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Holistic Skin Health

Link to the Episode

Anshu Bahanda: This is Anshu Bahanda on Wellness Curated. Thanks for joining me on this podcast. My mission is to empower you with health and wellness so that you can then go and empower others. Hi, Rabia. How are you?

Rabia Malik : Hi. I’m well. Thank you.

AB: So welcome again to our chat.

RM: Oh, thank you for having me.

AB: And tell us, what is wellness to you?

RM: So I think wellness to me is really looking at things; all different aspects of our life. So, for me, it’s really about physical health, but it’s also about emotional, spiritual well-being, and a big part of that is also looking good and feeling good. So, I think it’s a combination of all those things, really, for me. And I think that optimum wellness is really when you have a balance in all aspects of your life, I think. So physical health, but also emotional, internal, and feeling good about yourself. And I always feel like if you get all those aspects of life sort of to balance, then you’re going to feel your best.

AB: Yes, absolutely. Tell us a little bit about what you do, and I’ll start with asking you— why you chose not to work with injectables. You know, in our world today, where people are going out during their lunch hour and getting Botox and things like that. Why did you choose that?

RM: Yeah, I suppose I’ve ended up with a very niche practice because really… I mean, going back, I started to think about skin health and the kind of practice I wanted, about ten years ago. And at that time, there were really only injectables, but to me, what I wanted, I was 30 when I started the practice, I’m 41 now…

AB: Don’t tell us your age. We thought you were 25.

RM: You’re very kind, but no, I’m 41 and proud of it. I think that getting older is a privilege. So, for me, it was about aging well, and I wanted to be proactive with prevention and maintenance, but I didn’t necessarily want to go down the injectable route myself. And so, the focus of my practice really ended up being skin tone and texture, because ultimately, in my opinion, and in my experience over the past number of years, what really makes us look youthful is even skin tone and smooth skin texture. So having some lines from expressions, smile lines, they add to the character of your face, and I personally don’t want to take them away. I mean, for sure, I have lines around my eyes because I smile a lot, and you do get those lines from expression, but I wouldn’t want to take those away. And I think that you don’t want to lose the character in your face. So for me, it was all about tone and texture. That’s really the focus of my practice. And I started to see that as we get older, a lot of women were feeling like they needed more coverage— so foundation, makeup, but actually, that’s quite aging. So, as we get older, really, ideally, you want to be using less makeup, less foundation. And the way to feel confident with your skin and feel happy to be able to wake up in the morning, walk out the door and not put anything on— is really working on skin tone and texture. So that’s become the focus of my practice, really. 

And by default, I’ve ended up doing a lot of work with hyperpigmentation, because that’s such a common issue that comes up in my practice all the time. Particularly with South Asian skin, pigmentation is a big issue. So, I spend a lot of my time helping people deal with that. And I think that, by default, it has become a big part of my practice. And skin peels, I sort of fell into, because I’d done some training in the States and doctors in the UK don’t really work with medical grade peels so much, but in the US, they’re very widely used and they’re actually very effective, but very underrated, in my opinion. So, I sort of ended up doing a lot more of that. And I think it’s just really being guided by what people want. And in terms of the injectables, it’s not that I’m anti-injectables, it’s just that I personally feel that in today’s day, as you said, a lot of people feel it’s the first thing that they do. It’s a quick fix. And I think really, to get optimum skin health, it’s a journey and you’ve got to look after the inside. You’ve got to do all the other bits and pieces. And maybe the injectables are one piece of that, but they’re not what I focus on. But I have many patients who will get injectables with other doctors and then come and see me for their skin, and that’s totally fine. Each to their own. It’s just that because I choose not to go down that route myself, I don’t feel comfortable doing that for my patients. And I just think that there are alternatives and there are different things that you can focus on, treatments to stimulate your own collagen, and that’s really the focus of my practice. So, I think each to their own. Everyone has to decide what approach they want. And I think there’s so much out there. 

So, I’m that doctor for the people who don’t want to go down that route. And if they do want something, and I feel the only way they can achieve it is through either some botox or something like that, then I’ll refer them to one of my colleagues. So, I think you have to look at everyone as an individual. The only thing I would say is that, unfortunately, I feel people getting injectables are now starting to get them much younger. And I think that’s a shame, because I personally don’t think that’s a good thing. And I actually think you can end up aging yourself. So, some young girls in their 20s who’ve had a lot of injections end up looking the same as women in their 40s. So, I think you need to be careful. So, less is more, in my opinion.

AB: Lovely. And tell me, what is the main issue that you see, because you’re saying you do a lot in response to what your clients are looking for. What are the main skin issues you’d see that people come to you for?

