Are Skincare Products Worth the Hype?

Dr. Furnas (00:12):
Dior sells a 1.7 ounce face and neck cream for $7,500. Its active ingredient Yquem sap. It may lack scholarly proof, but Dior's description deserves a poetry award. The sap flows to the heart of the grapevine and it's harvested and infused into the heart of L'or de Vie la Creme. So how do you know if it works? Welcome to Skintuition. I'm Heather Furnas. 

Dr. Korman (00:47):
And I'm Josh Korman. Without an ability to speak a lot of French accents as two plastic surgeons, we lay aside our scalpels and explore and bring to you what's new, what's safe, and what to look for when you're ready to hit refresh. 

Dr. Furnas (01:03):
So before you rush to order that while supplies last, let's talk about the different classes of skincare products. 

Dr. Korman (01:15):
Well that the skincare products that work and the ones that don't work well, obviously that's not just, it depends on the person and what works for you and what doesn't work for you. That's ultimately the question. But really I think what we're talking about is medical grade versus over the counter products or as the other classic line is prestige products, which could actually be both. Those could be medical grade or over the counter or prestige. These are all the names. As Mel Brooks always says, marketing. It's all marketing. But anyway, to get to the point medical grade or over the counter products or prestige products like Dior's $7,500 face and neck cream, or should I now try to pronounce it with a French accent? At least with the accent grave over the e, creme? 

Dr. Furnas (02:06):
Yeah, so medical grade products have some sort of differentiation. This is not like black and white lying in the sand, but medical grade products can contain a drug that treats a condition, for example, an alpha hydroxy acid for exfoliation to treat wrinkles or salicylic acid to treat acne. So these would be medical grade products. They tend to be at higher concentrations than over the counter products, and they have to be pure at a greater level of purity than over the counter or drugstore prestige products. 

Dr. Korman (02:50):
But mostly those are things that I think most people don't even know what they mean. I think hydroxy acid, hydroxy acid, I think aren't there acids in our bodies already and salicylic acid, I guess that sounds like what's an aspirin? I mean I guess it's just like what do these words actually mean? And just because they mean something and just because they do things to cells in the body, does that actually translate into, does that make you feel like your face skin looks better? I guess that's ultimately the question. 

Dr. Furnas (03:22):
And some products really do treat like Retin A is FDA approved to treat fine lines and wrinkles, to treat acne and even to treat the texture and tone of your skin. So three things. That's the best researched product of all the skincare products, but even that can be diluted. Some sort of derivative of Retin A or vitamin A can be included in over the counter products. It's just that whatever you get in an over-the-counter product will not have the same concentration. Why? Because you're more likely to have a reaction when you have the more concentrated medical grade product. You may have redness or dryness, whereas the very dilute solutions that you can get over the counter, you are much more likely to be able to tolerate, but you probably won't see the same level of results, at least for some products. Now, other medical grade products may not contribute that much like cleansers. Some are just nice cleansers and some have an active ingredient like an alpha hydroxy acid, which is great for exfoliation, which helps with acne, helps with aging or salicylic acid, which unclogs pores and really helps with acne. So it's not a clear cut answer. 

Dr. Korman (04:53):
Yeah, I think what is kind of clear cut is teenagers acne is a big issue for teenagers. It can be also for adults too, but one of the most important things for teenagers is to wash your face. It's not even, I mean, whether you spend a dollar on a cleanser, $10, $50, a hundred dollars, a thousand dollars, how about just washing your face? Because I think that's part of the problem that exists with teenagers. Washing your face is actually a good thing and it's not that complicated. And it also doesn't even much matter with what you do it. It's like just wash your face and probably twice a day. So that's one thing. Same thing with sunblock. The sunblock is two x five x, 10 x, 15 x, 50 x, 1000 x SPF. Does it matter? Well, probably the most important thing is that it goes on about half an hour to 40 minutes before you actually go in the sun to just go to the pool, put some sunblock on and jump in the pool that's going to wash off in a second probably is not the best thing. So I think what we're trying to talk about is some nuances, things nuanced within the products, assuming that the general concept of if you have pimples wash your face, 

Dr. Furnas (06:12):
Then I'm going to go back to medical grade products to cover one other aspect, and that is accessibility. Generally, medical grade products are sold out of physician offices or some health professionals office or med spa, and yet you can get these things online. Now, it's one thing if you get the products online through the Med Spa's website or the company's website, usually the companies will divert people to actual practitioners because the practitioners can back them up if there is a complication or a reaction or a rash or something like that. But people will find these products online for a lot cheaper. The question is, were those products stolen or are they really just knockoffs that are not really the real product? Since these companies only sell to practices and med spas, they are not selling to companies that sell these things online. You have a very low level of security that what you're getting is really the real thing. It's not expired and it's not stolen. 

