The skincare secrets doctors DO want you to know: Reclaim skin health, rejuvenation and vibrance

In today’s world, skincare is largely focused on aesthetics, but what about its impact on our physical well-being?

In this episode of Health Matters, Dr. Saranya Wyles joins us to discuss the vital functions of our skin, tips for maintaining its health, and the latest advancements in skin healing and rejuvenation.

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Kristen Meinzer: This is “Health Matters,” a Mayo Clinic podcast where we discuss the latest medical advice, news, and research to help you live a happier and healthier life. 

My name is Kristen Meinzer, I’m a writer and journalist. For this episode we’re talking about skin rejuvenation! It’s hard to overstate just how critical our skin is in maintaining our overall well being. Not only is it our body’s natural barrier, keeping all of our organs and tissues (and gross body stuff) on the inside, and all of the environmental hazards on the outside, it’s also our largest sensory organ, the way we feel and touch the world around us.

It is also how we present ourselves to the world. As such, the aesthetic appearance of our skin can be an ever-present source of frustration, especially as we age and our skin gets progressively worse at doing its job. Our guest today is Dr. Saranya Wyles, a dermatologist practicing aesthetic and regenerative medicine at Mayo Clinic in Rochester, Minnesota. She’ll tell us more about our skin, how to keep it healthy, and new methods of healing and rejuvenation. Dr. Saranya Wiles, thank you so much for joining us today.

Dr. Wyles: Thank you, Kristen. I’m glad to be here.

Kristen Meinzer: Before we get to the big questions, can we just start off with one that might sound a little bit silly? What is skin? On the surface, we think we all know what it is, right? We see it in the mirror and we look down at our arms and hands and we, for the most part, most of us have skin. But what exactly is it and what purpose does it serve?

Dr. Wyles: The skin is what we wear. It’s our exterior protector. Our skin barrier helps us keep the internal organs and the external environment as two separate spaces, so that it’s essentially a protective layer. But beyond that, it also serves so many different functions. It could actually serve as a secretory organ, meaning it helps to create oils. It serves as an excretory organ, which means it’s getting rid of toxins like after a night out. Or if you’ve had some alcoholic beverages, it helps to excrete those out by sweating.

It also is a great absorptive organ, meaning it can help absorb things that we put on the skin. It’s very receptive to things like lotions and moisturizers that keep our skin barrier hydrated. It does a very important function of thermoregulation, which is helping us maintain our body’s temperature.

We do this by sweating. When we exercise, we also have different ways to keep our bodies warm with the hair follicles that surround the skin. Then finally, the most important thing I should say is its role as a sensation organ. This is the touch that we feel when we hug somebody, when we do a handshake. All of that is allowing us to sense and have that human connection. Skin does a lot of things. 

Kristen Meinzer: Wow. Then also, sadly, unfortunately, sometimes the not good sensations like, “Oh, that stove is really hot. This hurts.”

Dr. Wyles: Exactly. It can serve as warning signals. Overall, skin really helps protect us from the external environment in various different ways. 

Kristen Meinzer: Let’s get a little bit more into the different layers, shall we? I’m not just speaking metaphorically when I talk about layers here. There are actually many layers of skin. Can you walk us through those layers?

Dr. Wyles: Absolutely. I call this the cake layers of the skin. Let’s start with the top. What we have at the very top is called stratum corneum, which is basically when the skin turns over, it secretes itself off and it sloughs off. This later becomes what I call dust on the floor. We have an entirely new layer of skin every month. It helps keep our skin young and renewed. That’s the top layer. The next layer is in the epidermis. This is the layer that’s actively turning over. This layer includes keratinocytes and melanocytes. Melanocytes are important because they help produce something called melanin. Melanin does a lot of great things for our skin. Everything from keeping our skin tinted so that we can defray any UV damage or UV light.

It also allows the skin to talk to each other. The melanocytes talk to the keratinocytes and help reduce the oxidative stress or any external damage that’s coming in. The epidermis is a very active layer of the skin. It’s your first line of defense, if you will, to fight some of those external toxins. 

Kristen Meinzer: What’s the next layer of the cake, as you call it?

