Skinside Out

Skin Side Out Episode 70 explores the connection between skin health, metabolism, aging, and longevity. Dr. Zain, Heather, and Courtney discuss how dermatology is moving toward a more comprehensive approach that considers what is happening inside the body, not just what appears on the skin.
The conversation covers regenerative medicine, collagen, GLP 1 medications, muscle loss, metabolic health, inflammation, lab testing, and how changes in the body can show up through the skin. They also discuss the importance of working with a primary care physician, being cautious with emerging treatments such as peptides and exosomes, and understanding the difference between promising treatments and those backed by strong evidence.
The episode wraps up with five pillars of healthy aging: sun protection, preserving muscle and bone, optimizing metabolic health, reducing inflammation and environmental damage, and using aesthetic treatments thoughtfully. They also emphasize sleep, mental health, healthy routines, and focusing on becoming the best version of yourself rather than trying to look like someone else.

00:00 Skin, metabolism, and longevity
01:00 Understanding aging and the future of aesthetics
02:00 Taking a whole body approach to dermatology
05:00 Optimizing health before illness
06:00 What regenerative medicine means
07:00 Stimulating collagen and improving skin health
09:00 Regenerative medicine and PRP
10:00 What the skin can reveal about internal health
13:00 A skin finding that revealed severe metabolic problems
15:00 The importance of primary care
16:00 How aging affects collagen, muscle, bone, and volume
18:00 GLP 1 medications and muscle loss
20:00 Metabolic health and longevity
23:00 The importance of tracking health markers over time
25:00 Looking beyond standard lab testing
28:00 Challenges within the healthcare system
29:00 The controversy surrounding regenerative treatments
31:00 Understanding evidence, safety, and experimental treatments
33:00 Researching products and understanding what is actually being used
34:00 The future of dermatology
36:00 Personalized and integrated care
37:00 The five pillars of healthy aging
38:00 Preserving muscle and bone
39:00 Metabolic health, inflammation, and sleep
41:00 Using aesthetic treatments thoughtfully
42:00 Mental health and overall wellbeing
44:00 Small habits that can improve daily life
46:00 The future of longevity care
47:00 Launching a longevity program at Noor Dermatology Aesthetics
48:00 Closing thoughts

Creators and Guests

Host
Courtney Carroll, LE
Courtney Carroll, LE is a licensed aesthetician with extensive experience performing non-invasive cosmetic treatments and customized skincare.
Host
Dr. Zain Husain, MD
Dr. Zain Husain, MD FAAD FACMS is a dual board-certified dermatologist and Mohs micrographic surgeon with fellowship training in cosmetic dermatology.
Host
Heather Murray, PA-C
Heather Murray, PA-C is a distinguished board-certified and fellowship-trained dermatology physician assistant specializing in medical and cosmetic dermatology.

What is Skinside Out?

Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.

70 Skinside Out
===

Dr. Zain Husain: [00:00:00] Welcome to Skin Side Out. I'm your host, Dr. Zain, with Heather and Courtney. So today, we're talking about skin, metabolism, and longevity. It's on the tip of tongues of everyone these days, and it's really important to know what exactly these terms mean and how it relates to aging. And let's dive right in.

So the common question that I hear from my peers is, what is the future of aesthetics? And I think that is tied integrally with aging and how we view it, and how we can slow or, you know, at least reduce that, that process. So Heather, what are your thoughts?

Heather: Um, I think understanding why we age is a very, um, important step to understanding what longevity [00:01:00] means.

And-

Dr. Zain Husain: Because we're all aging. Yeah. I mean, there's nothing you can do to prevent that process.

Heather: Yeah.

Dr. Zain Husain: But can we slow it down?

Heather: Yeah. And can we maybe even reverse the signs of it, too? So using that knowledge to help people look better, feel better, function better, and f- to do all that for longer, too, I think is really important.

Dr. Zain Husain: Yeah. And it's nuanced because a lot of the treatments that are purported out there are experimental. Mm-hmm. They don't have clinical trials behind them or their extensive data. So you know, some of it could be snake oil, but some of it could have legitimacy behind it. So I think as this field evolves, we'll learn more.

But let's kind of talk about how we can start integrating it into our practice with our patients. So Courtney, how do you see aesthetics changing in how we approach our patients now?

Courtney Carroll: I think for a long time, and I hear this from patients [00:02:00] very frequently, where they've gone to their provider, let's say specifically dermatology, and maybe they're just looking at their skin and not taking it into a, a whole picture aspect.

And I think that's where, um, in a lot of fields, that's what's really lacking, is looking... We're all s- we all are specialists in certain- Mm ... departments, but looking at the whole, right? Mm-hmm. I mean, your skin is an organ. It's, you know, connected to your immune system, your GI system, um, vascular, all of these things.

So I think the, the hope and goal moving forward is to be able to, again, take a look at that larger picture and to connect more of those dots.

Heather: I think, um, the term holistic gets thrown around a lot, and I think it's this, like, trendy term. But if you break down what holistic means, it means looking- Whole

at the subject as a whole, and I think that's what medicine [00:03:00] should be. I don't know why it's some sort of trendy term. Um, and I think sometimes people think that holistic is, like, this re- froufrou thing.

but In the sense of dermatology and aesthetics, I think the holistic perspective is also focusing on not just correcting things that you're seeing, but optimizing and preventing or preserving things, too.

Dr. Zain Husain: I think the way that people have framed holistic is almost a rebuke to Western medicine.

Heather: Yeah. Mm-hmm.

Dr. Zain Husain: So we're treating illnesses, we're treating sick patients, and where Eastern philosophies really focus on more preventative measures- Yeah ... they're trying to optimize health, and also use less toxic or more natural types of remedies.

So I, in a sense, I do agree with some of that argument, but I do think that Western [00:04:00] medicine has a lot to offer. I feel like- Mm-hmm ... you know, there are diseases that holistic, um, or more natural remedies will not be able to treat, and I think there needs to be a balance.

Courtney Carroll: Mm-hmm.

Dr. Zain Husain: And I think that's where the conversation needs to go.

