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The Secret Formula

Ever wonder what I personally do to take care of my skin?  It really comes down to 3 things:

  1. Sunscreen – Do this to protect your collagen from Ultraviolet radiation
  2. Tretinoin (Retin-A) – Use this to help your body generate new collagen
  3. Halo – Do this to get rid of the damaged collagen that your body struggles to get rid of by itself.

The Basics


Fundamentally, the only reason our skin ever really “ages” is because of ultraviolet radiation.  The fact is that our epidermis is replaced every month or so by new cells produced from underlying stem cells.  So, they really don’t age.  Aging happens deeper than that.  Color changes like red spots, broken vessels, and brown spots all come from sun damage affecting blood vessels and pigment cells.  Then, all the textural changes come from ultraviolet radiation screwing up our collagen.  Collagen is also constantly being degraded and reproduced, but UV radiation causes molecular changes in collagen that both make it brittle AND make it much harder for our body to recycle it.  It’s really like trash that just builds up.

Avoid sun exposure and none of those things happen.  Your skin would stay baby butt soft forever.  I, however, don’t live in a cave and I REALLY like going to Hawaii.  So, hats, sunscreen, photo-protective clothing…  THEY WORK.  In the summer I basically carry a Colorscience brush in my pocket.  Its not much bigger than a set of keys.  Its powder so it’s not messy.  It’s water resistant.  It also doesn’t move around much when you’re working and get sweaty.  So easy.


After sunscreen, if there is one single product that you can count on finding in pretty much ANY dermatologist’s bathroom, and that’s tretinoin.  Basically, all dermatologists use it.  I suppose there is always some Doctor out there who doesn’t, but taking skin care advice from them would be like dental advice from Austin Powers.

The reason we all use tretinoin is because it enhances new collagen production and increases cell turnover.  These two things together help reduce fine lines, even out skin tone, and generally just leave the skin looking fresher.

Other Topicals

Sunscreen + Tretinoin are the heavy hitters of anti-aging. There are like 100 other topical products promoted for anti-aging and for those motivated to go the extra mile we can help you put together a regimen.

Personally, I’m just too lazy to add another step to my morning or night routine.

The Secret Weapon

I would probably be just fine with just my sunscreen and tretinoin, but I’m a bit self conscious about feeling like I’m the old man in the room. One of the side effects of going to medical school, especially if you also get a PhD like I did, is that you usually don’t start a family until much later than most of your high school or college friends.  Its a pretty simple formula:

Primary school + 4 years college + 4 years medical school + 5 years PhD + 1 year internship + 3 years dermatology residency = OLD

Kid school functions made me the most aware of it – its not unusual for me to be 10 years older than most of the other parents.

NO THANKS. It doesn’t make any sense for me to end up feeling like I look old when I’ve got access to all the best tools to look young.


So almost every year since about 2014 I’ve been getting Halo laser resurfacing of my face.  In a nutshell, it makes your skin replace some of the old sun-damaged collagen with brand new stuff.  Again, I don’t live in a cave.   It is impossible and impractical to eliminate all ultraviolet radiation exposure.  And, life happens.  So, what you want is an antidote for the inevitable exposure that still occurs.

Halo is PERFECT for this.  It takes about 20 minutes to do.  The downtime is pretty minimal.  I’m pretty bright red for the rest of the day. The next day I look a little bronzy and a bit swollen.  A few days later, pretty much back to normal.  I can get one done on Monday and go to work on Tuesday.

Canfield Visia and Tru-Age

We have this image acquisition and analysis device for the face called the Canfield Visia.  This thing takes VERY high resolution pictures of the face in set positions with fixed lighting and a controlled background.  It is by far the most reliable means to take pictures over time that you can actually compare side by side.  Without it, you have a hundred different variables, light quantity, light quality, light direction, background light, lens focal length, lens aperture, distance to subject, exposure time, position of the subject, etc, etc, etc.

Tru-Age Scoring and Reverse Aging?

Anyway, Visia does an excellent job controlling these variables.  In addition, it also can do all kinds of different image analyses.  One of them is this score they call “Tru-Age”. It basically counts red spots, brown spots, fine lines & wrinkles and assesses texture & the amount of UV damage.  Then, based on norms seen in the general population it can tell you how old your skin appears to be.  In 2022 it said that I was 5 years younger than my actual age.  In 2023 it says I’m 6 years younger than my actual age.  REVERSE AGING!  Woo-hoo!  At least of the skin of my face!

Since sunscreen + tretinoin + annual Halo is making my skin get younger each year, not only am I going to keep going, but I’m also going to start doing Halo twice a year.


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