampire. Well, I hope you're taking vitamin D3, then, okay. Okay, good. You know, I've always been a fan of morning sunlight because there's no UVA and UVB rays. And I tell people, if they want to get sunlight, first 45 minutes of the day, it's a great time to just. - Blue light is less as well. - Yes, and the blue light is less as well. And, you know, it's the UVA and UVBs that really kind of damage our skin, but it's still okay to be out in sunlight. First thing in the morning, I actually make a practice of it. You know, I just expose my skin to sunlight in the morning. You can tell I don't get a lot of sun. I'm not, I'm not red, and I'm certainly not tan. I'm a white boy like you or a white girl. - Yeah. - But, so, where do you fall on sun exposure? And even more importantly, where do you fall on sunscreen? Because, you know, a lot of sunscreens, I mean, there have been, what, 18 brands are so pulled from the market in the last 12 years, for having some kind of indirect calls, either to skin cancer or some. - Cursinogen, yeah. - Yeah, carcinogen. So, where do you fall on that realm? Sun exposure and sunscreen? - Well, the first thing I say to my patients is this skin has to match this skin, which has to match this skin. If you're gonna have a Birkin bag here, and you're gonna go like, "I love what we're to the sun." You know, sit there, and like, get the sun raised in, right? - Birkin bag. - You're creating, you're gonna cross wrinkly and fine lines, wrinkled pigmentation. And you're gonna get that crocodile back, and you always wanted it. You don't need to put people in a way. But you're not gonna, you don't need to be put on a weight list. - Just put a handle on it, yeah. - That's what I say. I'm like, "Are you gonna make a Birkin bag out of you to college?" - Yeah. - So the key thing, the problem with sun is exactly, it causes inflammation, it causes the cascade of glycation, oxidative stress, cellular turnover, aging, all the things we said before, fine lines, wrinkled, it deflates you, it can aid you. Your skin is like an organ, it holds everything in place. If I'm burning it, it's burning it down-- - Yes, yeah, burning it is terrible. - Literally, it goes down here. The other key thing we need to remember, is you mention Latinos versus Caucasians, or African-Americans versus Caucasians. We've got, and I'm Indian-African, by the way, as pale as I am-- - Indian-African. - African. - Yeah, as pale as I am. - Praxas and London. - Yeah. - Live part-time and go in the Middle East, okay. - Everywhere around the world. - Yeah, you got all the bases covered. - Basically, but here's the thing, right? I have melanin in me. So if you and I went into the sun, you'd burn quite quickly. I wouldn't, I have a protective melanin in me. So African-American skin, and remember there's 28 different types of collagen, right? So we've got, all of us have different types of, we have, collagen one and three. - Well, we were nine, but-- - Yeah, there's 28. So there's one in three that we really work on in aesthetics, that we really operate, that gives you your strength, your volume, the tightness, right? And then there's 4, 7, and 14 that work on the anchors between the beauty layer of the skin and the medical layer of the skin to hold it in place, right? But African-American people have different distribution to Caucasian people. African-Americans have more melanin, so they're protected from the sun. - Right. - Whereas you're not. If the UV damage is your cells, you get the aging, you get the glycation, you get the fine lines of wrinkles, you get the sunburn, right? But then on the other hand, African-American skin, pigments easily, key loads easily. So I think God's been fair to all of us, right? - He's fair. - Yeah, he's been fair in his distribution. Sun protection is key, whether you're indoor outdoor, I wear SPF all the time. And there's different types of SPF, I have SPF 30, I wear SPF 50, and I also wear sunblock, especially in heat like this. So you know, I do tend to put the sunblock, especially on the tips on my nose, zinc oxide-based. 'Cause that blocks it completely. Has the industry come out with something better? Not yet. - Right. - Are we waiting for it? Watching ways. - Right, but the non-nano zinc doesn't actually absorb into the bloodstream, which I'm a big fan of, because, you know, if you are gonna wear sunblock, it should be exactly that, a sunblock. It shouldn't be something that actually passes into the bloodstream and starts to disrupt our hormones. And there is a lot of links between different parabens and thylates and fragrances and things that actually do-- - Pullman disruptors. - Yeah, that are hormone disruptors. And so, when you talk about getting into this reticular layer of the skin, and actually feeding the fibroblast, or helping the fibroblast do their job, one of the things I've heard you talk about that I am an enormous fan of are exosomes, because these are little vesicles, they're about the size of a virus, they're about one-eighthundredth the size of a cell. They do penetrate deeply, just because of their micron size. Some of them carry, I'm molecular weight, hyaluronic acid, some carry growth factors. So these, I'm starting to see slowly, and I think you even have a skincare line that contains exosomes. And why did you choose exosomes? And for somebody that's not familiar with what they are, how do they work in the skin? Why should it be something they consider in the skin care routine? - Yeah, so I wanna step back a little bit. - Yeah, because you're not in my industry, you're not someone who's seeking me out. So in terms of a state treatment or treating things, you've got virgin and non-vergine, right? So virgin treatments are things you might be comfortable with, you don't want needles near your face, you don't want anything external put into you, right? And that could be things like prescription, great skin care, with great formulation of vitamin A, your retinoise, your exosomes, your epigeninate formulations. It could be lasers, a blade of non-ablative lasers, it can be skin-tightening modalities, your frequency, ultrasound, this is all you're comfortable with 'cause you're not putting a needle in your face. - Right, and those