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[00:00:00] Oh, yeah.

Dr. Kay: Well, hello, hello guys. You're listening to beauty bites with Dr. K secrets of a plastic surgeon. And today on the podcast, we're interviewing a fabulous dermatologist, Dr. Dustin Fortuna. He is all the way from Idaho. He has a really fabulous Instagram profile, and I think he's going to teach us about skincare myths.

What we hear on social media, what's true. What's not true. We'll talk a little bit about your charitable contributions and your future upcoming podcast. Welcome to the podcast, Dustin.

Dr. Dustin Portella: Thank you. I'm honored to be here.

Dr. Kay: Yeah. Tell me a little bit about, um, how you got into dermatology and decided that was your thing.

Dr. Dustin Portella: Yeah. I'll try to give it the quick version. But I grew up in a small town in Idaho and my dad was a [00:01:00] science teacher at the local high school. And from a very early age, I was in his classroom playing with all the chemistry stuff and looking at the frog dissections and just gained a love for science early on.

And he really pushed a lot of his students to explore careers in the health professions. And for a tiny little town in Idaho, probably per capita has more doctors and PAs and physical therapists and, and than just about any place. And I went to college thinking I would potentially do PA school. Um, medical school just seemed like it would be too long and, and a couple of things happened.

One, my roommate was going to go to medical school and I thought, well, if he can do it, I can do it. And then I. You know, I love to tell this story. I was studying and oftentimes I would study over the weekends. And I went to eat Chinese food and the fortune cookie that I got said you could prosper in the field of medicine.

Dr. Kay: No way.

Dr. Dustin Portella: Yeah, and I kept, I taped it to my study desk and [00:02:00] that was not the deciding factor, but I thought it was a nice coincidence. And I thought with my personality, I really think that medical school will be a better option for me regardless of what specialty I go into. And I'm going to be 35 someday anyway, so I might as well be doing what I want to do.

And I pursued medical school. I got a great mentor in dermatology that I started shadowing as an undergrad to really learn what it was like to be a dermatologist and saw the type of work that he did, the surgical work with Mohs Surgery, and became fascinated with it. And although I really thought I would do emergency medicine when I went to medical school, did quite well in school, did great on my boards, had the opportunity to do some research and publications.

And ultimately decided that I would really go for it for dermatology knowing that likely I would be happier long term, have less risk of burnout. And get to care for, you know, grateful patients and I was lucky enough to get in and became a dermatologist. [00:03:00]

Dr. Kay: That's a great starting story. As the universe sent you a fortune cookie, you can't even pay attention to that.

So now you specialize in dermatologic surgery, skin cancer surgery, kind of facial reconstructive, more of the complex medical derm.

Dr. Dustin Portella: Yeah, I do a lot of that, and uh, some things have shifted a bit over the course of my career, but have been able to build a great practice that serves patients really well.

Dr. Kay: Well, I know you're on social media a lot, and you teach people, and you kind of debunk all of these myths that are going on in TikTok. It's kind of super frustrating to see people talking trash. And on, on the gram and on TikTok, what's one skincare mistake Or myths that you hear people propagating over and over.

Dr. Dustin Portella: The thing that always comes up every year is probably people that are concerned about sunscreen as being toxic or being the cause of skin cancer. And this is just a never ending battle when it comes to social media and educating that sunscreen is [00:04:00] very important for the long term health of our skin.

And unless you're just going to wear long sleeves and wide brimmed hats all the time, but that it is one of the best things you can do to prevent. Aging of the skin and decrease your risk of skin cancer and that is probably the most common myth that we battle on social media as dermatologists and Plastic surgeons or anybody that really takes an interest in skin.

Dr. Kay: I totally agree. Have you? Tried any of the TikTok trends yourself? Like, do you do slugging? Are you using snail mucin? Um, what are your favorite trends that you think have some value?

Dr. Dustin Portella: Yeah, I have definitely tried the snail mucin. The brand is COSRX that I have used. I like it. It's not something that I regularly work into my routine.

I do do slugging once in a while. Particularly over the winter. Cause I have a little bit drier skin and, um, use, you know, several different products actually just recorded a YouTube video about slugging today. So, uh, that's probably the trend that I do [00:05:00] participate in the most, but most of them I have not tried because at face value, they just don't make sense to me.

