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6 Ways to TRANSFORM Your Skin Texture | Dermatologists Explain — Transcript

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0:00Does your skin look like this?
0:02This? Or this? These are all examples of
0:07textured skin, and it's not usually one
0:09thing that's contributing to texture,
0:11which is why it's quite difficult to
0:12treat and even in some cases diagnose.
0:15What's up everyone? We're back. I'm Dr.
0:16Shah. Dr. Maxfield.
0:18>> And welcome back to our channel
0:19Doctorly, where we talk about all things
0:20skin care and dermatology. And one of
0:22the biggest issues that I personally
0:23struggled with was skin texture. Now,
0:26this can look like tiny little bumps on
0:28the skin. They can be due to skin
0:29growths. They can be due to larger
0:30pores. They can be due to build up of
0:32sebaceous filaments. Or they can even be
0:34due to facial hair. So, in this video,
0:36we're going to be talking about what
0:37causes skin texture, and then we're
0:38going to be talking about the six top
0:40treatments to improve your skin texture
0:42with a bonus tip at the end. Right. So,
0:45these are the top tips for textured
0:47skin. Here we go. Here we go.
0:52So, we'll start off with what causes
0:54texture on your skin. And I'm going to
0:55use Dr. Shah as my mirror. So, we have,
0:59first off, fine lines and wrinkles.
1:00These are from muscle dynamics, but the
1:02subtle ones are actually just coming
1:04from time. He highlighted my favorite
1:05wrinkle there, which is the crow's feet.
1:07It's a marker of a good life.
1:08Additionally, we have oil glands. So,
1:09there are two ways these can cause
1:10texture. You can have sebaceous
1:12hyperplasia, where they become enlarged,
1:13or you can just have pores, where the
1:15oil gland sits at the base. Now, pores
1:16are their own unique thing. It's a
1:18combination of structure and that oil
1:20gland that we talked about. Then, we
1:21have moles. We won't address how to take
1:23care of those today. We also have these
1:25growths called seborrheic keratoses,
1:26which he has none of those where I can
1:28see. And then, he does have facial hair,
1:30as he mentioned, and the hair tip is all
1:32him.
1:32>> So, how do my patients really experience
1:34skin texture? So, one of that is poor
1:36radiance to the skin. So, when light
1:37hits your skin, they don't really have
1:39that reflectance to it. And that's
1:41because all that texture is causing the
1:43light not to really reflect back at
1:44people, so the skin can look what we
1:46call dull. The other thing that we see
1:48is, again, larger pores. So, you'll see
1:50those little kind of crater form look.
1:52It almost looks like acne scars for some
1:53people because the pores are so deep
1:55into the skin. The other thing that
1:56we'll notice a lot of times is that
1:58you'll actually see individual dots,
2:00especially in the case of seborrheic
2:01keratosis where you can actually see
2:02these little growths out of the skin.
2:04When you rub your finger over them, you
2:05can actually feel them on the skin. And
2:06sometimes these can even be
2:07pre-cancerous lesions in some case
2:09called actinic keratosis, which are
2:10these little roughnesses to the skin as
2:12well. And then finally, I would say
2:13probably the number one complaint that
2:15patients have for this is, especially if
2:16they're wearing makeup, is that their
2:17makeup just cakes in certain areas and
2:19never lays smooth on the skin. It
2:21wrinkles and creases around the eyes.
