#14: Top Answers About Skin Care

This week, Dr. Daniel Barrett speaks with Mallory Hoyle, Medical Esthetician at Barrett Plastic Surgery in Beverly Hills. This episode delivers top notch answers to the most frequently asked questions about skin care. That might sound like a simple Q & A about skin but we assure you it’s far more!

This week, Dr. Daniel Barrett speaks with Mallory Hoyle, Medical Esthetician at Barrett Plastic Surgery in Beverly Hills. This episode delivers top notch answers to the most frequently asked questions about skin care. That might sound like a simple Q & A about skin but we assure you it’s far more!

Dr. Barrett and Mallory reveal all the different real life choices and products that affect the skin and it’s absolutely mindblowing! Generally, we don’t even think that proper hydration, diet, and inflammation play a part, but you’ll learn how they are just a few factors. Get the lowdown on how to identify some of these issues and which over the counter and home testing products can help you take preventative action now.

Topics covered:

  • Acne
  • Pigmentation
  • Barrier...

On this episode of the natural plastic surgeon...

Dr. Barrett: I have super oily skin. What's the best drugstore skincare line for oily skin?
Mallory Hoyle: Ooph, drugstore…
Dr. Barrett: Right? This, this drives me insane because it's, like, you walk in to...I mean, like, I used to think Neutrogena was a really good skin care line. And then I look at some of the products they have, their chemical, you know, some of the ingredients they have in it. Yes, some of the active ingredients that you mentioned are still the same. But then you look at the other things like parabens and all this other stuff that can cause…
Dr. Barrett:...it was actually really important. I did, I did a food sensitivity test and there, there's a really good one out there. It's called Cyrex, it’s a C-Y-R-E-X food sensitivity test. I was off the charts.
Mallory Hoyle: Oh, wow.
Dr. Barrett: A, I was sensitive to everything, right? And just, like, I'm, like, what, what's going on? And if you actually do some research into it, most people….

You are listening to The Natural Plastic Surgeon Podcast. I'm Dr. Daniel Barrett, Board-Certified Plastic and Reconstructive Surgeon located right here in Beverly Hills. I specialize in cosmetic surgery of the face, nose, breast and body. This podcast is dedicated to those deciding if plastic surgery is right for them and revealing all the latest beauty secrets. New episodes premiering every Monday at 10 am. Let’s get started.


Dr. Barrett: This is the Natural Plastic Surgeon Podcast. We've got a special guest on the show for you today. She is Mallory Hoyle.
Mallory Hoyle: That’s me.
Dr. Barrett: Okay, she is our aesthetician here in our practice and yes, I am a plastic surgeon. And we do a lot of plastic surgery here but we do a lot of other things, you know. I feel like we're a head-to-toe kind of business in terms of, it's great if your boobs look awesome, but if your skin is bad, who really cares?
Mallory Hoyle: Right.
Dr. Barrett: You know what I mean? It's just, like, basics. And skin care is basic, it is, like, that basic level. When you look at somebody, the first thing you notice is their skin.
Mallory Hoyle: Instantly.
Dr. Barrett: Yeah. So, I’ll tell you guys a little bit about Mallory. She is from North Carolina, which is the state where I'm from’s little cousin down on the bottom.
Mallory Hoyle: It is.
Dr. Barrett: So I'm from Virginia, she's from North Carolina, so we have some, some good things to talk about there. You've been working in the skincare industry for about the past three years as a result, result of your own battle with acne.
Mallory Hoyle: Yes.


Dr. Barrett: You attended the Aveda Institute in Los Angeles and you’re a ZO Skin Care Certified Specialist which is awesome, it’s really hard to do to. ZO Skin Care is the product line that we carry in the office--it’s fantastic. So after your training, you actually worked at several places, dermatology offices. You were a lead esthetician specializing in aging management and acne prior to joining our team here at Barrett, Barrett Medical Spa, and you've been an incredible addition, our patients love you.
Mallory Hoyle: Thank you.
Dr. Barrett: And they are getting great, beautiful skin.
Mallory Hoyle: Yes.
Dr. Barrett: So, Mallory, we're lucky to have you part of our team. What, what can you share about what keeps you motivated? What's, what’s, kind of, driven you these past three years and gotten you into this?


Mallory Hoyle: Sure. Yeah, well, like you said, skin is one of the first things you notice when you look at someone. And that can, kind of, determine how someone feels about themselves. So taking social anxiety into account, depression, there are a lot of mental things that come into play with our skin condition. So that's what got me into skin care initially. I was in college and was plagued with cystic hormonal acne as soon as I turned 20. And I kind of missed the teenage acne, had perfect skin in middle school, high school and then, like I said, 20--boom it just appeared almost overnight.
Dr. Barrett: Were you, like, in middle school were you, like, haha I've got great skin...
Mallory Hoyle: Yeah, totally. Like, I miss that one.
Dr. Barrett: Yeah.
Mallory Hoyle: Yeah so I, I was so depressed. Would not go anywhere without makeup. You know, waited until it was night time to run errands or anything like that. And long story short, I met an esthetician who clear up my skin and just help build my confidence back socially. And I decided I wanted to help other people.
Dr. Barrett: What, yeah, now tell me about that. Is, is that a vicious cycle? When you have acne and you're trying to cover it with makeup, if you're not using the right makeup...
Mallory Hoyle: Yeah.
Dr. Barrett:...does that just make it worse and worse?
Mallory Hoyle: It does. 100%
Dr. Barrett: So maybe you were, like, you didn't, before you met this esthetician. Tell me about that.
Mallory Hoyle: Mac makeup, you know? CVS, not that anything's wrong with over-the-counter skin care. But it's not great, especially when you're trying to do with something that's deep within the skin. So a lot of mistakes that definitely just kept repeating that vicious cycle.
Dr. Barrett: What, what were some of the mistakes that you were making?