Dr. Kay: And slugging is kind of this process of layering on a moisturizer and then using an occlusive petroleum type of. Jelly or something that kind of lock it in. Right? What's your favorite combo of products with that?

Dr. Dustin Portella: So I recently did a co2 laser on myself and that's when I really, you know Get into slugging as every every year I do kind of a lighter version of a co2 laser on me And so I love to put on Ciclophate or cicaplast so either from a Venn or from La Roche Posay a real thick moisturizer and then I follow that up In slugging with a product called, um, Dr.

Rogers restore healing balm. So it's petrolatum free it's castor oil, castor wax, and glycerin. And it, it just feels great on the skin and actually helps hydrate rather than just occlude.

Dr. Kay: Okay. So I'll have to try that one. Um, what advice would you give a person that wants to go see a dermatologist? Like, how [00:06:00] do you know someone's really doing cutting edge advanced derm versus, okay, they graduated 30 years ago, they learned.

Stuff from 1970 and nothing's changed in their practice since then.

Dr. Dustin Portella: Yeah, there's a few different things you can look into. One, you want to make sure the person you're seeing is board certified. Not everybody maintains their certification. You can look on their practice website and many people will publish on their practice profile if they have been doing publications.

And that's something that I've tried to keep up on is continuing to work with researchers and publish. And so if they are still publishing, that means they're more likely to be doing. You know, things to keep themselves on the cutting edge. And you can also see what other activities they're involved in through social media.

Almost everybody is going to have an Instagram profile now. And is it just marketing and trying to sell you creams and lotions, or are they actually talking about new advances in the field? And unfortunately, you know, despite all [00:07:00] that, you can still go in and not have a great experience with somebody.

And that could be, maybe they're not keeping up or just a personality difference. So you do have to do some homework and I still think word of mouth recommendations from your friends and your family. are really valuable when it comes to picking a physician.

Dr. Kay: True, true. And, um, for skincare, is there any must have ingredients or regimen that you think people really, if you want to be simple, are there a few must haves besides sunscreen that you've got to have in your regimen?

Dr. Dustin Portella: Yeah, I frequently talk about this on social media, but if you are an adult now, this may not always be applicable to teenagers, but if you're an adult, you're concerned with aging of the skin. I do try to keep it simple, but the essentials in my mind are a gentle cleanser to use once or twice a day. I love to recommend an antioxidant in the morning, and that's most commonly going to be a vitamin C serum of some kind, but there's lots of great antioxidants that you can pick from.

And then your sunscreen, and I usually pick a [00:08:00] sunscreen that moisturizes the skin a bit so I don't have to have another product. And then at night time, you're gonna wash your face, wait till you're dry, and then use a retinol. Whether that's a prescription retinoid medication, or a high quality retinol that you get over the counter, or a physician dispensed retinol.

And then a moisturizer. And I think that really covers the basics for most people. It's going to give you, you know, 90 percent of what your skin needs from an anti aging perspective. And then if you want to start spending money on neck creams or eye creams or, you know, plumping creams, whatever, you're going to pay more money.

And I think it's kind of diminishing returns. That's not to say that these products aren't valuable, but the amount of improvement that you're going to see is probably going to be less than just sticking with the basics, that antioxidant, sunscreen, and retinol.

Dr. Kay: Totally agree. Um, retinol itself is its own little controversy.

What are your, you know, tips and words of wisdom regarding so many different versions of retin A? Is it retin A, retinol, retinaldehyde? Where [00:09:00] do you like to start patients? And then where do you go?

Dr. Dustin Portella: Yeah.

Dr. Kay: The best place.

Dr. Dustin Portella: Yeah, from an over the counter perspective, um, well, I think it's important for people to know that a retinol is not biologically active when you put it on.

It actually has to be converted into retinoic acid through the, the machinery in your cells. And not everybody is going to convert the same amount and how much is actually going to be active can vary widely from product to product and person to person. So if you want something that is biologically active over the counter, Uh, Adapalene is a great option.

It used to be prescription. It is a retinoic, it does hit the retinoic acid receptors. The other one that I use over the counter is from SkinBetter. It's their Alpharet and it is a retinoic acid. It actually is not a prescription, although it is retinoic acid, just like your Tretinoin. And so that is a really great option.

