Dr. Kelly Stankiewicz: Lasers, Microneedles, and Age Specific Skincare

We're revisiting a favorite conversation this week: our September 2023 sit-down with Dr. Kelly Stankiewicz, one of our go-to dermatologists. Dr. Kelly specializes in laser skin treatments that combat the effects of aging and can even create a youthful glow, if that's your jam. We also break down the four core pillars of a sound skincare routine: cleanse, exfoliate, nourish, and protect. And I asked Dr. Kelly for context around Jimmy Buffett's death and the skin cancer he battled, along with what we can all do to protect ourselves.

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 Key Moments:

“What's important is that you're hitting all four of the categories: sunscreens, antioxidants, exfoliants, and cleansers.”

“So people, when they hear that someone has died of skin cancer, they get very concerned because skin cancer is quite common. The type that Jimmy Buffett had is very, very rare. So all of my patients who've had multiple basal cell carcinomas and squamous cell carcinomas, which don't typically metastasize, are, you know, kind of up in arms because they don't really understand the difference.”

“When you're doing fractional resurfacing, you're decreasing your risk for skin cancer probably (or at least according to this one study) by about two times or maybe a little bit more.” 

Click Here for the full interview transcript.

Transcript

SPEAKER_00 0:14

Welcome to episode 297. This week we're doing something a little different and reaching back into the archive for one of my favorite conversations, my sit-down with Dr. Kelly about skin care and laser treatments, which first aired back on September 19th, 2023. When we recorded it, the news had just broken that Jimmy Buffett had died at 76 from Merkel cell carcinoma, a rare and aggressive form of skin cancer he'd quietly battled for years. It was a reminder that the son we spend our whole lives chasing asks something of our skin in return. So this week I wanted to bring Kelly's wisdom back to the top of the feed. What she shares about protecting your skin, reading the changes that matter, and what modern laser treatments can actually do is as relevant today as it was the day we first ran it. Maybe more so. Thanks for listening and enjoy the episode. Hey guys, so this week we've got Dr. Kelly, my favorite dermatologist to the Cognizetti around here anyway. And she's gonna be talking about lasers, skin lasers. She's an expert on that. That's her thing. And we're gonna talk about various other things to do with skin and Jimmy Buffett's tragic passing from a very rare form of skin cancer. She's gonna have some thoughts on that. So we're gonna get to her in a few minutes. People ask me a lot why you do what you do? What's this sort of driving thing? And why are you attracted to certain people and not others? And I come from a small town in western New York, basically a farm town. There was a little state university there. My parents were divorced when I was really young, and then my dad passed away in a car accident. And as a you know, as a kid, I was sort of a bit much for everyone. It was the 60s, right? 60s, early 70s. And do your own thing was not really the way it was, the way it is now, anyway. So people now are very much encouraged personal expression, be who you are. Back then it was hippies were around and stuff, but it it was really more about conformity. It was like don't stand out, keep your head down. And even my family would tell me, like, don't be exceptional, essentially. Which you know was sort of a lesson that I learned early on. Don't let people know about your inner life because they're not really going to be into it. And uh My family, the teachers, people around me really didn't. You know, they just wanted less David. They just wanted me to sort of be less and just, you know, sort of be like others. And that experience has really shaped me. And it is one of the things that sort of drives me to be the person I am today. So you know, the thing that gets me going every day is to just try and be the best version of myself. And it's it's sort of like pushing back against the stuff that happened when I was a kid, like, you know, be less than, and so now it's like, well, no, I want to like fully actualize all the things that I have. And I think sort of going along with this is this lifelong appreciation I've had for the other, because I spent like, you know, the first 25 years of my life being the other and being very much unlike others, and sort of like not having a roadmap on how to navigate things, like not really having mentors, not really having people show me the way. And my mom did the did the best she could, but you know I don't know this is the right word to use, but um it was disappointing. I wish I would have had more. And she did the best she could, but you know, still I wish I had more. And so this appreciation for the other, you know, when I was a photographer, like on my crew, there were just there just were no straight American white guys. Like it was always something else. And I and I've sort of always understood what it's like to be an outsider. And now, you know, with with ages and with superage, being older to an extent is sort of being an outsider in a weird way. Like we should be at the center of the way the world is today, at least here. I mean, I live in America, so very youth-centric. So championing the other, and in this case, people who are a little older. So that's that's a little bit on on how I got to where I am. So I hope that makes sense and answers some of the questions that we get, like, why is he doing all this? Well, that's why. Because uh I sort of got squashed down when I was younger and wasn't allowed to, you know, fully express me the way I wanted to. So now, you know, I'm I can do it a little better. So I'm hoping all of you guys are doing the same thing too. I'm hoping that everybody out there uh feels that they can express who they are today to the fullest of their abilities. Because time is short, right? Like if if not now, win. And you guys, each one of you are awesome in your own way. And and I just want you to know that. We're all so unique, and we all have so much to offer in a very special way that's unique to us. 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Get a free eight-count sample pack of Element's most popular drink mix flavors with any purchase at drinkelement.com slash agis. Find your favorite flavor or share with a friend. That's D-R-I-N-K-L-M-N-T.com slash AGIST. Hey, just a quick reminder that after my conversation with Dr. Kelly, we're gonna do just try this. Just that little tidbit that may help you live a little healthier, a little happier, a little longer. We're gonna get with Dr. Kelly right now. Hey Kelly, welcome to my house.