2:23And this is again another issue that's
2:24due to poor skin texture. So, the way
2:26we're organized how to treat this, we'll
2:27kind of go from like least invasive to
2:29most invasive because topical treatments
2:30won't take you all the way. That's one
2:32of the common conversations I have with
2:34my patients in the office is here's what
2:35you're doing over the counter, here's
2:36what's the prescription, but if you
2:38really want to commit to treating it,
2:40here is everything you can do. And so,
2:41that's what we'll do now. So, the first
2:43thing to help with your texture is going
2:45to be exfoliation. Now, this can be a
2:47really daunting topic, but I'm going to
2:48try to break it down as simply as
2:49possible as I can. So, you have your
2:51chemical exfoliants and then you have
2:53your physical exfoliants. Chemical
2:54exfoliants are ingredients like alpha
2:56hydroxy acids that chemically exfoliate
2:58the skin. Then you have your physical
2:59exfoliants, which you can actually feel
3:01rubbing up against the skin. That's your
3:02St. Ives Apricot Scrub. I recommend
3:04these on the body, but I generally do
3:05not recommend these on the face. So,
3:06specifically within the chemical
3:08exfoliation category, you have really
3:10two groups. You have your alpha hydroxy
3:12acids and you have your beta hydroxy
3:13acids like salicylic acid. Now,
3:15salicylic acid is great for pores, but
3:17it's not really great for that surface
3:18texture layer of the skin. And so, we're
3:20going to specifically focus on our alpha
3:22hydroxy acid group. Now, within this
3:23group, you have very small molecules
3:25that penetrate deeply in the skin and
3:26very large molecules that sit on top of
3:28the skin and exfoliate that very top
3:30layer of the skin. Now, the smallest
3:31molecule is glycolic acid and the
3:33largest molecule are your PHAs like
3:35gluconolactone. And in between that, you
3:37have lactic acid and mandelic acid. Now,
3:38the smaller the molecule it is,
3:40penetrates deeper, it's more effective,
3:42and can be more irritating to people
3:43that have sensitive skin. Larger, like
3:45gluconolactone, is going to sit on top
3:47of your skin, might not be as effective,
3:48but it's going to be great for sensitive
3:50skin. And so, for glycolic acid, that's
3:51going to be your really your heavy
3:52hitter, then lactic acid, then mandelic
3:54acid, and then your PHAs like
3:56gluconolactone. So, yeah, these are some
3:58of the ingredients you use for
3:58exfoliation over the counter. In the
4:00office, we use similar ingredients for
4:02chemical peels. They are certainly a lot
4:04stronger, and the range of depth varies
4:06considerably. You can get profound
4:08results with texture with some of these.
4:10Yeah, so with these deep chemical peels
4:11that we have in the office, you can
4:12basically resurface your entire face.
4:14Basically, your entire face peels off in
4:16this process of chemical peels. We have
4:18these gentle ones that are available
4:19over the counter that are used usually
4:21for once or twice a week. Now, if you're
4:22somebody who's acne-prone or you have a
4:24ton of texture as the main concern that
4:25you're trying to target, then maybe
4:26using a low concentration of some of
4:28these ingredients daily actually can
4:30make a difference to your skin. But, you
4:31don't want to use so much on this that
4:32you're going to over-irritate your skin
4:34barrier. It could actually make your
4:35skin worse.
4:36>> So, while exfoliators break up the bonds
4:38between skin cells, another way to
4:39increase skin cell turnover is to do
4:41exactly that. And that's where retinoids
4:43come in. So, retinoids, whether it's
4:45retinol, retinal, tretinoin, tazarotene,
4:47this whole family actually increases
4:49skin cell turnover and normalizes the
4:51thickness of the skin. It has a nice
4:53boundary, so it doesn't actually thin
4:54it, it thickens it over time to a normal
4:57extent. And so, retinoids in a similar
4:58way can directly help improve texture
5:00over time. Now, one of the major
5:01contributors to textured skin is going
5:03to be that stratum corneum layer, the
5:05very, very top layer of the skin
5:06becoming too thick. This is the same
5:09layer gets thickened when you have like
5:10a callus on your hand, for example, and
5:12that's going to add to a lot of the
5:13dullness of your skin. Now, retinoids
5:14normalize that layer, so it will make
5:16that layer thinner, even though it's
5:18going to make the rest of your skin
5:19thicker, including your dermis and the
5:20rest of your epidermis layer of the
5:22skin.
5:22>> And so, this is where retinoids play a
5:24big role, and you have of course the
5:25over-the-counter options, retinol,
5:26retinaldehyde, adapalene, and then you
5:28have your prescription versions,
5:30tretinoin, tazarotene. Tazarotene, in my
5:32opinion, being the most effective for
5:33this. But, you definitely will peel when
5:35you start using this. And so, this is
5:36going to normalize your skin, and it's
5:38probably going to be the number one
5:39thing I would recommend most people if
5:40they're going to pick one thing to do to
5:42improve their texture, but also target
5:43many other things, because we We know
5:45that also, like Dr. Maxwell was saying,
5:47is that wrinkles also do contribute to
5:48that textured skin. And so, retinoids
5:50also help with the wrinkles by helping
5:51to support your collagen. So, it's not
5:52only going to help with that surface
5:54issues of texture, but it's also going
5:55to help with those deeper issues that
5:56contribute to texture as well. Next,
5:58let's talk about the cleansing part of
5:59your routine. Now, of course, you can
6:00have cleansers that have exfoliants in
6:02them like glycolic acid and salicylic
6:04acid. I don't think that that's going to
6:06do a lot of the heavy lifting for you.