And then after that, we, in our clinic, we prescribe a lot of tretinoin. We use some [00:10:00] tizaratine. Uh, there's lots of newer options when it comes to retinol now. So if you want something that I, I think is more likely to be effective, start with adapalene or Skin Better Alpha Ret, and then get into the prescriptions.

Dr. Kay: I think that's perfect. Um, I think are you giving your patients tips and tricks as far as avoiding irritation, dryness, peeling, and like what's the best approach to get gradual improvements?

Dr. Dustin Portella: Yeah, it's not a bad idea for many people, unless you're just really oily skin to start with every other day use, or even every third day.

And if you are, you just don't want to use too much. We all have this idea that a little is good. A lot must be better. So really stick with that chocolate chip sized amount to cover the whole face or a pea sized amount. And I tell my patients. Wash your face and then pat it dry. You want to make sure your skin is dry.

Applying a retinol on wet skin is more likely to irritate and then just dot your forehead, chin, cheeks, and [00:11:00] nose, rub that in and follow it with a moisturizer starting every other or every third day and gradually building up to daily use. If that's still irritating for you, you can do the retinol sandwich method.

That's another trend from social media where you moisturize first, put on your retinol and then moisturize again. And that will dilute your product efficacy just a little bit, but it's better to use a retinol that you can tolerate and use it more consistently than to use something that causes irritation that you can only use once a week, in my opinion.

Dr. Kay: I totally agree. Um, there are some game changing new things coming out in DERM and I'd love to dive a little deeper into exosome based skincare and secretome based skincare or anything that you think is trending. Um, can you talk a little bit about, are you using exosomes in your practice? What are your thoughts on that?

Dr. Dustin Portella: Yeah, we're not using exosomes yet. It seems, um, that some of that has been murky, whether FDA is clearing all of those products that are becoming commercially [00:12:00] available, what is the source of them, are they, you know, actually going to be biologically active in the skin. I think that this is going to be a much bigger part of skin care.

Um, so right now, if somebody wants to do something a little extra where I'm often recommending peptides, cause I think there's a lot of great peptides available on the market that act as signaling molecules to kind of program your cells to do something different, to build more collagen or to fight antioxidants in novel ways.

Dr. Kay: Yeah. But I

Dr. Dustin Portella: think exosomes and secretosomes, they're, they're going to become more widely used as we get. broader adoption as we get more approvals from the FDA. Uh, but I'm not quite going there yet with my patients.

Dr. Kay: Interesting. Um, we'll talk about peptides then. I'm a huge peptide fan. What are some amazing peptides for the skin and how, why do they transform the skin?

Dr. Dustin Portella: So peptides, you can think of them as kind of signaling molecules and there's actually different classes of peptides. Some are going to be signaling molecules that tell [00:13:00] your cells. To do something and most commonly that's going to be, um, building collagen. So it's going to help activate those cellular processes and pathways that build collagen, because just like everything else, whether it's muscle growth, as we age, everything tends to slow down and we break down things a lot better than we build them up once we, you know, get over the age of 30, 40, 50.

So, uh, Metrixyl is a really good peptide. That's pretty commonly used now that is a signaling molecule that helps. Teach your body to, to, um, build more collagen. The other one that I most commonly see used is, um, is Argyroline. Argyroline is a peptide and it's actually going to inhibit the, the neurons that tell the muscles to fire.

So some people will call this Botox in a bottle where it limits the nerve transmission to the muscles. And it's supposed to help on fine lines and wrinkles. It is not nearly as effective as Botox, it has to be used [00:14:00] very consistently. But I do think that it has some benefit when used consistently if you're trying to avoid, you know, the needle of Botox.

Dr. Kay: Mm hmm. Are there, what are some specific brands that have those peptides in case listeners wanted to try them?

Dr. Dustin Portella: The brand that I'm most familiar with is called Depology, and they actually have a duo, they have a Matrixyl and an Argireline that are meant to be used in combination. Um, I, I've liked them, I've used those products personally.

I know there's many other brands that also have. Those peptides in them, but Depology is the one, and I have no conflict of interest, no financial relationship with them. I did do one branded partnership with them in the past, but no, no further incentive for me to recommend them other than I've personally used the products and been happy with them.