SPEAKER_02 7:45

Thanks. Thanks for having me.

SPEAKER_00 7:47

We almost never do these locally. They're always on Zoom, and great to have you here. You're a dermatologist, so clearly, we're gonna talk about all things skin. First off, like top of mind, I find your job and and people who are in plastic surgery, people who deal a lot with appearance, unlike the other forms of medicine. I break my leg or I've seen anesthesiologist or something, there's a real psychological component to what you do. People look in the mirror and I'm included. Sometimes I have these like fits of dysmorphia. It's like, oh my God, I look like this. Dr. Kelly, oh my God, you see this? How do you deal with hysterical people like me?

SPEAKER_02 8:27

Oh gosh. I mean, I I've been one of those. That's how I deal with it. I mean, any sort of medicine requires a lot of empathy. And in aesthetic medicine, your your empathy is, you know, kind of shifted away from like empathy towards the sick and dying to empathy towards the people who really want to change, you know, or make something better. So I don't know. I just that's me. I think you have to put yourself in their shoes and you have to understand where they're coming from. It's you know, in certain personalities, it's easier to do. You have to listen because uh sometimes you you can't go in with preconceived no, you know, notions about how you know people should be acting because you don't know what's going on in their life, you know. So you have to go in and you have to be quiet and listen and then put yourself in their shoes and have empathy like every physician should.

SPEAKER_00 9:34

I can just foresee, I mean, this is like something I would do. I would like to call you up and it's like, oh my god, you gotta see me right away. I have this like thing on my face or something, and there's no thing there. It's just like I've sort of imagined it. And you know, you would look at me and and then you would have to sort of deal with me like a crazy person.

SPEAKER_02 9:50

Like, I understand that you imagine this, but well, you know, that's uh the first thing that I ask when someone says you, oh my gosh, this thing you have to look at, you have to get it off, and I can't see it. The first thing I ask is, Do you have a magnifying mirror? Because that is 100 100% of the time, yeah. How did you know? That's where I saw it. Well, okay, throw away your magnifying mirror because nobody else is looking at your skin in a magnified fashion. And yeah, those things are horrifying. I mean, I don't have one at home, but if I go to a hotel and it's there, even I'm like, what is that? So, but I, you know, I never think it's trivial. I mean, you know, I as a dermatologist, I went through, you know, 13 years of school and you know, five years of training and 16 years into dermatology. Like it's a very, you know, honed skill. And so you can't like assume that everyone's gonna know what you're gonna know. So I never would think anything is frivolous or anybody's frivolous. But I love my mom recently, you know, was in the clinic and you know, what's this or what's that? Or, you know, and I'll you know, give the answer, and she'll be like, Well, how do you know?

SPEAKER_01 11:14

Like, because this is my job. This is my job, mom.

SPEAKER_00 11:20

That's really funny. How do you know?

SPEAKER_01 11:22

How do you know?

SPEAKER_00 11:24

I think only a mom can say that though, right?

SPEAKER_01 11:26

Only a mom can say that, yeah.

SPEAKER_00 11:28

Like, I would never say that. Like, how do you know, of course, like trained professional?

SPEAKER_01 11:32

Yeah.

SPEAKER_00 11:33

Funny. We were talking at some point the last time I went to see you and you you beautified me. There was uh you were talking about this like halo thing. So what's a halo? It's got a great name, by the way. Yeah, I love a machine called a halo.

SPEAKER_02 11:48

Yeah, I yeah, it's a great, it's a great treatment. Well, the halo is a fractional resurfacing device. Fractional resurfacing is where we either remove or sort of cook like a tiny fractional column of skin, and we do that all over the face in like a pattern. When we treat the skin with fractional resurfacing, it makes it more healthy and helps with brown spots, texture, fine lines and wrinkles, but it also decreases your risk for skin cancer and it kind of gives you this glow. Whenever you get um new collagen under the skin, it changes the way light reflects off your face. And so we call it like the halo glow. And that happens like about three months after.

SPEAKER_00 12:32

How long does the halo glow last?

SPEAKER_02 12:34

The halo it doesn't last forever, but it's it starts around three months after the treatment, and it probably lasts about a year, and then you need it again, you know, maybe a little less than a year.

SPEAKER_00 12:46

Oh.

SPEAKER_02 12:46

Yeah.

SPEAKER_00 12:47

Yeah, that's the thing about everything changes, right? Cells in your body, they're just living and dying and growing and changing and yeah.

SPEAKER_02 12:56

Yeah. I mean, I tell people, you know, when people ask me, like, how long is this treatment gonna last? You know, you want to say in your head, it's not lasting. It'll never it's in the moment it's done, it's gonna you're because your body is changing. It's changing all the time. Aging is relentless and it keeps going forward. And so anti-aging has to be relentless and therefore sort of like a ritual, you know, something that you enjoy and something that you you do in a you know a planned and regular fashion.