Heather: Mm-hmm.

Courtney Carroll: Yeah, I feel like, um, it's funny, when I was younger, I always felt like, yeah, just, you know, just prevent these things and you won't have to be put on the medicine. And once you work in healthcare, I mean, medicine does have its, um, function for sure, and there's many different diseases that require medication to correct.

But there are things you can do to prevent. I think about my dad who, you know, has been on the GLP-1. He walks eight miles a day. He changed his eating habits. He lost weight and was able to decrease his statin to the lowest dose, and he's off his blood pressure medicine. Mm-hmm. So I do think there needs to be a nice harmony between what you can do at home to help, um, prevent these things and maintain versus what medicines you might need to take, too.

Heather: Yeah, and, like, lifestyle medicine and [00:05:00] preventative medicine should be an adjunct to the overarching or core medical system.

Courtney Carroll: Mm-hmm.

Dr. Zain Husain: And also, just the thought of us, when we're at our healthiest, we should look not only to maintain that status, but to optimize. Mm-hmm. Mm-hmm. Um, what can we do to get better sleep, get better metabolic health?

You know, there's so many things that we can do to further improve, and I think that that is, like, the new frontier. Like, how can we optimize our health when we're at our healthiest, as opposed to waiting till we are sick- Mm-hmm ... and then having to, you know, get you back to that state of health. And you may not necessarily get back to that state.

Heather: Mm-hmm.

Dr. Zain Husain: So I do think that if we can really focus on making your healthiest version of yourself healthier- Mm-hmm ... I think that'd be huge.

Heather: Mm-hmm.

Dr. Zain Husain: Mm-hmm. So trendy term, uh, regenerative medicine. What does this mean, Heather?

Heather: it's all about [00:06:00] supporting your body's capacity to repair, restore, and adapt to its environment.

And so in dermatology, I think- Um, that can mean thinking beyond simply just adding volume somewhere and helping to get down to the fibroblast level and help your fibroblast be more, um, susceptible to things that we are trying to do.

Dr. Zain Husain: Yeah.

Heather: Or responsive.

Dr. Zain Husain: And the skin is the largest organ of the body, and it has an amazing capacity to regenerate and renew itself.

Mm-hmm. Um, you know, the cell cycle turnover is what? 28 days. Mm-hmm. Um, and it's a rapid rate, and we can use that to our advantage in helping to optimize our skin health.

Heather: Mm-hmm.

Dr. Zain Husain: So what ways can we utilize regenerative medicine to help us, like in the clinic with certain procedures?

Heather: I think anything that's gonna help stimulate collagen- Mm-hmm

um, is kind of one of [00:07:00] those, um, classic ways.

Dr. Zain Husain: Mm-hmm.

Heather: But, um, there are lots of different things. There's lots of topicals coming out too, whether it's topical biostimulators or topicals that are gonna help your other products be more effective. I think there's a lot coming down this pipeline, and a lot of it has been shown to work really well.

Dr. Zain Husain: Yeah, it's really exciting. Yeah. And Courtney, with your patients, when you're treating them, you know, with, you know, say your facials that you've been doing or your, you know, your microneedling cases, you're kind of trying to almost prime your skin to perform even better. What type of things are you using?

Courtney Carroll: I definitely encourage all my patients if they can tolerate a retinol, um, Retin-A, Tretinoin. I think that just acts as your kind of base of your pyramid in supporting, uh, collagen induction. Um, I love a biostimulatory, um, you know, product such as the growth factors from, um, Neocutis, like the Bio Serum [00:08:00] plated with exosomes I think does a really nice job at, um, you know, helping your cells kind of maximize their function and being able to process the treatments that you're doing a lot better.

Um, I know we've talked about ReCUE before, where we're actually repairing those fibroblasts that have kind of depleted over time and kind of restructuring them to be firmer. And, um, I think that's kind of a revolutionary product, to be honest. So I think things that they're doing at home, um, are really important.

And then even just further than that, I always tell my patients, you know, "If you're feeling under the weather, like, let's-" Mm "... hold off on your procedure. If, you know, you're just not at your best," I think that also plays a huge role. Because really, a lot of these, um, procedures are dependent on your immune response, and when that's weakened, you don't wanna, you know, pursue a treatment at that point, so.

Dr. Zain Husain: Yeah. Yeah. And even during your treatments, you're utilizing some of these topical treatments, like a, the PDRNs or, you know, exosomes- Mm-hmm ... simultaneously to optimize the result of that treatment. And then [00:09:00] aftercare, I mean, we also utilize these agents to help optimize recovery- Mm-hmm ... but also a more robust response.

Heather: Mm-hmm. Mm-hmm.

Dr. Zain Husain: So I mean, regenerative medicine can mean a lot of different things, but with the skin especially, like, we can really help- Um, you know, optimize those results that we're looking for. But regenerative medicine can be used elsewhere, right? So, you know, orthopedics has been using it for a long time- Mm-hmm

uh, for joints, for pain, and PRP is one of those classic- Mm-hmm ... treatments, um, that can really utilize your own body's growth factors to stimulate the healing process, and we've been using that also in dermatology for hair loss, um, also for helping to stimulate collagen synthesis for anti-aging purposes.

So, you know, regenerative medicine has a lot of utility, and I think we're just gonna learn more and more as time goes on.

Courtney Carroll: Yeah.

Dr. Zain Husain: Yeah. So another thing about [00:10:00] dermatology, which I always found fascinating, it's that it gives a reflection of what's going on inside the body. So not only do we see what's happening externally, you know, we do see sun damage all the time, other external factors that affect our skin- Mm

but our skin can reflect what's going on inside. Mm. So what are some of those things that we can infer from our skin health and how it appears?

Heather: Um, I think it depends on kind of what's going on. There are certain conditions that we classically see that can be related to internal abnormalities, um, like, I mean, acne, um, hair loss, um, different sort of like rashes, like acanthosis nigricans for example, we see a lot with insulin resistance.