Mallory Hoyle: Makeup choices.
Dr. Barrett: Okay.
Mallory Hoyle: For sure. Diet. I'm highly gluten intolerant. I had no idea and you're from the south. So our diet is, like, based off gluten and dairy and you know, butter and everything. So I had to really take a look at diet. Makeup was huge.
Dr. Barrett: Okay.
Mallory Hoyle: For sure. And just lifestyle. Getting enough sleep, proper hydration throughout the day is, is huge. And then, of course, products. What are you using on a daily basis? That was huge, as well.
Dr. Barrett: Awesome.
Mallory Hoyle: Yeah.
Dr. Barrett: I mean, that's fantastic. I'm glad you had that kind of aha moment. And you've really, kind of, opened my eyes in terms of a lot of the things that go on with skin care. We actually have a lot of questions. We have some, we have some questions from our followers and we also have some, kind of, the top questions that we found from some sites here that, that a lot of people have asked about skin care. And one of the things you mentioned was over-the-counter products like CVS. You know, ‘cause a lot of people are asking what can I, I, I lead a busy life and have a strict budget, what are, what are the bare necessities that I need for my skin?
Mallory Hoyle: Right. Common question. Bare necessities would be cleanser, a good toner and a good exfoliator.
Dr. Barrett: Okay, is this something that somebody could get at CVS or, like, what do you suggest?
Mallory Hoyle: I, I think that there are certain things you can get over-the-counter. Like a good salicylic cleanser, you can definitely get from Walgreens or CVS because it's the same active ingredient. But when you get into more targeted treatments like serums, you know, medical-grade retinol and Retin-A, those things, unfortunately, you can't buy over-the-counter. And what happens is you're spending, you're saving money buying a $12 cleanser but think about the amount of times you're gonna have to try something different. You could have spent $40, $50 on a, you know, quality cleanser and actually ended up saving money.
Dr. Barrett: Right.
Mallory Hoyle:...in the long run.
Dr. Barrett: So, that's my thing too. It’s like, you know, we're talking about your skin. You're going around you're showing everybody your face every single day. It's, like, why are you messing around? Why are you trying…when your car's broken you take it to a mechanic to fix it. Yeah, you can go to mechanic school and learn how to do it. But I, it really blows my mind every time people go…they go to Neiman Marcus and they trust the person behind the counter that just has, is just a sales clerk...
Mallory Hoyle: Yeah.
Dr. Barrett:...has, has some bullet points about the product. They really don't know anything about it. They don't know how to diagnose skin. And it's, like, why are we messing around with our skin when it, when it comes to buying products? Like, why are we experimenting with our own skin? It's just...
Mallory Hoyle: Absolutely.


Dr. Barrett:...blows my mind. You know, the products that we carry in our offices is THE ZO Skin Health Obagi product line.
Mallory Hoyle: It’s amazing.
Dr. Barrett: I think it's, I think it's the best out there. That's the most research-driven, and I looked at all the different product lines. There's some really good ones out there and some not so good ones, but in terms of value, it's, it's actually cheaper.
Mallory Hoyle: 100%. I agree.
Dr. Barrett: It's cheaper than what you can get at, like, when you buy at Neiman Marcus.
Mallory Hoyle: Yeah.
Dr. Barrett: I’m staring at Neiman Marcus. That's why I’m mentioning that. No offense to anybody. But, you know, Macy's or wherever you go where it's just, like, oh it must, it's $500, it must be good. Not necessarily.
Mallory Hoyle: Well you used the perfect word, exp, it’s experimenting.
Dr. Barrett: Right.
Mallory Hoyle: So that first thing you buy might not work, the second one, the third one. You go down the, down the list and then you, you’re $1,000 in and you don't have anything you like,
Dr. Barrett: Right. Yeah and your skin’s getting punished.
Mallory Hoyle: Exactly.
Dr. Barrett: And that's the thing is, like, you could be using a salicylic when you really need to be using, like, you know, something more enzymatic, or maybe lighter. Because you don’t have acne so it's, like, you know, you know, go to a professional, go to a, a licensed esthetician, go to a doctor.
Mallory Hoyle: Yes.
Dr. Barrett: You know. That, it, it could save you so much trouble.
Mallory Hoyle: Yes.
Dr. Barrett: I have...here, this is back to the drugstore thing. I have soo...this is from MAC_lak and M-A-C_lak.
Mallory Hoyle: Shoutout MAC_lak.
Dr. Barrett: I have super oily skin. What's the best drugstore skincare line for oily skin?


Mallory Hoyle: Ooph, drugstore...
Dr. Barrett: Right? This, this drives me insane because it's, like, you walk in to...I mean, like, I used to think Neutrogena was a really good skincare line. And then I look at some of the products they have their, their chemical, you know, some of the ingredients they have in it. Yes, some of the active ingredients that you mentioned are still the same. But then you look at the other things like parabens and, you know, all this other stuff that can cause inflammation in the skin. And it's just like, yeah, you're getting the active ingredient, but then you're getting these cheaper inert materials.
Mallory Hoyle: Additives.
Dr. Barrett: Yeah, and, like, fragrances?
Mallory Hoyle: Right?
Dr. Barrett: You guys, your skincare shouldn't smell pretty. Okay? It should smell like nothing. Unless there's an actual product in there, like mulberry extract, that's actually doing something for your skin that you can actually smell. You don't want perfumes in your skin...and I feel like you really just don't know what you're getting at a, at a drugstore. What are your thoughts on that for super...
Mallory Hoyle: Absolutely.
Dr. Barrett:...super oily? What should they do instead of going to the drugstore?


Mallory Hoyle: So the only thing that really comes to mind is, is maybe a sulfur mask. Or they have some of those charcoal masks. But the thing about oil is the only thing that can pull oil out of your skin is oil.
Dr. Barrett: Yeah.
Mallory Hoyle: it's the only thing that actually links to so...
Dr. Barrett: Interesting.
Mallory Hoyle:...putting on the Biore strips. It's, it sounds like a good idea. It’s doing nothing.
Dr. Barrett: What are those? Is that the one that pulls off of the blackheads?
Mallory Hoyle: That's, in theory, Yeah. That’s what it’s supposed to do. It takes off that top layer of skin.
Dr. Barrett: Okay.
Mallory Hoyle: But then you're left with the plug that's down deep in the follicle and that stays there. So then it resurfaces and you go back to CVS and buy your strips and...
Dr. Barrett: Yeah.
Mallory Hoyle:...just kind of keep doing the same thing. There's, there's no real solution to oily skin in a drugstore, unfortunately. Regular facials, good extractions, and surprisingly, using a facial oil helps with oil production.
Dr. Barrett: That's, that's pretty interesting.
Mallory Hoyle: Yeah.
Dr. Barrett: I never even thought about that. You know, I also like how you mentioned that it has to do with the total of your diet.
Mallory Hoyle: Yes.
Dr. Barrett: What's going on your body, your sleep.
Mallory Hoyle: Exactly.
Dr. Barrett: You know what I mean? It's, like, your skin is your largest organ in your body. It's a reflection of what's going on inside of your body. So if you're not getting good sleep, if you're eating food that you're intolerant to or if you're, have a chronic illness or disease or a leaky gut, all that stuff's gonna be reflected in your skin.