SPEAKER_00 13:31

So as you're describing this, cooking of the skin. Sounds profoundly unpleasant. I'm guessing when you cook someone's skin, there's some sort of anesthetic applied here.

SPEAKER_02 13:41

Yes. Yeah. So for the halo, we do uh topical numbing. And then I really don't like to see people in pain. So we usually add a bit of injected anesthesia as nerve blocks or in certain areas that are a little bit more painful. And then it's really, really tolerable.

SPEAKER_00 13:59

Does it smell bad?

SPEAKER_02 14:01

No.

SPEAKER_00 14:02

I'm just thinking like cooking flesh.

SPEAKER_02 14:04

Yeah, I mean, so we do use like a smoke evacuator so that you smell it. But I would so every single laser, I mean, the ablative and non-ablative lasers, the whole principle of a laser is to selectively destroy a structure by heating it up, but leaving the surrounding stuff intact. So, you know, when you destroy a blood vessel, you're like cooking the blood vessel from the inside, but you're leaving the normal skin behind. Same with brown spots, and then this is this particular laser um absorbs is absorbed by water. So the different wavelengths are absorbed different ways, but you know, different strengths or different intensities by water. And the ones that are not quite as intensely absorbed by water are the ones that cook the skin, and the ones that water absorbs really intensely remove the skin. So the halo is both non-ablative, which is the cooking, and ablative, which is the vaporizing or removing of skin. Yeah. So two wavelengths in one. That makes it a unique device in that sense.

SPEAKER_00 15:19

I had um the now very famous Brian Johnson on the show about, I don't know, about six months ago. And Brian, when he came on, he had all kinds of like scabs, like wounds on his chest and a little bit on his face. And he was, he told me he does IPL laser like weekly. Um and it looked really messy.

SPEAKER_02 15:42

Um well, he probably doesn't do the same area weekly because yeah, it takes about a week to heal from IPL on the face. On the body, it can take two and sometimes even three weeks to heal from IPL. So I if I had to guess, I would say he's doing one area and then doing another area and then doing and just like rotating through. I think that's pretty genius, but I'm biased.

SPEAKER_00 16:07

Why do you think that's genius?

SPEAKER_02 16:09

Well, I mean, so IPL is one of those, so now we have we have data that fractional resurfacing lasers, and we we always kind of suspected this, but now we have clinical like you know, data that fractional resurfacing lasers prevent skin cancer, both the non-ablative and the ablative. So when you're doing fractional resurfacing, you're decreasing your risk for skin cancer, probably, or at least by this one study, by about two times, or maybe a little bit, maybe a little bit more. But fractional resurfacing is kind of like not something you want to do all the time. It takes a lot more healing. You know, there's a lot more in that week while you're healing, it's a lot more. But IPL can be pretty mild, and we have good data that IPL also is anti-aging, like it changes the gene expression in your cells towards a less aged, you know, so it's not just a collagen thing, it's you're changing the gene expression. Yes. Oh, fascinating. Yeah. I mean, it was a small study that showed this, um, but they had control, they treated forearms, they had control arms of young skin, they had control arms of old skin, and then they had the treated old skin arms. And the treated old skin arms gene expression looked like the young skin gene expression, whereas the old skin that was untreated didn't. You know, I I don't know Brian Johnson, but I know that his goal is to change his you know chronologic age. And that is a great way to do it. And it's a little bit easier. You don't always have to look scabby or crusty after IPL.

SPEAKER_00 17:49

IPL, is that something that you can use on like any skin?

SPEAKER_02 17:54

Yeah. Well, it it can be a hair removal device, and so you don't want to use it on skin, hair-bearing skin that you don't want to remove the hair on. But yeah, you could put it on, you could treat any skin with it.

SPEAKER_00 18:07

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SPEAKER_03 20:49

Mm-hmm.

SPEAKER_00 20:50

Is that simply because you're removing cells or you're selectively removing damaged cells?

SPEAKER_02 20:58

Nobody knows for sure, but it's probably because it induces, you know, a healing process that recruits kind of like newer, younger cells. The mechanism is not known for sure. Because there it could have gone the other way. You know, skin cancers and preskin cancers divide faster. So if you're removing like a column of skin and you're hoping for it to populate from skin that's surrounding, there could it could have been the scenario where the faster dividing pre-skin cancers and skin cancers filled in that hole.

SPEAKER_03 21:33

Right.

SPEAKER_02 21:33

But it didn't turn out, it didn't, you know, it doesn't turn out that way. It actually improves the health of your skin.

SPEAKER_00 21:50

And then your immune system sees there's certain DNA damaged cells here that gotta go, and then they remove them along with healing your face. I don't know.

SPEAKER_02 21:59

Yeah, it could be. It could be that for sure. Yeah. I mean, so fractional resurfacing doesn't create a scar, but it definitely, you know, turns on some sort of healing response. You know, not necessarily the same wound healing response that would create a scar, but yeah, a healing response.

SPEAKER_00 22:18

Yeah, interesting. I saw what Brian looked like coming after his IPL. What happens with something like Halo, which sounds like more invasive? Like, what does somebody's face look like after you do that?