are looking to do the same thing to provide either micro-damage to that layer so that when it repairs, it repairs itself in a healthier way, right? - Yeah. - I would probably call that a format of stress, like micro-trauma, which in a controlled environment done by someone like yourself that understands what they're doing can be a good thing, you know? I also know people that have over-dermarolored themselves and gotten scarring, yeah. Because those needles puncture on the way in, they kind of tear on the way out with a lot of those rollers. - Doesn't do that. - Yeah, okay, good. Yeah, you know, 'cause we, Sage and I, when we first started our business, we had a girl working with us, beautiful, early 20s. And she discovered dermaroling, and I'm not kidding you, in three years, she had completely destroyed her skin. It looked absolutely terrible and she was actually developing these cars. - Yeah. - But I want to go back to some of these topicals. I mean, you have a skin care line, but I want to go back to some of these topicals and what exosomes are doing in the skin and why these biologicals-- - So I'm going to come to the biologicals for a minute. - Oh yeah, no, you should step back, so let's go. - So you've got, you've got the virgin-style treatments and then you've got the non-vergine-style treatments. And on the version, like you said, it's a controlled inflammation, it upregulates the medical layer of the skin, it tightens you, it cleans up any pigmentation stuff like that, it works on different modalities. Then you've got non-vergine where we might do intradermal exosomes, where you might inject hyalonic acid, mixed with exosomes, where you might inject biologicals, such as PRF, PRP, your own growth factors, or you might use bioestimulants, such as PLLA or calcium hydroxyapatite, to regenerate the dermis or even the bone on the periostial level to tighten you. So these are non-vergine, because I'm using a foreign body into you, right? So when it came to skin care and skin care formulation, there are only certain things that are licensed to certain prescription strength that we are allowed to use. But the key thing is here, when you're looking at ingredient, you want to look at bioavailability. Does this amount actually get to the endpoint, or does it go to the first pass? It hasn't got to just sit on my skin. Does it actually get to that cell, we're talking about the fibros, or the meninin, or the keratin side? What cell does it get to? And how much of the bioavailability actually gets there? And then what does it actually do? What was the outcome of it? And I think that was the key thing. I think name exosomes you, they're exosomes of vesicles, I love them, you love them, we love them in longevity medicine, intravenously, we love them in our hair, it's a scapulae to get hair growth from the effluvian phasor, shedding phasor cells. You're talking about exosomes, right? We love them into Germany to sell your regeneration grow, right? But what exosomes and formulations do is they create, they give signals to different cells to give you the output that you want. Wow. So they can take growth factors, DNA, mRNA, RNA, and they can say, okay, produce more collagen. Really? They can literally send this signal to that, wow, that's fantastic. And that's why, and that's why it's really, it's going to be, they're not going anywhere, as you can tell. And that's why it's really important, the epigenetic skin care, that if you are using exosomic formulation, that the bioavailability is actually there. Yeah, now also the, and by bioavailability, you mean that that exosome is still viable to enough to perform its function, right? They're not really living things, but they can also be inert because they're destroyed by heat or, or would have you. Or the delivery system is inept, yeah. You know, and I hear the terms collagen, elastin, and fibrin. Yeah. You know, obviously these are all involved in the scaffolding of the skin, the structure of the skin. What, for someone that's not familiar, you know, what is the difference between collagen, elastin, and fibrin in the skin? And are there different ways to stimulate each of them? And why are they each important in having youthful looking skin? I think collagen is the main player. Okay. So you've got the building lots of fiblasts, and collagen's actually the main player. It's a protein, right? Yeah, and in the dermis, it's collagen fiber one, about 80% of your dermis is collagen fiber one, right? There's one in three, but it's more one than anything. And then fibrin, and elastin, fibrin helps give you a fibric felt, in terms of the fibers. So if I stimulate the fibrin, you can actually get fibrosis as well. It can go the other way, right? And then elastin is that, you know, that tensile, do you want it to be loose and relaxed, or do it to tight, and you actually want things to bounce back. You want it to be a tensile, but you want it to bounce back. With age, you get the laxity. It's not going back up. So can you remember those days when you used to put on weight and lose weight? Yeah. And the skin never expanded. Right. Or you used to, I don't know if you, you know, if you body training and weight and you, you, you debulking, you either, you would either get, you know, lots of guys would get those stretch marks, stretch marks around their shoulders and their pecs and stuff because the muscle grew too fast. Exactly. So I say to patients, after they're just 35, you're very careful of weight gain and loss, or muscle gain and muscle loss. Because once you add, after they're just 35, you've got, you've got significant fiber loss degradation. And your fiber in elastin is not as strong as it used to be. So it doesn't bounce back. Whereas your collagen, you can keep up regulating it with different treatments that I have. OK. Most modalities in my industry work in collagen 5 is 1 and 3. We don't really concentrate on fiber in elastin. OK. So fiber in elastin, they're going to be-- They're-- secondary. --being lost at a rate that's commiserate with aging. But the collagen can make up for that because you're going to increase this protein. So what are some of the ways that you increase collagen in the skin? And then I want to get