Before You Start Tretinoin, Watch This

Dr. G (00:02):
You're listening to another episode of All the B's with me, Dr. G, and my scrub tech Bri.

Bri (00:09):
Happy Monday.

Dr. G (00:10):
Happy Monday. Okay. Let's just dive in. There's a study that shows 15% of people stop using Tretinoin because of skin irritation.

Bri (00:21):
Present.

Dr. G (00:23):
I would argue it's more than that because of the redness, the peeling, the tight burning sensation of your skin. It's making you question what?

Bri (00:35):
What am I putting on my skin right now?

Dr. G (00:37):
Right. I mean, I myself start Tret every August, September with good intentions. I want the smoother skin. It's one of the only things we know that increases collagen elastin. Improves the skin texture, erases wrinkles. But after a week you're like, "Fuck."

Bri (00:57):
Yeah. First two weeks is a little rough.

Dr. G (01:00):
So today on our podcast, we're going to dive into the difference between retinols and retinoids, why it's good for you, why it's hard to break into using it, why you should use it. And then maybe some baby steps so that you can start incorporating this. Essentially the gold standard for skincare. It's been around for a really long time, but there's nothing else like it, unfortunately. So that being said, we've got celebrity news.

Bri (01:28):
More importantly.

Dr. G (01:31):
More importantly.

Bri (01:32):
I don't know which article is coming first, but Jim Carrey. Okay. That's going to have to come first now. All right. Everyone's saying half the internet is divided that they cloned him and it's not really him. They just replaced him.

Dr. G (01:48):
I mean, why do we jump to clone now? Because I heard the same rumor about Britney.

Bri (01:54):
People put out all these videos of Jim Carrey really talking freely about politics and events and so forth. And all of a sudden now he's just like ... People say that the government tried to shut Jim Carrey up and they replaced him, so he would stop talking about things. I think this was regarding the Epstein files though.

Dr. G (02:15):
I know. I feel like the Epstein files is driving the body clone stuff, which is-

Bri (02:19):
Yes. He was like, "You guys have no idea what's going on about sex trafficking and all this stuff." And now all of a sudden they did a video side by side and it's him just being so sweet and a totally different person talking different, different demeanor. So half the internet says the government replaced Jim Carrey.

Dr. G (02:41):
I feel like the government might have more important things to do, like serving the male hockey team McDonald's, but-

Bri (02:47):
Amen. Let's go give the fish aquarium something to eat.

Dr. G (02:53):
I don't know. I mean, I feel like that's far reaching. I think he just got, somebody got ... He needs to step away from the syringe.

Bri (03:01):
He looks like the Santa Claus. I think it was Santa Claus one or two. I don't know which one. And he ends up cloning himself as Santa Claus into the plastic Santa Claus. I don't know if it's too late to pull that up, but he looks exactly like that transformation. He just looks like a very, very plasticy, refreshed, taut, plumped.

Dr. G (03:24):
Yeah, it's insane. I mean, he had a bad upper blephor bleph surgery. He already owned that. I mean, he didn't own it, but he already had that eyelid surgery that sort of feminized him. Oh my God.

Bri (03:38):
Tell me I'm wrong.

Dr. G (03:39):
You're not wrong.

Bri (03:40):
I'm not wrong.

Dr. G (03:41):
He does look like Santa Claus.

Bri (03:43):
Yeah. He really said, "Make me the plastic one."

Dr. G (03:47):
He's starting to morph into Axel Rose.

Bri (03:52):
I don't know who that is.

Dr. G (03:53):
I hate you. This is when we explore our generational differences.

Bri (04:00):
Is he like Bruce Springsteen?

Dr. G (04:02):
No, he's younger than Bruce Springsteen. He was the lead singer of Guns N' Roses and also underwent a super, super bizarre transformation that involved way too much plastic surgery. Yeah. Hot mess. I don't know what's going on with Jim Carrey. It would be, I mean, I know we're talking about them, but it's heartbreaking to do all this stuff to your face and then go out in public and people are losing their minds.

Bri (04:30):
Yeah.

Dr. G (04:31):
I think what part of it, part of the celebrity culture is that you surround yourself with people that tell you, you look fine. Yeah. You know what I mean? You're looking great and no one says, "No, that's not right."

Bri (04:43):
But then there's no slow transformation. It's just a complete 180.

Dr. G (04:48):
Well, because they're so excited about their transformation and no one's checked it and said, "Maybe not. "

Bri (04:54):
Yeah.

Dr. G (04:55):
Until they get out into the public eye and then-

Bri (04:57):
They're like, "Whoa."

Dr. G (04:58):
And we're all like, "What happened?"

Bri (05:00):
Everyone wants to feel young and refreshed, but I just feel like he's totally, he has changed. He's just unrecognizable. Even the way he talks in his voice, I don't know if he's trying to like ... Maybe he's doing a role, an acting role that required him to change his face.

Dr. G (05:17):
His method acting?

Bri (05:18):
Yes. And he's being very gentle and very ...

Dr. G (05:24):
Maybe.

Bri (05:24):
Jim Carrey, if you could slide into our DMs, I have some questions.

Dr. G (05:28):
We want to know more.

Bri (05:29):
We really want to know.