SPEAKER_02 22:30

Well, okay, I'm so the halo can be used in a variety of different ways. It could be used in a really low density, you know, non-ablative way, where you're just using the non-ablative wavelength and not the ablative wavelength. Or you could do it like I do it, where you're doing a pretty aggressive ablative, non-ablative, and I combine it with IPL. So you do the IPL first and then you do the halo second. In that scenario, you have a week of downtime. It takes a week for your face to heal. No matter what sort of laser, except for the most, the strongest, like fully ablative resurfacing, all the lasers take a week for your face to heal. Off the face, it gets longer. So the neck and the chest, like 10 days to two weeks, the arms and the hands, like two weeks to three weeks. The legs are more like four to five weeks, sometimes six weeks. Ouch. But these I've done these lasers and they can be done anywhere on the body. So just talking about the face, you have a week of downtime. And here at high altitude, the face really swells because you don't have that atmosphere of pressure like pushing back. So I tell people, you're gonna wake up in the morning, you're gonna look in the mirror, and you're you're going to say, Who is that person? You're gonna, and I try to like over-exaggerate, like, your phone isn't gonna recognize you. You will have to put in your pin code, you're gonna be swollen, you're gonna look funny, you know. And then almost every single person calls and said, I know that you said that I'd have a lot of swelling, but is this what you meant? And they send a picture. So swelling is always with the halo, the way that I do it. And then you have kind of redness and like little dots on your face that look vaguely like sandpaper. And then as the swelling goes down, they feel like sandpaper, and then you start to peel. So that's the story with most fractional resurfacing devices. When you use the halo in a like a lower setting, it's much less, like less swelling, less you know, scaling, less peeling. But yeah.

SPEAKER_00 24:39

Wow. Like, um, yeah, don't plan any dinner parties after Halo.

SPEAKER_02 24:43

Oh, I went down to dinner after Halo once.

SPEAKER_00 24:45

You did?

SPEAKER_02 24:46

Yeah, I just sat in the corner. Like you, it's remarkable like how people don't really notice. You feel very self-conscious when you know your face is on fire and you're, you know, like puffy and swollen. Other people just don't notice if you're in a dark room sitting in the corner.

SPEAKER_00 25:04

Wow. Okay.

SPEAKER_02 25:06

Yeah. But yeah, that's me. You know, we're all different in that regard.

SPEAKER_00 25:12

So what are some of the other things? I mean, clearly the the thing to do here is you know, don't DNA damage the cell. Oh, you know what the other thing I wanted to ask you about this DNA damage? So if you're if this you have cells in your skin that are damaged by DNA, do they circulate through your body at some point, causing other like does this migrate to other places?

SPEAKER_02 25:36

No, no, no. No.

SPEAKER_00 25:37

It just they just stay there. Okay. So they can't like suddenly they go somewhere in the into some organ and they start some trouble there.

SPEAKER_02 25:43

No.

SPEAKER_00 25:44

No. Okay. That's good to know.

SPEAKER_02 25:46

Yes. Yeah, it has to be cancer to spread.

SPEAKER_00 25:49

Okay. Yeah, we don't we don't want that.

SPEAKER_02 25:50

Yes. Okay.

SPEAKER_00 25:53

So people should be wearing mineral-based sunblock if they go out in the sun, especially here, because we're at high altitude and it's sunny all the time. It's like being in a microwave, especially when there's snow. It's just yeah.

SPEAKER_02 26:04

So for I don't know if you knew the statistic, but for every 1,000 feet of altitude, the sun is 5% stronger. Yes. So we're here probably like 65, something like that. Yeah.

SPEAKER_00 26:19

So we're that's 30%, 40% stronger.

SPEAKER_02 26:23

Yeah.

SPEAKER_00 26:24

Yeah. And then if you have it reflected off the snow, it's just Yeah, it's coming from all directions. Yeah. So what are the other things that you're telling people to do? Like I know some people really love the whole ritual of product, and I'm gonna put this product on this, that, and the other thing. And this this is sort of their window method at night. I'm I'm sort of semi-in that camp. What are you telling people to do?

SPEAKER_02 26:53

Well, so some of the things have to go on in the morning. So it can't just be your nighttime like wind down routine. Things that go on in the morning, obviously sunscreen and antioxidants. And then things that go on at night, like exclusively at the night, would be like retinoids. And then everything else can go on in the morning or at night or both. Um I divide when I'm talking to someone about anti-aging skincare products, I like to think of things in a framework because I don't like to tell somebody you have to use this product, you have to use this product or whatnot, because everyone has their own favorite products that they use because they think feel good or whatever. And so what's important is that you're you're hitting all four of the categories. So the categories are sunscreens, antioxidants, exfoliants, and that's kind of like an oversimplification of that category because I put retinoids and glycolic acid in that category, and they don't do more than just turn over the epidermis, they go deep into the dermis and stimulate collagen production. But there is something to be said, or there is an anti-aging effect of actually physically exfoliating dead skin cells and creating a turnover. So there's physical exfoliance in that category too. And then the last one would be like regenerative serums, which are regenerative peptides. This is like a really broad category, but generally they're molecules, like small little proteins that signal the skin to do different things. Like, for instance, there's one that tells the skin to eat up dead collagen and elastins so that new collagen and elastin can be formed. There's one that makes the epidermis thick, like turns on the stem cells of the epidermis. And, you know, an aging epidermis is thin and flat, and a young epidermis is kind of undulating and thick. So that particular peptide uh thickens the epidermis. There's one that goes into the skin and tells the skin to make more connections between the epidermis and the dermis, which makes the connection or the skin more healthy. Um so it's like the variety of these regenerative serums, and they you can't use them all at once.