into some of the topical modalities that people use because I believe some of these are short-term benefit for long-term loss. People are borrowing from their future, if you will, too much burning of the skin, scraping of the skin. And maybe you get this youthful rebound. But temporarily. Temporarily. But then you're literally borrowing from your future. You know, my wife has friends like this that were just laser and dermabrasion and micronealing freaks and skin look great for a period of time. And now it really looks terrible. And it's hard to get it back. If you want protein to build lean muscle, but without the caloric impact or need to cut, you need perfect amino. It's pure essential amino acids. The building blocks of proteins in a precise form and ratio that allows for near 100% utilization in building lean muscle and no caloric impact. So we build protein six times as much as way, but without the excess body fat we normally get during bulking. This is the new era of protein supplementation and it's real. If you want to build lean muscle without having to cut, you need perfect amino. I think the first thing you said about me was the inside. So for me, I don't diagnose collagen degradation because it doesn't present like that. You're presenting with adrenal fatigue or you're presenting with other features, right? And then it's a byproduct of the stress that you're going through. So I'm not focused on collagen collagen collagen. I'm focused on getting the inside correct first. I love that. So if we've got adrenal fatigue, then I'm working on that. And was it NAD? Is it peptide program? Can I move the needle away? Find some ways that people recover from adrenal fatigue because we do see women whose cortisol is floored out. They're just not producing cortisol. I've been out twice in my career. Have you really? I've had significant ban out twice in my career. So how did you get your cortisol back? Yeah, so I've been completely flawed. I was Eastern dominant with adrenal fatigue. I had to go through rewiring myself. I had to do my routine NAD. I had to turn around. I went on peptide program. I didn't just go on ACTH139 and do adrenal fatigue ones. I went on semi-concelling as well to optimize my mood and cognitive issues. Oh, so length, yeah, yeah. And the entire anxiolytic, that's peptide, yeah. So I went on those. And then I went on a microdose from Eastern as well. Wow. But now I'm coming to perimenopause. So I'm now changing that up a little bit. So we work on the inside first, before I'd work on the outside of your collagen degradation. On the outside, like I've said before, it's always virgin and non-vergent tools. What are you happy with? In my industry, everything is inflammation basis. Me causing micro trauma to upregulate the cells to wake them up. So it's either that, but there's a new area of medicine which we spoke about in the Saudi conference called regenerative aesthetics. I love that. That's where your biologics come in. That's where your exosomes are coming in. That's where things like polynucleotides are coming in. That's where prophylo is coming in. That's where your bioestimates have now come back again. They used to be out of affadish fashion, because calcium hydroxyapatite or PLA used to grow your face uncontrolled bioestimulations. You'd get that look. And you're like, no, no, no, I haven't had any treatment. I promise you for two years, they're still growing. Still going. But they've changed the mechanism of action. They've told us to inject much deeper and overdilute. And they've changed the molecule. So they've worked on it's changing the mechanism of action. So we've got different modalities now in terms of regenerative aesthetics and cellular regeneration that are not focused on just micro trauma, but work on a biological front on the front end on the outside, but also on the inside. We've got regenerative modalities, such as your exosomes, your mesenchymal stem cells, such as your peptides, or just natural things like therapeutic plasma exchange, or eBoo, IVO zone. Oh, I'm not saying all these things. It's great, because these toxins build up not just in our bloodstream, but in our tissues. And our skin is also a secondary route of waste elimination. Lots of waste is sort of excreted through the skin. And if you're full of toxins, they're going to come out in that way. And what happens? Do you remember the days when you must do intermittent fasting? You must be a pro. You do 24-hour fasting from-- Yeah, and then 24 or 72 sometimes. You're like a legend in fasting. And you've noticed that your skin just glows. Oh, it's unbelievable. The whites of your eyes are being there bright. And your skin changes in three days, which is fascinating to me. And that's why sometimes I say to patients, you can't get access to me, but you can get access to my knowledge. You can go on intermittent fasting. You can go into autophagy. Even your body can start repairing it, so it can start reducing the inflammation inside. Your skin will start glowing and repairing itself. You can do detoxification removal. All these creams that you're putting in for the next seven days. And you'll notice that your skin barrier function will start waking up again. Wow. And your skin will start repairing itself. If you remove all the things that you use for your acne and stuff like that, leave it alone for a few weeks. Your skin will wake up. Yeah. And you won't break out as much. Stopping. Even if you don't come and see me. Yeah, you know, it's funny. I had-- well, I have one teenager now, but I just recently turned 21. Both of them struggled severely with acne. One went on a very short course of acutane. We took him right off. But one of the interesting things, much to your point, was in both of their cases, when we applied the Lessons More theory, not overscarbing their face, not always-- not always using these facial cleansers in a lot of those parts. Benzoil peroxide and all those pads. And yeah, the acids, you know, I found that it really inflamed the skin. They would go from having acne to really red and inflamed acne. You could tell the skin was super, super irritated. But in both of their cases, both my youngest son and my youngest daughter, their skin