Dr. Wyles: Then after that is the dermis. The dermis is the area where you have a lot of the collagen, elastin, and it’s really the scaffold of the skin. It helps provide structure. It helps provide a lot of support for wound healing. If you were to get a burn or an injury, the cells in the dermis called fibroblast will help repair that injury.

It’s really important to have dermal support. We know that the dermis loses collagen as we age, and loses elastin. This allows for harmful things like scarring to occur. Then finally, at the very bottom is adipose tissue or fat. Fat’s really important because it helps with the thermal regulation, or creating that heat and creating that metabolism that the skin really needs, so, serving as a source of energy for a lot of the layers. Again, as a review, we have the stratum corneum, the epidermis, dermis, and then adipose tissue.

Kristen Meinzer: The fat layer, that’s interesting when you talk about what a positive function it has. Especially in the U.S., we tend to demonize fat, but you’re saying it definitely has a purpose when it comes to our skin.

Dr. Wyles: Absolutely. Patients that are female assigned at birth will have estrogen that is secreted by the fat. When we start to age, this estrogen declines, and that’s also associated with fat loss or fat decline. That contributes to reduced skin turnover, reduced skin functionality. Really that fat, especially in areas that support right underneath the skin, is important to keep some of these processes alive that are related to hormonal balance.

Kristen Meinzer: Not fair though. The guys, they get to have more sturdy skin longer.

Dr. Wyles: Well, they are at different risks, too. Patients assigned males at birth have a higher risk of developing skin cancers, precancerous lesions on the skin, and then benign skin lesions called seborrheic keratosis. There’s this whole separate list of risk factors for males compared to females.

Kristen Meinzer: Oh, wow. Is that just biology, or is that something that is due to lifestyle differences?

Dr. Wyles: It’s both. That’s a great question. Biologically, believe it or not, our intrinsic genes only contribute up to 5 percent of our aging. Everything else is related to extrinsic factors. Such as smoking, sun exposure, air pollution, all of those contribute considerably to how fast our skin ages, and definitely the component I mentioned, associated with hormone imbalance. Because after menopause, women age about 10 years faster, a decade faster, than men.

Kristen Meinzer: Oh, something for us to look forward to. Wow. Now, another question here about our layers of skin. What’s going on with some parts of my body where it seems that the skin is thicker? Are there more layers of skin on the soles of my feet and my hands, or is that different kinds of skin?

Dr. Wyles: There are lots of different types of skin. Skin varies. We call it topography. That’s like the geography of the skin. We have sun-exposed skin versus non sun-exposed skin. Thicker skin versus thinner skin. We are using our hands and feet more for contact. Evolutionarily, there’s a better benefit to having thicker skins in our palms and souls. We also have skin differences in what’s called intertriginous areas or skin folds.

Areas where skin touches each other. There’s going to be variability in sweating, variability in the skin glands there, so we have to keep that in mind. When we treat patients, we also know that skin varies with age. Pediatric patients will have very different skin all the way from a baby to a toddler, and then there are teenage years, they’ll have very different skin, in their thirties.

Then with our geriatric or elderly population, there’s also very different skin types.

Kristen Meinzer: How is our skin different when we’re a baby, for example, versus an elderly person? What is happening to our skin over time?

Dr. Wyles: Infants have very immature, sebaceous glands or oil glands. This allows them to have drier skin. Babies also don’t have a very good barrier, that is, intact. They actually lose more water from their skin, which a lot of pediatric patients tend to have eczema or atopic dermatitis, which is a condition where they’re losing water.

Then as we mature, in the teenage years, this is when the sebaceous glands are more robust.

This is when you’re starting to see more acne or folliculitis, which is a condition associated with hair follicle inflammation from sweating. A lot of differences in glands in that teenage period. Then when we get to the adult phase is when we have shifts in our skin microbiome. What does that mean? Those are little normal bugs that live on our skin that changes. Some patients may have rosacea or other conditions that are due to those shifts. Then finally, when we are older, our skin barrier kind of reverts back to the infant stage, if you will, because you actually lose water and you have more depletion of the barrier proteins.

That allows us to have drier skin or have itchy skin. Those are some of the things or clinical signs that we see in our elderly patients.