Dr. Korman (07:24):
That's totally true. The other piece though is Retin A or retinols, which are ingredients related to vitamin A, which actually do work a lot when you buy medical grade products, can you buy them online? Yes, you can. And yes, they carry all the risks that Heather just spoke about. But the other piece to it is just because you can get it, does that really tell you how to use it? So for example, Retin A, one of the things that's really a related issue is the dryness and how much your area or face, wherever you put it, should be moisturized. And a lot of people who have been using Retin A for quite a while, they will use it twice a day. If you start by putting it on twice a day in an area of your face, like your eyelids, which is very thin skin, you can really cause issues. 

(08:18)
It can burn your face, it can burn the area, it can be very, or at least very irritating. So it is actually important to get a medical professional of some sort to guide you to how to use the medical grade products. The word medical grade is specifically, there's that word medical because it can cause reactions. And to think that, oh, let's just bypass the medical person because I'll just go get it. The problem is that you don't get all the medical information and Google University and Internet University does not always help you. So just a suggestion. Obviously I'm biased because I am a doctor, but just a word to the wise, just because you can get something that's medical grade online, please figure out how to use it before you just go put a lot on. 

Dr. Furnas (09:12):
And there are downsides of not knowing how to use it. For example, there is photosensitivity, people are photosensitive with Retin A, meaning that the sunlight can really make them red much more sensitive to the sunlight. And so the instructions are to put the Retin A or vitamin A derivative on at night. Now some people don't tolerate it. Some people are very red. Sometimes you just need coaching to get through that period of time because it does get better. But you also want a medical professional to be able to recognize is this really too much of a reaction? Should you cut down on dose? Should you mix it with moisturizer or should you just switch to another derivative of vitamin A? There are a lot of products that are related to vitamin A, Retin A. Some are less potent, but better tolerated. Rein A is actually an amazing product because it works at the molecular level, it penetrates cells, it will affect the nucleus. It really does a lot for a lot of people. So you want that handholding because it does impact people with redness, dryness, and rashes. 

Dr. Korman (10:31):
So if we talk about what we should do with Retin A and what does it do, what does it not do? One thing that I think it's important to point out is if you look at the claims that come along with any of the products, whether it's drugstore over the counter, you will often find a line in the description where it says their studies or studies show, not that it decreases fine lines and wrinkles, but it will decrease the appearance of fi and lines and wrinkles. And so it's really important just like on your cereal box or the donut box or any other marketing term on any cover or jacket or box to entice you to get more interested to purchase it, please be careful of what you're reading. And if you like the color of the box, if the pink, if the red green, it's fine, but especially when you're dealing with medical grade or if you are thinking even over the counter in the drugstore, you don't want to be disappointed and you want to feel like what you're buying it's worth, it has value. No matter what you're spending on it, you want it to have value. So it requires a little bit of research, but whatever you do learn, because it's your face and you're putting stuff on it and skin is quite durable, but you want to get value and you want things to work and you don't want to waste time or money. 

Dr. Furnas (12:04):
So I did a few searches asking for the top five best skincare products in general, and these tend to align with anti-aging and prevention of aging changes. And they tend to be the ABCs, hyaluronic acid and sunscreen. So the ABCs we already talked about Retin A, which is a derivative of vitamin A, and then the B is a vitamin B three or niacinamide, which is actually pretty similar to the effect of vitamin C in that they both boost collagen production and they reduce hyperpigmentation and they basically fight aging. The vitamin B three prevents dryness and they prevent free radical damage. So this is the vitamin C and B three niacinamide. So free radicals, I mean that sounds like the 1960s or something, and the protestors and the hippies and all that. Free radicals are molecules that have gone awry. They've been damaged often through uv, which comes from obviously sunlight and uv, tanning beds, and that can cause cancer, sun damage, you can get that aged look in the skin just from that UV damage. And so those are products that can really maintain your skin and keep that aging at bay. And then you want to moisturize with hyaluronic acid. What is a moisturizer? There are different types of moisturizers. Humectants, hyaluronic acid maintains the hydration. That's a humectant. It attracts water and it keeps it moist. You have emollients and 

Dr. Korman (14:05):
Think raisin and grape. 