changed dramatically when we started skipping days washing it, when they just used warm water, and they actually didn't use any. And they had a little bit of sun exposure, not a lot, but just a mild amount of sun exposure. It actually really started. And we focused on hydration and good nutrition. It really did. Yeah, internal. It really started to change them. Well, my wife, who's been very public about this, just recently went through menopause. And on the way in, we noticed dramatic changes, mood, emotion, typical hot flashes, but also to her skin, almost overnight. And I've been deep down the rabbit hole of female hormones and their relationship to estrogen's relationship, the skin elasticity. And when these hormones floor out, the skin very rapidly loses its elasticity. But what was fascinating is, after hormone therapy, her skin bounced right back, it was unbelievable. I mean, I think menopause is like, if you could sort of design a perfect torture chamber for a woman, you know, it's like waking, water retention, loss of skin elasticity, no libido, sleep disruption, brain fog, and mood swings. There you go. And by the way, we're going to toss in a little frozen shoulder-- It's called to decline, but yeah. --cognitive decline, and we're going to maybe toss in some frozen shoulder, just really complicated things. A couple of tons was really fun times. And, you know, as we really-- I mean, when I got this test back on her, which is called a Dutch test, it really gave me so much insight into how so much could go so wrong, so fast, because these things floor it out. And I really would implore women to-- to really, if your perimenopause or you're going through menopause, you know, get a functional medicine doctor to do a hormonal evaluation on you. So what have you seen with hormone replacement therapy in men and women, and having effects on their skin? Yeah, so men, again, never come for-- I look tired, I've got folds, wrinkles, can you fix that? They then come, men come, and my wife sent me to get refreshed. Yeah. So men never come to me because I've got wrinkles on my face or folds here, and-- Yeah, fine with it, with it. You're quite chilled, right? You throw some jergons, you know, $2.99 CVS. I have to borrow some moisturiser. I'm like, I don't care what I pull my face, but the wife that pushes the man. It's so true. And then when you take the history from-- and like I said, we always do inside out. And then I'll find out, you're wide and tired. You're running on empty, you're not sleeping. You've got loss of libido. You've got mid-autumnal weight gain. You don't have that drive that you used to have. And I'm like, OK, let's do a testosterone test. We've got a little bit of testosterone deficiency. Are we in andropause? Do we even have adrenal fatigue on top? Are we just in andropause? So what happens in men is that the testosterone declines over a long time. And then with the collagen, and in terms of skin, you notice you get the bony resortions. You get loss of definition of your jawline. You have that sharp jawline used to have. Right. You also get foes and wrinkles in your face. That doesn't really bother you because you know, men should look like they've lived. Right, right. Doesn't really bother you, but you look a bit weathered, right? You might get recession of your hair line and you get the mid-autumnal weight gain. And like men, again, are always metric driven. If I change you on the inside, outside is five minutes. You're like done. That feels goodbye. I'm off, right? And I've got different modalities again. Is it virgin non-vergine, do I stick to just peptides? Do I stick to IVNAD, simple stuff? Do I do T-P-U-B-U, all that kind of fun stuff? Or do I go and testosterone replacement area? Are you ready for that? Yeah. My women will literally take the pencil and they will consult themselves. [LAUGHS] I need this. I've got this more. I've got this far. I literally woke up this morning, and this is a classic line in perimenopause. I woke up this morning, and my jowls were here. They were there yesterday, and they're suddenly down here. They suddenly look like I've aged 10 years overnight. This is what happens to sage. So women, they'll take their pencil, and they'll mark it all to it. And I just sit back and relax, and then I check my WhatsApp. So they're like, you're like, I've been here before. Yeah, I'm like, here's your charge for the consultation. You've diagnosed yourself. But the good thing about women is they'll tell you everything, and the picture's a lot easier, and they're very transparent. Yeah. So the picture's a lot easier. So again, on the inside, are they sleeping? What's their moonlight? So we can diagnose perimenopause just on clinical symptoms. One of you, like you mentioned, other symptoms. And they already had that in-clean, because they spoke into their friends. We talked to each other all day long. Oh, yeah, yeah. Women just-- They're flat out with their friends. And they'll come in. Yeah, they'll come in. I'm perimenopause. And you're like, you're 38. I'm perimenopause. It starts early in the night. Do you not know? You know, OK, no. You can start early in the morning. Yeah, yeah, yeah. Did you not know? I was like, OK, cool. Another problem. East shouldn't decline in women just happens overnight over the cliff. Right. And it just drops by 30%, overnight. Collegiate degradation happens, fine-line wrinkles, open pores, all in this. More inflamed condition. So say you had moderate aerosation. You just drank a glass of wine in your 30s. Now in your 40s, you're noticing broken capillaries. Yes. You're making skin thickening. You've got pores. Your face looks a little bit grubbier. The solanus is there. It does look as bright as it used to be. Yes. So you're noticing changes that you didn't see before. Your skin's thinner. The ceramides have gone. Because the East shouldn't dry. The ceramides are ceramides have gone. So you're feeling dry everywhere. You've got hair thinning. So this is what's happening. And then suddenly you're getting a middle of a normal weight gain. You are not eating at all. But you're still putting on weight in metabolism. Yes. Retaining water. You're retaining water. So women will come in. And again, do