Dr. G (05:30):
What's going on?

Bri (05:31):
We want to know if you've been replaced.

Dr. G (05:34):
Well, before ... Let's talk about local news where a former nonprofit chief operating officer was accused of using grant money for cosmetic surgery.

Bri (05:44):
I do not blame you.

Dr. G (05:46):
I mean, if you're going to embezzle, don't spend it on a car. I mean, come on.

Bri (05:51):
Exactly.

Dr. G (05:52):
Sadly, the nonprofit was for preventing fentanyl overdose. I feel like if you're going to embezzle from a nonprofit, you already should just go straight to hell. It's just awful. Yeah.

Bri (06:03):
Especially for fentanyl.

Dr. G (06:04):
There's no nonprofit where I'm like, "Yeah, I mean, I guess so. " No. If you're raising money to ... Every nonprofit's usually rooted in trying to do better and good for people.

Bri (06:15):
I feel like that's also what you think, but also, I don't know. So many nonprofits I feel like have this problem.

Dr. G (06:22):
They do.

Bri (06:23):
I feel like I would just make a nonprofit to embezzle stuff. You know what I mean? At this point, nobody actually thinks your nonprofit is legit. How are you getting such a big salary with a nonprofit?

Dr. G (06:34):
Well, okay. So part of that stems from staying in the rules for nonprofits. You can ask the nonprofit. They're supposed to have transparency. So for every dollar I donate, what percentage of that is going to the actual cause? So what percentage of it is going to the school or breast cancer research and they can send 90% of it or they can put 10% of it and the rest can go to overhead, but they have to be able to let you know. So already you have quite a bit of leeway for a nonprofit. This is like, it's not going to overhead, it's not going to salaries. She was just straight taking it. That's like another level of greed. I know we're supposed to take, let's say 50% of what comes in and it's going to go to the CEO and it's going to go to staffing and it's going to go to admin and this party we're going to throw for the office.

(07:34):
All of that would be legitimate. She was just taking the money and then using it for cosmetic surgery. It was just her own-

Bri (07:42):
Six million dollars.

Dr. G (07:43):
Personal. I feel like the next level of this is going to be all those GoFundMe's GoFundMe's when you find out what percentage of that is actually used for the intent. Although I feel like again, if you're donating to a GoFundMe, you don't really get to control where that money goes or whether it's ... Yeah. You just gave the money away. So if you're fine doing that, also give the dude on the corner $100. And then you can't get upset when he goes and buys alcohol with it.

Bri (08:13):
Kind of feel like I need to start a nonprofit.

Dr. G (08:17):
You do not.

Bri (08:18):
You also get some of your student loans forgiven after 10 years or something.

Dr. G (08:23):
Yeah. Okay. They

Bri (08:24):
Have a lot of things going on in there.

Dr. G (08:28):
Yeah. It's its own whole little world, but I'm glad they caught this. It was somebody at the company that was a whistleblower and called her out, which was good.

Bri (08:36):
Yeah. How does nobody notice $6 million missing?

Dr. G (08:40):
I don't know. It's usually a little bit over time.

Bri (08:43):
That's crazy. I want to see what she looks like though. Before and after surgery, I want to see if it's worth it.

Dr. G (08:49):
I think if you scroll up, you can see a photo of her getting indicted. She

Bri (08:56):
Better look refreshed.

Dr. G (08:57):
She does not. Actually, she's not that. Local news disappointing us.

Bri (09:05):
Come on, Fox.

Dr. G (09:07):
Do we get a photo? Not really. I swear I saw one earlier. All right. Well, we'll put it in the situation.

Bri (09:16):
We'll let you know if it was worth her stealing the $6 million or not.

Dr. G (09:20):
I mean, that's a lot of money for is- You can't even use all of that on cosmetic surgery. Now you got to start ...

Bri (09:26):
No.

Dr. G (09:27):
Absolutely not. You got to use that for some other things.

Bri (09:30):
She's definitely driving a ... Oh, no. Damn it.

Dr. G (09:35):
Well, that's her prison photo, but still not great. Yeah. She should have cost me.

Bri (09:40):
If I spent 6 million dollars, I expect to look like a Barbie in prison.

Dr. G (09:42):
Yeah. She needs like a $200,000 facelift. What was she doing?

Bri (09:46):
Ugh.

Dr. G (09:47):
Yeah.

Bri (09:48):
We did not spend that

Dr. G (09:49):
I would want my own hyperbaric chamber. Yeah. Come on, man. Infrared coffin.

Bri (09:54):
I would be wrinkle free. You wouldn't see a single pore on my skin.

Dr. G (10:01):
Yeah. That's ... All right. So that's our dream is $6 million to blow on cosmetic surgery. Yeah. Just saying.

Bri (10:07):
Absolutely.

Dr. G (10:08):
That's such a ... Yeah. Okay. Speaking of people who've probably spent $6 million on plastic surgery, the botch star and lip king dies after possible cosmetic procedure. What else would he possibly do?

Bri (10:30):
That's what I expect you to look like in prison if you're stealing $6 million. Okay?

Dr. G (10:35):
Yes. You need to be heading towards this visage.

Bri (10:40):
I fully expect that. Okay. So how did he die?