Um, any sort of like chronic inflammation in general can cause different things to happen on the skin. So like Dr. Hussein mentioned, I think the [00:11:00] skin is a window into the body and showing what could be going on internally. Um, not to say that like there's something wrong with you, but there just might be something imbalanced that can contribute to the skin.

Dr. Zain Husain: And that's why it's important to do like a deeper dive and look at, you know, potential lab abnormalities. Mm-hmm. Hormonal, um, fluctuations and, you know, abnormalities can really have drastic effects on your skin and how you feel. And, you know, many of those conditions that you had mentioned often are tied with hormonal imbalances.

Courtney Carroll: Yeah.

Dr. Zain Husain: So that's huge. Um, it could also imply other things going on in the body, right? So, you know, patients who are, you know, potentially suffering from cancer, you know, there are signs that we can see, you know, with our skin, um, you know, other dysfunctions throughout the body. So I do think that if we are able to see these abnormalities physically in the [00:12:00] skin, because sometimes it's, that's the first sign that we see, 'cause it's so visible, right?

Mm-hmm. We don't really know that anything internally is wrong. Um, we can really help these patients by referring them back to their PCPs, making sure that they do a further deeper dive, um, into any abnormalities, because it can really save a patient's life. I mean, we've had numerous instances with patients.

Heather: Yeah. I had a patient recently, I can't remember if I've talked about this on, on the podcast, but, um, he had cholesterol deposits on his skin, and we ended up biopsying to confirm that that's what it was. And, you know, sometimes you can get cholesterol deposits on the skin, and there's nothing really, um, abnormal internally, like your cholesterol's fine.

Um, but I had him, you know, go to his primary care. He- I don't think he actually had a primary care at the time. So he found a primary care, um, got some blood work checked, and his cholesterol was very high. His triglycerides, I think, were like [00:13:00] 6,000- Oh Normal is, like, under 150, and so anything above 500 is, like, ugh.

But 6,000, I have never seen it that high. Um, and you know, he kind of had this light switch turn on. Um, and I feel like his lifestyle has completely changed. Like, he's going to the gym now. He has a personal trainer. He's, um, eating differently. He's on a couple different medications, like Mounjaro, um, Metformin, a statin, I think.

And his triglycerides went from 6,000 to, like, 300, and it's just incredible how, like, somebody who came to us with what they thought was just, like, a little skin thing made such- Is that the PRP

Courtney Carroll: guy?

Heather: Mm-hmm.

Courtney Carroll: Yeah. We had drawn his blood for, um, PRP for his hair- Mm-hmm ... and-

Heather: And this was before... I told him he needed to go see a primary care, but he hadn't quite seen them yet.

Yeah. So he was [00:14:00] like, "Well, I really wanna do PRP." Mm. So we tried the PRP, and then-

Courtney Carroll: As soon as as soon as one of the girls drew it, she comes out and she comes to me with this cloudy pink, um- Mm Like strawberry milk ... po- strawberry milk. That's the best way to describe it. Wow. And she goes, "Courtney, have you seen this before?"

I said, "No." And, um, I think Dr. Hussain was... had left for the day, and I think you were in a room with a patient and, you know, we ended up googling it. And once he came out and we realized it was the cholesterol in the, in the blood- Yeah. Yeah ... and b- back to what I was saying about making sure you're at your-

Heather: Mm-hmm

Courtney Carroll: your healthiest when you're doing these procedures is so important. Um- Yeah ... and that was such a visual representation of that. Yeah.

Heather: Yeah. He definitely, I think, reached out to a primary care- I

Courtney Carroll: think that- ...

Heather: that day. Yeah. Like, showing him-

Dr. Zain Husain: Yes ...

Heather: that vial- Yeah ... I think, was life-changing for him.

Dr. Zain Husain: And sometimes patients need that wake-up call.

Heather: Yeah.

Dr. Zain Husain: Yeah. It's fascinating how many of these patients that we have don't have a primary care physician. Yeah.

Heather: So many. Yeah.

Dr. Zain Husain: And they're just baffled when, you know, we suggest that, you [00:15:00] know, they really should see a primary care physician. I mean, PCPs are so important. Yeah. They're like the quarterback, right?

They are helping to guide you- And your health in the best way possible, and it's gonna be preventative, it's gonna be actual treatment, and also, you know, you're going to have to sometimes even, you know, see other specialists, and they're the ones who are coordinating that. It's a very difficult field. I have a lot of respect for my PCP colleagues.

Mm-hmm. Oh, yeah. Um, it's a lot of work, but it can definitely save patients' lives.

Courtney Carroll: Yeah.

Dr. Zain Husain: Yeah. Yeah. So we've been talking a lot about skin, but let's talk about some of the supportive structures beneath, because I think that's also important part of health. So we're looking at, you know, the collagen, um, muscle, fat, and how it relates to aging and specifically our faces.

Mm-hmm. So what are these changes that we typically see, Courtney?

Courtney Carroll: Um, you know, obviously over [00:16:00] time, I think, what is it, starting at, like, 25 we start losing collagen production, so I think we see volume loss. But even further than that, I think a lot of people, um, deal with muscle mass loss over the aging period.

Women definitely, myself included, um, deal with bone density issues. Um, so, you know, I think, like you mentioned, it definitely goes beyond just the skin. Um, and that can reflect when you're noticing, you know, sagging or hollowing, um, depletion. Those are those visible signs of that, um, you know, internal function depleting.

Heather: Yeah, and the classic terms that we hear a lot are collagen and elastin. And I like to think of this as like, um, like a mattress. So like the collagen is the stuffing, and the elastin is like the spring of the mattress. And so that's helping to give... The collagen's helping to give volume, the elastin is helping to give that flexibility and elasticity.

And so we're [00:17:00] losing that over time too, so that in combination with the bone resorption, the, um, volume loss, whether it's, um, fat distribution or muscle, I think all play together with the aging process- Mm-hmm ... of the skin- Yeah ... and what we see externally.

Dr. Zain Husain: Mm-hmm. Yeah. And especially with the GLP-1s, we're seeing patients who are having rapid weight loss, but, you know, they're noticing significant, um, you know, impacts on their skin thickness, um, sagging and rapid muscle lost.