6:08But, where cleansers can be helpful is
6:09just removing that build-up inside of
6:11your pores. And so, I really like double
6:13cleansing for this, and I've really
6:14started to like this more and more,
6:16especially for sebaceous filaments. So,
6:17when you use an oil-based cleanser or a
6:19cleansing balm, because they're really
6:21heavily oil-based or I guess lipid
6:23soluble bases, you can basically massage
6:26these into the skin for 1 to 2 minutes,
6:28and I do think this helps to break up a
6:29lot of the dead skin cells, but also
6:31remove some of that build-up deep inside
6:33of your pores, because like being the
6:34oil in your pores dissolves like being
6:36the oil-based cleanser. I think that
6:38really helps following it with a
6:39water-based cleanser that helps to wash
6:41all of that away. So, this is a deep
6:42clean to remove what's in your pores,
6:44keeping them wide open to help minimize
6:46the appearance of that and how that
6:47contributes to texture. So, those are
6:49really the heaviest hitters in the
6:50over-the-counter space for topical
6:52ingredients. And I think even as early
6:54as this, you might want to move on to
6:55something procedural. Now,
6:56over-the-counter, there are multiple
6:58devices and things like that out there.
6:59One of the best-studied technologies is
7:02actually microneedling. Now, the most
7:04important consideration with
7:05microneedling is actually the safety.
7:06And so, we prefer microinfusion. So,
7:09microinfusion is where you take a
7:10sterile needle head, and it's a one-time
7:12single use, and then microinfusion as
7:14the name implies, both microneedles the
7:16skin, causing a direct stimulation of
7:17collagen, mechanically interrupting the
7:19structure of the skin so it heals after
7:21the trauma, but also it helps the
7:23ingredients you're using in your serums
7:25be more effective as it helps them
7:26absorb more deeply. Right. So, that
7:28mechanical trauma, we'll call it, to the
7:31skin of poking little needles in the
7:32skin help your skin to turn over. It
7:34helps to support your collagen. This
7:35will help with fine lines and wrinkles,
7:37but it'll also help with that surface
7:38level dullness that occurs due to your
7:39stratum corneum. Now, the more advanced
7:41version of this is to get microneedling
7:43done in the office where thousands of
7:44needles in the skin quite aggressively
7:46after we numb your skin. This can also
7:48help. So, then moving on to the
7:50in-office procedures, we also have
7:51lasers that specifically sort of target
7:53and resurface that top layer of the skin
7:55such as erbium. So, erbium is a laser
7:57that we consider ablative where the
7:59chromophore where it absorbs is water
8:01and like a CO2 laser, it targets the
8:03skin, it disrupts it, causes profound
8:05healing after that deliberate trauma.
8:08Now, I've seen incredible before and
8:09after especially from our colleague Dr.
8:11Dylan Greeny. He is a master with this
8:13technology. Even if this is like your
8:15first foray into texture in an office
8:17space, it will help you get just
8:18tremendous results. Yeah, and so what's
8:20great about these lasers in general,
8:22whether it's erbium or it's CO2 or
8:25anything fractional or fully ablative,
8:27fully ablative being a really aggressive
8:29procedure to do, is that it gets rid of
8:31all surface texture. So, a lot of these
8:33things that we're talking about before
8:35such as your chemical exfoliants over
8:37the counter and your retinoids, they
8:39tend to not get rid of things like a
8:40seborrheic keratosis or a sebaceous
8:42hyperplasia, for example. But, when you
8:44do these ablative or semi-ablative or
8:47fractionally ablative lasers on the
8:49skin, this gets rid of like all forms of
8:50texture on the skin. And so, this is
8:52where you're going to see really
8:52profound results, especially for those
8:54things that just build up with age that
8:55don't respond to your topical skin care
8:57ingredients. And so, I actually had a
8:59CO2 laser done relatively recently on my
9:02skin which when I was training, I mean,
9:03this was considered to be a taboo to use
9:06CO2 laser on my skin tone, but with the
9:08right settings, kind of lower settings,
9:10uh you can actually get away with it.
9:11And so, I was actually pretty happy with
9:13the results overall in terms of texture
9:15and tone. Yeah, now you just reminded me
9:17that he sent me a text or a picture
9:18showing he had gotten it and I forgot to
9:20like look at them closely the next time
9:22I saw him. And yeah, he's pretty glowy.
9:24So, I think this CO2 laser worked. But,
9:26it just shows how important not only
9:27this technology is, but also the user
9:29using the technology on you is for
9:31especially in-office lasers and peels.