Dr. G (10:47):
I think there's a lot of mystery associated with this.

Bri (10:49):
Was it during plastic surgery?

Dr. G (10:51):
Yeah, and they arrested two people. I'm not sure it was on the up and up, to be honest.

Bri (10:55):
If he looks like that with only spending $150,000 ... Just confused. It's currently unexplained as an investigation is underway.

Dr. G (11:10):
Yeah. More to follow.

Bri (11:12):
I feel like there's been so many articles recently about-

Dr. G (11:15):
People dying.

Bri (11:16):
People dying during cosmetic procedures. I feel like they're mostly correlated with Miami, but just kidding.

Dr. G (11:25):
No, I know. It's a lot of unregulated stuff, unfortunately. It's terrible. It's not worth it.

Bri (11:32):
I want to know who the two people that were arrested on suspicion of manslaughter. So it seems like maybe it wasn't legit.

Dr. G (11:38):
No, it does seem like it wasn't. They weren't even ...

Bri (11:41):
Yeah, like bad back alley house.

Dr. G (11:45):
Which again, if you're this ... The thing is, he's this famous and can afford somebody legitimate, but no one legitimate. I feel like he got turned away on Botched. Nobody legitimately is going to operate on him.

Bri (11:57):
Right. They're not that liability.

Dr. G (11:58):
He's forced to do the underground stuff because no board certified plastic surgeon's like, "Oh yeah, you need a little more."

Bri (12:06):
Yeah, absolutely not.

Dr. G (12:08):
So that's sort of the corner he was backed into.

Bri (12:12):
Okay.

Dr. G (12:13):
Wow. And then kind of unrelated Transformers actor, which is not how I know him, but Shia LaBeouf, do you know who that is?

Bri (12:21):
Shia LaBeouf.

Dr. G (12:22):
Whatever. Shia LaBeouf? I don't know.

Bri (12:25):
You don't know who he is?

Dr. G (12:26):
I know who ge is. I don't know how to pronounce his name. Just gets arrested in New Orleans, sloppy drunk.

Bri (12:32):
He has been a hot minute. He has been in Skid Row. He's done all the things.

Dr. G (12:41):
Yeah.

Bri (12:41):
He's been in tons of movies though.

Dr. G (12:44):
Yeah.

Bri (12:45):
And his estranged wife of eight years, I think they're finally getting divorced, but he's given Amanda Bines. That's kind of the thing he's been going through is he's just-

Dr. G (12:58):
She has addiction issues.

Bri (12:59):
Yeah. Was homeless, I think, for a little while. And he just keeps doing it over and over and over again. You know what I mean?

Dr. G (13:09):
Yeah. I feel like he might just be ...

Bri (13:12):
Yeah, I think he's

Dr. G (13:13):
Just- I feel like it's a combination of undiagnosed mental illness with addiction problems.

Bri (13:17):
Hundred percent. Very much so.

Dr. G (13:20):
Which at least it's not giving a bad wrap to cosmetic surgery.

Bri (13:23):
What'd you call him? Sheila LaBouff?

Dr. G (13:25):
La Boof. I don't know.

Bri (13:30):
Okay.

Dr. G (13:32):
That's going to go with ... Wait, what did you ... Faux.

Bri (13:36):
Fox hock. Words are hard, okay?

Dr. G (13:43):
It's Monday, man. Yeah.

Bri (13:45):
It's been a Monday. Okay.

Dr. G (13:46):
Our last celebrity little ... God bless her facelift, but Demi ...

Bri (13:53):
Demi Moore.

Dr. G (13:54):
I was going to say Demi Lemore.

Bri (13:55):
Okay. So

Dr. G (13:58):
Her hair transformation. Girl, nobody was looking at her hair.a for me. Pull off. Pilaf. Her little chihuahuas adorbs, but I barely noticed because ...

Bri (14:10):
It was the size of her.

Dr. G (14:13):
What the hell? And you know that leather suit she's in added a quarter inch to her frame.

Bri (14:18):
She got-

Dr. G (14:18):
So the fact that she looks so skinny in it is crazy.

Bri (14:23):
That dog is probably like three pounds and she's only a little bit bigger than the dog. I actually definitely want to find out where to buy her outfit. But also I just watched the movie she played in The Substance on Saturday. I know you haven't watched it. She was not even close to being that tiny, but the fact that she approved and allowed the last half of that movie was so wild to me. I just need you to watch it because it turned into almost like a spoof. It was insane. It was like the director just said, "We can't stop. We're committed and we're just going to keep going.

Dr. G (15:03):
Yeah, I've heard. I mean, it was a lot.

Bri (15:06):
Every time the movie should have ended, he's like, "No, I'm going to have some titties grow out of her face and then they're going to spit gallons and gallons of blood on everyone in the audience and then she's going to bleed out and her face is going to crawl out of her body." It was wild.

Dr. G (15:23):
Yeah, I have not. It's not even on my list of things to watch, but-

Bri (15:27):
You just have to watch it now.

Dr. G (15:29):
I would watch it on a plane or something. I just ...

Bri (15:33):
Crazy.

Dr. G (15:33):
Yeah. All right. Yeah. She looks not well.

Bri (15:38):
Landman, I mean, even she did not. She had a really fast-

Dr. G (15:42):
Was she on that?