RM: Look, as I said, pigmentation has become a really big part of my practice. I think partly because of the type of skin I have, and the fact that I help people with Asian skin, middle Eastern skin, and pigmentation is such a big issue for those skin types. But I think everything— from acne, to acne scarring, psoriasis, eczema, and all sorts of skin issues people are just looking for a slightly more holistic approach. So maybe they don’t want to go down the medication route or they’ve tried courses of medication, they’ve been to see their doctor, [but] they haven’t got the results that they were looking for. And so they might end up coming to see me because they want to try something a little bit different, or they want an alternative combination approach, because what I end up doing is really putting together plans for people that incorporate not only products, but also supplements and dietary changes and then treatments as well.

AB: Okay, so you mentioned acne and older people’s acne spots and acne ages…

RM: Yeah, well, I mean, look, I think adult-onset acne is becoming increasingly common, and I think there’s a lot of reasons for that. But traditionally, acne is something that we see around puberty. So, teenagers, young people, and that’s primarily hormonally driven. So you have a surge in testosterone, usually a change in the balance of hormones that leads to increased sebum production, and then you get breakouts. So, that’s one aspect— the hormonal aspect, which tends to be in younger people. But I think increasingly what’s happening is that, first of all, people’s hormone balance is being affected by lots of different environmental factors. I think there’s a lot more polycystic ovarian syndrome out there, which affects hormone levels and can also contribute to adult acne. And then I think there’s also a lot of dietary factors as well, and internal inflammation. So, I think all these things kind of contribute. So, it’s really interesting. I think that there is definitely also a genetic element, but I think there’s a lot more environmental sort of factors now that come into play. And stress is a big one. In the past year, we’ve seen so many increases in breakouts, and a lot of it is stress related because, again, stress raises your cortisol, and increased cortisol levels affect the hormone cascade. So, you end up with, again, potentially changes in your hormone balance, which can contribute to breakout. So I think there’s so much going on, and often people are just not really sure what to do about it. And I think, again, you have to go back to the root. It’s very easy to prescribe a medication, and sometimes that works in the short term, but often what happens is that the underlying issue is still there, so the acne continues until you get to the bottom of it. So, I think for me, it’s really about helping people long term to sort out the underlying issue— whether that’s a hormonal thing, whether it’s a dietary thing, or whether it’s internal inflammation, and then just giving them the right combination of products to use at home to support their skin as well.

AB: And what about acne scars? What do you prescribe for those?

RM: Yeah, so acne scars, I think the thing with acne scarring is, first of all, there’s no point doing anything in terms of treatment until you get on top of the active acne because otherwise, you’re just going to be in a cycle. So, you’ll end up with spots and then marks and scars, and then you’ll be in a cycle of treating one and then a new one comes out. So, I think the first thing is to get the active acne under control and then when you’ve stopped breaking out, if you want to address the scarring, then I think micro needling is a great in-clinic treatment, which gets great results. And I think in terms of topicals to use at home, some form of vitamin A, retinol or tretinoin really helps with skin resurfacing, so it helps improve the appearance of scars.

AB: Okay, fantastic. And tell me now, the other thing that I had lots of questions about was aging skin. So, what do you recommend for aging skin and what age should people start? How young should they start looking after their skin?

RM: So aging skin is again, you can look at it in a number of different ways. There are different things that happen to our faces as we get older, all the way from changes to the skeletons. So, bone changes, muscle changes, changes in fat composition. So, there’s lots of different levels of the aging face. But if you’re just looking at skin, I would say the number one thing that everyone can do is protect their skin from sun damage with some form of mineral based sunscreen, ideally every day, because UVA, which is what contributes to skin aging, comes through the clouds. So, even on a cloudy day in London, you’re still exposed to low level UVA. So, I think, you know, number one is to protect your skin. And then I think that the next thing I would say is, you know, protect your collagen. So, our collagen levels start to decrease from the age of about 25— definitely from 30 onwards, but [in our] early to mid-20s, we start to see a decline in collagen production. So, maintaining collagen in the skin with the right topical ingredients. So, things like vitamin C, which is an antioxidant, but is also a precursor for collagen. So, having some form of vitamin C in your skincare in the morning will really help. And then some form of retinol at night, definitely from the age of about 30-35 onwards, depending on your skin type, I think really helps. And then there are some really interesting new peptides that are coming out which help stimulate collagen and that’s something that I’ve been really interested in and have incorporated into the products that I’m going to be launching in the next month or so. I think that there are some really interesting new active ingredients that can contribute to collagen production as well.

AB: Okay, that sounds amazing, actually. The new peptides sound really interesting.