Sarcopenia is a big issue. Mm-hmm. So muscle loss, um, with GLP-1s because, you know, it does affect your appetite, so you're not taking in as much protein. Mm. And if you're not doing any resistance training while on one, yeah, you're gonna lose muscle mass.

Courtney Carroll: Mm-hmm. Yeah.

Dr. Zain Husain: And muscle is really important. Mm-hmm. Yeah.

It is a metabolic organ. Mm-hmm. It's so important for our [00:18:00] functioning, daily living.

Courtney Carroll: For aging. Yeah. There, there's the studies out there- Mm ... showing muscle mass plays such an important role in how long people are living. Yeah.

Dr. Zain Husain: And the muscles play a direct role on bones, right? Mm-hmm. Yeah. Because you need that stimulation and, you know, osteoporosis is a thing.

I mean, Courtney, you're You're- I can speak

Courtney Carroll: on that. ... model. Yeah.

Heather: I think in the beginning it wasn't really counseled enough about the- Mm-hmm ... resistance training if going on a GLP-1. And I think so many people, you know, after being on it for a while were starting to realize that, "Oh, shoot, maybe I need to be-

Courtney Carroll: Mm-hmm

Heather: doing this too."

Courtney Carroll: Yeah. I was gonna say earlier, you know, it's interesting because there's been so much, um, discussion and kind of backlash against people on GLPs. "Oh, they took the easy way," and, you know, it's funny to me because- A lot of the people I see on GLPs, that was almost like the inspiration to do better.

Like, I look at, like, [00:19:00] people like my dad, you know, or, like, my friends, myself, who, you know, it- when they started that GLP is when they're like, "All right. I'm gonna start exercising, you know, more regularly-" Yeah ... eating better. Um, it's, I think there's something to be, yeah, said about kind of the, the mental, um, effect that the GLPs have, too.

Dr. Zain Husain: But not only that, it's improving so many other metabolic- Mm-hmm ... factors. Yeah. Right? We're n- noticing benefits with a variety of different, you know, markers. Mm-hmm. We're noticing decreases in, you know, depression- Mm-hmm ... addiction- Yeah. Yeah ... um, cancer risk. I mean, it goes on and on and on- Yeah. Yeah ... all these benefits.

So-

Heather: Cardiovascular ...

Dr. Zain Husain: I mean-

Courtney Carroll: Cuts down on the drinking urge. Mm-hmm. I, I have so many friends who have quit vaping, uh, once they were on the GLP-1s. I mean, it, it's... I think it's an astounding medicine. Mm-hmm.

Dr. Zain Husain: And I feel like as, as we learn more, it's going to become more standard of care for more of these patients to go on them because they are so remarkable.

Mm-hmm.

Courtney Carroll: Mm-hmm.

Dr. Zain Husain: Yeah. So talking about metabolism, let's [00:20:00] kinda dive into how metabolic health ties into longevity and aging. So Heather, what are some of the things that we are looking at from a met- metabolic standpoint and how it ties in directly with longevity?

Heather: I think there are a lot of things. Mm-hmm. I think the thing that people think about first and foremost is, um, like, insulin sensitivity or insulin resistance, um, and helping to regulate your glucose.

Uh, I think that kind of hits at the top of the list, especially because, like, there are some GLP-1s that are approved for insulin resist- resistance or diabetes. Um, but I think there are a lot of other things, too. So like, the cholesterol, um, your lipids, like we mentioned earlier with the patient, um, blood pressure, body composition.

Um, and I think BMI is I don't love [00:21:00] it. Um, I think there are some instances where, like, your BMI might be really high, and you fall into the overweight or the obesity category, but muscle mass- Mm-hmm ... contributes to that as well. Mm-hmm. And muscle weighs more than fat. So I, I think you have to take it with a grain of salt.

Courtney Carroll: Mm-hmm.

Heather: Um, and kind of going off of that, muscle mass, like we already talked about, is great for so many different things, but not having that can- Mm ... you know, potentially cause other issues too. And so focusing on those but also having the lifestyle, um, portion of it. So like we mentioned, sleep, nutrition, physical activity.

Um, and I think kind of diving into physical activity a little bit more, focusing on, like, cardiovascular, um, improvements. So, um, there's different types of activities, anaerobic and aerobic [00:22:00] activities, um, that can help improve the cardiovascular functioning. Um, and I think chronic infla- inflammation in general, um, I think can impact in so many different ways.

Um, and you could be chronic in- chronically inflamed from a lot of different things, whether it's, you know, something like chronic stress or a chronic condition. Um, I think checking inflammation, so whether that's like ESR or CRP, is really important to kinda get that overview. I actually had a CRP checked this past year, and it was high.

Dr. Zain Husain: Was elevated?

Heather: Yeah. And I don't know if it was- accurate timing because I did go to the gym the day before, and I was really sore. So I don't know if it was, like, I had so much inflammation from- Mm ... working out really hard and... [00:23:00] But it kind of made me step back and be like, "Okay, I am kind of chronically stressed.

Maybe my stress is contributing to this." So I've kind of been, like, working on that myself, too, and I think that's really helpful to get an overview of, like, what is actually going on. Even though, like, my cholesterol is fine, what el- like, what else could be contributing to that inflammation that I might not be seeing, but I'm feeling it and, like, experiencing it internally, too?

Dr. Zain Husain: That's a great point, and I think following biomarkers over time-

Heather: Yeah ...

Dr. Zain Husain: is valuable 'cause you can see trends. So for me, the wake-up call this year, I mean, I was getting my checkup and, you know, getting my labs drawn. The

Courtney Carroll: 40-year-old.

Dr. Zain Husain: Yeah, the 40-year-old checkup.

Courtney Carroll: Cholesterol.

Dr. Zain Husain: Yeah.

Courtney Carroll: That was yours.

Dr. Zain Husain: So yeah. I mean, my cholesterol was elevated.

Courtney Carroll: Mm-hmm.

Dr. Zain Husain: Like, elevated.

Courtney Carroll: Oh.