Bri (15:42):
Yeah. She was the main star in this season. Oh, wow. She had a really fast transformation.

Dr. G (15:48):
Yeah. I mean, she literally looks like little femurs encased in black leather.

Bri (15:53):
Like the dog. It's like I just next to her.

Dr. G (15:56):
I love her dog. I can't with the dog. So

Bri (16:00):
Cute.

Dr. G (16:01):
The dog is adorbs and that's her little friend. I'm so

Bri (16:03):
Here for it, but it is so wild.

Dr. G (16:06):
I saw some clip of her standing and doing a little twirl and I was like-

Bri (16:11):
Don't break-

Dr. G (16:12):
Literally, yeah, please don't trip because you're going to break both hips.

Bri (16:18):
I just want to know how ... Yeah. I mean, I know how, but ...

Dr. G (16:22):
Yes. Someone needs to dilute her tirzepatide, please. Yeah.

Bri (16:28):
We need to maybe eat something.

Dr. G (16:30):
I mean, I guess it's slightly healthier than the cocaine of the '90s, but it's still really bad.

Bri (16:35):
That's true. I think the movie really did it for her.

Dr. G (16:38):
I don't know. All right. Let's move on to retinol.

Bri (16:41):
Okay. Retinol, tretinoin.

Dr. G (16:45):
Retinoids, tretinoin, all the things. Okay. So there's a Cosmopolitan article, Your Guide to the Best Treatment for Acne, Wrinkles, Dark Spots and Bumpy Skin. So in general, I would say if there's a product that claims to do everything, the product is lying. This is the exception, right? You read about ... Let's talk about the peptides like NAD+ or some of the other ones that everyone's injecting, which we're trying and failing to see any benefit

(17:17):
Or even creatine or any of that stuff. They usually say, oh, it's going to give you more energy, but then they always launch into ... And it's also give you more mental clarity and you're going to feel better and you're going to be more energized and you're going to sleep better and you're going to ... And you're like, okay, well, there's no way- I still sleep like shit. Yeah. Give me a break. However, Tret actually does all the things because it's increasing skin turnover and boosting collagen production. And there really isn't any other product that can do that. And when you're putting it on your face and you're getting all that benefit, then you can. If you have acne, it's going to increase cell turnover. And so there is some purging at the beginning while that cell turnover increases, gets rid of some of the stuff, but also keeps your pores from clogging.

(18:11):
It has a-

Bri (18:12):
I wouldn't say purging. I would say your face looks like a Sahara desert for two weeks. Everything is-

Dr. G (18:18):
Well, if you have acne, it will purge a little bit.

Bri (18:21):
Oh yeah. You're purging, you're dry, you're flaky, you're unwell.

Dr. G (18:25):
You're itching.

Bri (18:26):
Yeah, you're red.

Dr. G (18:28):
That's the hard part about prescribing it for acne is that it looks worse before it gets better. So people stop, right? Yeah. So it's usually that first four to six weeks, you really have to hang on because your skin is going to look worse and then it'll get better. With regards to wrinkles and dark spots and all that stuff, it does get worse in that you're super sensitive to the sun. It's red, patchy, flaky.

Bri (18:55):
And also knowing the proper way to start it, shout out to my sister, Jesse, who just decided to start using it and used it heavily for five days straight. She destroyed her skin and she had to end up doing all this stuff to get it back to where it was. I think just knowing how to start it, how much to use, when to start it, I'm sure no one's going to suggest to start it during summer if you're out at the beach all the time. I don't know, knowing ...

Dr. G (19:28):
Yeah, I feel like going slow. So the prescription form, Tretinoin or Adapalene, which is a derivative that's also prescription, but now you can get it over the counter. Both of those, I tell patients to start one application a week. It's probably not even barely going to do anything, but you just put it on one night a week and do that for two weeks. Because if you meet ... Occasionally I meet patients who are in their 60s or 70s and they've been using it religiously for decades and they can slather that shit on at night, every night because they've built up a tolerance to it and their skin's amazing. There's really nothing else, but it takes time to get there. I think there's a pretty famous quote from ZO, Dr. Obaji, the founder of both Abaji skincare and then ZO skin. And his response, if you complained about the harshness of the products was, "Your skin is just Weak."

Bri (20:30):
Wow, I love that. It's like every soccer dad out there on the field.

Dr. G (20:34):
Pick yourself up. But although he does have a point, you don't have to destroy your ... We don't have to tear it down to make it better. This isn't bootcamp for your skin. There are other ways of approaching it. You don't want to weekend warrior it and then never come back. So just like if you haven't been working out, you don't want to go do some hardcore hit class or CrossFit or something and then either injure yourself or be so destroyed and sore that you can't come back to it for two weeks.That doesn't solve anything. So I think gently letting your skin adjust to it. And if that's just applying a pea-sized amount every Monday for three weeks and then ... Because the thing is, it doesn't kick in. Your sister was probably fine the five days, but then when it all catches up to you,

Bri (21:28):
Oof, it was ... I think we both cried.