you want to say an avergillin or non-vergillin? So my women are still not HRT ready. They're not my identical hormone replacement ready either. So I just have to use the tools I have. Whether it's peptides, NADs, whatever it is. Just to optimize their mood, get them to sleep with a Delta sleep induced peptide. What is it that I can do in a natural way that they're comfortable with? Yeah. And on the outside is easy. I've got loads of modalities to thicken their skin. Tighten their skin. Do they want to buy a stimulant to lift on the bony level? So they can have jawline definition back. Do they want an inflative laser with exosomes to continue regeneration? Yes. But if I can convince them to go and buy identical hormone replacement therapy or HRT, a lot of women are now going on it much younger because it's outcomes. I think so many women are suffering unnecessarily because they have this fear of getting on a biomedical hormone therapy. And I've seen miracles happen for women that are suffering overnight, my wife being one of them, and I'm a big fan. And I've been deep down the rabbit hole in the research. And some of the studies that linked hormone therapy to breast cancer actually debunked that link in the very same study just after it was carried on for a longer period of time. I think it was the Women's Health Initiative was the big one that really got a lot of-- It's been debunked, right? Yeah, it's been debunked by the Women's Health Initiative. So if you are listening to this podcast and you're one of those women, don't be scared of seeing a function medicine doctrine getting on biomedical hormone therapy. I would say go on it. Yeah, because it can be. So you've mentioned peptides a number of times. What are some of your favorites for skin? I mean, like the GHKCU copper peptides, you're like BBC, what are your-- So I don't really use peptides for skin because I've got so many different modalities already, right? So I don't really need to use peptides. I've got better things that can work, right? The GHKCU is a popular one. Phymosin beats is a popular one. You can do sub-dermal injections. Or you can just micro-needle it in. It's not too how you want to take it. For me, I use peptides for the internal stuff. Yes. I don't use peptides for skin. I don't use peptides for hair either. I use exosomes for hair. Yeah. It's just so your regeneration is much stronger, right? So the outcome is there for my patient because if I promise you something, I don't deliver some game over. Yeah. Again, I'm the worst doctor in the world. In dermatology. Yeah, yeah, I'm the worst doctor in the world. So your reputation matters. But also you have to do good by the patient. So I have to say these are the modalities you've got. If it was my hair and my hair follicle, this is what I would use. So I want to talk about the new breed skin technology. Tell me about that. How are you using that for your products? So for me, like I've always mentioned, and probably for you as well, bioavailability is important. Formulation is important. And one thing I didn't understand, I'm a practicing doctor. Yes. I'm a practicing doctor. But what I didn't understand is how one's gain care rank and work on all of us the same way. I couldn't agree with you. We're eight or nine billion different types of people. We're doing personalized medicine. Why are we not doing a personalized approach? So then I was looking at formulation. I'm like, what do I like in practice? That is prescription grade strength. And can I get it over the counter? So I was like, okay, most of the skin products sit on the beauty layer. So it's not even going where we need it to go. Right. How do I get my 12 favorite ingredients to go to the medical of the skin without you needing a prescription? Yes. And then how does it treat open pores or in this finalized wrinkles? Pigmentation rosacea and all the common things we suffer from, right? Inflammation. But it works on you differently to me because we're different ages. We're different sexes. We do have different skin conditions. Right. So then I wanted an epigenetic formulation. So I took the 12 prescription relatives. I shouldn't wrap it in Japanese technology. I spent about seven years and we lab in formulation and clinical trials and studies. And we proved that it goes to medical level skin, the reticular dermis. Wow. So if you're fibroblast or you're melanin or you're inflammatory cytokines, or whatever it needs to differently to mine. Wow. So if my problem is pigmentation and yours is rosacea, it acts on you differently to me. Wow. Regardless of gender, gender, age. By using cell signaling or something. Cell signaling, epigenetics, formulation and that kind of thing. Wow. So we've done that in our paediatric biometic adaptive complex 12. So that's in adaptive skincare. Okay. And that's why you call it adaptive skincare. Adaptive skin. Yeah. Adaptive skin. I'm calling it new breed skin technology because I want it so fun, you know, like Rianna Fenty. I want it so it fun. I want it to be just as cool. Yeah. Yeah. Well, you're pretty cool. I mean, look at your boots. Yeah, thank you. I've got styled. Yeah. And then on the other side, devices over the counter devices, so you know, your LED mask, your microcurrent devices, you know, does it actually lift and tighten? Right. How do I get my hands on you over the counter without you having to come to me? So I was like, well, microcurrent only goes to the beauty there and the dermis. It doesn't go to the muscle. It doesn't go to the bone. It doesn't go to where we restructure. And we age from the bone. Do you remember grandma? You said these big, wide eyes and pictures. And now they're like tiny, beady, rhomboidy and like the cartilage of the nose is grown and the ears are grown. The jawline has moved forward. Her back was the eyes are beady. Yeah. It's just skull resorbing as you age. Wow. And we age from the skull and everything else slips off. Wow. And that's why you get the fat. Yeah. And then the balloon deflate, so the skin deflate, so it doesn't hold it as much. So you've got the perioste and the skull resorbing and the balloon resorbing, so in between everything slips. Right. So I wanted a technology that doesn't need