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Speaker 1: Hello and welcome to Mamma Mia's You beauty podcast. The podcast.

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Speaker 1: That is especially for your face. I'm Chessie Hunt and

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Speaker 1: you have hit play on my weekly Ask an expert

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Speaker 1: episode where I chat to someone knowledgeable in the beauty biz. Normally,

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Speaker 1: many of the treatments or products or ingredients we look

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Speaker 1: at on this show are all geared towards the common

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Speaker 1: goal of making our skin look. It's absolute fresh and

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Speaker 1: glowy best.

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Speaker 1: But today I'm joined by Doctor Steven Cristen, a leading

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Speaker 1: Australian cosmetic doctor based out of the All Saints Clinic.

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Speaker 1: And he's gonna explain the kinds of products you need

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Speaker 1: to be using in your routine to get that amazing

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Speaker 1: skin integrity, but also all the mistakes he sees from

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Speaker 1: clients walking in his door, thinking they're doing the right

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Speaker 1: thing by their skin, but are actually not Doctor Crimson.

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Speaker 1: Thanks for joining us today.

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Speaker 2: Great to be here. I appreciate your time. So

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Speaker 1: just back to basics for a minute. What does skin

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Speaker 1: integrity even refer

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Speaker 2: to skin integrity itself, I think, relates to how well

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Speaker 2: your skin is dealing with the environment in a medical

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Speaker 2: or clinical context. How well you're dealing with UV exposure

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Speaker 2: chemicals the dryness of the skin. We have a lot

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Speaker 2: of environmental considerations to take in when looking at how

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Speaker 2: skin is dealing with its environment, so skin integrity can

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Speaker 2: be

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Speaker 2: when you're a child as well. And if you get

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Speaker 2: a bad sunburn that's impacting on your skin integrity from

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Speaker 2: a health perspective, right and we've all grown up in Australia.

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Speaker 2: And as much as I hate to say it, we've

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Speaker 2: all probably had a sunburn or two growing up. I

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Speaker 2: know in my generation, my mum used just to roll

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Speaker 2: me in ref foil and push me out on the beach.

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Speaker 2: Those days are gone, but of course we see the

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Speaker 2: effects of that later on in life. 25 in the

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Speaker 2: mid 20 S. It's sort of when we start to

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Speaker 2: lose that delicate balance of

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Speaker 2: of collagen production versus degradation. As you sort of get

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Speaker 2: past that point, your body is not making as much collagen.

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Speaker 2: It's not protecting it as well as they used to

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Speaker 2: when you were younger, so there is a steady decline

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Speaker 2: in that thickness of that dermis because of that collagen

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Speaker 2: and elastin production, and that's all done by cells called fibroblasts.

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Speaker 2: And the fibroblast is super important in cosmetic medicine on

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Speaker 2: the acetic side, because what we are trying to stimulate

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Speaker 2: with

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Speaker 2: devices and lasers and all these sorts of things, so

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Speaker 2: many of

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Speaker 1: us who are listening to this show definitely our listeners

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Speaker 1: are interested mostly in skin from an aesthetic perspective and

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Speaker 1: are doing all the things, whether it's professional treatments or

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Speaker 1: using products or even just using sun protection with the

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Speaker 1: goal of making it look better. But would you say

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Speaker 1: that skin integrity actually needs to go a bit more

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Speaker 1: hand in hand with that in order to improve

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Speaker 1: aesthetics?

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Speaker 2: 100%? I think the two things are very hard to

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Speaker 2: pull apart. You can't have one without the other. When

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Speaker 2: we think about the aesthetic side of skin integrity, we're

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Speaker 2: thinking about things like pigment and redness and flakiness of

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Speaker 2: the skin and reactivity of the skin to certain things.

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Speaker 2: That's what we see, you know, fine lines, pigment and

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Speaker 2: all that sort of tone of the skin. But that's

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Speaker 2: an example of what's going on underneath.

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Speaker 2: So when we look at skin integrity from a physiological

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Speaker 2: health perspective, we need to understand why the skin reacts

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Speaker 2: in certain ways

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Speaker 2: but also underpin those life choices and health choices that

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Speaker 2: will help protect your skin and keep it nicer for longer.

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Speaker 2: And I often harp on about this to my patients,

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Speaker 2: the most important thing, by far and large, especially in Australia. Sunscreen.

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Speaker 2: And I think a lot of people get that these days.

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Speaker 2: But you'd be surprised the amount of people that come in,

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Speaker 2: ladies and men that come into my clinic, I say

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Speaker 2: how to use sunscreen. Yeah, I use it sometimes when

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Speaker 2: I'm out in the sun,

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Speaker 2: but that's not enough. You know, your sunscreen application needs

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Speaker 2: to be at least twice a day. It needs to

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Speaker 2: be SPF 50 it needs to be an Australian standard.

