Ali Abdaal (00:00): All right. So having the perfect
skincare routine is actually pretty simple. All you need is a few things. Number one,
use a moisturiser, number two, use some kind of sunscreen every day. Number three, use some kind
of retinoid every evening. Feel free to wash your face with a cleanser if you really want to. And in
fact, you can do two in one and you can get this sunscreen moisturiser combination. And that is all
you need to know to get a really solid skincare routine going, but, okay, let's go a little bit
deeper into the details. Like why should we have a skincare routine in the first place? And then what
is the scientific evidence that these are the sorts of products that we should actually care
about? Well, there's two main reasons. Number one for healthy skin and number two for pretty skin.
And a question that I like to think about is what are the actions that I can take right now today
that my future self would be very glad for. Ali Abdaal (00:38):
So in theory, if I can find the perfect evidence based productive skincare routine that helps me
maximise my skincare results with minimum effort, then I'm winning in terms of health and also in
terms of looks. By the way, quick thing enrollment for my part-time YouTuber academy is currently
open and closes on the 4th of July. So if you want to find out more about my live five week online
course, where I teach you how to do YouTube, click the link in video description. The problem is that
there are millions of skincare products out there, like avocado, face masks and charcoal cleansers,
and LED therapy and snail slime face creams. Speaker 2 (01:06):
Slather On the slime. Ali Abdaal (01:07):
Now I trained as a doctor, but I'm not a skincare specialist.
So I've enlisted the help of my friend, a New York trained dermatologist Dr. Usama Syed to
find out exactly what we should actually be doing to get good skin and apparently to get like 90%
of the results all we have to do is follow three or four simple rules and we'll do absolutely fine.
So why should we actually use a moisturiser? Well, the most important thing that the skin
does is that it acts as a barrier to the outside world and it keeps irritants and allergens outside
of our body and locks in moisture. If our skin loses moisture and gets dry and cracked, that
barrier gets weakened, which means inflamed red itchy skin. And you might even get infections.
Dr. Usama Syed (01:43): And the way the skin is built is that they
call it a brick and mortar system where, you have the little cells, which are the bricks
called the keratinocytes and you have the mortar, which is like the little paste in between it made
up of different types of fats and proteins. Now what these moisturisers do, especially the ones
that are evidence based, is they will replenish that layer of paste to help keep that barrier
intact so you don't lose moisture. Therefore, you don't have inflammation, itchy skin.
Ali Abdaal (02:07): Now anyone can get dry skin,
but you're especially likely to get it after having a hot shower because that dries out your
skin and strips away your natural protective layer of oils. So we want to find a good
moisturiser that rehydrates that skin, replaces our natural fats and proteins and helps keep the
skin barrier intact. So what sort of moisturiser do we actually want to get? Well, Usama's main
recommendations for moisturiser are any standard product from Eucerin, CeraVe, or La Roche-Posay,
mainly because those are huge companies that have the budgets to do lots and lots of research and
quality control on their products. Dr. Usama Syed (02:35):
I firmly believe no skincare products should ever cost more than $30, because anything beyond that
point is you're paying for the fluff. The active ingredient and getting something effective can
always be done for less than $30. Ali Abdaal (02:46):
So what products do I use? Well, my main dedicated moisturiser is from CeraVe and I use CeraVe PM
for moisturising in the evening. It's very nice. It's very chill. It's available absolutely
everywhere. It's reasonably priced and it feels really nice on my skin. And then in the mornings
I use the Altruist dermatologist Face Fluid, SPF 50 moisturiser, which is a moisturiser
combined with sun cream. And this brings us to rule number two of my productive skincare routine,
which is to use a sunscreen every single day. Ali Abdaal (03:12):
Well, have a look at this case report from the New England Journal of Medicine, which is one
of the most prestigious medical journals in the world. They looked at this truck driver who'd
spent 28 years working with just the left side of his face, being exposed to sunlight through the
driver's side window. He's 69 years old in this photo, but the researchers said that the left
side of his face, which has a bunch of wrinkles and damage from sun exposure is apparently more
like what you'd expect from an 86 year old skin. That's what the sun does to your skin, if you're
regularly exposed to it without any protection. And that happens even if you never actually get
sun burnt, but you just tan. Ali Abdaal (03:40):
Technically this is called photoaging or dermatoheliosis. And it happens because the
sun is constantly bombarding us with UV radiation that mutates the DNA in our skin cells. And then
in the long term, the more of this UV light that we're exposed to without protection, the
more we get wrinkles and dark spots from that DNA mutation. And that DNA mutation can also lead to
skin cancer, which is ultimately just unrepaired DNA mutations that snowball into cancer.