Kristen Meinzer: Between the adulthood, the young adulthood period and the elderly skin period, what is happening to our skin where a lot of us start to get, let’s say, age spots or sagging or other things happening during those in between years where we’re not a fresh-faced 25 year old, but we’re also not 75 yet either?

Dr. Wyles: What you’re pointing to are these hallmarks or signs of skin aging. This includes easy bruising or purpura. You also have more fragility of your skin, so it’s easier to shear or easier to get wounds because of the fat loss that we described earlier. The fat that we have underneath that cake layer of skin actually cushions a lot of the blood vessels that we have living there. So when we lose that fat layer, those blood vessels are more exposed and prone to more easy bruising, and our skin also thins over time, which is prone to more injury.

Then you have drier skin because you have increased water loss. The sun damage that you point to, these lentigos or solar lentigos, are signs that actually start to happen because of our immune system aging. How do you know that? Because we are exposed to the sun chronically, since our birth. Why don’t we get sunspots when we’re less than 18 years old or when we’re younger? Because we actually have really good immune systems that can fight the DNA damage.

It’s called oxidative stress. When the skin gets stressed with UV radiation, our immune system can come in and clear that DNA damage and could clear that haphazard pigment formation and reset itself. But after a certain age, for some folks that’s 30, some folks in their forties, they start to notice these brown spots and they say, “I’ve never had this before. I’ve never done anything that’s different.” It’s actually a sign of the immune system aging. You just don’t have that equipment to clear that damage as well.

Kristen Meinzer: Skin — our largest organ, our fleshy protector. It’s a multi-layered defense system. Each layer has a function, whether it’s maintaining moisture levels, offering physical and chemical protection, or hosting the nerve cells that allow us to physically interact with the world around us. As we age, our skin goes through drastic changes. From infancy, through our teenage and adult years, and into old age, our skin is undergoing shifts in its composition and durability.

By the time we’re older adults our skin will naturally become thinner, drier, more frail, which makes it more prone to tearing or bruising. How does the aging of our skin impact its ability to act as that protective barrier? And what are some simple measures we can take to protect our skin, so it can protect us in return?

Let’s talk more about skin damage. Can you walk us through things that risk damaging or weakening our skin? You’ve already mentioned a few, but if you could go into more detail about that.

Dr. Wyles: Absolutely. Our skin is susceptible to intrinsic aging or extrinsic aging. Let’s break that down. Intrinsic aging are factors from within: genetics and oxidative stress that basically accelerate some of the aging of our cells. Extrinsic aging, which contributes the majority of the reason that the skin is damaged, comes from things like UV damage, tanning beds, air pollution, and smoking. These are exposures that we’re coming into contact with in our daily lives. 

Kristen Meinzer: When you say it’s damaging the skin, what exactly is it doing? What is the sun doing to our skin? Or what are those cigarettes doing to my skin?

Dr. Wyles: Yes. What they do is they expose harmful toxins to the skin — everything that is  going from oxidative stress, which means it basically increases the level of stress that the skin is under, that the skin constantly has to repair and reduce that noise coming from outside to damaging our DNA, to damaging our telomeres, which are at the ends of the DNA.

That’s kind of speeding up some of these aging processes in that way. That can present as skin cancers. It can present as pre-cancer, or it can even present as haphazard melanin, which basically means the sunspots or other changes that you’re seeing, like wrinkling, early skin changes.

It really contributes to a lot of change at that molecular and cellular level. One concept that I want to introduce here is the idea of cellular senescence. What does that mean? Cellular senescence is cell aging. We’ve now done research to find that this is really the root cause of aging.

Senescence is a state, it’s called a cell cycle arrest. A cell’s going on, functioning normally, and all of a sudden it gets injured by a mutation, by a stress that’s coming externally and then it tries to repair itself, but it gets too many mutations. Then it goes into this arrest phase. It’s almost like our body’s ability to control damage.

Like you’re not behaving normally. I’m going to arrest you in that state. It’s really a clever mechanism. It’s evolutionarily conserved, and it really helps prevent skin cancers. But what happens is if our immune system doesn’t clear these things, senescent cells, or what we call zombie cells, then these zombie cells are constantly secreting negative factors. These negative factors go and break down your collagen, break down your elastin, reduce that melanin protection from the UV.