Dr. Furnas (14:07):
Yeah, that's good. Yeah, raisin and grape. And you want a grape, you want to keep the grape. And something like an emollient or an occlusive can be petroleum or mineral oil. And so that's really great when you have super dry skin, maybe like your cracked heels or we use petroleum to heal, for healing after laser, but those can clog pores and so hyaluronic acid doesn't. It's the same stuff that we inject as fillers to plump up lips and fill in grooves in the face. And then sunscreen, which we've mentioned. So there's a physical block like zinc oxide or titanium, and then there are chemical blocks which actually are absorbed and will absorb the UV rays and it's released as heat. So those are the five best, A, B, C, hyaluronic acid and sunscreen.

Dr. Korman (15:12):
Not to try to question anything. So if I'm in the drugstore or I'm at the doctor's office and I walk in and I go, okay, I'd like some A, B, C and sunscreen. Okay, so there are 20 different sunscreens and A, okay, those are the retinols. And then B and C, does that mean that's four products? So being a boy, I'll tell you that boys do not like to put so many layers on and not to spend too long every morning, every night. So just like with a vitamin pill, is there a vitamin pill, you just take one a day. Are products made with A, B, C, and sunscreen or is it just pick whichever one is most important to you and go with it? What's a boy to do? 

Dr. Furnas (16:03):
Well, we've talked about Retin A, and that's like the champion of vault. Vitamin C comes up the next as far as searches and things that it does and fighting free radicals. There is some skincare, I mean some protection against the sun, much milder than a sunscreen. And so if you're going to choose one, I would choose a sunscreen because you want to block those UV rays before they even get to create the damage that they do. 

Dr. Korman (16:34):
So why is it that people talk about if you have really oily skin that you should have something to make it drier? Otherwise you get the oil clogs the pores, and you get pimples, but then if your face is too dry, your pores can get clogged and then you can get pimples like, okay, what's a teenager to do? Like, huh? 

Dr. Furnas (16:57):
This was actually a really good point because we talked about the different moisturizers. So in treating acne, if you have all this exfoliation and you're using Retin A and you're doing all this stuff, your skin gets dry even though at a baseline you've got these overactive sebaceous glands which produce oil. So you still need a moisturizer. And this is where you're going to look to a humectant, one that hydrates a skin that would be hyaluronic acid, but you want to stay away from the creams, the oils, the really thick moisturizers because that's going to cause acne by clogging those pores. So you still need a moisturizer, but this is where you have to really know something about moisturizers. 

Dr. Korman (17:46):
So since there's so many lasers, and again, laser light is, it's not light, it's artificial light. Laser is an acronym. It's not just regular light. So there are many lasers that work as ablative lasers and non-ablative lasers, meaning taking off lasers of skin or going after certain skin cells. And we've talked about different lasers on different episodes. But my question is, okay, so if there are all these fancy lasers, is there just a laser I can do and that I don't have to worry about skincare? Why do we have to deal with skincare and why is skincare so important? And I think one of the things that's really important to remember is that skin is the largest organ in the body. It's a very dynamic organ that keeps replenishing. So it always bugs me when I see this product will build up more collagen. Well, doing nothing also builds up more collagen. So help me out here, Heather, why am I so confused? 

Dr. Furnas (18:44):
Well, it is very confusing When we treat people with laser or peels or microneedling, rf, various energy based devices, we're kicking up the inflammation process. And that is what really will stoke the production of collagen. But that's going to be temporary and eventually the benefit will kind of settle out, and that's where you need a regimen of skincare products to keep that up. We talked about the ABCs, the vitamins A, B three and C all contributing to collagen production. And so it's like going to a week long spa and you've exercised and you've reduced your calorie count and just eaten the best. But then you go home and if you go home and you don't maintain, you're going to go right back to where you were or maybe a little bit better, but you're not going to have the same impact as if you're continuing to nourish the skin, protect the skin. And in some cases you can turn the clock backward with Retin A as the FDA is approved for fine lines. So they go hand in hand. But Josh, you're right, people want something permanent. They say they don't have time to do these other things, but it's like you don't have time to exercise every day and you want some permanent fix. It's just not going to happen. 

Dr. Korman (20:17):
So let's talk a little bit about parts of the face, because eye cream is such a popular thing. And what is it about eye cream that's different about the other creams and what is it about those crow's feet that everybody sees? The first, I don't know, what's the singular of crow's feet? Crow's foot? I'm not sure, but whatever it is that's like, oh, getting old quick, do something. So what is it about eye creams? What's so special about eye creams? 