(21:33):
That sucks. I had a nanny that also used an over-the-counter product, but put on too much and slept with it or whatever, and also had kind of burns from where it peeled too deep. So you can use those products as a retinol peel if you want to. There's a product made by ZO, they always change their name, so I can't remember which one it, but it has a pretty high intensity, intense concentration of retinol, not the retinoic acid. So one step away from that. But if you put on one layer and then two layers, like if you put on five layers before you go to bed, that is the equivalent of a peel and you will get that peeling effect, but your skin, I wouldn't do that straight out of the box. You need to be using that product for some time before you're like, "Huh, I'm going to put another layer on. "That's crazy. Because you can do too deep of a peel and create new problems and hyperpigmentation and skin damage if you get too deep. Sucks. So one night a week, start one night a week, and then you work up to Monday, Friday, and then you work up to Monday, Wednesday, Friday.

(22:46):
And then maybe that's where you stay, honestly, that's okay. And then if you want to work up to daily, then every couple weeks you can increase another day so that your skin can handle it and you can always back off a little, especially if you're going to go to Hawaii for the week or something like that.

(23:04):
Right. I feel like it's also important to know what to not use it with because I don't think I realized this when I ... The first time I started using it, am I saying this right? Salicylic acid. And there's things like you're not supposed to use at the same time you put on, like vitamin C or salicylic acid or all these things that make you even more dry and red. So I think also knowing ... I think it's a little bit probably more important to ... Do you think getting a prescription from a doctor or somebody who can tell you what to do or tell you what to use it with or not use it with versus just use it-

Dr. G (23:41):
Get on DermStore and pick-

Bri (23:42):
Right. Going to Sephora and getting something that has some, no one knows what's in it, but it says it's retinol or whatever And destroying your skin with it or not.

Dr. G (23:54):
Yeah. I mean, I think even the over-the-counter products, like I said, can cause damage if not used properly because the ingredient itself is strong. So retinol, they're all derivatives of vitamin A. Retinol needs to be broken down or transformed before it's an active ingredient. Retinolic acid's already the active ingredient. So that's kind of the major difference. So that's why you can sell retinol over the counter. The problem with over the counter products, what you get at Sephora or Ulta or CVS is that you don't know what percentage of retinol's in there or what form of it, but let's just start with how much is in there. It's not going to be a lot because it's not in their best interest to put a lot in there, right?

Bri (24:40):
Right.

Dr. G (24:40):
First of all, they don't want you to have the bad side effects. And second of all, it's cheaper to put less effort.

Bri (24:44):
You only need a little bit to brand it.

Dr. G (24:47):
Correct. So there's something where you call a whisper of it in there. So you don't really know what you're getting. No one's putting a percentage of retinol on their over-the-counter product in general. Now, so then the next step up is medical grade retinol like we carry. So we have a 0.5, a 1.0 in the Alumier MD retinol, which we know is both two things. You know exactly how much is in there and it's been formulated to slowly deliver. So that's part of it is just the active ingredient and then how it gets delivered and then what is it in? So the retinol that Alumier makes, for example, is combined with a peptide that also strengthens and nourishes the skin. So there's complementary products in there that are helping your skin restore and kind of protect it, protect the skin barrier as the active ingredient is doing its thing.

(25:47):
So strengthening the skin in other ways. And then usually any, whether it be ZO or Alumier MD or SkinMedica or anybody that, any medical grade skin company that carries a retinol, it's encapsulated. So it's a slow release. So it doesn't just like ... Because I still remember using a version of tretinoic acid. So it was Rafisa by ZO. They don't make it anymore. And all of a sudden, I realized I was putting it on my face, but I was kind of skipping my jawline for whatever, just in the way I was applying it. And I realized it and then started making sure ... Well, the rest of my face was acclimated and my lower jawline was all red and tore up. And I remember Erin who was at our office at the time, and she's still in plastic surgery. She's a nurse now. She was like, "What the hell did you do to your face?" And I was like, "Girl, I didn't think anybody was going to notice because yeah, all of a sudden I'm using the same product, but I was making sure it actually got everywhere and bringing it down to my chin." And so it was just horrible.

(26:56):
It was like letting the lower half of my face catch up awful. So Rifisa was a prescription strength retinoic acid. Those also come in different percentages, 0.025, 0.05. And then there's usually an equivalent retinol. The retinol needs to be 10 times stronger than the retinolic acid. But again, you can change the percentage. And again, with those products, you can get generic retina as a prescription, usually pretty inexpensive. It's going to be harder on your skin than if you get one of the more bougie ones. And we like Altrino, we carry that in the office. That one is specially formulated so that it does sort of spread evenly on your skin no matter how crappy or sloppy you are with the application.

Bri (27:46):
Does the Lord's work.

Dr. G (27:48):
It really does. So they've spent the money on the technology to get even application with the normal human error of just slapping the shit on your face. And then there's some that are ... My daughter's using one that is also working to combat hyperpigmentation and it's more designed for acne and so that it has another special formulation in there to be like lightning at the same time. There used to be a product, I can't remember if it ... TriLuma, they pulled it off the market and then they put it back on because of the controversy surrounding hydroquinone, but it was a combination of retinoic acid, hydroquinone, and then corticosteroid, hydrocortisone.

Bri (28:33):
Kind of feel like I want that on my face.