Dr. Kay: Oh, good. Um, I think skin is like such a reflection of your internal wellness. You know, it's our biggest organ. It's reflects your GI tract function and your brain function. They, it's all tied in as neuroectoderm. Can you explain kind of your Thoughts on how skincare fits into [00:15:00] the overall bigger picture of longevity or your skin as a reflection of your inner wellness?

Dr. Dustin Portella: Yeah, and this is something I think is unappreciated by many people but our skin, you know does So many functions for us, but it's also influenced by what's going on inside the body and we see specific problems on the skin in people who have liver disease, who have kidney disease, who have obesity or cardiovascular disease.

The skin can almost serve as a window and I remember recently seeing a patient who was fairly young and he had really prominent Earlobe creases, this diagonal earlobe crease, and we call that Frank sign. And it's not a highly specific, you know, indicator of cardiovascular disease, but this patient was a little bit overweight, kind of that barrel chested look, and I asked him if there was any history of heart disease in his family.

And he said, yeah, there's, you know, a lot of people have had heart attacks. And I said, well, this is not, you know, I'm not trying to alarm you, but. The fact that you're fairly young still and you have these [00:16:00] prominent earlobe creases, I think this would warrant a conversation with your primary care doctor on your cardiovascular health.

And this was not something that was really on his radar.

Dr. Kay: Just

Dr. Dustin Portella: yesterday I had a patient who was morbidly obese. And has very bad psoriasis. We know that all the extra visceral fat can be inflammatory. It is a hormone producing organ. And that inflammation was contributing to this really hard to control psoriasis for him.

And so, it, it all Is, you know, kind of a window to the internal health of the body. And I do talk about that a lot, both on social media and with my patients in person on their sleep quality, their nutrition, their exercise habits, how we can use those things to lower our insulin levels, to lower our glucose levels in the body and how that's going to.

impact the skin and glycation products and all these different pathways. And I find that very rewarding. And many patients are very surprised to have a dermatologist address those things with them when sometimes their family [00:17:00] doc isn't even addressing those things with them.

Dr. Kay: Yeah, I, I, I agree with you. I think, um, It's you've seen in your own self that after periods of stress, you break out, you know, your skin kind of gets dullness when you're not taking care of yourself and you're not hydrating, et cetera.

Um, I've been using red light therapy. I think that's such a game changer and I recommend for our patients. We use it in office. Are you doing any kind of red light, blue light treatments? What are your thoughts on the. Light in the skin.

Dr. Dustin Portella: Yeah. I do like red light quite a bit. Um, there's obviously a ton of different products you can get.

I generally recommend getting, you know, don't, don't buy the cheapest thing you can find over the counter, but you don't necessarily have to buy the most expensive thing either. The. Biggest part about red light I think is consistency with use. It is something you have to be committed to because doing this, you know, once a week or a couple times a month is not going to make significant changes in your skin.

But if you are going to get into it, set aside that time in your self care routine to [00:18:00] use the red light therapy on a daily basis, um, or every other day at the least. So that you can get the anti inflammatory benefit. You can get the mitochondrial stimulation. You can get the collagen production because it's low, low level light therapy.

I do red light therapy consistently at home. I have a full body panel that I stand in front of at night. I usually do sauna and then I do red light therapy before bed and I sleep like a baby.

Dr. Kay: Yeah, I think it's so beneficial. What's kind of the mechanism of how the red light helps. Skin to transform or what actually what benefits can actually create for you?

Dr. Dustin Portella: Yeah, my understanding and maybe you have more insight than I do is that it does stimulate mitochondrial function Which is the powerhouse of the cell which is going to help you be more efficient about Um, using the energy that is provided to your cells. And that's just one of those other things that as we age, it becomes less efficient.

You can supplement that with, uh, vitamin supplements like [00:19:00] coenzyme. Q10 is, is another thing that can help your mitochondria. Uh, the red light therapy has some anti inflammatory benefits. So if you. have rosacea and your skin is very inflamed and you have a broken skin barrier. I recommend red light therapy for a lot of my rosacea patients.

Uh, blue light therapy. I recommend for more of my acne patients because it has activity against the, uh, acute bacterium acne bacteria that is contributing to acne. And so those are some of the mechanisms that I'm familiar with and why I recommend it to patients.