9:33And then our last recommendation before
9:34our bonus recommendation is another
9:36in-office procedure and it's just
9:38something that I notice as soon as you
9:40get it done in my patients, myself, my
9:42family members is that just that
9:44radiance occurs that reflection of light
9:46off the skin occurs almost immediately
9:48after a week or so after using this and
9:50then it kind of goes away once the
9:52procedure's worn off. And this is
9:53actually Botox injections. So any
9:55neuromodulator, Botox, Dysport, Xeomin,
9:57Daxxify, another D, I was thinking of.
10:00Any of these, right? So they basically
10:02paralyze the muscles in your face and by
10:04doing that, they help everything to sort
10:06of relax and by relaxing those fine
10:08lines and wrinkles start to sort of melt
10:09away, especially those very like surface
10:12level wrinkles and so it can help a ton
10:13with that.
10:14>> I will anecdotally swear this to be
10:16true. I noticed I think this is such an
10:18under talked about benefit of Botox and
10:20we're guilty of that too. We rarely
10:21bring this up, but it really creates a
10:23tremendous glow that lasts for a few
10:24months. Now, whether this is directly
10:26due to the Botox effects on the muscle,
10:28I think there's more to it. We know that
10:29Botox can help the appearance of pores
10:31temporarily as well and then I know
10:33Daxxify has their own data showing that
10:34it helps with the overall glowiness of
10:36the skin, but I see that change not just
10:38with Daxxify. I see it with most if not
10:40all of the botulinum products.
10:42>> Right. And it's been over a year since
10:45I've had any type of neuromodulator
10:47injected and you can tell. So like you
10:49can see my fine lines and wrinkles, you
10:51can see full movement of my face. So
10:52again, this is not something that you
10:53have to do every 3 months as some people
10:55would suggest. You can do it less
10:57frequently. You can do it more
10:58frequently if you want to do it. So it's
10:59not something that you have to commit to
11:01long-term and I know that a lot of
11:02people are sort of scared of Botox. So
11:03it's not something that you have to
11:04integrate. I will tell you that as soon
11:06as it gets done within 2 weeks you're
11:07going to notice like a really healthy
11:08radiance to your skin. And in fact,
11:10there are some people who will kind of
11:12micro inject small doses of Botox over
11:14the entire face that have that relaxed
11:17look over the entire face not just in
11:18the areas that develop these dynamic
11:20wrinkles. And the bonus tip, I'm not
11:22sure why it's really a bonus tip. Maybe
11:24because it seems purely anecdotal, but
11:26it's hair removal.
11:27>> It's not anecdotal. I believe it to be
11:29true.
11:30>> [laughter]
11:31>> So essentially on our face, right? we
11:33have these terminal coarse hairs that
11:35all of us see, right? So, you're talking
11:36about your beard, your eyebrows, for
11:38example, your sideburns, right? And
11:40these are things that you see and you
11:41say, "Okay, these, if I want to remove
11:43them, I can remove them. It's quite
11:45obvious, right?" But what I notice
11:46actually is that every single time I get
11:48my eyebrows threaded, right, cuz I get
11:50my eyebrows threaded when I have time
11:51to, and I notice that in these areas,
11:54like, you know, kind of center in
11:55between my eyebrows, you know, on top of
11:56my eyebrows, the skin right immediately
11:58around it, as soon as I
12:00just looks more smooth, it reflects
12:02light a lot better. And the reason why
12:05is because not only are you removing
12:06these coarse terminal hairs that we can
12:07see with the eye, there's also these
12:09imperceptible hairs on our skin that are
12:11usually blond or something that you
12:13can't see called vellus hairs. And those
12:15vellus hairs, they do actually deflect
12:17some of this light, break up some of the
12:18light, reduce some of the radiance to
12:20the skin. And so, anytime I remove any
12:22facial hair, I notice that underneath
12:23that, as soon as I apply my
12:24moisturizers, they seem to layer better
12:26on the skin. If I apply a tinted
12:27sunscreen, I notice that it's not
12:28pooling around the hairs as much. And
12:30so, I do think hair removal can play a
12:31really good role in improving the
12:33texture of your skin. But it's probably
12:34no one talks about it because it's not
12:36something that would be recommended in
12:37skin care. It's anecdote, but I do
12:39believe it works. And I'm going to add
12:40another layer to this. I think this is
12:41the same reason dermaplaning works. So,
12:43whether it's a tinkle razor over the
12:44counter or whether it's an actual
12:46scalpel with an aesthetician or a
12:47dermatology office, and what that does
12:49is it does remove all of those vellus
12:51hairs and the terminal hairs and also
12:53the top layer of the stratum corneum.