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Speaker 2: The Australian standard is actually higher than the other standards

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Speaker 2: around the world. First of all, sunscreen is the most

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Speaker 2: important thing, and that's where I start with all my patients.

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Speaker 2: The next thing that when we look at protecting the skin,

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Speaker 2: we need to understand that the skin is a barrier

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Speaker 2: to water loss. It controls how much water we lose,

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Speaker 2: And I mean, apart from other physiological processes

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Speaker 2: that trans epidemic water loss we really need to protect.

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Speaker 2: So the next most important thing is a moisturiser. There's

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Speaker 2: lots of great moisturisers out there. The first thing to understand,

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Speaker 2: I suppose about a moisturiser, is that it doesn't moisturise.

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Speaker 2: It just blocks that trans epidermal water loss. OK, and

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Speaker 2: that's super important to understand.

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Speaker 2: There are moisturisers that do additional things moisturisers that contain ceramides.

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Speaker 2: I know when people come in with a bit of

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Speaker 2: barrier dysfunction. That's something I always go to, because the

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Speaker 2: barrier dysfunction is often related to loss of that epidermal

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Speaker 2: water loss junction and loss of those ceramides, which are

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Speaker 2: the lipids in the skin that help protect everything.

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Speaker 2: Two staples, sunscreen twice a day and then a nightly moisturiser.

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Speaker 2: Gentle cleansing, of course, is obvious, and that's where we start.

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Speaker 2: What

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Speaker 1: are some of the areas of the face but also

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Speaker 1: the body that are most susceptible to skin integrity issues?

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Speaker 1: And also what kind of signs might you see in

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Speaker 1: these areas to tell you that something is going

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Speaker 2: on? The skin itself is homogenous, the layers the same

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Speaker 2: across the body.

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Speaker 2: Now some areas of skin are thinner than others. The

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Speaker 2: thinnest part of the skin, and the body is right

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Speaker 2: here under the eye. And it's also interesting is that

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Speaker 2: fat skin doesn't have any fat underneath it. So it's

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Speaker 2: an early indicator, often of how your skin is ageing

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Speaker 2: and how you're losing that plasticity. And that's why we

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Speaker 2: often identify sort of that tetro, or that that loss

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Speaker 2: of volume and that loss of skin down there, that

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Speaker 2: fitting of that skin is one of those areas that

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Speaker 2: shows us we're ageing

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Speaker 2: as far as areas of the body. Like I said,

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Speaker 2: the skin will react similarly all round. But some skin

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Speaker 2: areas don't have as much vascularity and blood supply as, say,

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Speaker 2: other skin areas, so areas on the neck and the

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Speaker 2: chest and so forth they won't heal as quickly as

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Speaker 2: the princess to face simply because of the way the

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Speaker 2: skin is supplied by blood. Where do you start seeing it? Well,

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Speaker 2: you see it everywhere, and some of those signs,

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Speaker 2: I suppose the skin abuse or you're not looking after

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Speaker 2: your skin to the dym. That pattern of pigment throughout

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Speaker 2: that epidermal and sometimes dermal layer rubbing your skin or

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Speaker 2: cleansing can make it often quite red exposure to heat

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Speaker 2: and cold can often make it quite red. It's just

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Speaker 2: lost its ability to protect itself. So those are the

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Speaker 2: sort of early signs that you see, noting that they

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Speaker 2: come on in different rates in different parts of the

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Speaker 2: body because of the way the skin reacts.

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Speaker 1: What are the essential steps, then, in a daily skincare routine,

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Speaker 1: if you are looking to promote and maintain good skin

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Speaker 1: health integrity, you mentioned the moisturiser and the sunscreen. These

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Speaker 1: are non-negotiable. Is there anything

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Speaker 2: else there is? And if we start just at basics,

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Speaker 2: we've spoken about the sunscreen. We've spoken about the moisturiser. Obviously,

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Speaker 2: daily gentle cleansing is important, but you really need to

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Speaker 2: make sure that's pH balanced to your skin. You don't

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Speaker 2: want to be causing too much acidity or alkalinity to

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Speaker 2: the skin,

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Speaker 2: so making sure that you have a nice pH balance

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Speaker 2: to your cleanser is important over cleansing or using soaps

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Speaker 2: and harsh things. It takes the oil off, and it

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Speaker 2: just affects that transient water loss again. It affects your

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Speaker 2: ceramides and the oil of the skin, and the oil

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Speaker 2: of the skin is really important.