Dr. Kay: Nice. I've also read a recent study that talked about how it's beneficial for hair because It improves endothelial nitric oxide production, and then that helps with blocking conversion of dihydrotestosterone to testosterone that makes hair thin out.

So like for red light caps, that's another mechanism of how it's helping. So I think it's great for circulation and sauna, like you mentioned, sauna, how does that help the skin?

Dr. Dustin Portella: Yeah.

Dr. Kay: People [00:20:00] should be doing sauna in their longevity regimen.

Dr. Dustin Portella: Yeah. So the sauna has been pretty extensively studied in Europe, particularly Finland, where almost everybody has a dry sauna in their home.

Those traditional heat coils with the rocks, you can pour water on it. And they've shown. That in, in population studies, people that use a sauna two times a week have about a 20 percent reduction in all cause mortality. So that includes dementia, cardiovascular, cancer. If you're using it four to seven times a week, it's up to a 40 percent reduction in all cause mortality.

So this is activating heat shock proteins when your body is stressed. It's good for us to be stressed sometimes, not the chaos of life. You know, where you got too many deadlines and you've overcommitted yourself, not that kind of stress, but metabolically or physiologically stressing your body intentionally through, um, heat exposure activates these heat shock proteins that help to clean up bad cells [00:21:00] that help improve our cellular metabolism and processes.

And that impacts us internally, lowering inflammation. That reflects on the skin as well. So that is something that, that I do in my practice and I recommend it to patients. Now, a lot of people have extrapolated that data from the finished studies into infrared sauna, and I do like infrared sauna. I think that it's beneficial, but I don't know that we can necessarily make the leap that all of the same benefits apply.

I think they work a little different and probably have different benefits.

Dr. Kay: And by that same token, what about cryotherapy? These same people that are in Europe are also jumping in like polar bears into icy cold. Do you, do you do cryo or do you think that that's helpful to skin or is it too much of a shock for skin?

Dr. Dustin Portella: You know, I don't think that it necessarily negatively impacts your skin too much. Um, it's super uncomfortable. Uh, I do do it. I have a cold plunge at my house. And for me, there are, of [00:22:00] course, physiologic reactions that happen with cold exposure. You're going to get a big jump in your epinephrine, norepinephrine, dopamine, when you get out because your body's happy that you're not freezing anymore and you feel great afterwards.

The biggest benefits that I've seen personally when it comes to intentional cold exposure is just the mental resiliency of it, just doing something hard and kind of building that. Mental muscle that you can do hard things and that for me translates into being able to buckle down and get work done or, you know, dealing with other stresses that come up in life because I've been able to put myself through something challenging on a consistent basis.

And when we're growing up. You know, we do more hard things. We're involved in sports and things, but a lot of adults, we don't necessarily challenge ourselves in those ways. We don't compete like we used to as kids. And we're not necessarily, we're just so used to being comfortable that I think that there's value in intentionally becoming uncomfortable and maintaining that kind of [00:23:00] mental toughness.

Dr. Kay: I think we seek comfort. We almost like insulate ourselves from any variability and your, your body craves a little bit of variability. Um, I am a big fan of taking some supplements for cellular health and metabolic health. What about you? Are you taking a regimen that you can share with our listeners?

That's what you recommend for longevity profile management.

Dr. Dustin Portella: Yeah, I, um, there's a few things that I take more consistently. So in the morning times, I often take DHEA, um, and vitamin D just to help, you know, um, make sure my body has the pro hormones and things to build growth hormone, testosterone. I take fish oil.

I take an. A thousand milligrams of EPA consistently, um, that's the most heart healthy form of fish oil. And then, um, I do have a prescription, uh, and I take on a weekly basis rapamycin. Wow, really? I think there's some interesting data on that. Um, [00:24:00] obviously.

Dr. Kay: What dose? I gotta hear all the details.

Dr. Dustin Portella: Yeah, so I take six milligrams once a week.

Dr. Kay: Okay. And,

Dr. Dustin Portella: um, really don't, you know, feel any different on that. Uh, you know, anecdotally I could say that if I, over the holidays, you know, I've been taking this and eat worse over the holidays because there's so much stuff. And I didn't have the typical, like, waking up feeling inflamed and stiff and sore like I normally would.

But I don't know if That's because metabolically I've, you know, I'm healthier overall. I've been working out more or if it's the rapamycin necessarily. So, and that one is, that's a whole different conversation. You can't just buy that over the counter. You need to have a conversation with the doctor.