12:55Now, if you think of it like this, all
12:56those little hairs, they make a person
12:59kind of blurry. Like, if you zoom in on
13:01a photo, you know how it's kind of just
13:03tangential, little fuzz around the
13:04edges. And if you remove all that,
13:05everything looks a little bit more crisp
13:07and clean. And I think that's part of
13:08what Dr. Shah has appreciated over time
13:11with his threading.
13:12>> Yeah, and just sort of a little caveat
13:14here on dermaplaning cuz I don't know
13:15what other video we would put this in,
13:17but you know, dermaplaning is kind of
13:18widely recommended by aestheticians. We
13:20even had done it in our dermatology
13:21office at some point, and I do think it
13:23improves texture. I do help think it
13:24gets rid of these tiny hairs, and I
13:25think all of this contributes to more
13:27radiant skin. Now, the challenges I've
13:28actually seen anecdotally and something
13:29that we really just don't probably
13:30report enough in the literature is that
13:32a lot of people that get dermaplaning
13:33done will will break out afterwards.
13:35Now, part of this could be done due to
13:37the procedure, not using the right type
13:38of blade. It could be that your hair
13:40grows back, you can kind of get ingrown
13:41hairs that can create these acne-like
13:43lesions on the skin. And then, the third
13:44reason is sort of aftercare, right?
13:46Making sure that your skin barrier is
13:47sort of exposed after this procedure.
13:49So, making sure that you're clean
13:50afterwards, that you're washing your
13:51face regularly. But, whatever the reason
13:53is, I do notice that a lot of people
13:55will break out after dermaplaning. So,
13:56just be cautious with something like
13:57that if you're new to dermaplaning. You
13:59don't want to end up with worse texture
14:00than when you started if you start
14:01breaking out and developing acne
14:02afterwards. So, if you have texture,
14:04this kind of takes you over the breadth
14:05of what you can do, whether it's from
14:07over-the-counter topicals to a double
14:09cleanse to microneedling, microinfusion
14:12to procedures, to removing your hair.
14:15This really gives you an entire
14:17armamentarium of options that can help
14:19your skin.
14:20>> To make this as actionable as possible,
14:22because I think that's one of the key
14:23things when you come to visit our
14:24videos, Dr. Max and I talked about this
14:25a lot, is that we want to make sure that
14:27whatever we educate people that there is
14:28an opportunity to really take action
14:30afterwards and actually start to
14:31implement this into your routine. And
14:32so, what I would say is that if you're
14:34going to really go after texture fully,
14:36you don't need to do all of these
14:37things, but this is how I would
14:38integrate all of this into a routine.
14:40So, first, starting out with double
14:42cleansing, that's something that you
14:43could start every day at night tomorrow.
14:45The next thing I'd start doing is a
14:47retinoid five nights a week and an
14:49exfoliant the other two nights a week.
14:51So, I would do three days of a retinoid,
14:53one day of an exfoliant, three days of
14:54retinoid, one day of an exfoliant.
14:56>> And then, once you've mastered this over
14:58several months, this is when I would
14:59start to integrate something like
15:00microinfusion every two weeks. Now,
15:02you've once you've mastered that, that's
15:04when I would start to integrate a
15:05procedure, whether it's chemical peel in
15:06the office, erbium ablative type of
15:08laser in the office, or microneedling in
15:10the office. That's something you're
15:11going to want to do once or maximum
15:13twice a year in order to go after
15:14texture. And then, finally, Botox would
15:16be every three months theoretically, but
15:18you could do it theoretically also once
15:20a year, like I do. That's kind of how I
15:22fit it into my routine. And facial hair
15:23removal is something that you can do at
15:24any time too. You just want to make sure
15:26if you're going to get waxing done that
15:27you take a break from your retinoid for
15:29at least 3 days. And so this is how I
15:30build it into a routine, but start with
15:32those core basics first. So hopefully
15:33this was helpful. We built you an entire
15:35textured skin care routine without even
15:37meaning to actually. But this is
15:38something you can take with you and
15:39adjust and integrate into your life. All
15:41right, we'll put some link below to some
15:42of our favorite chemical exfoliants and
15:44retinoids so it makes it easier for you
15:45to shop for some of those. Thank you all
15:47so much for tuning in. Please like,
15:48comment, and subscribe and we'll see you
15:49in the next video. We'll see you in the
15:51next time.

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