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Speaker 2: So gentle cleansing is important. I will often start all

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Speaker 2: my patients on a retinol with the aim to building

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Speaker 2: up a tolerance to a retinoid, which is more of

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Speaker 2: a prescription version of a vitamin. A derivative I know

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Speaker 2: we all hear about retinol in lots of products is

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Speaker 2: a plethora of research on its efficacy and importance in skin.

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Speaker 2: And for me and for my patients, it tends to

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Speaker 2: be my go to once they've picked all those

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Speaker 2: the goals with sunscreen with moisturise and a cleanser. Once

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Speaker 2: the skin is stabilised on that, then we start a retinol.

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Speaker 2: Why retinol? A retinol, is essentially a bit of a

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Speaker 2: wonder drug in the context of skin. It increases the

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Speaker 2: rate at which the skin cells turn over. Primarily, that's

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Speaker 2: how it works. But in doing that, it decreases redness.

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Speaker 2: It decreases pigmentation. It reduces fine line and thickens the derma.

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Speaker 2: So you get more collagen, more elastin. So that's four

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Speaker 2: big goals. But a lot of people do this incorrectly,

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Speaker 2: so a lot of people will go to their GP.

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Speaker 2: They'll get prescribed a retinol because they've heard about it,

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Speaker 2: or they'll just pick one up the shelf and they'll

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Speaker 2: just lather on. If you go and put a high

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Speaker 2: strength retinol, go to sleep. You'll wake up in the morning.

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Speaker 2: Maybe not the next morning in the morning after with

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Speaker 2: with a whole lot of regret. Redness, flakiness, irritated skin. OK,

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Speaker 2: so the point is our skin will build up a

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Speaker 2: tolerance to retinol, and everyone's skin

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Speaker 2: is different in how it reacts. Some people go straight

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Speaker 2: onto a high strength prescription retinoid. Not many, though. It's

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Speaker 2: about building up that tolerance and making that part of

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Speaker 2: your life. But they are important things to understand about,

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Speaker 2: especially the prescription versions of the retinoid. They do make

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Speaker 2: you more sensitive. A little bit of redness and flakiness

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Speaker 2: is actually part of the journey, so it's not necessarily

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Speaker 2: a complication

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Speaker 2: telling you might need to ease off a bit, but

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Speaker 2: it's turning over their skin cells faster. So that's why

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Speaker 2: we get that redness in blat from retinol. The other

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Speaker 2: thing is, it's not a one hit wonder. It's something

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Speaker 2: that you really start seeing the benefits of around the

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Speaker 2: 6 to 12 month mark. So once you have all

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Speaker 2: those things and you're aware of those things, then it's

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Speaker 2: time to start on a retinol.

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Speaker 1: We talk a lot about retinol and retinoids on this show,

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Speaker 1: and we are often just thinking about it from an

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Speaker 1: aesthetic point of view. I'd never actually considered that it

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Speaker 1: had a lot to offer in terms of skin integrity

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Speaker 1: as well. So that's good to know all

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Speaker 2: around. Yeah, well, you think about it. All it really

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Speaker 2: is doing is increasing the rate at which that layer

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Speaker 2: of cells is regenerating, so it's an important part of it.

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Speaker 1: How has other technology advances or innovation in the skin

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Speaker 1: field helped when it comes to improving skin integrity? Has

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Speaker 1: there been anything exciting?

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Speaker 1: Not lately.

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Speaker 2: That's a good question that I mean, you talk about

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Speaker 2: technology and skin and my mind, because I do. I

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Speaker 2: use a lot of lasers, and my mind goes straight

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Speaker 2: to lasers. Of course, they're not new at all, But

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Speaker 2: there certainly is a lot of new lasers that are

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Speaker 2: available now that have the added benefit of increased safety

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Speaker 2: profiles and indeed, using hybrid wavelengths to achieve your results. So,

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Speaker 2: using ablative and non ablative wavelengths to achieve results and

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Speaker 2: decrease the down time, the other thing

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Speaker 2: I suppose new well, not new, but definitely that's quite

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Speaker 2: popular at the moment is like the radio frequency micro needling.

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Speaker 2: I've been quite surprised by the results to be absolutely blunt.

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Speaker 2: It's one of those things that you know is a

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Speaker 2: go to for us. If you're happy and willing to

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Speaker 2: wait to see the differences that it makes, it's quite amazing.

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Speaker 2: And really, it's working on the same concepts that lasers

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Speaker 2: working on. So when you use rejuvenation in the context

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Speaker 2: of a laser or energy based device, you're causing heat

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Speaker 2: in the dermis.