They’re just this idea of the rotten apple spoiling the cart. It continues to damage the surrounding environment. When you asked about what are the changes that you see from external damage, it’s really contributing a lot to what we’re now calling premature senescence. Prematurely going into this cell arrest state and creating havoc in the skin environment.

Kristen Meinzer: Now we’ve talked about the damage that we can get just by being alive. But then there are also people who are just born with weaker skin or in some cases, maybe born with even missing patches of skin. What’s going on there? Can you walk us through some of the conditions that people might just be born with?

Dr. Wyles: Yes, that’s a great question. That’s because our immune system plays a very active role in making sure our skin barrier is healthy, serving as a protective layer.

There’s a lot that can go wrong with the immune system that causes autoimmune diseases. Certain autoimmune conditions like vitiligo, where you have patches of white pigmentation on the skin, is essentially your body’s immune system kind of attacking these cells and getting them to be cleared. That’s a missed signal to the body. That’s a change in the immune system that causes that.

You can also have changes in your genes. Certain patients may have conditions called epidermolysis bullosa, which is a rare condition, but they are more prone to wounds on their skin and more prone to skin cancers within these wounds. It’s a very terrible condition that happens to our pediatric patients due to collagen gene (COL7A1) mutations.

Everything from the immune system to genetics can govern what type of skin disease we can have. There’s a lot of nutritional factors, metabolic factors, and other variables that can cause changes on the skin. The skin’s actually a great portal to looking at our overall health and overall aging. It gives us clues or cues that we can be aware of to be mindful of what’s going on inside.

When I say that, I mean small things like leaky gut. When we have leaky gut, low levels of inflammation in our body, that actually presents on the skin as eczema or atopic dermatitis. There’s a lot of cues that we can learn from just observing and evaluating the skin.

Kristen Meinzer: Wow, that’s incredible. I never realized that my skin’s just trying to send the message, this is what’s happening in your guts. Please pay attention. Or this is something that’s happening in your immune system, right?

Dr. Wyles: Exactly. 

Kristen Meinzer: Now, a lot of what we’ve focused on so far, Doctor, has been related to skin keeping us healthy or skin giving us signs of what’s healthy or not healthy within us. But people often have issues with their skin, especially as their hormone balances shift, as you mentioned, as we age or even as the result of injury, or scarring and so on. While these may not directly be related to physical health, they can still cause some psychological stress.

Dr. Wyles: This is very important to talk about, as aesthetic medicine. I practice aesthetic medicine and we may not be life-saving, but we are life-changing. Because it really empowers our patients to be their true self. What do I mean by that? Often, with different signs of external aging, whether it’s wrinkling, whether it’s pigmentation, whether it’s volume loss, you look in the mirror and your internal self doesn’t align with your external self.

You could say, “I feel different than how I look,” and that directly affects people’s confidence. These are really valid concerns and can empower people to do things that they’ve always wanted to do, or just to try to align to what they want to see.

Kristen Meinzer: You mentioned that the best thing we can do for our skin is to take care of it when we’re younger. That ship may have sailed for some of us, but it’s never too late to take care of your skin. What are the ways we can protect our skin before it gets more damaged?

Dr. Wyles: Yes. Let’s talk about the category of Topicals. There are a lot of actives that are out there and I break it down to three actives that I do myself and I tell my patients to keep it very simple. These are the three ingredients that you need to help you stick to a consistent skincare routine and to help you keep that skin barrier healthy.

First you can start off with a cleanser. It’s really important to cleanse your skin with a gentle cleanser over the counter. There are various products out there that are gentle cleansers. You don’t want it to necessarily foam. It doesn’t need to foam, but it just needs to help take away that dirt or accumulation of pollutants that you can wear over the day.

A good cleanser is important. Second step is vitamin C. There are a lot of different vitamin C options out there, and it can range from anything from 20 to 200. You don’t necessarily need to go for the higher price point. What’s more important is to make sure you replace your vitamin C every three months because it can expire. When you take it out of the bottle, it can oxidize and get this orange, crusty color.

What’s really important is that you wear the vitamin C on a consistent basis, twice a day, actually, it’s not just for protection from the sun. It also helps, it serves as a cofactor for collagen building. You can even wear it in the morning and at night, just make sure to replace it every three months. Then the third ingredient. Retinols are great. Even over the counter retinols have good evidence behind it. You don’t need a prescription strength retin a to have these active benefits. Retinol has this ability to accelerate skin turnover.