a transducer gel. That doesn't need, you don't need to be like, use my creams. Yeah, it doesn't need a current. It doesn't, and I don't need to be, you might not like my creams, so don't, yeah, don't use my creams. Right. But it's also, I wanted you to be able to take a technology that goes to the bone and it lifts and contours. It goes to the fat pads and reposition them. That goes to the lymph nodes and decongest you. Right. That goes to the frontalis muscle here and release his tension and gets rid of headache. It will go semacitism, your teeth grinding tension and release it. Right. So this is called trans-ion, it's more of what oscillations, it's vibration technology. So everyone's like, oh, you're based on a sex, so I'm like, no. We did clinical studies and we made different sonic wave patterns to go to different anatomical planes to give you different outputs. So we made cutes, which gives you the perfect bone structure, but each sonic wave pattern gives you different outputs. What does this look like? Okay, handheld device? Yes, handheld device. It looks a little bit like a sex toy. Oh, it does. Right. But it's in a really cool, charging case. It's all right. I'm not scared of those. Let's just be honest. But it's in beautiful colours. It's in hermost orange in your bone and you're like, can you use it in public? You can use it in public and no one's going to say anything to you. Okay, good. Maybe like, that looks cool. Yeah, it's cool. She just whipped that thing out on a bus. Exactly on the plane, your D puffing is great. You know I'm all about optimizing performance and lately I've been using the ion weighted vest during my workouts and it's been a game changer. It isn't your average weighted vest. It's designed to fit like a second skin, activating your core and proving blood flow and even helping you with recovery while you train. What I love most is that the weight is perfectly distributed. It doesn't pull on your shoulders or throw off your alignment, whether I'm doing strength training or cardio or just taking a walk, I'm burning more calories, building muscle and pushing my endurance even further. If you're serious about levelling up your training and unlocking your full potential, check out the ion weighted vest at iongear.com. That's a-i-o-n-gear.com and you can use code ultimate for 10% off and start training smarter today. Now, let's get back to the ultimate human podcast. But actually, but what it actually does is study, show that it changes the cells. Because at one point, it's not temporary. With use, you can re-educate, it's like going to the gym and the muscle, reposition, re-educate your cells. So what you're going to do is some, it's a horseshoe shade and then it's going to connect to the wire and some people really put in force and it's the connecting wire brace, like doing this. It's not going to give your face lift, just calm down with attention, let the device do its own work, lifts and contours your face. Reposition is a fat pack. It can relieve tension. It could depuff your face, depending on the protocol. And is this, is it using microcurrent or is it using sound wave? What is that? It's using sonic wave. And it's called trans anatomical, so each anatomical plane oscillation technology. So some, you know, the different tissues respond to different wavelengths. So muscle is going to respond differently than connective tissue than a bone. So you actually provide different wavelengths to stimulate those different areas. And we've really heard of somebody starting with skin care from the bone out that really makes a lot of sense. I never really thought about, you know, skull resorption because you are having, you know, osteopenia and osteoporosis. These are, you know, de-mineralization of the bone. Why would you not have it in the, in the skull makes perfect sense? But it's just like when we assess you in the face and, you know, you won't contour anything like that. Some people want their lips done or they want their cheeks done, something like that. The first thing someone looks at is your eyes. Yeah. Next thing is your teeth. Fix that first. Yeah. Forget your lips. Yeah. Right. So true. So it's, it's, it's understanding and the reason why we went in and out is because of the journey that we've both been on. We understand internally what's happening pathophysiologically and histopathologically on each cell that we can now understand what happens on the outside. Yeah. Yeah. And so is this used in conjunction with the skin care routine because I have seen as many as 14 steps in the skin care routine and I'm like, how can anyone stick to that kind of program where you literally have 14 things you have an enzyme, then you have a cleanser, then you have, you know, the, you know, what do you call the, uh, what's the sandy things? Microdermabration. Microdermabration, you know, exfoliation, that's the way I was looking for exfoliation, then you have something you put on right after that, then you have a toner. Um, so what is a good basic skin care routine? Okay. So let's go back to basics. Yeah. Let's go back to basics. Regardless of gender, and I always do this, regardless of gender, heritage, age, regard, and if they were like, you know, the 21 year old sitting in the room, the 16 year old sitting in the room, then there's me, there's you, right, 30s, 40s, 50s, whatever it is, regardless of gender and ethnicity, there's something that's going on in our skin for all of us, the same thing. There's only two things that are happening that we're still not only feeling the same. We all have fibroblast degradation from the age of 20s, early 20s. Okay. College and elastin, your hyaluronic acid, your gags are all going down. Okay. That gives you fine lines, wrinkles, open pores, awareness. Okay. So all of us, regardless of ethnicity, have some form of pigmentation. So in me, it's going to be brown, in you, it's going to be pinky-purpley or vascular. So fair hair, festkin, pinky-purpley, vascular, brown hair, darker skin, tights, brown. So if I'm only just treating those two things, I'm going to be together with that, I'm going to give you the perfect canvas. Mm-hmm. Those are just two creams. Okay. Obviously, they're my creams. But they're