SPEAKER_00 29:10

It would be silly.

SPEAKER_02 29:12

Yeah, they work. Yes, they do.

SPEAKER_00 29:14

This is a silly question, but I what you're describing sounds like kind of magical.

SPEAKER_02 29:19

Yeah, I think that the topical products that have good science behind them are a very overlooked part of anti-aging. I think that they is probably the most important thing that we do. Like if you can't do lasers or injectables, topical products make a difference.

SPEAKER_00 29:39

In normal skincare, seemingly people can say anything about anything. It's like, oh, you know, looks you look youthful after seven days. Or, you know, I mean, how many times have we seen it?

SPEAKER_02 29:49

Radiance, luminosity.

unknown 29:50

Exactly.

SPEAKER_02 29:51

Like, like, what is that?

SPEAKER_01 29:53

Right.

SPEAKER_00 29:54

How does like a normal person discern uh like if I want a peptide that's gonna better link my my dermis with my epidermis? How do I know that this works? Like, how do you discern?

SPEAKER_02 30:07

Well, I I think so there is there are a couple like broad categories where you can get your skincare products from. Like one would be the drugstore, one would be the department store, and the one would be a spa, and then another one would be your medical, you know, dermatologist office. Um, and dermatologists and other, you know, medical professionals tend to like to see like the clinical evidence. We like to see randomized controlled trials, we like to see objective measurements, like, you know, oh, this really does increase. Like, I took a skin biopsy and I can see there's more collagen and elastin in there. And so that segment of skincare products are, you know, what you I think you can really depend on. Um, and they're you know, a variety of different brands and and things.

SPEAKER_00 30:59

So I'll just ask you.

SPEAKER_02 31:01

Yeah. Yeah, just ask me. Yeah. This is all baffling to me.

SPEAKER_00 31:05

What do I exactly do and when do I do it? Yes.

SPEAKER_02 31:08

And then I would say, like, oh, give you a grid with those four categories, sunscreen, antioxidants, exfoliants, and I would tell you to put you know them in your those four categories what you're using, and then if you want to change stuff in and out, I think it's helpful. I think it uh boosts, you know, the look of the improvement if you're changing things all the time.

SPEAKER_00 31:28

Wow. Okay. That's so interesting. I I feel like sometimes I should know so much about these things and I don't. And I like, okay. I didn't I didn't know this was like a peptide thing that did that. That was fascinating.

SPEAKER_02 31:42

Yeah. I'm waiting for you to say, how do you know that? I'm just kidding.

SPEAKER_00 31:47

Oh, well, I know how you know that. You're a highly educated professional. I just kidding. I mean, that would be like somebody like in my old career, if I said, you know, I think we need to change the lens on the camera and do this. And somebody said, Well, how do you know that?

SPEAKER_01 32:04

Yeah. Because I just do. I just do. Right?

SPEAKER_00 32:08

This is knowledge I have. Okay, so I I had a reader question.

SPEAKER_01 32:13

Okay.

SPEAKER_00 32:13

Which you this may not be completely out of your sphere, but maybe you know something about it. So the question was about lymphatic drainage and something called Brazilian lymphatic drainage. Do you ever I don't know anything about these things. Is it is this something you ever heard of?

SPEAKER_02 32:28

No. I mean, we do refer people to physical therapy for lymphatic massage and lymphatic drainage, and it's usually in scenarios of swelling, either lymphedema or lip edema, which is where you get extra fat and it's painful. So massaging, you know, the areas where there are high flow lymph areas like in the groin and moving fluid up and then wrapping the body is a medical, you know, uh strategy. But I I'm sorry I can't answer anything about Brazilian uh lymphatic drain.

SPEAKER_00 33:06

I think if you put Brazilian in front of anything, it just sounds like exotic. And and like, oh, it must be better. It's Brazilian.

SPEAKER_02 33:12

Yes, I think so too. Yeah.

SPEAKER_00 33:16

It's really your husband is Brazilian, so clearly Brazilian husband.

SPEAKER_01 33:21

Can't argue with that.

SPEAKER_00 33:24

Um Are you seeing any interesting things out there on the horizon? Technologies, peptide stuff, machines, things that you think are interesting that may be coming to market that people should know about.