Dr. Furnas (20:52):
Yeah, I've long puzzled about this why something so particular. And in fact, the skin is particularly thin there, and that muscle acts right on that skin and you've got the same lines around the mouth, but the skin is thicker there, so it's a different interaction, whereas that really fine eye skin is contracted by the muscle and also swells because we get that puffiness and dark circles that come with swelling and lack of sleep. And so the eye creams tend to be thicker. They often will have moisturizer called ceramide, which is more of an emollient as along with hyaluronic acid. So a combination combination in addition to the active ingredients like vitamin C, retinol, a type of Retin A and peptides, we'll get to peptides in just a moment. 

Dr. Korman (21:54):
So eye cream is actually really beneficial. And I think eye cream is good before you have the lines. I think that's the part that's also important, that it's not like anyone's trying to sell you, but they are things from when you're young and there's a very short tie between the pimples and wrinkles in humans. But it is really important to understand that when you have really deep wrinkles already, the creams themselves are really not going to do that much. And so when it is most beneficial is when you actually don't have them. And that will help you to not get them or not get them as deeply. And yes, there are things obviously to do when they come and you don't want to be feeling like, oh my gosh, I'm 20 years old and I got to start spending too much money on creams when I've got pimples and I'm trying to, what am I putting moisturizer? It gets a little confusing. But I think it is important to recognize that as much as it seems hard to believe, aging is something that happens to everybody and these moisturizing technologies in the form of just even an eye cream is something that's worth not ignoring, whether you're a boy or a girl or a man or a woman, because it really does help in that zone. 

Dr. Furnas (23:12):
Yeah, I saw an interesting article few years ago in our main scientific journal that looked at twins. One twin had used moisturizer on her chest, upper chest, and the other twin had not in a series. So there were a lot of twins and there was a clear difference in the skin. The twins that had used the moisturizer looked vastly younger. So something as simple as moisturizer that we think of as not being results oriented really is great at prophylaxis and protection of the skin. 

Dr. Korman (23:50):
Prophylaxis meaning to stave off stuff. 

Dr. Furnas (23:53):
Exactly. Staving off those aging changes. So does it matter what order you see gotten all those ingredients and products? Does it matter what order you put them on? 

Dr. Korman (24:07):
Well, probably don't want to put stuff that's going to get in your eye or get in your mouth that's going to bother you. But I think if you think about it, the sunscreen should probably go last because sunscreen is creating a barrier. So the sunscreen goes last, or if it's the only thing you're putting on, it goes first and last because it's the only thing. But assuming it's not the only thing, obviously I'll throw my vote in for sunscreen goes last. 

Dr. Furnas (24:36):
Cleanser goes first. So that's a pretty easy one too. So you're not going to put everything on and then cleanse it off. So cleanser goes first and then toner. Now 

Dr. Korman (24:47):
What is toner? What is toner? 

Dr. Furnas (24:50):
Toner is not essential, but it corrects the pH to five to seven. So why correct the pH? Apparently that reduces the chance of infection. It protects the skin and it allows the other products to penetrate the skin better. And so particularly if you're using other active ingredients, then the toner can help those products penetrate better. 

Dr. Korman (25:19):
But I think it can also risk draining the wallet or the pocketbook too. 

Dr. Furnas (25:26):
So to be clear, just like a medical grade cleanser is not essential unless you you have acne or some condition that you are treating and that cleanser has an active ingredient. Toner is not essential. But if you do have something like acne, then you do want to use toner if you have a condition, but it is not essential. And so then after the toner, put your serums on. So serums are sort of wet types of things, and vitamin C. 

Dr. Korman (26:04):
So vitamin C can come in the form of a serum or in the form of a cream. So cream is like you can't see through it in serum looks like it's like some kind of that word salve. I never know what a salve is, but I think that's what a serum, A serum is a salve. It's kind of like that thick sort of clear but not clear stuff. So what's the difference? 

Dr. Furnas (26:30):
Well, with the vitamin C serums, vitamin C is not the most stable ingredient, and it can be destabilized with light. So it typically comes in a brown bottle to protect it from light damage. And so the serum is going to be a stable product, or it should be if you buy the right brand. And so put that on with the serums. And then vitamin C and creams may be less effective. Those would go on later. So serums would be like niacinamide, that vitamin B three, hyaluronic acid can sometimes come in a serum. So put your serums on and then you can let that dry, let the serums dry. 

Dr. Korman (27:19):
So obviously when you cleanse your skin and you pad it dry or whatever you're going to do, then you can put the next layer on, which is, what is that? The toner? 

Dr. Furnas (27:30):
Toner. If you use the toner. 

Dr. Korman (27:31):
Okay, so you do the toner and then how long the toner, you let the toner dry? 