That top layer of the skin, the epidermis, it speeds it up because as we age, we slow down that process. Instead of shedding the skin, every month in a healthy way, we are now doing it a month and a half, every two months, it is haphazard and it’s not consistent. Retinol is the reset button to help keep that skin renewing on a consistent basis. You want that, because then you can maintain your healthy skin barrier and it keeps your skin hydrated. Also keeps your skin more youthful.

You just want to make sure you’re using your retinol at nighttime only because it can make you more sensitive to the sun. Retinols are also involved in collagen production. It helps that dermis, the second layer, is used to maintain a healthy scaffold or a healthy structure. The last thing is to make sure that the skin barrier is hydrated, wear a good moisturizer with sunscreen. 

Dr. Wyles: A tinted sunscreen, at least SPF 30, is going to go a long way. Why do I say tinted? The tint is not necessarily because it’s a color that’s going to create a foundation-like effect. The tint actually protects from visible light. We’ve learned more about that actually. Room light, visible light, and now thanks to Zoom, all of the ring lights that everybody’s using. That’s actually emitting light rays that can damage the skin as well.

You want to be using a tinted sunscreen to help defray some of that damage coming from that. Making sure you reapply is another important factor. Make sure you use a tinted sunscreen and reapply at least twice a day over the course of the day. In addition to providing a protective outer layer, our skin can also clue us in to what’s happening inside our bodies. Issues with our immune system or metabolism might manifest as skin irritation, signaling that something is going on inside.

Since our skin is trying to protect us, it’s only fair that we make sure to return the gesture. To keep that protective barrier healthy and effective, we should limit exposure to environmental factors that can damage the skin like UV light, air pollution, smoking. Our skin also deteriorates over time, due to aging and our genetics. Luckily, a lot of that can be combatted using a simple skin care regimen focused on protection and cleansing.

Next, let’s look at how the field of aesthetic medicine is constantly evolving to find new ways to repair and rejuvenate the skin.

Kristen Meinzer: What about those of us who maybe already have some damaged or weakened skin? What options are there to help heal or rejuvenate our skin? I’ve heard people talk about things like lasers, injectables or even 3D bioprinting.

Dr. Wyles: Okay, so let’s start with lasers and then we can work our way to injectables. Lasers are in two categories. Ablative or non ablative lasers. We talked about the cake layer. Ablative lasers damage that top layer of the cake. They create these micro channels or micro small injuries of heat to the skin. Why do we want that? Because the skin renews from damage. We need to create wounds to create regeneration.

Lasers actually create a very controlled thermal injury that allows the skin around it to start regenerating or healing and creating new skin. Healthier skin has better collagen, better elastin, etcetera. That’s an ablative laser. Non ablative lasers don’t damage the skin layer directly, but they kind of resurface the skin on top, still creating levels of heat that allow the skin to turn over.

Non ablative lasers. One example would be, erbium or thulium type of lasers where they help rejuvenate the skin, remove pigment, and there’s actually studies that have shown that it reduces skin cancer by 50 percent by doing these types of lasers. They can have a huge impact.

Kristen Meinzer: It’s not just aesthetics. Lasers can be for better health. 

Dr. Wyles: Exactly, yes. Pre-cancerous damage. It can really help reduce that risk, keeping the skin healthy. For all the different factors that I mentioned, your skin is not just its appearance. It actually is a protective barrier. It’s a secretive organ, an excretory organ. It helps regulate your temperature and helps you feel sensation. To keep all those functions active, doing healthy skin habits will go a long way.

Kristen Meinzer: Oh, that’s great. Can you tell me a little bit more about injectables?

Dr. Wyles: Yes. As we age, we see different signs of aging, whether it’s wrinkles, whether it’s the crow’s feet and other areas. Injectables are microdoses of toxin that can be injected to various areas of the face and neck and other areas to help relax those muscles to reduce the formation of these active lines. 

You may have heard about the most popular Botox, but there’s actually a lot of cousins to Botox. While early on, you may be seeing these lines or wrinkles that only occur with movement. Later on, we call them static rhytids. It’s for resting wrinkles. Applying Botox can help reduce some of those static wrinkles that can form later on, and certainly if you were to combine that with good skin care, then you’re getting into a feeling that you can help reduce the signs of aging.