Dr. Usama Syed (04:01): So what sunscreen does is it gives you an extra
layer of that protection, so that not relying upon your own pigment, your own melanin. Instead,
we're getting a physical barrier, which will stop genetic mutations being created by the sun. And
not only is that great for preventing skin cancer also, it prevents things like photoaging.
Ali Abdaal (04:18): All right. So what sort of sun cream should
you get? Well, there's loads of different options on the market, but there's mainly three things
that you want consider here. Well, the first thing you want to look for is that you want to
find a sunscreen that's broad spectrum. Now, back in the day, people used to think that it was only
UVB raise rays that actually damaged our skin. But now we know that it's UVA rays and also UVB
rays and broad spectrum sunscreen has protection for both sorts of rays and therefore gives you the
maximum protection. Now some sunscreen is physical and some is chemical. It doesn't really matter
which type of variety you go for. What matters is that the SPF is high enough. And that is the
second thing that we need to look out for. Now the actual SPF number of the sunscreen refers to
how much longer it would take for the sun to make your skin go red with the sunscreen on compared to
without the sunscreen on. Ali Abdaal (04:58):
So if it would normally take one hour of direct sunlight on your cheeks to make them a little bit
red, then in theory, with SPF 15, it would take 15 hours if you got exposed to the exact same amount
of sunlight. But it's not quite that simple and there's extra issues that we do want to consider
with SPF. Firstly, we don't need to actually burn for the sun to damage our skin and cause ageing,
we want to be protected well before our skin actually gets physically red. Secondly,
the SPF is calculated based on a pretty thick amount of sun cream actually going on the skin.
Dr. Usama Syed (05:23): I do say don't go below 30
typically. The number that you get on there, you never truly get that level of protection based on
how normal people wear it. Because it would rely on like a pretty thick layer of sunscreen, like
caked on there. Most of us will be getting around like say 60% of that true SPF protection factor.
So if you use a 50, you'll actually get a 30. If you use a 30 you'll get a 15 kind of thing.
Ali Abdaal (05:42): And finally, in reality, we sweat and
smudge our faces all the time, which takes away a lot of our sun cream protection during the day.
So in an ideal world, we actually want to top up our sunscreen every few hours. I don't personally
bother with this, but what I do try and do is I use a high SPF like SPF 50 because chances
are even with SPF 50, I'm only really likely to get SPF 30 or 20 or 15 levels of protection. Now
the final thing to think about with sun cream is comfort. And the issue with the max SPF sunscreens
is that they can be uncomfortable or make you look like you're wearing this sort of white
pasty makeup. And the thing we want to bear in mind is that some SPF is way better than no SPF.
So actually an SPF 30 sun cream that you actually like and feels comfortable on your skin and that
you're actually going to wear is way better than the state of the art gold standard SPF 100 sun
cream that you buy once. Ali Abdaal (06:26):
And they never really use because it makes you look like a clown. Right. So what products do I
actually use? Well in the mornings, I use Altruist dermatologist Face Fluid, which
has SPF 50 built into a moisturiser. So that's what I use on my face. This one costs about $11
here in the UK. And then usually on my body, I will also use the Altruist dermatologist,
sun cream with SPF 50. And this is what I use on my arms, on my legs, on my neck, on my shoulders,
whatever, especially if it's a very sunny day and I'm going out in t-shirt and shorts and this
one's actually really cheap. It's about $4 or five pounds here in the UK. But to be honest,
you can find whatever product works for you in your country. It doesn't really matter.