Mallory Hoyle: It is. Yeah, I just got gluten nuked last week.
Dr. Barrett: What’s that mean?
Mallory Hoyle: I ordered something that was gluten-free...
Dr. Barrett: Yeah?
Mallory Hoyle:...and it was not.
Dr. Barrett: Oh, how'd you figure that out?
Mallory Hoyle: So it's like instantly. Well, I did a food sensitivity test...
Dr. Barrett: Okay.
Mallory Hoyle:...which is something I actually wanted to touch on during the podcast is figuring out what you're intolerant to or sensitive to. Because that can be not an easy switch, but a change that makes a big difference in your skin. So anyways, I ordered something with gluten-free toast...
Dr. Barrett: Yes.
Mallory Hoyle:...and maybe 30 minutes after I ate it I started to get a headache.
Dr. Barrett: Oh my gosh.
Mallory Hoyle: Yeah, I got a little sick to my stomach. And I thought, oh my gosh. And then maybe 48 hours later, I started breaking out. So it's a real connection to the skin as far as, like, food sensitivities, being intolerant to certain ingredients. So that's huge for a lot of people. And, you know, if you have heartburn, oh, take a pill. If you have all these different ailments, right? We've been, kind of, taught to put a band-aid on it, opposed to looking at the root cause, and where it's really coming from. And with skin, I think it really does boil down to what you're using and, and, and what your body is trying to tell you.


Dr. Barrett: Yes. So we can dive a little bit deeper into this. And I'll just spend a quick moment on this. This is actually really important. I did, I did a food sensitivity test and there, there's a really good one out there. It's called Cyrex, it’s a C-Y-R-E-X Food Sensitivity Test. I was off the charts.
Mallory Hoyle: Oh, wow.
Dr. Barrett: A, I was sensitive to everything, right? And just, like, I'm, like, what, what's going on? And if you actually do some research into it, most people shouldn't be sensitive to anything. At most, maybe two sensitivities. And that's rare. That's, like, 5% of the population. 95% of the population should not have any sensitivities. Maybe you have one sensitivity, but to have more than one sensitivities….so what I, what I found out is I had leaky gut syndrome, and so I had to, I had to actually treat that. So you know, there's…because if you have a leaky gut, you're sensitive to everything, ‘cause everything is just pouring into your bloodstream. You're gonna have, you’re gonna have antibodies, so all that stuff. So you could take a deeper dive into that stuff. I'll let you guys search that out on the internet.
Mallory Hoyle: Yeah.
Dr. Barrett: But let's get back to some basics, okay?
Mallory Hoyle: Let’s do it.


Dr. Barrett: What, what is, like, a basic skin care regimen that you recommend for somebody?
Mallory Hoyle: Sure. Basic skincare regimen. Definitely, you need a cleanser. There's this big myth going around that you don't need to wash your face just splash it with water. But cleanser to get off the dirt, oil, just the all the environmental stressors of the day.
Dr. Barrett: Okay.
Mallory Hoyle: So definitely a cleanser, a toner is really important. It's going to balance your pH levels, kind of, replenish the hydration factors after you use a cleanser. And then that preps your skin for whatever you use afterwards.
Dr. Barrett: Yeah, I mean, let's talk about this. You know, we don't live in a natural environment anymore.
Mallory Hoyle: Right.
Dr. Barrett: We're not living out in the woods where we're surrounded by beautiful air, beautiful sunlight, natural exfoliants all around us. So it's, like, you need a cleanser. You, you're gonna have, you’re gonna have, if you're sitting in your car every day you're exposed to environmental toxins, you know? It's all building up in your skin. Makeup, all that stuff.
Mallory Hoyle: Yeah.
Dr. Barrett: So I, I'm with you. I mean, if we all lived out in the woods and caves, then maybe we wouldn't need it. But we don't, we, we live in a pretty toxic environment with a lot of, a lot of problems.
Mallory Hoyle: Yes, that’s a reality.
Dr. Barrett: Yeah.
Mallory Hoyle: Totally. After a cleanser, I say get a, get a good serum, something that's specific to your skin care needs. If you're working on anti-aging/sunspots, hyperpigmentation, vitamin C's amazing. The ZO vitamin C is really amazing because it's stabilized vitamin C, and not all vitamin C is the same.
Dr. Barrett: Right.
Mallory Hoyle: Which is something to note...Hyaluronic acid is huge.
Dr. Barrett: No that's true, because you'll see, oh it has vitamin C, but it's already oxidized. You put it on your skin, it's already scavenged its free radicals by just sitting exposed to the air. That's the benefit of vitamin C--it's a free radical scavenger.
Mallory Hoyle: Yes.
Dr. Barrett: And if you, if you have an aqueous form, you have to, it has to be stabilized. And that, and that's what people don't realize is that looking for simple ingredients and, and they're not packaged well, not gonna do you any good.