just two creams. That's my pay-to-deformulation. But if I was going to say to you that you're not going to bother with my skincare, and you're going to go and use just two, three products, the only thing I would say to you is use an SPF, use a beta-glucan-based serum, beta-glucan-based. Beta-glucan-based. And I'd actually say to you, wash your face with water. Mm-hmm. Yeah. That's why I listen to you. Really? And if you can tolerate a retinate or retinol or something, vitamin A, derivative-based, because that's the strongest ingredient that has a mass in the amount of studies, there isn't anything that's been studied more in our industry. In retinol. Yeah, retinol, retinol, retinol, which, wherever one you can tolerate, right? Once a week, twice a week. To upregulate the fiberglass. Ah. And that's it. That's all I would start with. Really? So, washing your face with water, applying one of these creams, so just washing and apply the cream. There's not a multi-step. You're not a big believer in taking those abrasives of things and scrubbing off the layers of this cream. You just gave me the stories of not just your kids, but also one of your ex-employees or colleagues. Mm-hmm. Oh, yeah. She dermal rolled herself. It was terrible. 24, by the time she was 20, last time we saw her, she was 27, maybe 28 years old, and there was a noticeable, you know, scarring on her skin. She was actually going for a laser to try to correct what she said. She said less is more. General. Because once you've damaged certain cells, you know, when you've got the stretch marks, you're like, gang muscle, right? We can't get it back together. We can't get these borders back together. Have you ever seen anyone fix stretch marks properly? No. And if we do CO2 blazer, if we do a carboxy therapy, even if we're exosomes in there, we can lighten them a little bit. Yeah. It can take the change of pigmentation. Mm-hmm. But that's about it. And you can bring the borders slightly together, but it doesn't go back to a new bar skin with her. No. So once you've damaged certain skin, it's really hard to bring back. Yeah. So you're going to be careful. And that's why I talk about the Birken bag, never this skin is thin. The skin under the eye is super thin. Mm-hmm. The skin around this area is thin. The next skin is thin. These areas you don't want to damage. Yeah. Very true. So are there any different, I mean, are there any topical modalities that you think are great practice? Are there any particular lasers that you're a huge fan of? Because I know there's CO2 lasers, there's Blatian lasers, there's Class 1 and Class 2 lasers. There's so much that when you walk into most cosmetic clinics, you can get paralysis of analysis. Yeah. You can also get lost in the programs that they're trying to offer you without really having a fundamental understanding of, okay, which one of these is going to borrow from my future? Which one of these is actually going to give me real skin regeneration? It changes. Yeah. And real changes. So I would go back to basics again. Okay. And I would say, let's first put you on a skin prescription, great skin program. Okay. Let's reeducate the cells. You've had your skin in your whole life. It's not going to happen overnight. It's going to take me three to four months to give you good skin. Mm-hmm. And I always promise you 70% improvement and we aim for 90. Wow. So what we do is we reeducate, we might resurface you. We might use a partial blade, if not full ablative, a full ablative laser such as CO2. I'd only do my 40s up. Okay. So it's like a facelift or something like that, but I do a non ablative laser such as fractal, which is less damage, but I'd combine it with exosomes from regeneration, right? How would you apply the exosomes intravenously, interdermally, no, interdotypically, or interdermally, right? One of the other. Okay. And then, because that will, of course, tell you a regeneration. Okay. So you either do microineline, like your colleague did, prescription microineline, or you can do a partial laser such as a fractal, which is a baby laser, right? Okay. But not an ablative full ablative. Fractals are light laser, right? It's not ablative. It's a lighter version. You want a CO2. You don't need that yet. Okay. And then what happens? We put you in a prescription way. Skin program. It's just creams. The next six to eight weeks. Morning and evening, two minutes and a couple of minutes in the evening, you yourself within four weeks, you're not wearing as much makeup, pores have gone away. The skin feels tighter, because we're working on the reticular dermis. We're getting your cells to start behaving again and stop up regulating to regenerate again, right? Yeah. And if you need another, if you need another booster, we might do another booster. Mm-hmm. And the first phase of the skin changing, it takes skin cells six to eight weeks. The chyrotonin sites, eight weeks, to change their behavior. Wow. We're up to 12. So the first eight weeks, I call transformation, and the second phase, and this is the most important phase, I call permanence. We want the skin to permanent behave like that. Wow. For the six to eight weeks. And in this program, we increase the active, so we might increase the dose of the retinate. We might increase the dose of the prescription rate of the active, and they're just creams. By the end of it, you have perfect skin. Wow. You turn around and you continue it, and say you started with inflammatory active, yes, I'm scarring. You're just a break out. I say to you, you know what, in three to four months, you're going to have, you're going to tell me off, and you're going to complain about one or two spots in such a whole phase. Because literally, if you can go on a cellular level and retrain the cell slowly, rather than attacking them and blasting them, because you don't want to borrow from your future in your own words. Yes. You want to re-educate them slowly, and you want them to behave in that way for the rest of their lives. Mm-hmm. And that's the key thing, slow and steady wins the race. I totally agree with that. Is there anything that you know of to actually increase the density of these fibroblasts? Yeah. So, the neocologenesis, most of