Dr. Zain Husain: And, you know, I generally eat pretty healthy. I work out. I try to get enough [00:24:00] sleep and, you know, I don't really fit the profile of someone who would have that elevated-

Courtney Carroll: Yeah ...

Dr. Zain Husain: cholesterol, you know. And I had other markers that were also elevated and, you know, it really kind of shook me a little bit.

Yeah. I'm like, "Oh, I mean, I am at higher risk, so I gotta do something about it." So I took action and, you know, along with my primary care physician, you know, we are taking steps to reduce cholesterol. Um, also taking some medications that can help with metabolic health, too, because I am high risk, um, because, you know, my parents, hypertension, diabetes, um, high cholesterol.

Like, I've got all the factors. I'm South Asian, which puts me at another, you know, higher risk tier. Mm-hmm. And I just have to kinda be more aggressive and proactive to avoid any, you know, downstream effects and, you know, potential cardiovascular disease.

Heather: Mm-hmm.

Dr. Zain Husain: So I think that it's been really [00:25:00] enlightening to me and going on this journey and kind of looking at my patients from a different view 'cause, you know, like, oh, I'm young, I'm healthy, you know, I don't really have to worry about things.

And then you kinda see the numbers and I'm like, "Oh, okay. Gotta do something."

Heather: Yeah. I think it's also important, like, um- Not just checking... I, I think the basic labs are really great, but there are other things too that can contribute. Like, there are genetic tests that you can do, and it's like your genetic risk for certain conditions like heart disease and stuff like that.

And like, um, maybe even checking the particle sizes of your cholesterol. Yeah. That makes a big difference. I

Dr. Zain Husain: actually got that checked.

Heather: Yeah, I

Dr. Zain Husain: did too. Mine was sky high. Yeah. Like, it was... I'm like, "Oh my God."

Heather: Yeah. Like I said, my cholesterol was fine- Mm-hmm ... but my particles were off. Yeah. And so the sizing is not- Mm-hmm

um, as protective as it could be. And so- Yeah ... I think there are just so many different-

Dr. Zain Husain: Yeah ...

Heather: um, [00:26:00] labs that we can check to have a better overview of like what is actually going on. Like, yeah. Yeah,

Dr. Zain Husain: LDL, LDL-A, and you know, uh-

Heather: Yeah.

Courtney Carroll: Yeah I think that's the hard part is, you know- Care is lacking in that department.

You go in for your annual labs. I mean, for the first, like, 10 years of my adult life- Mm-hmm ... I wasn't even getting my thyroid checked. Like, my primary- Really? Yeah, my primary didn't even check my thyroid.

Heather: Yeah.

Courtney Carroll: And it wasn't until I was having symptoms that could have been thyroid related and I urged her to check it.

Thankfully, it wasn't. But it just, it- for me, it just spoke to a bigger issue. I mean, even things like vitamin D. You know, I've always had chronically low vitamin D. I can always tell when I'm low in vitamin D. Mm-hmm. I feel fatigued. I feel worn out. I just- Mm-hmm ... I, yeah, I'm not at my best. And it's just little things like that, that your normal labs are really only your CBC, you know?

CMP and, yeah.

Heather: CMP. Just a classic lipid panel that- And

Courtney Carroll: that's it, I mean.

Heather: Yeah.

Courtney Carroll: Doesn't take into account really much else. [00:27:00]

Heather: Yeah.

Dr. Zain Husain: Yeah. And that goes back to having a really good primary care physician. Yeah.

Heather: Yeah.

Dr. Zain Husain: Someone to really look at the labs and make sense of it and guide you.

Heather: Yeah.

Dr. Zain Husain: I feel bad because, you know, the pressures of healthcare now- Mm-hmm

you don't have time with your doctor.

Courtney Carroll: Mm-hmm.

Dr. Zain Husain: And, you know- Yeah ... like you're rushing in, rushing out, like, getting your labs, and then maybe getting a message, maybe not, um, telling you what your results are. Mm-hmm. And, you know, you see them maybe once a year, and it's, it's not enough for a lot of patients.

Heather: Yeah.

Courtney Carroll: I think cost is the other... You know- Mm-hmm ... you think about insurance, and I can't tell you how many times I've had to fight with, um, my insurance about- And

Heather: reimbursement ...

Courtney Carroll: reimbursement. Yeah. I mean-

Dr. Zain Husain: Oh, yeah ...

Courtney Carroll: you, if my vitamin D has been low to the point where it was 11 at one point, which is- Mm ... very low, normal range is 30 to 100, why am I having to argue that I should be having this test done

Heather: w- To routinely

Courtney Carroll: check it

to routinely check it? Yeah. You know? And that's, I think that's the other hard part for patients is if the insurance is not covering labs- Mm-hmm ... it gets more [00:28:00] expensive to check these things. And then to Heather's point, the reimbursement for providers is decreasing yearly, so they don't have as much, you know, incentive or capability of checking these labs, so.

Heather: Yeah, I think it's so frustrating because a good primary care does so much. Like you said- Mm-hmm ... they're the quarterback- Mm-hmm ... of the whole system, and I don't think they get recognized a lot for it. No.

Dr. Zain Husain: Mm-hmm. They're underpaid, overworked.

Heather: Yeah.

Dr. Zain Husain: Mm-hmm. And they're just trying to do what they can in a system that's broken.

Heather: Mm-hmm. Yeah.

Dr. Zain Husain: And it's sad.

Heather: Yeah.

Dr. Zain Husain: Um, all right, so moving on. Let's go and talk about some of the controversies surrounding, you know, regenerative medicine and, you know, all these new treatments. Um, what, what's the big deal about these treatments and why is it controversial?

Courtney Carroll: I think because right now it's still so new, and some of...

You know, I always say sometimes [00:29:00] the data hasn't caught up to the, to the procedures or to the medicine. I think there could be a little bit of that. But as a society that is very data-driven, when we don't have that, you know, people can get critical. So I think there's a lot of nuance right now, um, because of how new these, um, these things like the peptides are, treatments, things like that.