SPEAKER_02 33:40

So I really keep my finger on the pulse of lasers. That's my you know sub-specialty within dermatology. And as far as laser technology goes, it's usually pretty quiet for like a decade more at a time. And then there's like a big burst in technologies. And we're sort of kind of in a quiet spot right now, but I do believe that soon there'll be some new devices, fractional resurfacing devices and technologies. But the latest right now is an anti-aging treatment called Elochore, which is called microcoring. So instead of removing skin with lasers, what we just talked about, and when you remove skin with laser, either by cooking it or by vaporizing it, it usually leaves a cuff of coagulation around it so that those holes don't collapse. The improvement you're seeing is from a wound healing response or a healing response, not from you know actually taking out skin. Like you're not getting tightening from taking out skin. So elicor is micro coring, which uses no heat at all. It's just a tiny needle that removes a core of skin. And so you do get that collapse. And and in addition to the wound healing. So is that a good thing?

SPEAKER_00 34:55

Yeah.

SPEAKER_02 34:55

Well, yeah, because it's tight, it cut the tight end. It tightens up. Yeah, yeah, yeah. So it's like a it's like a micro facelift. Right. Okay. You know, you're removing 8% of the skin or less with each treatment, and the holes close down, and you have 8% less skin. And then you do it again, same thing, you know. So, you know, that's that's kind of the latest on the horizon.

SPEAKER_03 35:19

Does that hurt like heck?

SPEAKER_02 35:21

It's a device that needs numbing for sure. Yeah. But I don't think it hurts like heck. And certainly while you're healing, it doesn't hurt like heck. But, you know, it doesn't need like general anesthesia. You we do the same topical numbing and nerve block kind of situation.

SPEAKER_00 35:36

Aaron Powell There's something called like microneedling, is that right? Is that sort of like this, but with a machine?

SPEAKER_02 35:42

Well, the difference between microcoring and micro-needling is that micro needling is a is a solid needle that goes into the skin and makes a hole, but then the skin the hole collapses right away. So it's just like penetrating and it's just like a wound healing response. Microcoring is a hollow needle that removes a core of skin. And the origin of this device, I think we talked about this a little bit last time. We had a little podcast chat. The origin was a theory called skin copying that came out of uh Dr. Rox Anderson's lab at Mass General. He's the one that invented fractional resurfacing, along with um Dieter Manstein at at Harvard, at Wellman Center for Photomedicine. And they said, well, if you can remove like damage fractional columns of skin and the skin heals without scarring, could you harvest those tiny columns of skin and then put them in, you know, a burn scar for some everything in aesthetics started with a burn scar origin. Anyway, you know, and put it in a wound like a burn scar. Could you do skin grafting that doesn't leave a scar in the harvesting site, right? And it turns out it works. Like if you can take those little tiny microcores and spit them into wounds, it heals really with a better looking scar, you know, a skin that's more normal, more normal than a scar. Uh, they're still working on it. I don't think it's been perfected yet, but but it's been you know studied, it's been being studied for you know more than 10 years now, and it and it works. And I think that the one like major challenge of skin copying was the engineering of the needle. Like, how do we make a needle that's so small that's hollow, that can take a core of skin out, and you know, still doesn't leave the the harvesting site with a scar. So the there's like a size of a column that you can remove from the skin without creating a scarring like wound-healing response. And once they figured out the engineering of that needle, then then it was moved into the aesthetic space as well as you know, being studied for skin copying.

SPEAKER_00 37:56

So just imagining um the thickness of the wall of the hollow needle.

SPEAKER_02 38:03

Yeah.

SPEAKER_00 38:04

Wow.

SPEAKER_02 38:06

It looks like a regular needle. You don't you don't notice that it's you know hollow.

SPEAKER_00 38:13

Wow, impressive technology.

SPEAKER_02 38:14

And then the other cool new laser that's out has nothing to do with anti-aging, but has to do with acne. Oh. So there is an there are two new lasers that are focused on the sebaceous gland. So a brand new, like novel wavelength that's selectively absorbed by sebaceous glands. And when you kill sebaceous glands, you shut down kind of the fuel to the fire of acne. So those are up and running and working well.

SPEAKER_00 38:42

What caught I what causes acne?

SPEAKER_02 38:45

Ooh, thanks for asking. I love that question. Well, okay, so there's four components to like the cause of acne or the origin, and we're talking teenage acne here, because there's the teenage acne, and then there's like the female like hormonal cystic acne, which is a totally different like animal. But they both are related to overproduction of zebum. So you have a hair follicle, you have an oil gland that empties into the hair follicle. In hormonal acne, there's a lot more oil production. It's controlled by your hormones. So mostly testosterone. So if you block the testosterone receptors in the skin, female adult hormonal acne gets much better. Teenage acne also has a component, there's more oil production, but there's a component of plugging of that hair follicle. Um, that's where retin A comes in, because that like exfoliates off that plugging of the hair follicle. There's a bacteria on our skin. It lives in the follicle, it doesn't like oxygen and it eats oil. So a plugged pore with more oil production is like heaven for that bacteria, and it it overgrows. And when that bacteria overgrows, then the inflammatory cells come in to attack it. So you've got inflammatory cells, bacteria, plugging of the pore. And if you could shut down oil production, then you know, all of those things wouldn't happen.

SPEAKER_00 40:14

Why do you need oil production in around a hair follicle?