Dr. G (28:35):
It's nice. So we can compound it. Occasionally I prescribe it to patients through a compounding pharmacy because it is a great option. You just can't stay on the steroid for too long. So the hydrocortisone or any application of steroid to your face, although it is soothing, thins the skin, which is the opposite of what we're trying to accomplish. It just makes the retinoic acid more tolerable. And then the hydroquinone is essentially a bleaching agent. It's not a bleaching agent, but it's inhibiting your body's ability to produce darker melanin cells. And so by doing that, it usually decreases hyperpigmentation very effectively. So those two in combination are great, the HQ and the retinolic acid.

Bri (29:23):
Okay.

Dr. G (29:24):
Bri's like, "Ugh, wake me up when it's over." That being said, it reminds me of another point, which is retinoic acid or retinol will increase the effectiveness of all your other skin products. And I think it's worth repeating that. Using a retinol or retinolic acid will increase the effectiveness of all your other skin products because it's turning over your skin cells. So everything else you slap on your face has an easier pathway. It's going to penetrate the skin better. And it's similar to an exfoliation. So if you use an Exfoliating scrub or some other, like you said, salicylic acid, lactic acids, any of the acids that are taking off that top layer of skin, the reason that is important is because if you're not exfoliating or turning over your skin cells, everything you're putting on your face, the peptides, whatever, they're just sitting there. They're not penetrating.

(30:21):
So that's why it's helpful.

Bri (30:23):
Okay. Well, we love that. See, I didn't even know that. Maybe I'll have to restart again. I feel like though I do too much shit to my face at work. Every time I ask Cynthia for a peel or something, she's like, "Have you used this? " I was like, "No." And then I just stopped using it.

Dr. G (30:37):
Oh, I usually lie. And she's like, "Oh, your face is getting really red."

Bri (30:46):
I'm just extra sensitive today. Okay. I'm just going to start lying then. Doctors are the worst, man.

Dr. G (30:55):
That's a PSA. Don't do that. If they tell you, "Have you used a retinolic acid product in the last three days, the last five days, and you have, say yes." Because I have legit burned the skin under my eyebrows. When my hairstylist, shout out to Cassie, has waxed my eyebrows while I'm at an appointment. And then she's like, "Oh shit." And I'm like, "God damn it. I should know more than anybody else." And it's not like I'm putting retinoic acid under my eyebrows. I'm just telling you that stuff gets everywhere. And so literally we'll peel off skin with a little bit of wax.That's not okay. It's fine. It healed. My skin was just being weak. But you need to know that if you do a peel or something, yeah, your skin's vulnerable and you're not supposed to have used it. Anything, any kind of glycolic acid peel and all that stuff, you need to stay off of it.

(31:54):
Laser, all of those things.

Bri (31:56):
Yeah. I know. When I did the CO2 laser and I was like, "Okay, just leave half an inch so I can get my hair bleached tomorrow." And I went to my hairdresser and she was like, "I'm not even comfortable bleaching your hair." I was like, "It's fine. Don't worry about it. " Wonder.

Dr. G (32:10):
Right, because it's another harsh product.

Bri (32:13):
Yes.

Dr. G (32:13):
And your skin barrier is like ...

Bri (32:16):
I left half an inch. It was fine. Yeah, it's fine. It's fine. So if I was a brand new person starting off on my retinol- Skin journey. ... tretinoin skin journey, what would you say I start with first?

Dr. G (32:30):
Okay. So what I like to do is offer them a retinol because like I said, that needs to be converted. It's usually a medical grade one. If you've never done anything, start at the 0.5 or the 0.25, but 0.5 is probably reasonable. And then that product, the Alumier MD one, for example, the one we carry in our office is calm enough that you can put it on every night. Nobody's going to have a reaction to that because start with a 0.5, it has all these other ingredients that make your skin tolerate it. And then once you use that for three months or something, then maybe bump up to the 1.0. And then when you get used to that, then if you want something stronger, then you can go to a low dose retinoic acid like Tret and we carry the Altrino. That's how I would go about that.

(33:19):
And then once you're there, then again, I would back back down and maybe use the Altrino once a week. You can use your retinol the rest of the week and then slowly work it up. Generally, and Erin used to like to do this, is to incorporate one tube of the retina ... One tube of tretinoic acid. So yeah, Tret once a year. So you could do it ... Usually I would wait until I got back from Hawaii every summer and then start then. And then once I've worked my way through that tube, which takes three to five months, then just switch to other stuff and then come back. Now the anti-age MD product that we're using now has retinol-ish adjacent shit in it. And so honestly, I've been just kind of relying on that with working.

Bri (34:16):
Yeah. I feel like I use that too and it doesn't have any of that.

Dr. G (34:20):
It has everything you need and it doesn't have any downside. There's no skin reactivity. If you want to go easy, that's the way to do it. Hit the easy button. But you're right, you do need to have, I think, a skin consultation. So you're not wasting your time putting vitamin C on at night with it because they counteract each other. So vitamin C goes on in the morning and retinoic acid, don't put retina on in the morning because it increases your skin sensitivity. So no one uses it in the morning, period. Full stop. Don't put it on in the morning.

Bri (34:50):
Yeah.

Dr. G (34:51):
That's also-

Bri (34:52):
It's also hard. You go out, you're more susceptible to burns and stuff.