There are risks to it, but that's kind of the regimen that I've got myself on.

Dr. Kay: Nice. Just that. Nothing else.

Dr. Dustin Portella: Yeah. I've, uh, intermittently I'll take stuff, but not, I'm just not consistently taking it.

Dr. Kay: You just go right for the big gun.

Dr. Dustin Portella: Yeah.

Dr. Kay: Interesting. Okay. So no other antioxidants, no resveratrol, NAD.[00:25:00]

Glutathione, nothing else like that.

Dr. Dustin Portella: Yeah, I just haven't worked that in yet. Um, some of them I have, but I, I, for whatever reason, I just don't get them taken as consistently as the others. But I, I think the, you know, the data and the benefits are really good there. It just hasn't really worked its way into my daily routine yet.

Dr. Kay: Interesting. Okay. Um, are there any other practices that you're recommending in your, in for patients like to do micro needling with, are you using college and stimulators? Um, what are the things we can do to get the skin foundation and the college and to be really strong and good and not become thinned and atrophy.

Dr. Dustin Portella: Yeah, there's a number of procedures that we offer in the office. And for anybody seeking these procedures, they're very beneficial. But you also want to make sure that you're optimizing your body metabolically. You can't rely on a laser or microneedling to make you look young forever if you're eating a poor diet, if you're not getting sufficient sleep, and if you're not physically [00:26:00] active.

Ultimately, you will not win that battle. So, If you're doing those other things in your lifestyle, I think micro needling is a great option. Causing those micro injuries stimulates collagen growth. We do the same thing with CO2 laser or Erbium laser in our practice. And we often will combine that with PRP, which is the platelet rich plasma.

And the growth factors that come along with that, putting that on the skin afterwards. We've recently, um, trialed, but haven't widely recommended. The buzzword on social media is the Salmon Sperm Facial. I don't know if you're using it in your practice, but we've used it on one patient and been very happy with those results.

Dr. Kay: Yeah, polynucleotides, the PDRN derivatives that are in the salmon sperm. There's not a whole lot of science published on the controlled randomized studies, but it does anecdotally seem to be like something that really gives some vitality to the skin. Patients are liking it so far. [00:27:00] Yeah. Um, yeah, I'm, I'm a fan of trying new things, but I also do look real carefully at the research that's out there and make sure I think that they're scientifically sound.

Yeah. There's so much hitting us in, in aesthetics and dermatology all every week there's a new product.

Dr. Dustin Portella: Yeah. Yeah, there really is. And a lot of companies are getting into markets to make a quick buck. So I think it's important, like you said, to dive into the research and look at, is it sound? Are they actually doing controlled studies?

And are we seeing those benefits in the studies and then in our clinical experience?

Dr. Kay: Yeah, it's a fine line because I think if we wait for drugs to come through pharma approved and be tested and Trialed everything cost 20 million dollars and it's innovative companies that have ideas that are scientifically sound May not ever get through the FDA for those things.

Yeah, it's interesting that we can You know, try them at least at some level. Um, one of the things I know that I think about frequently is the amount of preservatives and [00:28:00] junk that's in our skincare. And I was listening to another guy, a podcast recently where they talked to a toxicologist talked about the average woman putting on 12 different skincare products on her skin.

By the time she left the house and got to work, she had already applied 12 different ingredients. And each skincare item of course, is chock full of colors. preservatives, shelf stabilizers, and like the amount of preservatives and things we put into our skin. I don't know if we consider that enough. I don't, what are your thoughts on that?

So for women, it was, they were playing at least 12 things and also for, um, adolescence and for men, it was like four men don't put many things on, but do you think that these toxins and preservatives and chemicals are affecting us? Or microplastics, actually.

Dr. Dustin Portella: Yeah, I, I think there's probably an effect and this is an area where it's just very difficult to get solid data.

Now, a lot of times we can take an ingredient and we see that it has an effect in, [00:29:00] in the laboratory in mice or rats, for example. But when you dive into it, they're using it at doses that are thousands of times higher than we're exposed to in humans. But then you ask the question, well, if you're getting a low level exposure over 30 years, what's Is that clinically significant or is that having an impact on our hormones?