them. Neocologenesis. Most modalities are based on something called neocologenesis, like new collagen formation, right? Right. And what we call it, it's a fibroblast up-regulator, it increases the density of the fibroblast. Perfect. If we increase the density of the fibroblast, we're increasing everything else. And what increases the density? So, it depends. We can do inflammatory-based modalities, or we can do biologics, or we can do virgin or non-vergine, or we can just do prescription-grade ingredients. It just depends what you're comfortable with. That's phenomenal. And then, just whining things out, you know, you. I won't take you deep down the rabbit hole of peptides, but I'm a huge fan of peptides, and we use them internally for lots of things. What do you use? BPC157 for wound healing and repair, something called TB500 for wound healing and repair. So, like post-surgical recovery, anytime someone has, like, knee, hip, shoulder, rotator cuff, injury, low back, especially if it's chronic and persistent. You can do a subcut. Yeah, yeah, you can do it sub-Q. BPC is probably one of the few peptides that's tolerated well orally, because it's a gastric peptide. But we find the combination of those two works really well. GHKCU copper peptide, NAD, I know you're a fan of NAD2, 50 milligrams a day in sub-Q injection or a transdermal patch. In full disclosure, I'm a partner in a peptide manufacturer called peptule by Vaisalius lab sciences, and I chose these guys because they manufacture in a CGMP-certified lab. They don't source ingredients from China, and the peptides really work. A lot of the over-accounted peptides have all kinds of nasty things in them. Heavy metals, fillers, binders, and very often they're not even peptides. Yeah. And it's hard for a consumer to know because, I mean, how are you going to evaluate whether they're not just why capsule is, you know, rice bran or a peptide other than by the fact that it either worked for you or didn't work. But, you know, not being a dermatologist, but having seen the, I would say, the greatest shift in what we see by trading the inside, showing up on the outside, is when we balance hormones. You know, you see a noticeable, youthful appearance in both men and women that get their hormones balanced. You know, when they're estrogen dominant, a progesterone is deficient, or the cortisol is floored out, or like you said, stress and inflammation has just teed their adrenals. You know, we see it, you see it in the skin, they just look and feel tired. And in a few weeks, you know, they seem to really, really bounce back. So Dr. Valle, I, for some, I'm so appreciative that you came on the podcast because it's so interesting that we saw each other in Saudi and now we're here in the Middle East. I think this is one of the most fascinating regions of the world because they are growing so fast. And they're so hungry as well. So hungry. Yeah. And they're innovating and they're, it's like they want the brightest minds, they want the best food, they want the most educated population, they, you know, they're really thirsty for knowledge in this area of longevity, anti-aging. You must be a very popular human being walking around here. I saw you get mobbed after your, after your talk here. You go up to, we've got love, yeah. Yeah, we sure did. So I wind down all of my podcasts before we go into the VIP and we have some questions for my VIP community by asking all my guests the same question. What does it mean to you to be an ultimate human? For me. Mm-hmm. Mm-hmm. For me. I'm very many pauses at a moment. So for me, full disclosure. Full disclosure. If you ask me in two weeks time, it would be a different answer, right? Yeah. So for me, at the moment, yeah. You might be angry. Yeah. I might be completely different. And for me, it's just contentment. Mm-hmm. Like for me, the ultimate human, because I've got access to everything. Mm-hmm. And like, you're like, you're on a peptide stacking program. I want a peptide stacking program. Yeah. I have access to everything. I have a flag of like, I mean, cortisol overdrive. I know what to do. So I'm quite privileged in the industry to have that access. Yeah. So for me, at the moment, it's just contentment. I want to get to that phase where the highs are high, but I don't feel it high. And the lows are low, but I don't feel them low. Mm-hmm. Just streamlining and just getting through like content and happy. Yeah. What will be will be and what won't be, won't be. Yeah. I think there's a lot of genius in that letting go of the things that we can't control. Yeah. I've focused a lot on that as I've got an older or more mature or whatever you want to call it, you know, frustrating yourself with the things that you have no control over is just, that's only on you, you know, but getting frustrated about the things you can control, it's a little different, but it was so often things just not pass off are stride during the day that we have zero control over. I don't get frustrated in traffic anymore. Yeah. I'm just like, that's what it is. Yeah. I feel like, especially because you're an entrepreneur like me, we go through such high highs and we go through such low lows that you have to get to a point where you're just like nothing, nothing. Our emotion is so tied to our outside environment. How well did this mean to go? How bad, did that mean to go? What did they say? Because I validated, was I not? Yeah. Well. It is. And that's why I say I'm Pairman and Paul's at the moment. So ask me on another day. I'll give you a different answer. Yeah. So it depends on my cognitive resilience. All right, Dr. Valley, we're going to go into the VIP room for those of you that are interested in becoming a VIP, you can head over to the ultimatehuman.com/vip. This is the community that I am pouring myself into. We do private podcasts. We do live Q and A's. I have a Gary AI in there that you can ask anything to. You can feed it your labs. You can feed it your genetic testing. You can ask questions about supplementation, diet, lifestyle, travel hacks. Anything you'd like, I think you'll find it fascinating to interact with the Gary AI. But for the rest of you guys, until next time, that's just science. (upbeat music)