Ali Abdaal (06:58): All right. So this one is a little bit more
rogue. So we've all probably heard of moisturisers and sunscreen, but most people have not heard of
retinoids. And in fact, I hadn't really heard of retinoids as being good for normal people's skin
even though I went to med school. I only really heard of retinoids being a treatment for acne
and that's exactly what they started out as. It was like this vitamin A based treatment for acne
in the 1970s. But then researchers found that the active ingredient retinol actually had a bunch of
anti-ageing effects as well. Dr. Usama Syed (07:24):
I think it is as close as possible to a miracle ingredient that you'll get anywhere in the
world of skincare. When it comes to retinoids they genuinely lay a credible scientific case
for helping reduce pigment, unevenness, helping to minimise wrinkles, help to minimise acne
breakouts. And they do all of these things to a level where it's noticed in clinical trial data
and on biopsy samples from the skin. Something that does all of those things
with minimal to no downside I consider that to be something which it really is worth your time.
Ali Abdaal (07:54): Now there's been a tonne of
research and studies into retinoids and like Usama says, they've pretty consistently found that when
you apply a strong enough retinoid for a long enough time, then there's three main positive
effects that you get. Firstly, retinoids reduce wrinkles by promoting the growth of collagen and
elastic fibres in the dermis or the thick middle layer of our skin. And if we have enough collagen
and elastic fibres deeper down in our skin, then it gives our skin a healthy, young looking
structure. Ageing and UV damage makes us lose these collagen fibres. And that's what makes our
skin sag and look old. The second positive thing that you get from retinoids is that they reduce
uneven pigmentation, i.e. like dark or discoloured spots that you get on your skin, particularly
again from sun damage. And thirdly retinoids also make our skin cells regenerate faster, which means
our skin consistently looks fresh and new. Ali Abdaal (08:35):
So overall basically retinoids make most people's skin look younger and smoother and healthier. So
if like me, you do want to start using a retinoid, then remember that you are playing a really long
game because it does take a long time to see results. And to be honest, when you're young
and you don't really have that many wrinkles, I think it's mostly preventative rather than
kind of curative as it were. And the thing with retinoids is that they can also make some people's
skin feel a little bit more sensitive. It can make your skin peel and it can sometimes make your skin
feel a little bit painful. And that's why a lot of people don't actually stick with it long enough to
see the benefits. So what sort of retinoid should you get? Now, this is where it kind
of gets complicated because retinoids actually come in different types of strength levels.
Ali Abdaal (09:10): Now the first big one is
retinols. Now retinols are part of the retinoid family, but they are the weaker version. Now,
if you see any kind of skincare product labelled anti-ageing and you can get it over the counter,
it usually has some kind of retinol in it, i.e. the weaker version of a retinoid. Then
we have retinoids, which are stronger and they're generally prescribed by a doctor. And tretinoin is
one of the most common ones and the one that I use. You'll see a bigger change with retinoids
than retinols because they're stronger, but the side effects can potentially be stronger as well,
like peeling and dry skin and like a little bit more sensitivity. So if you are going for
a retinoid, then it is worth it to be a little bit more careful with these and maybe even consult a
doctor before actually start to here's one. Dr. Usama Syed (09:46):
What I always tell people is when you're using a retinoid at the beginning, it should make you
feel a little bit dry at least. If it doesn't even teeter on the edge of making you feel a bit dry,
you wonder whether you need a higher strength because maybe your skin is just more tolerant
and maybe you need to apply more, because it should be, especially at the beginning, it should
be like, Ooh, I feel a little bit dry today. Like I need to put on more moisturiser since I started
my retinoid this first week. And if you don't feel that it's probably not strong enough for you.
Ali Abdaal (10:08): The over the counter
retinoid based product that Usama recommends for beginners is Differin gel, which costs about $20
and has a slightly newer type of retinoid in it called adapalene, which causes less irritation
than a lot of other retinoids. But because that one's kind of hard to get in the UK, the one that
I get is actually from a place called Dermatica, which is like this online consultation type thing.
They're do an online consultation with you. You send them some pictures of your skin.