Mallory Hoyle: Yeah, exactly. So just a serum that's targeted to whatever specific concern you want to treat. And then on top of that, a nice face oil or a moisturizer. Something to never forget is sunscreen.
Dr. Barrett: Yeah.
Mallory Hoyle: Definitely want to use your sunscreen. We had someone ask if you need to wear sunscreen on cloudy days, on Instagram. And that's, it's funny, it seems like an obvious answer. But everyone asks that question. And the answer is yes, you definitely need sunscreen, whether it's rain or shine. Clouds partially filter out sunlight, but not the rays.
Dr. Barrett: Right.
Mallory Hoyle: So you're still getting those UVA/UVB rays.
Dr. Barrett: That's the thing. It's, it’s, there's a lot of people they're like, oh, sunlight, it’s great. It’s natural for you and I, and I agree with that for a certain extent. But it just depends how much damage do you want? I mean, like, we don't have as much protection in our ozone from the sun. And it's, like, we live in Southern California, we're getting a lot more exposure than our bodies actually evolved to handle. So it's, it's, to me it's, it’s one of those things it's, like, well do you want wrinkles and sunspots on your face? No? Then wear sunscreen. You know?
Mallory Hoyle: Exactly.
Dr. Barrett: And that's, and that’s another key is, is find a…I like physical blocking agents for sunscreen…
Mallory Hoyle: I agree.
Dr. Barrett:...because they don't bind to your skin. A lot of people don't realize that there's a difference between physical blocking agents, like titanium dioxide and zinc oxide. The zinc oxide is like when you get that white stuff on your nose, when you see the lifeguards?
Mallory Hoyle: Yeah.
Dr. Barrett: Just completely blocks the sun. Doesn't bind with your skin, just sits on the surface. And then you have other, like, products that have, like, benzenes and all this other stuff. You gotta be, you gotta be careful with those, because some of those can be, actually interact with your skin. If you're having sensitive skin and breakouts. You want to avoid those chemical sunblocks, unless you're gonna be out in the water and you need something that's gonna be waterproof.
Mallory Hoyle: Right.
Dr. Barrett: So that's, that's why I'm typically a physical sunblock kind of person.
Mallory Hoyle: Physical is the way to go.
Dr. Barrett: Yeah.
Mallory Hoyle: And more people are talking about that, which is awesome.
Dr. Barrett: That's great.
Mallory Hoyle: Yeah.
Dr. Barrett: You mentioned…one other thing I wanted to ask you about regimen. What about exfoliation?


Mallory Hoyle: Exfoliation is key.
Dr. Barrett: Yeah.
Mallory Hoyle: Always. Everyone needs to exfoliate. When you're a kid, you're dead skin cells take care of themselves. They slough off on their own.
Dr. Barrett: Yeah.
Mallory Hoyle: And then, as early as 12 years old, our skin cells stop replenishing themselves. So those dead skin cells stay right on top and then they build up over time. They build up, build up, build up. Unless you're exfoliating, and sloughing those dead skin cells off. And doing so gets rid of the dead skin cells, but it also makes room for your new cells to come to the surface. Which is the goal.
Dr. Barrett: Right? It's…Yeah, so it's, like, your cell turnover, right?
Mallory Hoyle: Yes.
Dr. Barrett: You get a completely new set of skin cells every six weeks. And people that don't stimulate that process start to get slowed down to eight weeks to ten weeks to twelve weeks. And guess what happens? Pigment builds up, that dullness builds up, you get clogged pores, ‘cause all you got these dead skin cells just hanging out on top of your skin. So exfoliation I, I look at that, it's, like, it helps stimulate your cell turnover. So active exfoliation every day. It's just a great stimulation for your skin and I use it, I exfoliate every single day. I use, like, five different ZO products
Mallory Hoyle: Nice.
Dr. Barrett: Every day.
Mallory Hoyle: Yeah.
Dr. Barrett: And, and people are, like, why is your skin looking so good? I was, like, well combination of Botox, and living in Virginia, studying in libraries my whole life and then just really good skincare.
Mallory Hoyle: Yeah.
Dr. Barrett: I think. And it's really made a difference.
Mallory Hoyle: Yeah, I love the polish--the ZO polish.
Dr. Barrett: Yeah.
Mallory Hoyle: Everyone's favorite.
Dr. Barrett: Oh it’s, it’s great. It does have some anti-inflammatory properties in it, which is also good. You want to calm the skin down. Sebum, which is the oil in our skin, is very inflammatory.
Mallory Hoyle: Sure.
Dr. Barrett: So all right, let's move on. Why am I still breaking out after 40?


Mallory Hoyle: Good question.
Dr. Barrett: Yeah.
Mallory Hoyle: A lot of people have that question. Kind of, like, what I touched base on in the beginning. You assume if you missed those teenage breakouts that you're in the clear, you don't have to worry about acne. And then throw in some hormones and stress, air pollution…you know, all the things that come out as diet, lifestyle and, and you, you got acne in your 20’s, 30’s, 40’s.
Dr. Barrett: It's crazy.
Mallory Hoyle: It's not uncommon. And again, just to revisit what we already talked about. Looking into food sensitivities, you know, your, your day-to-day lifestyle. How much sleep are you getting? How much water are you drinking a day? What, what does your diet look like? Those are really important as far as hormone balance goes. And then, of course, some people have deeper issues and then it's best to check in with, like, a hormone specialist or...
Dr. Barrett: Yeah.
Mallory Hoyle:...you know, whatever you prefer.
Dr. Barrett: It, it, it's tough because a lot of the things that, this especially affects women, is birth control.
Mallory Hoyle: Yes.
Dr. Barrett: Birth control pills are it, it's, obviously getting pregnant when you don't want to is not good. But the, the, the damage that birth control does to people's skin is just, is, is difficult.
Mallory Hoyle: And pregnancy. A lot of women...
Dr. Barrett: Yeah, yeah, pregnancy is, is brutal in terms of, because your, your body is gearing up towards providing for the baby and not so much your skin, right? So you get massive production of pigmentation, melasma, all this other stuff. But guess what, that happens when you take the pill too.
Mallory Hoyle: Exactly.
Dr. Barrett: A lot of people don't realize that. They’re, like, I started noticing getting this brown mustache. What is that? I’m like, that's melasma and I, first thing I ask them is, like, are you on the pill?
Mallory Hoyle: Yeah.
Dr. Barrett: And then they're, like, yeah. And then they’re, like, no one ever told me that this can happen to my skin.
Mallory Hoyle: Right.
Dr. Barrett: Which is...that's frustrating.
Mallory Hoyle: Yeah, it is frustrating.
Dr. Barrett: ‘Cause I think, I think everybody should have that discussion with their doctor before they start...
Mallory Hoyle: It should totally be disclosed. And then the thing about birth control is it takes, you know, it's not like you stop it and then it is out of your system. It can take up--years--to, kind of, get back on your regularly scheduled program, which is even more frustrating.
Dr. Barrett: Yeah.
Mallory Hoyle: Yeah. That's huge for, for any breakouts over 20, definitely tell people to start looking into your hormonal balance.