Dr. Furnas (27:35):
Yes, you're supposed to let it dry. Now this does mean an investment of time. So if you're impatient, skip the toner or pat it dry depending on your motivation. And then the serum.

Dr. Korman (27:51):
Okay, so then the serum goes on. So how is that going to, and you let that dry before you put the next thing on. 

Dr. Furnas (27:59):
So put it on really light so you're not waiting five minutes for it to dry. You don't want to put a lot on. And then 

Dr. Korman (28:07):
Because that also helps to leave more in the bottle so you don't run out of it too soon either. 

Dr. Furnas (28:12):
Good point. Because all of this stuff is expensive. It is an investment. And then after the serums, you can put on your eye cream and then do spot treatments. It might be whether you're doing benzoyl peroxide or whatever spot treatment you're on. And then put on your retinol, your Retin A, your retinoldehyde, your retinol, whatever form of vitamin A you can apply after the serum, but before your moisturizer. 

Dr. Korman (28:46):
And never if you're pregnant, because Retin A is bad if you're pregnant. 

Dr. Furnas (28:50):
Never if you're pregnant. And avoid it when breastfeeding too. But yes, never. You don't want any form of vitamin A while you're pregnant. Good point, Josh. And then you can mix your retinol with a moisturizer. So either put it on before the moisturizer or mix it with a moisturizer if you're really sensitive to it, and then put your moisturizer on. And then your sunscreen and then your makeup. 

Dr. Korman (29:15):
So in the seven layer cake here, how long does the moisturizer take before you put the makeup on to dry? 

Dr. Furnas (29:22):
Well, moisturizer. And then sunscreen. And then makeup. So one question is what if you have a foundation that's got SPF 30, SPF 45, are you good to go without the sunscreen? 

Dr. Korman (29:39):
I don't know. I don't know. After seven layers, I'm so full from the first three, I can't even get to the fourth, fifth, sixth or seventh. Wow, that's a lot of layers. 

Dr. Furnas (29:50):
Well, the amount of foundation you would have to put on to really put on enough sunscreen would be not a good look. And oftentimes the foundation sunscreen doesn't have the exact percentage of SPF or level of SPF that it says. So you really want to put your sunscreen on to get that benefit of the sunscreen and then put your foundation whether or not it has SPF on, and then you're good to go five hours later. 

Dr. Korman (30:24):
I just want to say for those of us that don't wear makeup, I would say it sounds like you can get away with a cleanser and you can have toner, maybe not, cleanser, then a serum, maybe, maybe. But certainly some kind of moisturizer eye cream and then sunscreen. Would you say that's it? 

Dr. Furnas (30:50):
Yeah, and I would back up before the moisturizer and say, Retin A does so many things for the young for acne. It prevents those fine lines, or it can help prevent fine lines. It can help treat fine lines, and it improves the texture of the skin. As long as you don't go around with the high levels of Retin A, there is the Retin A tomato face look, and you just look dry and red. It's not appealing. It's not helping, it's not really a benefit. So just go down to the level that is appropriate for your skin. But I'm a big Retin A or 

Dr. Korman (31:29):
Yeah, but it's not appealing. But it can be peeling, 

Dr. Furnas (31:32):
Right? It can be peeling. Yes, it does make you peel. So why don't growth factors and peptides and exosomes come up in Google searches a top five? 

Dr. Korman (31:47):
Because people don't know, because there's not enough studies, because it hasn't been around enough, because people are afraid of things. They don't want to be bad for you. I don't know which is the answer. 

Dr. Furnas (32:04):
Yeah, absolutely. All of those. But they hold a lot of promise. So we're early on in the research with these things. They are expensive. Some are really hard to get to penetrate the skin. Exosomes are mostly used after some energy device or sharp mechanical device that breaks through the skin and the exosomes can then penetrate the skin through the injury. So there are a lot of things that we're working are not we, but researchers are working on. They are costly. So it's not like people are going to just run out and get these things without the research, but the research is really promising. We have discussed peptides and exosomes and to a lesser extent, growth factors in previous podcasts. And they are really chemical messengers that can rev up collagen production. And we've also talked about sort of reversing some of the aging changes at the molecular level. So they really hold a lot of promise and they may in fact, one day make it to the top five. 

Dr. Korman (33:23):
Okay. Well, thank you for listening to this episode of Skintuition. Join us every two weeks as we tackle topics from hair loss to hormones, pimples to wrinkles, skincare products, and discovering new ways to feel better about ourselves. 

Dr. Furnas (33:40):
Follow us, comment, ask questions, and keep in touch. We'd love to hear from you.