RM: Yeah, some of them have actually been around for a long time, but the peptides that I’m actually bringing into my product range, I’ve been working with in clinics for many years, but we didn’t really have good retail products, we didn’t have anything to give to people to buy or use at home. So yeah, I’m very happy to be able to bring that into a home care range. Because I think… particularly after the past year of COVID and who knows what the future holds in terms of in-clinic treatments, but I think that’s what people want. They want effective products that they can use at home and really get the result…

AB: …that they’re in control of rather than always having to go to somebody.

RM: Yes, totally.

AB: And what about… the other area that people ask a lot about is the area around the eyes.

RM: Yes.

AB:  Because even for young people, that’s very delicate. You see, sometimes it’s quite damaged.

RM: Yeah, totally. And again, I think sun protection is a big thing. So, I think wearing sunglasses when you’re in prolonged sort of sun exposure, if you’re out all day, if you’re exercising outside, then you do want to protect your skin. So, sunglasses, sunscreen are really important. But then, I think eye creams are controversial because you don’t necessarily always need a separate eye cream, it really depends on the formulation. But again, you want to be using the right active ingredients at the right concentrations. And I think if a product is well formulated and doesn’t have any potentially irritating ingredients, then you should be able to use it around the eye area. But obviously always check first if it’s a formulation that you can do that with. But again, some form of vitamin C in the morning, and some form of retinol and vitamin A at night will help support the eye area. And there are some really concentrated eye treatments as well that I recommend. There’s a few eye products that I really like. There’s one called Opti Crystal by Cosmedix, and there’s another really concentrated one that you can only get from doctors called Eye Doctor. So, that’s one that we prescribe for people as well. And then I do a lot of eye peels to really help with under eye darkness. And they give great results. So, I think they do work. You need to be consistent and you need to have a routine. 

AB: Okay. And tell us. I love that you sort of have a more holistic approach to it. So, what are the new, exciting scientific discoveries that you’ve come across recently in skin health?

RM: So, I think what’s interesting is, like I said, there’s always new and interesting active ingredients. I think various growth factors, stem cells, peptides, there’s always new combinations coming onto the market, which I think are really interesting. I think it takes time to see how they perform because you don’t always have the studies, but it takes time to kind of see what the outcomes will be when you use them in a clinic or in a product. But there are really interesting formulation developments. I think that there’s some new forms of vitamin A coming onto the market which are a lot less irritating than previous formulations. So, that’s really exciting. And I think there’s also really interesting online skin analysis tools, augmented reality things where you take a selfie and there’ll be some sort of computer program that will scan and then give you advice based on the outcome. So yeah, I think there’s a lot of that sort of thing that’s going to come onto the market and I think there’s a lot of technological advancement in terms of at-home devices as well. Because as I mentioned, I think there’s a lot more demand for tools, devices, things people can use effectively at home. So, I think we’re going to be seeing a lot more of that as well.

AB: When you’re talking about at-home devices— anything that’s really state-of-the-art, which has come out that maybe a lot of people won’t know about— you recommend in terms of a device?

RM:  I think that there’s nothing that is so new per se, but I think that there are forms now that bring some of the technologies into people’s homes more easily. So, LED light, there’s now a lot of masks that are much more accessible. They used to be really only available in clinics and they were very expensive and not necessarily so easy to use. But I think now there are great at-home options. I think that there’s even at-home micro needling devices. And in fact, I’ve just done a little guide to at home tools and treatment.

AB: That’s lovely. So given that we want to empower everyone with health and wellness and obviously you feel like that as well, and that’s one of the reasons you’ve chosen not to do stuff that you don’t do yourself, which is creditable. So tell me, what is your last advice to our followers?

RM: So, I think less is more. Be consistent and find a skin expert or someone whose approach you really believe in and who you trust, and stick with them. Because I think what ends up happening often is that people get really confused and they kind of come across one opinion here and then something else over there. They don’t know who to listen to. And so, I always say just find somebody whose approach really resonates with you, because at the end of the day, we’re all different. We all have slightly different approaches, and we all have a slightly different focus. So I think you just need to find someone who you connect with and then really stick to their regime or to what they recommend, because then you’ll really see results.

AB: That’s wonderful. Do laser facials work for everyone?

RM: I don’t think they work for everyone. I think it really depends on your skin type. I think they can be good for some people, but you really need to know what laser is being used and the settings that it’s being used at, because not all lasers and not all settings are suitable for all skin types. So, I think you really need to go somewhere where you trust that they know what they’re doing and they also understand your skin type. Because laser for some skin types, even like my skin, so South Asian skin, I’ve had pigmentation from laser as a response to that. And that’s going to someone who really should know exactly what they’re doing and you can still end up with issues because our skin is just prone to putting down melanin. So, I think you need to be really careful, particularly if you have Middle Eastern or Asian skin.

AB: Okay, what would you suggest for pigmentation?