Dr. Barrett: Yep.
Mallory Hoyle: For sure.
Dr. Barrett: Okay, let's, let's touch on that brown spots and melasma a little bit more. So one question we have is where did I get these brown spots, hyperpigmentation in my face? How can I lighten them?
Mallory Hoyle: Yeah, that’s everyone's question.
Dr. Barrett: Yeah.
Mallory Hoyle: Where do they come from? They probably been there for a while.
Dr. Barrett: Yeah.
Mallory Hoyle: And there's things that make them darker and more obvious.
Dr. Barrett: Okay.
Mallory Hoyle: So sunspots and age spots can actually start ar, around childhood. So some of the sunspots that people get might not be from vacation they took last week. It could be from the summer before when they were outside every day. Or when they were, yeah, six-years-old, out playing every day. So, those are tricky. It can take sometimes, you know, an hour, someone's out in the sun and they get darker. And then there's other cases where it's pigmentation that's been way deep in their skin and then it decides to creep up.
Dr. Barrett: Right.
Mallory Hoyle: And, and shows up in the form of age spots or sunspots. But they're definitely treatable.
Dr. Barrett: Yeah.
Mallory Hoyle: Thankfully.
Dr. Barrett: Yeah, we, and yeah we also talked about melasma also. That, that could be from pregnancy control or birth control and also sun damage may which makes it worse.
Mallory Hoyle: Definitely. And again, sunscreen is huge. The sun, the UVA and UVB rays will make them darker and it pushes them deeper into the skin. So if you do have sunspots, age spots, hyperpigmentation, sunscreen, sunscreen, sunscreen.
Dr. Barrett: Yeah.
Mallory Hoyle: For sure.
Dr. Barrett: To stop it from getting worse.
Mallory Hoyle: Exactly. My favorite products that we carry from ZO to help with pigmentation: Vitamin C is huge, just in, again, suppressing those melanocytes and making sure it doesn't get any darker. And then you go on the side of lightening and I love all our retinols.


Dr. Barrett: Well, let's back up. So let's, let's understand melanocytes. Melanocytes are the cells in our face, in our skin, that produce pigment.
Mallory Hoyle: Right.
Dr. Barrett: So, I think we all have the same amount of melanocytes, or perhaps some have a higher concentration of them based off a ethnicity. And then the ability to produce pigment is up-regulated in some people based on genetics, and then also based on environmental exposure.
Mallory Hoyle: Right. Yeah, so there's a chemical agent called tyrosinase. And that's what tells your melanocytes to release or not. So everyone has the same amount of melanocytes, some of them are just more active...
Dr. Barrett: Yeah.
Mallory Hoyle:...than other people. So yeah, the first thing to do is suppress those melanocytes, so they're not producing.
Dr. Barrett: Right, it's, like, hey, melanocytes, calm down.
Mallory Hoyle: Chill out. Yeah.
Dr. Barrett: So it’s, so we get that with a lot of post-surgical, inflammatory hyperpigmentation.
Mallory Hoyle: Yes.
Dr. Barrett: So you can see where there would normally not be any darkness they, we have an incision and that, that whole area becomes hyperpigmented.
Mallory Hoyle: Right.
Dr. Barrett: And that's because we up-regulated their response.
Mallory Hoyle: Yes.
Dr. Barrett: Because of the surgical trauma.
Mallory Hoyle: Right, so the first thing to do is block those melanocytes. That's a big mistake people make is not, first of all, cutting them off. And then you can lighten.
Dr. Barrett: Yeah.
Mallory Hoyle: So there's a couple of steps. It's suppressing those melanocytes and then we can focus on lightening and brightening everything up.
Dr. Barrett: Yeah I mean, like, if you, if you have to, it’s source control, right?
Mallory Hoyle: Right.
Dr. Barrett: So you have to, like, get the, get that stimulating source under control. Is it too much oil? Is it too much sebum? Is it too much sun exposure? Is it hormones? What's going on that's causing the hyperactive melanocytes? Calm that down.
Mallory Hoyle: Exactly.
Dr. Barrett: Then actually chemically suppress them and then you can work on lightning. Which is...tell us about that.


Mallory Hoyle: Exactly. So our favorites here are the ZO Retinol Skin Brighteners. They come in different percentages, which is nice because it's customizable for people that are maybe a little bit more sensitive. For patients that want a more aggressive approach, you can put them on a higher percentage. So love those, they also just came out with Brightalive...
Dr. Barrett: Well, yeah, so let's back up. So is that, you're talking about hydroquinone-based products?
Mallory Hoyle: Hydroquinone-based products.
Dr. Barrett: And retinol?
Mallory Hoyle: And retinol. So it's double whammy.
Dr. Barrett: So the way I like to look at retin…so first of all, the, the two most heavily studied skincare products out there are retinol and vitamin C. Both of them have a double-randomized controlled studies in terms of improving wrinkles and improving pigmentation.
Mallory Hoyle: Wow.
Dr. Barrett: Retinol works, it's like a tiny little, it's like, it's like gasoline. It's like a tiny little molecule that goes all the way down to this, to the cell nucleus and it's just ignites everything, right? So it just, it just, when you want hydroquinone to really work, you pair it with retinol. It just makes everything work really much better.
Mallory Hoyle: Right. Yeah, so those are great.
Dr. Barrett: So you were mentioning, you were mentioning retinol skin brightener.
Mallory Hoyle: Yes, the retinol skin brighteners. No brainer.
Dr. Barrett: Yeah.
Mallory Hoyle: And then we have the pigment control and pigment control plus blending cream. Both of those are forms of hydroquinone. Those are great. And then Brightalive, which is new to ZO. It’s a non-retinol, non-hydroquinone skin brightener which is exciting for, for people that don't want to go that route, or maybe they want some lightening while they're pregnant.
Dr. Barrett: Yeah.
Mallory Hoyle: It’s just a great alternative.
Dr. Barrett: That, that’s, that's true. Because the downside of this gasoline molecule called retinol…it works really well...is there's an adjustment phase. It takes about six to eight weeks to, kind of, adjust to using retinol.
Mallory Hoyle: Right.
Dr. Barrett: And you can have, you can have red flaky, irritated skin, dry skin. A lot of people don't tolerate that. And I'm just, like, you know, if you want a sexy body, it's not gonna happen by sleeping on the couch. You got to go to the gym. You gotta work out.
Mallory Hoyle: Yeah, it’s gonna hurt a little bit.
Dr. Barrett: Yeah, it's gonna hurt a little bit. Yeah, so it's, like, the same exact thing is true for your skin.
Mallory Hoyle: Absolutely.
Dr. Barrett: How would it be any different? It’s an organ, just like your muscles in your body.
Mallory Hoyle: It is. Agreed. Yeah, and then it, for an even, you know, more aggressive approach, of course, peels are fantastic for lightening pigmentation. And again, just overall maintenance. You know, once you have lightened those spots, you still need to protect your skin with sunscreen, daily power defense, a good antioxidant. Vitamin C, of course, but, yeah, our retinol skin brighteners and the hydroquinone are game-changers.
Dr. Barrett: Yeah it's, it's amazing how far they’ve come. Yeah, I know. It’s ‘cause the, the old Obagi, when it came out in the 80s, the stuff was really harsh. And so now we're getting really good effective products that don't have as much side effects.
Mallory Hoyle: Yeah.
Dr. Barrett: Anticipated reactions is what they’re saying.
Mallory Hoyle: Exactly.
Dr. Barrett: So. Which I think is fantastic. All right, I want to change gears a little bit. And I, I actually saw a patient today who had large pores.
Mallory Hoyle: Yeah.
Dr. Barrett: So one of our questions is, is it actually possible to minimize pores and what causes large pores?


