As one of Southern California’s leading plastic surgeons, my appearance is important: I’ve got to talk the talk, and walk the walk.

Honestly, I wish it weren’t so.

I spent years in an operating room, with patients’ lives in my hands daily, treating everything from hernias, to mastectomies, to gunshot wounds…

…and I loved it, until I discovered plastic surgery.

There’s art and craftsmanship in this field. It requires intense discipline, and each case is unique.

And in the past quarter century, I’ve performed thousands of procedures: facelifts, post-cancer breast reconstructions, mommy makeovers, you name it.

(I’ve even been awarded a patent, for a novel plastic surgery tool. Yes, that’s how “into it” I am.)

It’s so rewarding for me to help people feel happier about their appearance… to feel like the person they always wanted to be.

And frankly, I’d like to think that my reviews speak for themselves:

Justine H. Review

Margo B. Review

Randa H. Review

But the fact of the matter is…

I'm Judged On My Appearance

…and I've come to accept that.

The Ranch & Coast Plastic Surgery Center is located in the heart of Del Mar, California, one of the country’s wealthiest zip codes.

So it doesn’t matter how many five-star reviews I have… it just wouldn’t do for patients to show up, and meet a doctor who looked like he’d let himself go.

That’s why I’ve done my best to stay active, and to keep my skin healthy.

There are a few topicals that I’ve found to work, I’ll list those out shortly. And I don’t mind saying that both my patients and I have had great results with Botox.

But the more that I dug into the science, the clearer it was: there is a huge, gaping hole in how we treat aging skinespecially for women.

For example, Botox can help with wrinkles, but it’s expensive, and it does little for smoothness, or texture.

And as I matured into my mid-fifties, I noticed that the lotions I was using – even the expensive ones – weren’t having the same effect.

I seemed to be loosing elasticity by the day, becoming crepey and dry. I noticed the same with many of my patients. And the fact is…

The Eye Is Drawn To The Skin Imperfections We Hate

So when patients tell me that they've been fixating on wrinkles, dry patches, sagging, and other signs of aging, I have to reassure them: it’s totally normal, and it’s not their fault.

After 25 years of speaking with countless patients, I can confidently say these two things:

And after diving into the research papers, and testing everything under the sun, I knew that the “state of the art” just wasn’t good enough.

Because conventional treatments simply miss out, where it matters most. You see…

When Skin Loses It's Luster And Firmness, It's Caused By A Condition That I Call “Dermal Collapse”

And this is where I want to share a bit of the science, because it will help separate fact, from fiction.

Let’s start with the basics. Skin has two layers: the epidermis, and the dermis.

Skin Layers

The epidermis is the thin surface layer of the skin. Think of it like the “bricks and cement” on a house. It’s there to keep the environment out.

Then we have the dermis, the thicker supporting layer below. Think of it like the frame of the house, along with its insulation. It’s there to support the bricks and cement from within.

When we're younger, these two layers are plump, healthy and radiant.

But over the years – for reasons I’ll tell you about momentarily – both of these layers begin to degrade, and eventually collapse.

Young Skin vs. Old Skin

So the skin begins to sag under its own weight.

Wrinkles begin to form.

Splotches and discoloration appear, and the skin loses its vibrancy.

All stuff we want to avoid, so let’s talk about why this happens.

The Epidermal Destroyer #1: Loss of Ceramides

Recall that the top layer of the skin – the epidermis – is sort of like “bricks and cement”.

The “bricks” are dead protein cells, and much of the “cement” is made of little fatty molecules called ceramides.

The good news is that we don’t really need to worry about the bricks, so I won’t dwell on them today.


But the cement… that’s where we run into big problems.

Imagine that the cement on a brick house began to degrade. The bricks would start to collapse into each other, right?

Well, that’s exactly what happens when ceramide levels begin to drop.

The “ceramide cement” holding skin cells together weakens.

When that happens, moisture escapes, and the whole structure begins to break down… so the skin's surface starts to get saggy, dry and “weathered” looking.