And I think that there are certain things that are potentially more damaging than others. But in many cases, there's also fear mongering around an ingredient based on data that doesn't really translate to humans. Overall, I do think keeping your lifestyle, like your diet, you know, the fewer hands that touch the food before it gets to you.

I think that's a good idea. Less processing, fewer skincare products to accomplish the same thing. You don't need to jump on every trend that comes on social media. And I think it's something we need to be conscious of. I'm very open to changing my mind on any product if the data comes out and says, this could be more concerning, [00:30:00] but on many of those things.

It's a leap right now to say it's absolutely toxic and we have to take this out. And we've certainly seen examples of companies that are pulling parabens from products and putting in other, um, you know, preservatives and stabilizers that cause way more allergic reactions on the skin. So there is a trade off on some of these things.

And I'm really excited to learn more about it as more studies are done. But it's, uh, something we have to be careful of for sure.

Dr. Kay: How much information is out there on makeup and skin? Like, we are slathering so much on our skin every day and, um, YouTubers keep teaching us to put more and more layers. And I just wonder how it could possibly be healthy for the skin to congest and clog the pores and put colorants and dyes

Dr. Dustin Portella: and,

Dr. Kay: you know, layers of product on there.

Dr. Dustin Portella: Yeah. And it, I mean, it speaks to the other aspect of just our, you know, mental health as well, that so many people feel like they need to do this in order to be accepted [00:31:00] by society. And I think that, you know, maybe that's where the shift needs to happen is that we need to all be more accepting of ourselves and of other people to go out, you know, bare faced or to use fewer products.

Dr. Kay: Yeah. It's super interesting. I wish that, uh, dermatology would dive a little deeper into that and make it socially and scientifically the right thing to do to put less layers of crap on your skin. I mean, I know it's been done since Cleopatra's time. We women have been wearing makeup for decades, but I'm just curious if there was scientific rationale beneath of, you know, Around the fact that maybe we shouldn't congest and clog our pores or layer on, um, red dyes and things like that.

Dr. Dustin Portella: Mm hmm. Yeah, I would like to see less of that. Um, I'd certainly like to see less of it when people are coming in for their skin exams because it's really hard to do an exam when they've got six layers of makeup on their face.

Dr. Kay: Yeah, and that makeup doesn't budge.

Dr. Dustin Portella: No.

Dr. Kay: It's like, really stays on. Well, tell me [00:32:00] what you think, um, emerging trends may be, the technologies or innovations that you're super excited about that you see coming.

Dr. Dustin Portella: Yeah, I, I would love to say that I see it coming, but the FDA keeps teasing us and then doesn't deliver, and that is, better sunscreen filters. We have a lot more options in Japanese and Korean market. And even in the UK and Europe where we have filters that are probably safer on the skin and for our metabolic health and do a better job protecting us from especially those higher UVA ranges.

Now the FDA has a, uh, a new one that they're investigating the Parsol, which. They're saying might not come in approval until spring of 2026. It's been over 20 years since we've had a new sunscreen filter. So I would like to see the FDA move on that more quickly. Um, you know, I. I think it's a little funny, obviously COVID and developing a vaccine was a very different [00:33:00] situation and we had a need for that in society, but they approved that so quickly and yet we've waited 20 years for a sunscreen filter.

So I would like to see more sunscreen filters be introduced into the U. S. market. Again, I think peptides are going to continue to be an emerging trend, um, exosomes in the office and then eventually will those become, you know, something you can get and use over the counter. So I think that there's a lot of, a lot of opportunity in, in that.

And then supplements, things like the NAD, the NMR, I'd like to see the way that those start to impact our metabolic health as the costs come down, as more people adopt them and we get more research on them.

Dr. Kay: How about gene therapies for skin problems? Do we see that coming anytime soon?

Dr. Dustin Portella: Yeah, there's a few gene epidermolysis bullosa where these people, they just don't make the proteins that keep their skin cells together and they get huge blisters.

So we are seeing some early gene [00:34:00] therapies there, but it's such a rare problem that, um, you know, it's not necessarily being translated widely, but I do think that we will see an explosion of that over the next 10 years. One thing that I'd really like to see that I know companies are working on Is we are seeing a patient for psoriasis, for example, and it's classic psoriasis and there are a dozen different biologic medications that I can choose from to treat that if we can't get it under control with topicals or light therapy, but sometimes I'll pick one that costs 80, 000 a year and it doesn't work for them and then we have to switch to a different one.