Mallory Hoyle: It is possible to minimize them but not necessarily through products.
Dr. Barrett: Okay.
Mallory Hoyle: So, so there's a lot of marketing: shrink your pores, smaller pores, and those are kind of gimmicky. You can shrink, you know, minimize the pore size with lasers, more high-technology, sort of, treatments, but our pores actually solidify and liquefy that's where the open and close term comes from.
Dr. Barrett: Okay.
Mallory Hoyle: It actually started from estheticians, so it’s our fault.
Dr. Barrett: Okay.
Mallory Hoyle: In facials we use steam to open the pores, which basically means liquefy them.
Dr. Barrett: Okay.
Mallory Hoyle: And then when they close they’re solidifying the stuff inside.
Dr. Barrett: Okay.
Mallory Hoyle: So that's where the open and close things come from. So your pores don’t actually open or close.
Dr. Barrett: Okay.
Mallory Hoyle: But they can get bigger, you know, if you have a, a lot of blackheads or big breakout, it can certainly stretch the pore.
Dr. Barrett: So that's, that’s what I, that's what I've heard and, and when you start to get some really good control of your oil and sebum production.
Mallory Hoyle: Yes.
Dr. Barrett: You can actually, you, you, you get less volume of stuff inside your pores.
Mallory Hoyle: Exactly.
Dr. Barrett: So the appearance actually goes down.
Mallory Hoyle: The appearance.
Dr. Barrett: Yeah. And I've actually, when you step into, more my territory, in the operating room, I can actually shrink them with a CO2 laser. And that's just because I'm causing cellular tightening and myofibroblast production, so that it shrinks these dermal elements in the skin. Which is...
Mallory Hoyle: You can see it almost instantly with the, the CO2.
Dr. Barrett: Yeah, you can. Yeah, and it tightens up. But, you know, that's, that's a little more involved with it than a daily skincare regimen.
Mallory Hoyle: Definitely. But the sulfur mask by ZO is great.
Dr. Barrett: Yeah.
Mallory Hoyle: For pore size because, like you said, it limits the oil production, which in turn, makes the pore seem smaller because you don't have so much oil production going on. Your, your glands look smaller.
Dr. Barrett: Great.
Mallory Hoyle: Yeah.
Dr. Barrett: So instead of a, you know, king size pillow, you know, you have a twin size pillow.
Mallory Hoyle: Exactly.
Dr. Barrett: Yeah cool.
Mallory Hoyle: No more Biore strips.
Dr. Barrett: Yeah. All right, let's, let's move on. This is a question, this is a different subject. Rosemary Elizabeth Griffin asks, ke, keratosis pilaris tips.
Mallory Hoyle: Oh...
Dr. Barrett: Do you know what that is?


Mallory Hoyle: I do.
Dr. Barrett: Okay.
Mallory Hoyle: I do. I'll tell you a funny story. I had it my whole life. I remember going to the derm and getting it, they would have like the, you know, the nitrous gas and, like, freeze it off. So painful. Yeah, and it went away after I stopped eating gluten. Yeah, it has a lot to do with food sensitivities and intolerances.
Dr. Barrett: Okay.
Mallory Hoyle: Yeah, but something else you could do is, like, our dual-action scrub, something with a salicylic, and just really get in there a few times a week and exfoliate.
Dr. Barrett: See, I, I had that, you get them on extensor surfaces. What does that mean? That means the back your arms, your thighs. If you don't know what it is, it’s like, it's like little goose, like little chicken bumps...
Mallory Hoyle: Yeah,
Dr. Barrett:...that don't go away. And it's like clogged pores, a little clogged hair sometimes.
Mallory Hoyle: Yeah.
Dr. Barrett: And, it, you know, when I was really getting them bad, was in fact, when I was eating a lot of gluten, so I had no idea. I would actually, I would do an exfoliant scrub with the, with the ZO scrub and they would go away. But I’d have to do that every morning. And now I don't have to do it, probably because I changed my diet.
Mallory Hoyle: Probably so.
Dr. Barrett: It's interesting. So they're your tips, Rosemary…is a, exfoliation, salicylic...
Mallory Hoyle: Yeah.
Dr. Barrett:...and then check your gluten.
Mallory Hoyle: Yeah.
Dr. Barrett: All right, cool. We, we have all kinds of regimens for people. And this one, this question is from, I guess, Syru, Serenia Miranda, and she said, what should a 27 going on 28-year-old be incorporating in their skincare routine?


Mallory Hoyle: Good question, actually. Yeah, definitely some retinol.
Dr. Barrett: Oh, retinol already, in your 20’s?
Mallory Hoyle: Yeah. Definitely, I think after 25, retinol and Retin-A.
Dr. Barrett: After 25? Okay.
Mallory Hoyle: For sure.
Dr. Barrett: Like, what concentration are we talking about?
Mallory Hoyle: Very low.
Dr. Barrett: Okay.
Mallory Hoyle: Yeah.
Dr. Barrett: So like a, like a baby dose.
Mallory Hoyle: A baby dose.
Dr. Barrett: Okay.
Mallory Hoyle: At that point, it's, it's more preventative.
Dr. Barrett: Yeah, agree with you. And, and then, what about vitamin C at that point?