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Speaker 2: A laser burns a hole to get its way down there,

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Speaker 2: unless it's a non bladed laser, whereas a micro needling

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Speaker 2: device pokes needles and creates heat down in that layer,

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Speaker 2: and your body responds by activating fibroblast to initiate the

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Speaker 2: healing response. So in that context, it's a job, you know.

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Speaker 2: We've been using it

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Speaker 2: for many years, the downtime and the technology and the

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Speaker 2: current devices and the use of hybrid wavelengths. It's a

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Speaker 2: bit of a game changer for a lot of people

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Speaker 2: because I think somehow in this industry, over the years

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Speaker 2: we've created with Botox and fillers and all these sorts

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Speaker 2: of things. We've created this environment where everyone wants a

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Speaker 2: relatively instant result.

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Speaker 2: But when it comes to skin, and when it comes

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Speaker 2: to using devices, that's not the case. These are the

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Speaker 2: things that when you're triggering your body to heal, you

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Speaker 2: need to wait for these results. Another great new technology

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Speaker 2: is something called PICO stands for PICO Second, which is

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Speaker 2: a physics term, which measures times.

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Speaker 2: So treating for the second is how quickly a Peco

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Speaker 2: laser initiate its energy delivery. And the benefit of this

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Speaker 2: is that it works quite differently to a lot of

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Speaker 2: other devices and the fact that it doesn't create a

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Speaker 2: lot of heat because the heat in darker skin types

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Speaker 2: can cause issues like hyper pigmentation, hyper pigmentation. So we're

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Speaker 2: always worried, and we're always holding back with some devices

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Speaker 2: and people that have a Type 345 Fitzpatrick skin type.

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Speaker 2: So those darker skin types

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Speaker 2: so with the PICO laser, whereas it can still cause

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Speaker 2: damage in the wrong hands, it's certainly a bit of

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Speaker 2: a game changer in regards to the fact that rather

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Speaker 2: than using thermal ablation using something called photo a ablation,

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Speaker 2: the photons of the laser are moving so fast they

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Speaker 2: cause cavitation under the skin, so it causes a collagen

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Speaker 2: healing response without the burn. So that's quite new in

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Speaker 2: the context of rejuvenation. But it's also quite an effective

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Speaker 2: pigment laser on a kind

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Speaker 1: of completely different note.

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Speaker 1: Are there some things that we would do to our

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Speaker 1: skin aesthetically, that are having the opposite effect on our

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Speaker 1: skin from an integrity perspective, So things that we would

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Speaker 1: do to make ourselves perhaps look better instantly,

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Speaker 1: but not necessarily great for our skin integrity? Long term.

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Speaker 2: First of all, it's that more must be better, especially

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Speaker 2: with topical skin care products. I think you need to

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Speaker 2: know what you're putting on your skin. I find a

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Speaker 2: lot of patients will come in with a lot of

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Speaker 2: barrier dysfunction for the reasons that they're overtreating.

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Speaker 2: They're using a vitamin C. They're using Mandela acid. They're

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Speaker 2: using aza acid. They're using all these different things because

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Speaker 2: it's in all these products and everybody tells us that

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Speaker 2: it's great. So I always try to get my patient's

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Speaker 2: skin at a balance first just by treating those basics.

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Speaker 2: The sunscreen

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Speaker 2: good moisturiser. Some ceramide repair and gentle cleansing and then

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Speaker 2: see how they land from there before you start adding actives,

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Speaker 2: including retinol. So you've got to sometimes go back to basics.

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Speaker 2: I find some of my patients with the best skin

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Speaker 2: apart from sunscreen. Tell me they do nothing.

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Speaker 2: So you really need to land first and find out

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Speaker 2: where your natural balance is before you start adding in things.

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Speaker 2: And I think too much information out there. So really,

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Speaker 2: my advice is always to come and see a really

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Speaker 2: good aesthetic practitioner to come and have a look at

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Speaker 2: your skin. Go through your history. Look at what you're using.

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Speaker 2: Take you back down to basics and then build you

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Speaker 2: up from there to find

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Speaker 2: what works for you. Because it's very individual. So overtreating

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Speaker 2: is a good time. I think people just overtreat

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Speaker 1: Doctor Crimson. Thank you so much for this crash course

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Speaker 1: in skin integrity. It has been great talking to you. OK,

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Speaker 2: thanks. I appreciate it. I hope you

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Speaker 1: enjoyed that chat with Doctor Crims. Thanks for listening. Today

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Speaker 1: I'm Chass Hunt. Our show's producer is Cassie Merritt, and

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Speaker 1: audio production is by Leah Pos. And I'll be back

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Speaker 1: next week in your ears with another beauty expert in

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Speaker 1: the hot seat. Catch you then