And then that one works. And I think that we're not too far away from being able to do a tape test on the skin, send in a few skin cells, and the lab can tell us which inflammatory marker is driving their psoriasis. So we can pick the right medication the first time, limit the cost of prior authorizations and of a medicine that doesn't work.

So I think [00:35:00] that will. That will be something I'm excited about as a dermatologist, but so many of these things, I think, could be better addressed earlier on with better lifestyle.

Dr. Kay: I think that, um, people are discovering that for themselves to like changing diet, changing gut microbiome can really impact the skin.

And some of these chronic diseases that traditionally are just medically treated, right? Yeah. Yeah.

Dr. Dustin Portella: The gut and the skin microbiome. That's. It's going to be another area that I think is really huge. Um, it's obviously important. We know it, but we just don't have a lot of precision medicine when it comes to that right now.

How to specifically tweak it to accomplish a result, and uh, that's something that I, I'm very excited about.

Dr. Kay: Mm hmm. It's almost like we need to look at the genetic profile of the eczema sufferers, and then the psoriasis sufferers, and then like see which exactly, as you said, which inflammatory genes and markers are turned on in each of those categories.

Um, And then correlate that with their gut microbiome. That would be so interesting. [00:36:00] Well, I think this has just been fascinating. You're such a great resource for skin and skin knowledge. Um, you mentioned that you go around the country and then you have an, is it an RV or an Airstream or what is it that you're driving?

Yeah,

Dr. Dustin Portella: we've got, um, you know, a great big 39 foot motor home. That's been converted into a mobile clinic. And we go out and do charitable care to uninsured patients, homeless population, um, and then a lot of free community skin cancer screenings.

Dr. Kay: That's excellent. And do you do that every year, every summer?

Are you going out pretty regularly?

Dr. Dustin Portella: Yeah, we did six events in 2024. We want to double that this year, do more events and just get to more areas. One of the challenges is, of course, the time and then licensure. You have to be licensed in every state you want to go to and that's such a laborious process.

Dr. Kay: And

Dr. Dustin Portella: so we're doing a lot of that work in Idaho. We'll start going into Utah this year where I'm also licensed and then hopefully grow [00:37:00] beyond that. But we use this as an opportunity to deliver care to individuals who might not get it otherwise. And then when consent is given, it's never, you know, a condition for getting treatment.

But if somebody will allow us to use their story to teach about their condition, we have the potential to reach a much broader audience and help educate and elevate the health of many more people who might have eczema psoriasis or rare skin disease.

Dr. Kay: I agree. That's such a great mission. Um, and you're starting a podcast coming up pretty soon.

What are you going to talk about on that podcast? All about skin, I assume.

Dr. Dustin Portella: Yeah. So, um, the podcast is called Skin Fluence. It'll be launching, um, likely in February and it's going to be largely skin focused, but we are going to bring in a more comprehensive look at health and how that impacts our skin. So we're going to include lifestyle factors and mental health factors.

Which all is important to me and I try to exemplify that through, um, you know, my social [00:38:00] media and my lifestyle. So we're really excited about that. And, uh, I'm going to have guests come on there as well as have a semi regular co host to discuss these options, you know, um, topics. We're going to have a lot of fun with it.

And, uh, hopefully, you know, there'll be, um, a good audience for it.

Dr. Kay: Amazing. I can't wait. I want to be on there.

Dr. Dustin Portella: Oh, we would love to have you.

Dr. Kay: Well, Dustin, where can people find you on your social media handles if they want to reach out?

Dr. Dustin Portella: Yeah, I am on all social media platforms at DrDustinPortela, D R D U S T I N P O R T E L A.

Um, everywhere, including TikTok, at least for the next few days. We'll see if that survives.

Dr. Kay: Yes, we'll see. We're keeping our fingers crossed. We'll see. Um, well, that's it for now, beauties. Thanks so much for tuning in. And you can find me on my Instagram as beautybydrk, d r k a y, doing amazing things with people's faces.

And our website is the same as beautybydrk. com, where we have amazing skincare, [00:39:00] as well as a line of internal radiance products that help you look good from the inside out. That's it for now, guys. Stay beautiful.