To help visualize this, I’ve enlarged the epidermis in the next picture, to show how it looks like when ceramides begin to degrade.

Ceramids Degrade

Here’s the really unfortunate thing: our bodies produce fewer ceramides as we age.

In fact, much of what I’ve noticed in patients who complain of “aging skin” – the lack of color and vibrancy – was directly caused by lower ceramide levels.

The bottom line is this: as people age and produce fewer ceramides, skin suffers.

Now it’d be bad enough if that was all we had to worry about, but it’s not, and that brings me to…

The Dermal Destroyer: Oxidative Rot

…and the good news is, this one isn’t entirely age-related.

Rot House

The bad news is, it’s really nasty.

Oxidative rot is what happens when molecules called “free radicals” attack and degrade healthy cells (yes, including skin cells).

…which begs the question: what unleashes these “free radicals” upon us?

And the sad answer is: our modern diets, lifestyles, and environments.

When people get too much sun, eat unhealthy foods, drink alcohol, or smoke, cellular processes take place to set these free radicals loose.

And even if someone ate nothing but spinach from their own garden, I’m sorry to say that our modern world is chock-full of toxins… from the chlorine in our tap water, to the aluminum in our anti-perspirants, to carbon pollution in the air we breathe. And don’t get me started on industrial farming!


When we ingest these toxins, they decompose into free radicals in the body… and oxidative rot is the result.

No matter where it happens, it’s not good for organs!

But skin is especially susceptible. It’s the biggest organ on the body, and the primary exit point for free radicals and other lurking toxins.

So as those free radicals make their way up and out of your body…

The Dermis Slowly Rots From Within

Recall that the dermis is the “bottom” layer of the skin – the framing of the house, and the insulation.

It’s largely made up of two proteins, collagen and elastin, as well as a gooey molecule called hyaluronic acid.

These work together to support the top layer of the skin, and to keep everything moist and firm.

Dermis Rot

But look what happens when the body tries to eject the free radicals, through the dermis.

They attack and degrade your collagen, elastin, and hyaluronic acid…

…(and not to mention ceramides, too)…

…accelerating the Dermal Collapse, and making it even worse.

The effects are inevitable:

Thin, wrinkled, sagging skin.

Dryness, as moisture simply “escapes” through the degraded skin.

Dark spots, as your pigment shifts and collects, like rubble in an earthquake.

The look of being “aged” and “weathered”.

At least, that’s what you see when people see it in in the mirror.

It’d Look Even Worse Through A Microscope.

Together, the dermis and epidermis make up an “antimicrobial barrier” to the outside world – the first line of defense against infection.

But with Dermal Collapse, and weakened ceramide cement, it’s easier for bacteria like Staphylococcus aureus (also known as “Staph”) and Pseudomonas aeruginosa to form colonies in the thin, collapsed skin.

Through a Microscope

When that happens, the immune system gets stressed, and as a result, it causes people to feel awful!

Now the good news is, we don’t have to accept all of this sitting down. While we’ll get to some of the more advanced remedies in a minute, let’s start with…

Simple Tip #1: Drink More Water, And Do More Cardio

I know, I know… same advice that every other doctor says.

But there’s a reason for that!

Water helps flush the body of toxins and free radicals, so they go out through urine, instead of through the skin.

Cardio and Smile

And cardio is good for all sorts of reasons! Heart health, brain health…

…and when we boost our heart rate, that means more vitamins, antioxidants, and nutrients getting pumped through the blood vessels, and out to the skin.

All other things being equal, people simply have healthier, fresher skin if they do cardio a few times a week.

(That's why I always tell patients to get in a few brisk walks, and smile as they realize that they're “sending in the supplies” for their skin to manufacture fresh new collagen, elastin and ceramides!)

That’s because…

Beautiful Skin Is Created From Within

…from the nutrients in the blood, upwards to the dermis, and finally to the epidermis.

So yes, diet and exercise do matter.

But what about topical creams and lotions? Or collagen supplements, the latest craze?

Well, it’s time to separate fact from fiction (so that more innocent people don't get separated from their money).