Dr. G (34:55):
Yeah.

Bri (34:57):
If you're at the beach all day, every day, it may not be for you.

Dr. G (35:00):
Yeah. Irritation's pretty normal, but it just depends on where you're starting from your skin. So I think if you've never done anything, I'd probably just start ... Even with a retinol, I would start once or twice a night and then work up and see how you're doing. And then that way you don't go through the like, "Oh shit, this sucks and I'm going to stop doing it. " And then it doesn't thin your skin. It's doing the opposite. It's actually going to thicken your skin. It helps the dermis. It's causing skin cell turnover, but it's not thinning your skin. The only thing that's going to do that is a steroid cream, which you should not be putting on your face every day, period. I

Bri (35:43):
've been told I have a very thick skin. Okay. Well, by everyone that injects me with Botox, except for you, because you just shove it in me.

Dr. G (35:52):
Nobody got time to discuss that. It's a tiny little needle. Just

Bri (35:54):
She's like, don't be weak.

Dr. G (35:56):
Yeah. Your skin is weak. Yeah. So that's my retinol guide. I would say if you want to play around with the over the counter stuff, knock yourself out.

Bri (36:07):
Is there

Dr. G (36:07):
Anyone that's like- That's not much cheaper.

Bri (36:09):
Not a good candidate for retinol. Can anyone use it or-

Dr. G (36:13):
Really anyone can use it. Any

Bri (36:14):
Skin type?

Dr. G (36:16):
Yeah, it's good stuff.

Bri (36:18):
Okay.

Dr. G (36:18):
You just might need to combine it with other things depending on what your concerns are. But yeah, the only person who's not a candidate is a person who doesn't use sunscreen. So if you're not putting sunscreen on every day, then get out.

Bri (36:29):
You should be putting sunscreen on. Everyone that listens to our podcast should be putting sunscreen on.

Dr. G (36:35):
Yes.

Bri (36:35):
That's the moral of our podcast. Wear sunscreen?

Dr. G (36:39):
Where sunscreen? Wash your face.

Bri (36:41):
And don't embezzle. Unless it's worth it.

Dr. G (36:44):
And if irritation is happening, I mean, it is quote unquote normal, but maybe back off. You're not doing anything wrong, but you're not going to make it a lifelong commitment if your skin's irritated. So either rethink the formulation or just use it more sparingly. Just use it a couple of times a week. Honestly, if that's all you can accomplish, you never get past that point, it's still fine because it's doing what it's supposed to do. So you will still get a benefit if you're only using a retinol or retinolic acid a couple of times a week. It's still better than nothing. It's the same. I feel like I liken it to exercise. Do you need to work out seven times a day or seven times a day? Seven times a week? I mean, no, you don't. It's nice if you can do it. You can't do the same workout every day.

(37:30):
So mix it up a little bit. And just because you only have time to work out once or twice a week, still do it. It's beneficial. You're going to get your gains. It's just going to take a little time.

Bri (37:41):
And is it something that you generally stay on forever?

Dr. G (37:45):
Yeah. You don't need to cycle it off. Like I said, it's nice to switch it up a little bit so your skin doesn't get lazy, but there's no great science behind that. I think for us in our field, in our environment, we mix it up because we're always trying new things. We're here for you.

Bri (38:05):
Be the guinea pigs.

Dr. G (38:06):
Yeah. We're okay with that. It does get that reputation. Hydroquinone is something that you're supposed to cycle off and we could have a whole separate podcast about that because that's a skin bleaching melanin suppressing ingredient that's often used in combination with retinoic acid, but that is just because it works better if it can get penetration better and that's facilitated by the retinolic acid doing its thing. So helps out all the other products. It's a hero. It's a hero product.

Bri (38:35):
It's a hero.

Dr. G (38:36):
It's our hero. We need t-shirts. We do. It's our hero. Oh my God.

Bri (38:45):
No weak or lazy skin here.

Dr. G (38:48):
That's right. Okay. Well, if you're listening today and you have questions, give us a call. We love to talk about skincare.

Bri (38:55):
Yes. Come on in.

Dr. G (38:57):
Happy to answer your questions. You know what I really like actually when people come in and you ask them what they're using and they're like, uh, it's a little blue bottle. Just take a picture. Yeah. I feel like we were doing this during COVID and we should probably bring it back where you take a picture of your skincare lineup and then you can bring it and then we can talk about like, okay, that can go in the trash. That's not doing anything. That's really effective. You only need to be using that at night and help tailor a regimen. Because as much as people love to go in and be like, "Okay, well, I'm going to start on a whole new thing, but then that means you have to throw away all your other shit." It's fine if you want to transition into something.

Bri (39:39):
Yeah.

Dr. G (39:39):
We get it.

Bri (39:40):
If you're using the St. Ives face scrub, shout out to my sister. Don't even take a picture. Just say you're not using it.

Dr. G (39:45):
Just throw away.

Bri (39:45):
Just say you're not using anything. Just say I've never used skincare before.

Dr. G (39:48):
Jesus Christ. The little micro tears in your skin. Oh no.

Bri (39:53):
Oatmeal scrub as a daily face wash. 33 years old.