Mallory Hoyle: Vitamin C is great. I agree with that.
Dr. Barrett: Yeah. I feel like that's a, that’s a no brainer. Because it doesn't really have any anticipated reactions like redness and stuff like that, that retinol can have. So it should be I think...and, and it also has one of the most well-documented amounts of evidence for...
Mallory Hoyle: Sure.
Dr. Barrett:...in terms of wrinkle prevention and pigment reduction.
Mallory Hoyle: Yeah, that's a good one.
Dr. Barrett: Okay. So what's been...what questions do you have that, that's come across your workplace? Anything today that you encountered, or anything in the past week that, that are pretty common that you want to talk about?


Mallory Hoyle: Yeah, so we touched base on a lot of the most frequently asked questions. I have one here that, it sounds silly, but I get asked a lot. Why do I have more wrinkles on one side of my face than the other?
Dr. Barrett: Really?
Mallory Hoyle: Yeah.
Dr. Barrett: Okay.
Mallory Hoyle: And it has a lot to do with how you sleep. Believe it or not, what side you sleep on. A lot of people have more wrinkles on the side of their eyes or face, on the left side, because that's our driving side. So you're exposed to the sun longer on that side of the face. But...
Dr. Barrett: You know what, there's a picture, and we can maybe link to it in the show notes of this truck driver who…have you guys seen this? Where...
Mallory Hoyle: It’s insane.
Dr. Barrett: Yeah, he was a truck driver for, like, 30 to 40 years. And you can see the whole left side of his face is completely more wrinkled than the right side of his face.
Mallory Hoyle: Yes. They put him under the Wood’s lamp.
Dr. Barrett: Is that what they did? Oh my god.
Mallory Hoyle: Yeah, there's so much sun damage.
Dr. Barrett: Yeah. So that, that goes to show you the effect, the environmental effect of UV light on your face. Or sunlight.
Mallory Hoyle: Absolutely. Yeah. So that's, that's the answer to that one. That's where more wrinkles come from on one side.
Dr. Barrett: Yeah, but I do, you know what, I do notice that with filler too. When I have my filler patients and they, they have a crease that’s bigger on their nasolabial line versus the other side. And I'm like, look, there's some asymmetry here, like, what side of your bed are you sleeping on?
Mallory Hoyle: Yeah.
Dr. Barrett: And they’re, like, I always sleep on my left side.
Mallory Hoyle: Yeah. It’s true.
Dr. Barrett: And, maybe you should try alternating that. Or sleep on your back.
Mallory Hoyle: Definitely. JLo sleeps on her back. So...
Dr. Barrett: JLo does? She looks amazing. I want what she's doing…All right, so barrier dysfunction.
Mallory Hoyle: Yes.


Dr. Barrett: This has been a topic that has actually gotten some interesting research done lately. And I, I was wondering if you could chat about it.
Mallory Hoyle: Sure.
Dr. Barrett: Okay.
Mallory Hoyle: Yeah. So barrier dysfunction is really the root cause of most skin problems. Barrier dysfunction comes in different forms if it's left untreated. So it can turn into acne, rosacea, psoriasis, all the things that people, you know, have issues with on their skin. But it, on a smaller scale, it's basically your skin's microbiome.
Dr. Barrett: Okay.
Mallory Hoyle: So the balance of good and bad bacteria. And just like...
Dr. Barrett: So there’s bacteria that live on your face?
Mallory Hoyle: There is, yeah.
Dr. Barrett: Okay. Yeah.
Mallory Hoyle: Everywhere, really. So when that bacteria isn't balanced, you don't have a protective layer on the skin. So you can think of it, kind of like a cell nucleus that surrounds that cell. It protects what comes in, what goes out. It's kind of like the control center.
Dr. Barrett: Yeah.
Mallory Hoyle: And when that barrier isn't there, you have nothing kind of refereeing or controlling what goes in, what goes out. So you end up with a lot of sensitivity, irritation. That's the main way to diagnose barrier dysfunction is sensitivity. People that say, oh, I'm so sensitive..really only about 15% of the population is truly sensitive. And that's genetic sensitivity.
Dr. Barrett: Right.
Mallory Hoyle: And then the other 85% is something we call it “acquired sensitivity.” So it comes from using the wrong products, the environmental stressors we talked about, diet--all of those things. So most people are not truly sensitive. It's acquired sensitivity, otherwise known as barrier dysfunction.
Dr. Barrett: Yeah.
Mallory Hoyle: So treating that as basically just repairing that barrier. Lots of antioxidants, niacinamides, lots of repairing agents. And you can think about, like, brick and mortar, right? So the bricks being part of your skin and then the concrete around it. And when any one of those bricks is missing, you have gaps and holes in the skin. So instead of the ingredients going on top of that layer of bricks, it goes straight to the bottom and causes, you know, irritation and things like that. So barrier dysfunction is huge when you treat anything. Some people don't have barrier dysfunction, which is great. But most people have barrier dysfunction if they are experiencing, you know, any type of skin condition that is not great.
Dr. Barrett: Yeah.
Mallory Hoyle: Yeah.
Dr. Barrett: No, I, I think I, I went through a period of rosacea one time. And it's, it's so funny how little we know about our microbiomes...in our gut, which is super, super important. We have more organisms living in our gut than we have cells in our body. I think we have more organisms living in our gut than the population of humans on the planet.
Mallory Hoyle: Oh, wow.
Dr. Barrett: Yeah. And the same is true for our skin. It’s, like, if you ever noticed that if you use something different on your skin or, like, that's why antibacterial soap is kind of a no-no.
Mallory Hoyle: Right.
Dr. Barrett: You know, it's like you don't, like, you don't want to get ri...
Mallory Hoyle: We need some of that.
Dr. Barrett: We need some of that bacteria, you know? So it's, like, it, it's harmless. It's, it's there to, kind of, protect us, and it's just keeping that good bacteria and keeping that bad bacteria out.
Mallory Hoyle: Yeah. It's like how you explain leaky gut syndrome, how you were sensitive to everything.
Dr. Barrett: Right.
Mallory Hoyle: It's kind of like leaky gut syndrome of the skin--the barrier dysfunction--you're sensitive to everything.
Dr. Barrett: Right.
Mallory Hoyle: And that's a dead giveaway that someone's dealing with barrier dysfunction.
Dr. Barrett: And would you treat that differently if you, if you…?
Mallory Hoyle: You would treat it differently. You want to repair the, the barrier before you try to treat any of those specific concerns. So repairing barrier dysfunction is going to the root opposed to putting that band-aid on.
Dr. Barrett: Right.
Mallory Hoyle: Yeah.