Dr. Zain Husain: And we're gonna do an episode on peptides alone. Yeah. But I know it's a hot topic in- Mm-hmm ... aesthetic medicine, functional medicine, and there probably is a role for it. Um, but like Courtney had mentioned, the data is not robust, and there haven't been, you know, clinical trials. Um, you know, the FDA has not approved many of these treatments.

So it's kind of like the Wild Wild West.

Courtney Carroll: Mm-hmm.

Dr. Zain Husain: Um, I have had patients who have had great results, um, self, you know, reported, um, by using some of these peptides, um, or other treatments, and I think that we'll learn more as time goes [00:30:00] along. And, you know, like, we have more data for, like, you know, skin-based peptides as opposed to, like, you know, oral and injectable peptides.

So I think we will go over all that data, or lack thereof, in our next episode. Yeah. But, um, I think it's interesting.

Heather: Yeah. I think it is very exciting. Um, and like you mentioned, like, it is easy for people to get ahead of themselves or to get ahead of the evidence. And, um, you know, it's, it's important to remind yourself, like take a step back and like, what is approved, what is it indicated for, and what are the studies, how long were the studies for, what are the risks?

Um, and so it, it's nice that it is such an enthusiastic time, um, for people, but I think social media plays a part in that in a good and a bad way. And, um, I think you have to be [00:31:00] careful with, like the language that is being, um, given or provided, um, because a lot of it is based around- a- a lack of evidence-

Dr. Zain Husain: You know?

It's ex- it's experimental right now ...

Heather: right now. Mm-hmm. It is very expon- Yeah ... experimental.

Dr. Zain Husain: Um, and just to kind of give background, I mean, drugs take a long time to- Yeah ... not only get developed, but tested to make sure that it's safe.

Heather: Mm.

Dr. Zain Husain: So, like, you know, our GLP-1s, I mean, they've been, you know, through rigorous testing and, you know, that's why it's available.

It is a peptide, right? Mm-hmm. Mm-hmm. And it-

Heather: It's been around for so long- It has ... for diabetes. Mm-hmm. So it's not something new. I know, people don't- Don't

Dr. Zain Husain: realize

Courtney Carroll: that ... realize that- No ... which is so crazy. Yeah. They think that it just came about, like in the- Mm-hmm ... last two or three years. Yeah. I'm like, "No, no, no."

Yeah.

Dr. Zain Husain: Yeah, but there's a lot of safety data- Yeah ... a lot of studies, and we have to make sure [00:32:00] that, you know, our patients are safe. So, you know, before recommending anything, I mean, our patients need to understand that this is experimental and they could have consequences. Mm-hmm. Mm-hmm. Um, but, you know, patients also wanna see the benefits, and I don't, I don't blame them for wanting to try.

Right. I mean, who wouldn't like to, like, you know, increase muscle mass or, you know, decrease weight, um, by just taking a pill or an injectable or feeling much better- Mm-hmm ... um, regenerating and healing faster?

Courtney Carroll: Mm-hmm.

Dr. Zain Husain: So I get it, and it is tempting. I mean, I've thought about it.

Courtney Carroll: Mm-hmm. Yeah, I think the other problem too is, um, you know, all of these are really broad terms, so it's so funny, like, you know, exosomes, growth factors, um-

Heather: They're like buzzwords now

Courtney Carroll: they're buzzwords. And pe- even peptides. And- Mm-hmm ... you know, you really wanna know where they're being sourced from, um, because [00:33:00] it's so easy just to say, "Oh, this is a growth factor serum," and it's almost a baseless claim. I mean- Yeah ... if you were to ask some of these companies, like, "Yeah, where are you s- like, where are you sourcing it?

You know, what are you... Is this plant growth factor? Is this human growth factor?" Mm.

Heather: Mm-hmm. "

Courtney Carroll: Is it human placenta?" Mm-hmm. "Is it human, um, bloo- like exosomes?" I mean, like, where is your source? Mm. And I think that also, um, is worth questioning.

Heather: Yeah.

Dr. Zain Husain: And that's why I think it's important to do your research. We curate products in our office that have a lot of evidence and we know that patients have had benefit from.

So yeah, I mean, if you're gonna go on Amazon and pay, like, 20 bucks for, like, a serum that, you know, has PDRN or like- Mm ... other growth factors- Yeah ... I mean, I'm really doubting-

Heather: Yeah ...

Dr. Zain Husain: you know, their claims and how much of it's actually in the serum.

Heather: Yeah. Mm-hmm.

Dr. Zain Husain: So. All right, so let's get into the future of [00:34:00] dermatology.

Where do you see dermatology heading in this exciting era?

Heather: I think it's- You know, kind of just reviewing everything that we've mentioned. Like, I don't, I don't think it's going to be a skin-only kind of field or treatment. Um, I think looking at the patient as a whole is taking a whole new level of a meaning, and, um, really focusing on internal changes, um, can make a big impact, whether that's, you know, targeting, um, like fibroblast, like still cells within the tissue versus looking at other organs that may be, um, imbalanced.

Dr. Zain Husain: Yeah. I mean, I think integration with all the organ systems-

Heather: Yeah ...

Dr. Zain Husain: is going to be the standard of care going- Mm-hmm ... in the future. And we can't [00:35:00] just look at an organ in a silo and put blinders on, you know. We have to really assess and be astute with what we're seeing and how we can, you know, improve a patient's health.

And the only way we can do that is really take the time and delve in. I mean, there's no other substitute. And, you know, people say that AI will be able to replace, um, many of our functions, but I don't think AI can necessarily put all those clues and pieces together-

Courtney Carroll: Mm-hmm ...

Dr. Zain Husain: with having a live patient, um, you know, in front of you.

I don't think it's just possible 'cause there's so many nuances and things that we can note on, you know, physical exam just by talking with the patient. Um, so that's kind of where I think, um, you know, dermatology's gonna head. Um, you know, definitely having more an integrative kind of philosophy. We're also gonna hopefully see more personalized and individualized care, um, maybe perhaps based on genomics.[00:36:00]

I mean, I think that is definitely- Oh, yeah ... a possibility is with AI and kind of looking at genes and how we can optimize skin health, reduce inflammation. I do think that certain treatment options can be tailored then, and I find that to be really exciting.