SPEAKER_02 40:18

That is a mystery. Some people say, and that you know, that that it's it's like an evolutionary like vestige of the past. So you know how you how you have sweat glands that when they they secrete water so that when you're hot, you get cool by evaporative cooling. Well, oil may do the opposite, where it shuts down evaporative cooling so you produce more to keep yourself warm. And what is interesting to me about that theory is that every year, no fail, and it's gonna happen this year too, hasn't happened quite yet, but right around this time, like into October, everybody comes in with an acne flare. Oh, my acne was so good over the summer, and it's just so terrible right now. And some of it probably is because you know, you're back at school, like there is UV light, does help kill the bacteria associated with acne. You're probably eating differently, you're stressed. But the other component is the weather is starting to get cool. And so, you know, do we make more oil production? You know, do we make more oil when it starts to get cold just to keep ourselves warm? I mean, it it doesn't have a function now, but yeah, I mean, because we wear clothes, but we're all animals. We're all animals.

SPEAKER_00 41:40

Wow.

SPEAKER_02 41:40

But yeah, the the sebum, like it and sebaceous gland, like why it's there is kind is a mystery, you know. There are stem cells in sebaceous glands that are good, you know, responsible for healing. These lasers don't remove sebaceous glands, so we have to assume that they will, you know, your your skin will still heal the same. They've been studied for long enough that I think we know that that's the case. But um yeah, other than that, there's no real reason why we have sebaceous glands except to give us acne.

SPEAKER_00 42:16

Wow. I never knew any of this.

SPEAKER_01 42:19

Really? Oh, great. Oh, good. Okay.

SPEAKER_00 42:24

I don't really anticipate an acne flare in my 65-year-old future, but I agree.

SPEAKER_02 42:29

I agree. And if you have something that looks like acne that flares, it's probably not acne. It's probably rosacea or perioral dermatitis, which is very common at high altitude.

SPEAKER_00 42:40

I don't want any of that. Hang tight. More with Dr. Kelly in just a moment, right after a quick word from our sponsor. I used to think the afternoon fade was a caffeine problem. Have another coffee, push through, keep going. But caffeine mostly mutes the signal that tells you you're tired. The fatigue is still there, building underneath, and when it wears off, you feel the drop. What I like about Element Lemonade Iced tea is that it takes a different approach. It uses full black tea extract. So the caffeine comes with L-theanine and polyphenols, the way it exists in the plant. Then it adds a meaningful dose of electrolytes, sodium, potassium, and magnesium, the same foundation as Element's Core Hydration Mix. For me, that makes sense in the summer. Heat, training, travel, long work days, all of that asks more from the system. I reach for lemonade iced tea when I want something that feels clean, steady, and actually refreshing, with no sugar, artificial colors, or strange ingredients. Get a free eight-count sample pack of Elements most popular drink mix flavors with any purchase at drinkelement.com slash AGIST. Find your favorite flavor or share with a friend. Once again, that's D-R-I-N-K-L-M-N-T.com slash AGIST. Jimmy Buffett. You getting a lot of questions about that?

SPEAKER_02 43:53

A lot of questions. All day, yes, since we learned of his passing.

SPEAKER_00 43:59

And what do people want to know about Jimmy Buffett?

SPEAKER_02 44:01

So people, you know, obviously, when they hear that someone has died of skin cancer, they get very concerned. Because skin cancer is quite common. The type that Jimmy Buffett It had is very, very rare. So all of my patients who've had multiple basal cell carcinomas and squamous cell carcinomas, which don't typically metastasize, are you know kind of up in arms because they don't really understand the difference.

SPEAKER_00 44:28

I see. So he had this rare carcinoma, skin carcinoma. What was it?

SPEAKER_02 44:34

As far as I understand from the news reporting, he died of a skin cancer called Merkel cell carcinoma. Merkel cells live in the skin. They're associated with nerves. We consider them like the cells of touch or touch cells. So they live kind of in the epidermis, they live in the hair follicles, and they transmit touch sensation. It's a cancer that shows up on the skin. It's not subtle in any way. It's quite obvious. It's rapidly growing. It looks angry. It's not something that you would miss on your skin. It's commonly deadly. You know, it spreads inside kind of quickly. Yes, just like other skin cancers, it's found on sun-exposed areas, but it's associated with a virus. A research team that found the virus associated with Kaposi sarcoma was looking specifically for viruses, and they found this new virus that's called the Merkel cell polyomavirus. It integrates into our cells and creates the skin cancer that's neuroendocrine in origin.

SPEAKER_00 45:43

What I'm curious about is normally skin cancer, I think of like sun, you know, UV, but this is something else?

SPEAKER_02 45:50

Well, it's definitely seen on sun exposed areas. And there probably is an association with UV light, but it may not be as simple as UV light damaging DNA or our DNA, which is how we think of other skin cancers, which is why old sun exposure predisposes you to skin cancers today. Like even if you're very good about sun protection now, it can come back to haunt you in the form of damaged DNA. And that's not necessarily true for Merkel cell carcinoma, but there probably is a component of sun exposure because UV light is very immunosuppressing in the skin. When UV light hits the skin, it chases away the immune system in the skin and allows you know a virus like that to reactivate or integrate.