Dr. G (39:58):
Wow. I hope she doesn't listen to this. She needs to be like, What?

Bri (40:02):
Sorry.

Dr. G (40:04):
Yeah, that's a no. Yeah. But other than that, let us know. If you're using the St. Ive scrub, immediately throw it into the trash and then come talk to us.

Bri (40:12):
Immediately come in. That is helpful. It is helpful coming in and being able to be like, "Oh, this is what you need. This you can start slowly get a little gist of ... " Because not everyone has the same skin type. No. Not everyone needs the same things. We all order the same stuff in the office, but they're all different.

Dr. G (40:28):
Yeah. And we all have preferences too because people will have sensitivity. So if one retinol, even if it's medical grade isn't working for you, it might be ... It's usually not the retinol, it's the other carriers that you have a sensitivity to. So it's what it's compounded in, if you will. And if that's ... Maybe there's some ingredient. There's one that's a derivative of grapes, resturvis ... I can never pronounce it. Anyway, that one people have a sensitivity to, and if that product is-

Bri (40:56):
My body loves grapes.

Dr. G (41:00):
I was like, there's no way I'm having a reaction to that.

Bri (41:02):
Ain't no way.

Dr. G (41:04):
Anyway, if that product is ... It's a common added in ingredient. So if you have a sensitivity to that, it's not the retinol, it's this other stuff, which I can't pronounce. But anyway, yeah. So sometimes it's other things in the mix up and in the formulation. And so you need to find a different formulation with the same key active ingredients.

Bri (41:25):
Okay. Yeah. My skin can't do vitamin C. I've tried it a couple

Dr. G (41:29):
You've tried definitely-

Bri (41:30):
I don't think I've gotten past that point. Maybe I just haven't committed to it long enough because my skin hates it.

Dr. G (41:37):
Yeah. You maybe just have to find the right formulation. I did get an argument with my sister about it because she's ... I forget what bullshit Sephora version of vitamin C she's using. And I was like, vitamin C is inherently unstable. So it really doesn't ... To get the active ingredient on your face, you should not waste your time.

Bri (41:59):
So surprised your sister uses a Sephora brand vitamin C.

Dr. G (42:02):
She's a pain in my ass. So she was like, "Oh no, I mean, I think this one's working or it's not working or whatever." I'm like, "Well, let's start with the vial. Is the vial dark colored?" She's like, "No, it's clear." I'm like, "Okay, well then-

Bri (42:15):
You're not.

Dr. G (42:16):
We're already done."

Bri (42:17):
Yeah.

Dr. G (42:17):
Because it needs to be dark colored because it's very susceptible to degradation in the presence of sunlight. So once you open oxygen and sunlight are going to break it down. So if you have a serum and the vial isn't amber colored, and it's stupid.

Bri (42:36):
Yeah,

Dr. G (42:37):
Whatever. It's just science.

Bri (42:38):
The one we have here is in a brown bottle and you have to crack some things into it.

Dr. G (42:41):
Yeah. It's not active until you drop the crystals in to the serum. And then as you use it over time, you will see the serum go from clear to slightly darker if you're not using it fast enough, you know it's not as active then. Yeah. It's getting oxidized. We also carry the ZO version, which is in a cream. So that one, it's stable in a different formulation, different way.

Bri (43:03):
Maybe I'll have to try that one.

Dr. G (43:05):
Yeah, you could try it. That one's very drying because it's ZO. That stuff does not fuck around. And then there is some vitamin C actually, a different formulation of it in the Antiage. So you are getting some.

Bri (43:18):
Okay.

Dr. G (43:19):
Perfect. Got to do it somehow. But yeah.

Bri (43:23):
Slay.

Dr. G (43:25):
Slay. So you are getting a version of it that ... And each company has their own formulation and their own science to back, but I can't even remember the name of the Kate Somerville or whatever. Girl, they're just putting it in and making it smell nice.

Bri (43:39):
Is that what your sister uses?

Dr. G (43:40):
She uses a bunch of different things. She mixes it up. She uses some medical grade, some compounded, and some over the counter.

Bri (43:48):
Confusing.

Dr. G (43:49):
I know.

Bri (43:50):
Just use all medical grade.

Dr. G (43:51):
I know. Don't mess around with it. Yeah. Anyway.

Bri (43:55):
Your kids know that. I

Dr. G (43:57):
Know. Well, the other stuff is all about the packaging and the smell and how it feels. It doesn't necessarily need to be good.

Bri (44:05):
Yeah. It just needs to look pretty. Well, we really destroyed our sisters on this one.

Dr. G (44:09):
Yeah. Sorry y'all.

Bri (44:11):
Sorry.

Dr. G (44:14):
All right. Well, I think that wraps it up. Use good quality skincare. Use something that has a retinoid derivative at least on there and your skin will appreciate it.

Bri (44:26):
Yeah, absolutely.

Dr. G (44:27):
If you got questions, reach out. DMS, call, like and subscribe.

Bri (44:33):
Like and subscribe. Bring your weak skin over here.

Dr. G (44:38):
Well, we're going to scrub in.

Bri (44:39):
And scrubbing out.

Dr. G (44:44):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restorestplasticsurgery.com or follow us on Instagram @RestoreSDPlasticSurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.