Courtney Carroll: Yeah. I think I... You know, it's funny, like when I first entered the dermatology world as like a medical assistant, I was always shocked in that first year how much communication we did with, you know, rheumatology, endocrinology, primary care.

I, I felt like it really was this like fusion of systems, you know, not just the skin. And so I think it's almost, um, always kind of had that forefront of, you know, like I said, kind of connecting the, the dots and putting the puzzle pieces together and looking at not just the skin, but the biology, you know, behind it.

Heather: Yeah.

Dr. Zain Husain: Yeah And then let's end off by talking about the five pillars of healthy aging. So this is kind of a construct that I use with patients to help them [00:37:00] think about their health and how they're aging, and how we can impact those specific pillars to optimize health. So Heather, let's go through them.

Heather: Sunscreen, number one. Sun protection, I think, is one of the most powerful things we can do. Um, from an aging perspective, it's going to help minimize the risk of skin cancers, but it's also gonna help minimize development of other things that we see, sun damage, um, you know, sunspots, uh Volume or collagen depletion too, I think is very related.

And there are a lot of sunscreens too that can help reverse some of that DNA damage that we've had in the past. 'Cause it's never too late to start. Mm-hmm. Um, you know, don't be hard on yourself if you've, you know, had a history of not wearing sunscreen. I think, um, starting now is, is the best thing that you can do for your skin.

Courtney Carroll: Courtney, what's the next [00:38:00] pillar? Preserving muscle. So, you know, um- I would say muscle

Dr. Zain Husain: and bone.

Courtney Carroll: Muscle yeah. You... I should say that, right? Um- I cued you. Yeah. Um, yeah, being, being aware of, uh, your protein intake, your, um, you know, weight-bearing activities, um, both for muscle and for, for bone density. Um, certain vitamins, you know, your, your vitamin D, your K2, things like that to help, um, yeah, keep those nice and healthy.

Mm-hmm.

Dr. Zain Husain: All right, third pillar, um, optimizing metabolic health. You wanna look at glucose- Mm-hmm ... blood pressure control. Um, look at body composition, cardiovascular fitness, and trying to reduce your risk factors.

Heather: Mm-hmm. Um, also reducing unnecessary inflammation or environmental damage. So, um, trying to avoid smoking, um, excessive UV exposure, especially in the [00:39:00] middle of the day when it's, when the UV index is, you know, very high.

Um, focusing on sleep, I think is huge. That, and that's something that people don't really think about. Sleep is

Dr. Zain Husain: medicine.

Heather: Yeah.

Dr. Zain Husain: It's therapy. It

Heather: is.

Dr. Zain Husain: It's, it's needed.

Heather: Yeah. And having a good, like, um, like sleep hygiene, I think is really important too. So, like not having your phone in bed or not watching TV right before bed does make a big difference.

Courtney Carroll: Getting rid of the TV in my bedroom was- Yeah ... the best thing I could've done for myself. Mm-hmm. Yeah. Second to buying a really good mattress. Yeah. Yeah. Like, an investment in a mattress. Yeah. Honestly, I feel like those two things have made such a huge difference.

Heather: And I think people are so addicted to their phones these days.

Mm-hmm. Yeah. It is so frustrating how many times I'll look over in the car and somebody's literally scrolling on TikTok while they're driving. Yeah. And I think it, like, it is an addiction. Mm-hmm. I, I don't know [00:40:00] how that works exactly. Mm-hmm. But I think a lot of times, you know, we get into bed, and we easily reach for our phone 'cause we need that doom scroll or whatever before we call it quits for the night.

And I think that we don't realize how much it's impacting- are relaxation, but I mean, so many different things. But I think I was tying it into sleep, for example. But there are so many other-

Dr. Zain Husain: Yeah ... things that- There's a lot

Heather: of psychological harm from- Yeah ...

Dr. Zain Husain: uh, social media. I mean, Meta just got sued- Mm-hmm

and they lost. Mm-hmm.

Heather: Um-

Dr. Zain Husain: For what? For basically, um- Like

Courtney Carroll: younger ...

Dr. Zain Husain: impacting mental health- Oh, gotcha ... of younger-

Heather: Totally could see that,

Courtney Carroll: yeah ... uh,

Dr. Zain Husain: individuals.

Courtney Carroll: So- Yeah. I think there were quite a few, like, suicides that that was kind of the basis of the case. And how, um, allowing, like, younger people to be on social media has been so detrimental to their mental health.

Heather: 'Cause they're so easily influenced. Mm.

Courtney Carroll: They're so easily influenced. Yeah. Yeah.

Dr. Zain Husain: I mean, it's made to be addictive.

Heather: Yeah.

Dr. Zain Husain: Yeah. I mean, [00:41:00] it's, it's sad.

Heather: It

Courtney Carroll: is

Heather: very sad. Yeah.

Courtney Carroll: I like a podcast before... If, if I need some kind of mental- Mm-hmm ... stimulation before bed, I'll put a podcast on. I don't-

Heather: Yeah.

Dr. Zain Husain: Yeah.

Courtney Carroll: Yeah.

Dr. Zain Husain: I don't have a problem falling asleep.

Just tuck me in and I'm- All right. So let's round out with number five, Courtney.

Courtney Carroll: Um, using aesthetic interventions thoughtfully. So, um, I think the goal always is to enhance and not replace. Um, I always say, you know, when you go in for your cleanings at the dentist, you're still flossing and brushing at home, and your skincare should kind of be treated the same way.

So these are things that, um, you know, you're doing the work at home. You don't wanna just say, "Oh, I've skipped sunscreen for the whole year, and now I'm just gonna IPL it away." Mm. So just considering, um, you know, what you're doing at home and not just jumping to procedures as a, as a means to, um, get where you wanna be.

Heather: Kind of [00:42:00] going off of that, aesthetics, in general, has really switched from trying to look like something or someone specifically versus now enhancing you to be more like you. Mm. And so, like, embracing that-

Dr. Zain Husain: Like the best version of yourself.