SPEAKER_00 46:44

There's a certain group of people out there that feel like uh more sun, better. Like I'll be healthier if I get more sun on my skin and I'm tanned, and I but maybe not.

SPEAKER_02 46:57

Those people should spend a week with me in the clinic and just look and see what sunlight does to your skin. It's devastating. I mean, if you live that way, you're going to look like a leather bag. And that doesn't mean you shouldn't enjoy outdoor activities and but you should do it in a sun-safe sort of way, wearing sunscreen and hats and sun protective clothing. And I mean, it's unequivocal that UV light causes skin cancer. And I think that Jimmy Buffett's situation has kind of you know brought that to the forefront. Skin cancer can kill you. So it's I don't think it's a longevity strategy.

SPEAKER_00 47:38

No. Well, I I agree with you.

SPEAKER_02 47:41

I mean, we talked about vitamin D levels and how that's important for the immune system and having a good immune system, but you don't need the sun to get vitamin D. You you can get it from a supplement. And if you're not good at absorbing that supplement, you take more and you check your levels.

SPEAKER_00 47:59

I'm one of those. I I check my levels every quarter, and it took me about six months. Like mine were, I think, in the high 20s. And I think to get them up into the 40s, I had to take 10,000 IUs a day. And then to get it over 50, I still had to take almost 10,000 IUs a day. And now I think they're about 58 now. So I sort of alternate like 10,000, 5,000.

SPEAKER_02 48:25

I like how you're doing that because you can definitely overdose on vitamin D. I actually had an elderly patient who was in the hospital with a vitamin D overdose. Ooh, how much were they taking? They weren't taking very much at all, but we had recommended narrowband UVB treatment for a skin condition. I can't remember what it was. This was a while ago. And as soon as he started getting the light treatments, he overdosed. So yeah, I like how you're I like how you're doing that.

unknown 48:54

It's good.

SPEAKER_00 48:56

Really big on testing. Yeah.

SPEAKER_02 48:58

Smart.

SPEAKER_00 49:00

If somebody wants to get in touch with you, I know you're in Park City, but if somebody wants to get in touch with you, Tim, how would that happen?

SPEAKER_02 49:07

Ooh, that's a great question. Could they get in touch with you and you give them my information? Or what? Yeah. Okay.

SPEAKER_00 49:13

I can do that. We'll put them in the show notes.

SPEAKER_02 49:14

Okay.

SPEAKER_00 49:15

Absolutely. And if you're if you're in this neck of the woods, everybody I know who's like really knows what's going on, Dr. Kelly is their dermatologist. I'm just saying. I'm saying a lot of other physicians I know go to see you. So thanks so much for coming over. It's it's so nice to see you and and have someone here in person.

SPEAKER_02 49:37

Thank you so much. I love blabbering on about you know random things. So thank you.

SPEAKER_00 49:42

Absolutely. All right, take care now. Okay, bye. Bye. Isn't Dr. Kelly great? I just love chatting with her. I love that she just like showed up my house. You know, just before I thought we were gonna do this on Zoom, right? And I get an email like, I'll be at your house in a few minutes. I was like, whoa, uh wait, I gotta set all this stuff up here. So we did, and it was great. It's so much better doing these podcasts with people in person. I I love it. I wish I could do it all the time, but modern world. This week on Just Try This, we have a seasonal tip. And this is the season where it's getting a little cooler outside, at least it is where I am. If you live in Miami, probably not, but for the rest of us. And as it gets cooler, what happens is the heat comes on. And as the heat comes on, in general, the humidity inside tends to fall. And that can cause some issues. So our skin can dry out, that's not so great. Doesn't look so great. And then also for our sleep, what happens is as our nasal passages dry out, we can often wake up in the middle of the night, and we're not quite sure why. I mean, we don't feel, we don't understand why when we wake up, but what's happening is because our nasal passages have dried up, they've sort of closed down a little bit, and it causes some issues with our breathing, consequently, it causes some issues with our sleep. So this week on just try this humidity. So there's a couple of ways to deal with this. You can get a humidifier, keep it in your bedroom where you sleep at night. You can also try a xylitol nasal spray to keep your nasal passages irrigated and happy. Maybe you just like run the shower if the bathroom's like near your bedroom and close the door and keep that humidity in there. One thing to keep in mind if you keep a window open this time of year, what's gonna happen is that is actually going to accelerate the loss of humidity in the air. So this time of year, you wanna sort of pay attention to that. Like, don't circulate a lot of air from inside to outside, it's just gonna make it even drier inside. This week's tip pay attention to the humidity in the room where you sleep. You're probably gonna sleep better. Thanks for joining us on the show this week. It's so great to have you guys with us. You guys, if you like this podcast, hey, I'm gonna ask you a favor. Pass this off to someone you know and ask them to subscribe. It would really, really help us. And if you can, please leave a five star review. You can do it. You know you can do it. If you want to leave us a comment, we would love that. Please, we love comments. Until next week. Everyone, have a wonderful week. We'll see you then. Take care now.