But remember with injectables, like Botox, it’s going to take multiple sessions over the course of the year. It takes two weeks to turn on depending on the Botoxin, and then it takes three months to turn off. It is something that needs to be kept up with where you’re going in for a certain number of aesthetic procedures over the course of the year.

There are other injectables, like fillers. There’s a whole category of biostimulators, which are in the filler group. There’s also the hyaluronic acid fillers that are more traditional fillers. You just want to be careful with who your injector is and how it’s applied. There’s a lot of different anatomical considerations when you’re injecting fillers because it can have certain complications associated with it.

You want to make sure you go to a board certified dermatologist or a provider that has experience with injecting fillers on a long term basis to help get the results that you want, and not distort the natural beauty that you are born with.

Kristen Meinzer: Just a quick question. If you were giving a patient filler, would you be just trying to literally fill out their sagging or their wrinkles? Is that what you’re doing?

But filling it with hyaluronic acid or filling it with another substance? You’re just literally filling in the empty space?

Dr. Wyles: Exactly. Then this is where art meets science because the filler technology is like sculpting, or it’s like clay that you’ve been given to recreate that empty space. But you want to be careful of where you put it. It really varies on every patient. 

The newer alternative is the biostimulator. Actually, the recent aesthetic trends are showing that the wave from fillers are moving away.

We’re actually entering a new era of biostimulators that create that natural volume, whether it’s the polylactic acid or calcium hydroxyapatite, which just basically stimulates your cells to make the collagen and elastin. We’re not relying on an exterior fill, but rather a natural collagen to fill.

Kristen Meinzer: Oh, that sounds exciting. Because then my own body is essentially taking care of the work for me, right?

Dr. Wyles: Exactly. With time those signals can fade. We’re basically reintroducing that bioregenerative signal that taps into the body’s natural way of healing. That’s really the basis of regenerative aesthetics is to try to tap in and get your body to biohack or get your body to do these natural healing mechanisms.

Looking at products like platelets or PRP, Platelet Rich Plasma. Platelets are the first responders to wound sites. They’re part of that regenerative cascade already. How can we take these platelets outside the body and use it for regenerative therapies, whether it’s for skin rejuvenation or hair restoration?

Then there’s stem cells. Stem cells are where we started, but it’s no longer where we are. Stem cells have shown some utility for certain dermatological conditions like burns and been used in that setting, but in a very controlled way. They take a process where you have to take them to the lab and culture them and they have to be alive in that setting.

If they’ve been cultured too long, taken to the lab and grown over time, they can have phenotypic deviation, meaning it can really shift from being outside of the body. It’s really hard to bottle up a stem cell and put it on the counter shelf. 

You just want to be careful with these over-the-counter products that may have the word stem cell in it because they are not viable.

It’s not a true source there. Even plant stem cells are actually myth busted. It comes from the stem of the plant, not really stem cells.

Kristen Meinzer: You’re kidding.

Dr. Wyles: Clever little marketing there.

Kristen Meinzer: So tricky. 

Dr. Wyles: Now you’re going to hear a lot about exosomes or extracellular vesicles. There is a product called plated or platelet-based extracellular vesicles. What does that mean? There is a company that actually takes pooled platelets. They’re near expiration platelets, or blood products from FDA-compliant sites and then they are able to take out exosomes or extracellular vesicles away from the platelets itself. 

It’s not cells. You take the cells out. It’s just the factors. It’s like the messages that the platelets are secreting. It’s how they talk to each other. But these messages are very powerful, because they can have signals like regenerate, renew, and heal. We could take those messages and basically have them in a powder form that can be made into a skin therapeutic to help with wound healing and a lot of other conditions that we’re working on right now at Mayo Clinic.

It’s very exciting, new technology that is really revolutionizing how we address everything from age-related conditions to inflammatory conditions to systemic disease. Just be mindful that these can really vary. It’s really new in its science and its technology. We’re still doing research to understand that  more.

Kristen Meinzer: How long before would I have to wait for some regenerative treatments to actually start taking effect?