Heather: Yeah, the best version of yourself. That's a good way to put it.

And so, you know, we're not trying to change who you are, and I think embracing who you are is very important. But we also want you to look and feel your best, and be able to do that for a long time.

Dr. Zain Husain: And then can I put a plug in for mental health? I think that is so important. Mm-hmm. Mm-hmm. Um, you know, getting a good therapist, I think is amazing for you.

I think everyone should have one. Mm-hmm. Mm-hmm. I do think that if you're struggling with mental illness, I mean, it can affect the rest of your health- Mm-hmm ... um, dramatically. So, you know, make sure that you seek help if you need it.

Courtney Carroll: Mm-hmm. Yeah. Your mental health [00:43:00] can definitely affect your hygiene, it can affect your eating, your, your exercise routine.

I mean- Your skin ... your skin. And, you know, it's, it's something that fortunately I think has been brought to light, um, you know, within the last year or two, just more people realizing that they're not alone, and it's nothing to be like, ashamed of. Um, but I think it plays such a huge part, you know, as someone who's dealt with, like, depression and anxiety.

You know, it, it can really bog you down where you don't wanna get out of bed, you don't wanna do anything. So yeah, I think having a good therapist is so important.

Heather: I think COVID kind of shed a light on a lot of different things that are changing in the healthcare system- Mm-hmm. Mm-hmm ... like, like focusing on things like that, and just kind of trying to be your best version of yourself.

Courtney Carroll: The best advice I ever got from my therapist was just do one thing a day. And, you know, sometimes you overwhelm yourself by saying, like, "I have this huge to-do list. Like, I need to, [00:44:00] I need to vacuum, I need to do the dishes- Mm-hmm ... I need to do this, this, and that." Yeah. And it becomes so overwhelming that you get paralys- The mental load

yeah, you, you get paralyzed from just feeling like, "Okay, I don't wanna do anything." Mm-hmm. She said, "Just do one thing a day. Don't worry about the rest." And honestly, that was so helpful for me, because even on the days where I just would just vacuum, like okay, like I at least did something. Yeah. Or then maybe the next day I'm like, "Hey, I vacuumed.

Like, that wasn't so hard. Like- Mm ... let me do the dishes too." Yeah. Mm-hmm. Motivate you. And you don't feel over- overwhelmed. Mm-hmm. Yeah. Do

Heather: you make your bed every day?

Courtney Carroll: Yes and no. I don't really sleep cr- like, you know how I sleep. I sleep like a Victorian child. So it's not hard to make my bed. Um, you know, I just, like, re- That's true.

That's true. Yeah I, I'm not doing the whole, like, tuck in the pillows. Like the old, like, '50s housewife kind of vibe. Yeah. But, I mean, I just...

Heather: There's a book I had to read, um, before PA school that was, like, uh, it's s- called something like-

Courtney Carroll: Make Your Bed, Girl.

Heather: Yeah.

Courtney Carroll: Yeah, yeah. Or- No,

Heather: I don't know if it's girl

Courtney Carroll: there is a book called, it's like Make Your Bed, Girl.

Heather: Oh. That's right. Yeah, I don't think it was girl.

Courtney Carroll: Oh, okay. Maybe...

Heather: But it was [00:45:00] pretty much, um, like the first thing you do, like try to make your bed every day because that's something that you can do that's, like, easy to do- Mm-hmm ... and you feel accomplished.

Yeah. And then the rest of your day is more productive- Mm-hmm ... and you feel like, you know, "If I can make my bed, I can do this." Mm-hmm. Yeah. And I feel like it's kind of a silly, um, thing to think about, but if you leave your bed messy- Mm ... then, you know, maybe you'll th- throw stuff everywhere in your house.

Mm-hmm. And then your house gets messy, and then your life feels messy and- ...

Dr. Zain Husain: you know. It's a ritual- Oh,

Heather: yeah ... that

Dr. Zain Husain: kind of keeps

Heather: order. Yeah.

Courtney Carroll: Yeah. Mm-hmm. H- having a clean environment really is so productive-

Dr. Zain Husain: Yeah ...

Courtney Carroll: for your mental health, and you just feel better. I mean, even, like- Yeah ... I went away this weekend and I came home to, like, a nice clean apartment, and just, just feel, you're just less stressed overall.

Yeah. So.

Dr. Zain Husain: Yeah. And I find this topic, um, of just aging and metabolism and longevity so fascinating. I know [00:46:00] that there are a lot of medical professionals that aren't necessarily interested, and that's fine. But I do think it's important to kind of delve deeper into some of these topics. And, you know, I, I, I've read a lot about, um, this type of medicine, um, with aging, regenerative medicine.

And, you know, that really inspired me to actually motivate myself but also help to motivate my patients. And, you know, we created a program for our patients who are really invested in their skin health and their optimal aesthetic, um, you know, ideal, but also optimizing their physical and metabolic health.

And I feel like that's where we can really achieve the pinnacle of ultimate wellbeing. So that way we're able to coach our patients, guide them with thoughtful aesthetic blueprints, and then also guiding them through metabolic, [00:47:00] um, health through certain supplements, um, medications, and diet, um, coaching.

And I think that it's going to be a really successful program because I think people are yearning for that information, and they just need someone to help guide them. Mm-hmm. So I'm excited to launch our longevity program, um, at our practice, Noor Dermatology Aesthetics, and we'll see where it goes. I'm really, really curious to see how it's gonna help me with my health journey, and I'm sure you guys are also interested in, you know, optimizing your health, so we'll see where it takes us.

Courtney Carroll: Mm-hmm. Who doesn't need a little accountability? Mm-hmm.

Dr. Zain Husain: Yeah, definitely. I mean, with anything in life, if you're held accountable, you're more likely to accomplish your goals. Mm-hmm.

Heather: Yeah.

Dr. Zain Husain: So...

Heather: Yeah.

Dr. Zain Husain: All right. Well, this was a great episode. Um, this wraps up our talk on aging, longevity, and skin health. If you enjoyed this episode, please like, follow, and subscribe.

But until next time, skin side out. [00:48:00]