It's a bit of a faff initially because technically a doctor has to review those images and prescribe
it for you at least here in the UK. But then once you've been prescribed it, they just send
you it every month. I've been getting the deliveries for about seven months now.
Ali Abdaal (10:41): So I initially started on a 0.025% tretinoin
and then over the last seven or eight months, it's been up to 0.1% tretinoin which is like
a decent level of strength for a retinoid. And remember the general recommendation for retinoids
is to start with a tiny pea sized amount every other night, and then work your way up to once a
night using lots of moisturiser at the same time. And this helps keep your skin from drying out.
Dr. Usama Syed (11:03): So when it comes to cleanses is basically
water is good at removing debris, but a cleanser is supposed to kind of help to
remove some of the oils that might stay on your skin that are hard to remove with just water.
Ali Abdaal (11:14): Some dermatologists say that if you're using lots
of heavy cosmetics or if you have visible dirt or like loads of sweat on your face, then yeah, you
can use a cleanser, but actually for most people you could just clean your face using water without
needing to worry about these kind of products. Anecdotally, for me, I find that on days where I'm
consistently using my cleanser morning and evening those weeks, I tend to get a lot less breakouts
of like random shit on my face. Like I tend to get kind of troubled areas around the nose and
stuff. And generally I find that if I've forgotten to cleanse, then I'm more prone to those kind of
things. So, and equals one. But yeah, this is rule number four and it's a little bit optional.
Dr. Usama Syed (11:46): It will have some benefit incrementally
and you should focus on a hydrating cleanser that doesn't end up stripping your skin of
all the oils and leaving you feeling tight. It should end up being very gentle and in
the end, your skin should actually feel more moisturised even after having cleansed it.
Ali Abdaal (12:00): So a hydrating cleanse like this one is going
to remove the oily stuff without theoretically stripping away all of your skin's natural oils.
And it'll also usually contain special ingredients like hyaluronic acid, which apparently keeps your
skin hydrated and ceramides, which is what all the CeraVe products include, which are basically fats
that replace some of your skin's natural oils so you can lock in moisture and keep that skin
barrier intact while also having a cleanser. So the one that I use is the CeraVe hydrating
cleanser. It's pretty reasonably priced and you can get it from most places. And what I like
about the CeraVe products is that they're very like chill. They're not like trying to overly
wow you with the avocado extract or the hero ingredient. It's just literally it looks like
medication and that's what skincare really needs to look like. It doesn't need to be as fancy as a
lot of these other really expensive products that we get sold by random influencers.
Ali Abdaal (12:46): So here is my overall productive skincare routine,
adding up all of this evidence based stuff. In the morning, I wake up and I shower and I cleanse
my face in the shower with the CeraVe hydrating cleanser. And then when I'm out of the shower,
I dry my face with a face towel and I put on the Altruist SPF 50 Face Fluid,
which is the sunscreen and moisturiser rolled into one. So just two products in the morning
and it's super nice and easy. And then in the evening after brushing my teeth, I generally
wash my face with warm water. And again, I use the CeraVe hydrating cleanser in the sink.
And then again, I dry my face with a face towel and then I put on my Dermatica retinoid cream. And
then after giving it a few minutes to settle in, I moisturise with the CeraVe PM moisturising lotion.
And that feels pretty good. Ali Abdaal (13:29):
And that's it. Like honestly, before having this extensive conversation with Usama and a
few other dermatologists to be like, what should I actually be using for my skincare routine, I
thought skincare was going to be this complicated thing. And I didn't want to bother with it,
but now like once I saw the before and after photos and once I spoke to dermatologists
and they were like, yeah, these are the only three or four products that actually matter.
It simplified the whole thing. And now I've been using this kind of productive skincare routine
for the past eight months I think now. Ali Abdaal (13:54):
You can also find my full interview with Usama about skincare on my vlog channel. He goes in
depth on more products and treatments that he'd recommend. So check it out if you like. And if
you're interested in more legit skincare advice from an actual board certified dermatologist,
then definitely check out Usama's channel linked down in the video description. Hope you enjoy
the video. Hope you got something out of it and hopefully see you in the next one. Bye-bye.