Dr. Wyles: If it’s a topical application of certain regenerative products out there, then we would be looking at anywhere from six to 12 weeks. That can be more immediate. Because it’s creating a nice skin health change. These are things like skin glow, reduction in brown spots, all of those. But if we’re talking about more structural change, that’s deeper within the skin, like nasolabial fold, volume loss, or temporal hollowing, then we need to do products like biostimulators that may take even up to six months or even two years to see that change.

Because I always talk about it as two different signals. We are giving positive signals to bioregenerate or biostimulants, but we also have the negative signals of aging and senescence that are occurring concurrently. We’re almost going against the grain there, in terms of the aging signal. It does take a little bit of time for the cells to create that youthful appearance.

Kristen Meinzer: A downer here for a second. Since we’re operating mostly in the US, how are these procedures viewed by the medical insurance industry? Is insurance going to cover any of these treatments or procedures that you’ve mentioned today?

Dr. Wyles: That would be the goal one day, but not today. Unfortunately insurance does not cover any of the procedures that I’ve talked about today. We are working towards getting insurance coverage and a lot of that also takes FDA approval. Some of the work that I’ve talked about today is in the preclinical or clinical testing setting.

We’re waiting for FDA approval for the right indication. A lot of things in aesthetics we do are done as an off-label use. For insurance coverage, a lot of it needs to be on-label, too.

These are things that we’re working on, especially in dermatology for finding things like nonablative lasers that can help reduce skin cancer. We would love to have insurance to cover that, but it’s not quite, we’re not quite there yet.

Kristen Meinzer: All right. Looking into the future of science for a second, what about 3D bioprinting? Is that real? Where is the research currently? And what are some of the use cases?

Dr. Wyles: 3D bioprinting is a new tissue engineering technology that we can use to actually model skin. Right now, a lot of the ways that we study skin and understand skin is done in animal models, which are not truly representative of human skin. Sometimes we can collect human skin from surgical waste and study that in the lab.

But that’s also limited in how long it can be alive, etcetera. These new 3D bioprinted models are what our lab is working on. We’re very excited about it because we can essentially recreate skin, and we can recreate different skin diseases, too. Things like eczema, things like aging skin, things like graft versus host disease or immune mediated condition. It’s essentially a modeling system so we can better understand the skin and test different skin therapeutics.

Kristen Meinzer: Will that modeling system eventually be able to actually just make skin to replace my own skin?

Dr. Wyles: That’s the goal. Eventually we go from diagnostic to therapeutic. When we shift it, eventually you want to see for burn patients or others where we can use these 3D-printed skin to specifically print to their wound size or replace an area that is not being able to be reproduced otherwise.

That’s definitely a goal that’s within reach. We have to make sure that we’re building the complex skin layers very carefully, because as we mentioned, the skin has so many roles. We have to make sure the blood vessels are there. The nerves are there to talk to each other and all of these organ systems like glands that are there to secrete.

The skin, as simple as it may seem, is quite complex. Once we get all those worked out of the puzzle, then we will be able to do the right testing to offer it to patients. 

Kristen Meinzer: Wow, this has all been so fascinating and so informative and sci-fi at the same time. A lot of this almost feels like it’s coming from the future to help us. We so appreciate you walking us through all of it. Dr. Saranya Wyles, thank you so much.

Dr. Wyles: Absolutely. It’s my pleasure to be here. Thanks, Kristen.

Kristen Meinzer: If you find yourself stuck in front of the mirror frustrated with the way your skin is behaving, try to remember bumps, wrinkles, and discoloration are sometimes the inevitable results of the hard work our skin performs as our protective barrier. There are also some exciting new treatment options available and in-development that can help our skin maintain the structure and strength to keep up the fight. Those treatments include platelet-rich plasma, extracellular vesicles, and 3D bioprinting.

However, the best thing you can do for your skin is to care for and protect it now, so it can continue to care for you long into the future. The best way to do that is to establish a simple but regular maintenance routine that you can stick to. If you haven’t already, start working that routine into your day, and remember that no one has perfect skin. Not even those celebrities populating our screens.

Okay, that’s all for this episode. But if you’ve got a question or topic suggestion, you can leave us a voicemail at (507) 538-6272. We might even feature your voice on the show!

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