Dr. Barrett: Awesome. Yeah. I mean, we get, we, one of the things you mentioned earlier was peel. And I get a lot of patients that, we, we get a lot of patients that come in, they're, like, hey, I just want a peel, I just want you to just, like, peel everything off.
Mallory Hoyle: Yeah.
Dr. Barrett: And it’s just, like, okay, well what skincare regimen are you on? And they’re, like, nothing. And I’m, like, okay, well, yeah, how do you expect this one-time treatment to, kind of, correct everything? It just, it just doesn't work that way.
Mallory Hoyle: Exactly.
Dr. Barrett: So it's just, like, we say no sometimes to these people that come in and they just want a peel. To, kind of, peel everything off. Like, look, let's get you conditioned for six weeks, get the skin ready, get your barrier function back before you’re about to blast your skin with, with acid or laser...
Mallory Hoyle: Exactly.
Dr. Barrett: There's just, there's so much more involved. It's not, there's no quick fix, you guys. It's constant dedication to all of those different aspects that we talked about to really have good skin health.
Mallory Hoyle: Yes. Which is why Dr. Obagi’s line is so great, because he really, really focuses on barrier dysfunction. Went to really great seminar that ZO held. And the first 30-45 minutes was all on barrier dysfunction, which is huge because people really don't touch on that or, or talk about it. And his line really is focused on repairing that dysfunction, which is amazing.
Dr. Barrett: Got it.
Mallory Hoyle: Yeah.


Dr. Barrett: All right, so we're gonna, we're gonna finish up here with the last question, what's your top, you know, skincare tip that you can recommend to people? Yeah, I mean, you can think about this one for a second. I, I will tell you mine. And this, this, kind of, changed my whole mentality about skin care. And that is getting…there’s a big paradigm shift from moisturizing and protecting your skin. They’re, like, your skin needs to be protected. That was a big, that was a big…it was like, it was like when they designed, when they came up with Listerine for bad breath. Ha, halitosis--they came up with a term for it, like, people had bad breath--halitosis. Just so they could sell more Listerine. And it turns out, you don't really need Listerine. If you have good oral health you don't, you don't have bad breath. So it was, it's kind of a big marketing scheme and, and that's what happens in the 50s and 60s and they came out with, oh, you have to moisturize your skin to protect it. And I think it's, I think the wrong, that, that's the wrong signal we want to send to our skin cells. And that, we want to kind of stimulate and challenge our skin cells. It's just like if you want to be, if you want, like I said earlier, if you want strong muscles, you go to the gym, you work out. The same is true for our skin.
Mallory Hoyle: Absolutely.
Dr. Barrett: You can't just sit there and moisturize, it tells it to go to sleep. It tells it to go to sleep and relax and become thin and transparent and then you get, what, sensitive skin because then you have barrier dysfunction. So to me, the most important concept to understand is stop moisturizing your skin. Like, just, you know, you need...
Mallory Hoyle: Yeah.
Dr. Barrett:...you need to go the other direction. You need to, kind of, do things that are stimulating, more effective for your skin type...to really get all of that natural stuff produced on its own.
Mallory Hoyle: Yeah, I like that. I’m gonna use that.
Dr. Barrett: Yeah, I mean that's, that yeah, that's, no that's my big thing. And, and Obagi...and I learned that from Dr. Obaji himself. And, and it makes, makes total sense. Why we are sitting around caking all this moisturizer on our skin, it’s just telling our skin to do the wrong thing.
Mallory Hoyle: Yeah, it's a lot stronger than people think. Our skin is resilient.
Dr. Barrett: I know. I know, we evolved over thousands of years? With no skincare products. We’ll be fine. Okay? But, but that being said, now we have a bunch of more environmental toxins that we have to...
Mallory Hoyle: Right.
Dr. Barrett: Inflammation in our bodies, all that stuff...
Mallory Hoyle: A balancing act.
Dr. Barrett: Yeah. So all right, now your turn.


Mallory Hoyle: My turn. I'm gonna piggyback off what you said there towards the end--your skin type. I think that's huge when you, you're trying to treat your skin or buy products or book a service. What, what is your skin type? I think that's huge to figure out and, kind of, go from there. Because a lot of people buy for dry skin. Maybe you're really sensitive or dehydrated internally.
Dr. Barrett: Right. Yeah.
Mallory Hoyle: So knowing what your skin type is is huge. As far as what your treatment options are, what products are best for you...
Dr. Barrett: Yeah, it's not one size fits all.
Mallory Hoyle: It's not one size fits all. And then, again, going back to, kind of, what we touched base on the beginning, is find a, find a professional...
Dr. Barrett: Yeah.
Mallory Hoyle:...find an esthetician, go to, go see a derm, go see a, you know, a plastic surgeon. Go to someone that is, you know, certified and able to speak to your specific needs opposed to…Instagram’s great but...
Dr. Barrett: Right.
Mallory Hoyle:...the advice that they're giving out, it's kind of generic, so it might not be for you. So finding something that's specific to your needs and what kind of goals you have, your skin type, is key.
Dr. Barrett: Yeah.
Mallory Hoyle: It'll save you a lot of time.
Dr. Barrett: No, absolutely. It’ll save you a lot of time, and, and it's, it's, our skin is a valuable organ. And we have to really treat it and, with respect and take care of it, just like anything else in our bodies. So I mean, that's, again, back to what I do, it's great if you got your boob job, but if your skin looks bad, it doesn't really matter.
Mallory Hoyle: Yes, we, we’re full circle here at Barrett Plastic Surgery.
Dr. Barrett: We are. Absolutely. All right, Mallory. Thanks so much for being on the show.
Mallory Hoyle: Yeah it was so fun.
Dr. Barrett: Yeah. And you guys, if you have more questions about skin care, please check out our website, DrDanielBarrett.com. And you can also check out the ZO Health website. They've got a lot of the products that we carry here in the office. And the reason why I love their product line, and I don't, I, trust me, I, I'm not paid by them, and I don't, I don't have any, you know, any affiliation with them other than carrying their products in the office. They do the most research, they have the most non-inflammatory products, ingredients in their products that I think work the best. So.
Mallory Hoyle: Agreed.
Dr. Barrett: Yeah, great. All right guys, thanks for tuning in.
Mallory Hoyle: Awesome.

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