RM: Okay, so pigmentation is a huge subject, which we could probably talk for as a separate thing. But very briefly, what I would say is, first of all, for many people, pigmentation is a lifelong chronic issue. So, there’s no cure. It’s about managing it. And the way to manage it is to limit your exposure to the sun, which is usually the main trigger, and also to look at the hormonal levels, because changes in hormone balance, again, can be a very big contributing factor. So, for a lot of people, they have pigmentation issues around pregnancy or around menopause, because that combination of the change in internal hormone levels as well as exposure to UV is like a recipe for pigmentation. So, people really need to understand what the contributing factors are and then manage their exposure to those. And then you need to support your internal health by increasing your antioxidant intake. So, you then need to have the right product, the right supplements, and the right treatment. And then it’s a chronic and a maintenance regime. So you never kind of think of pigmentation as, okay, that’s it. I’m doing a treatment and it’s gone forever. Usually, what happens is you can get it to go away, but the minute you’re out in the sun or by the time summer arrives again, often what happens is it comes back, so you’re constantly managing it. So, in terms of my top takeaways, I would say vitamin C is like the easiest and probably one of the most effective things to incorporate. So liposomal vitamin C as a supplement— so an oral supplement and then some form of vitamin C topically— so on your skin. And then I work with peels to really help with pigmentation management, and we get great results. So find someone who really understands pigmentation and can do very customized peels, because again, you don’t want to be too aggressive because then you can cause more pigmentation. So, it’s getting the balance right. But in terms of the easy things, I would say start taking a liposomal vitamin C supplement and start using vitamin C on your skin. Start with that. And I would avoid hydroquinone because hydroquinone often leads to rebound pigmentation. And what that means is that initially you’ll get some improvement, but when you stop using it, often the pigmentation all comes back. So it’s not a long term solution in my experience.

AB: Okay, and what about eyebags?

RM: Okay, so again, the definitive solution for eyebags is surgical. I wouldn’t say to you that any sort of non-invasive treatments are really going to work, because what an eye bag is— is the movement of a fat pad. So, it’s an anatomical change in the face. So, that’s the ultimate solution. But there are some non-invasive things that can help. So, for example, the Plexr treatment that I mentioned can help. Some types of lasers can help. I find that the eye peels that I do work more for discoloration, they’re not really going to help with eye bags, but they can certainly help with improving the appearance of the undereye area. But the only real definitive solution is surgical. 

AB: Okay. And I’m going to ask you two very quick questions. One is, is Obagi good? I don’t know what Obagi is?

RM: Look, it’s a medical grade skincare range prescribed by doctors, developed by a doctor called Obagi in the States about 30 years ago. And it was a great medical skincare line, particularly when it launched. It was probably the first of its kind. I’ve worked with it over the years, and I think it had its place. My personal opinion is that technology has moved on. We now have access to newer formulations, newer active ingredients. And in my opinion, Obagi is a very aggressive range, which I personally, I think that there are other less aggressive approaches which are actually just as effective in the long term. So, I am personally not a huge fan of it because it’s not the route that I sort of go down. And I find now, because of the way people’s lifestyles are, people don’t want a lot of downtime. So something like an Obagi is very aggressive. You’ll get a lot of skin peeling, a lot of redness, and a lot of people just can’t tolerate that, it doesn’t work for them. So, I prefer things that are slightly longer term, so they might take a bit longer to get the results, but they’re going to be less aggressive and less downtime along the way.

AB: Okay, and I have a great question for you for the last question. How can you make the skin glow? I don’t know if you have a thing like a lot of people are selling at the counter.

RM: Yes, I think glowing skin is the ultimate goal, isn’t it? So, it’s what we all want. But I think of it in two ways. You can get a very quick, superficial glow by exfoliating skin. I think there’s some great enzyme-based masks. I like one called Pure Enzymes by Cosmedix. It’s on my website. I think that’s a good, very gentle but effective exfoliant. And I think that kick starts that whole skin renewal process, which contributes to glowing skin. At the end of the day, you need to get rid of the dead skin cells on the surface of the skin for skin to glow. But the ultimate glow is really from the inside. So, you need to be eating well. You need to be sleeping well. You need to be not drinking too much alcohol, but drinking plenty of water. You need to be hydrated. And if you’re doing all of those things, then your skin is really going to glow from the inside out. And I think that the ultimate glow is really when you are addressing all these different aspects. But I think the exfoliators are a good quick fix.

AB: Okay, that’s lovely. Thank you for all the advice. Take care. 

RM: It’s a pleasure. Thank you. Thanks, Anshu. bye. 

AB: Thanks for joining us. Hope you enjoyed the Wellness Curated podcast. Please subscribe and tell your friends and family about it. And here’s to you leading your best life.