Skinfluence with Dr. Dustin Portela

There is a version of skincare advice that stays comfortably abstract, and then there is this. Dr. Dustin Portela and Austin Lee turn the tables on themselves, answering yes-or-no questions about real decisions they face in the clinic, the treatment room, and their own lives before explaining why. The format cuts through the usual hedging fast. Would they put their own teenager on Accutane? Yes, both of them, without hesitation. Dr. Portela has taken it himself and would take it again. Would they spend $1,000 on a single skincare product or a full routine? No, and Dr. Portela's take on that is blunt: you will get more benefit from spending $1,000 on a laser procedure than from any cream at that price point. Would they get preventative Botox at 25? They both said no, and their reasons are more honest than the clinical ones. Some questions reveal real disagreement. When Dr. Portela asks whether Austin would try a treatment that is not yet FDA-approved if the evidence was compelling, Austin says yes. Dr. Portela says no, and explains why the gray market makes that position nearly impossible to hold in practice: unknown purity, no human data on most peptides, and third-party testing that frequently finds the active ingredient is not even present in the bottle. Other questions open into something more personal. Would they do a procedure on a close friend or family member? Both have, and both still do. Dr. Portela performed a laceration repair on one of his kids and still hears about the occasional scar twitch years later. Austin did a CO2 laser on his wife. The tradeoff, they both agree, is that you become on-call around the clock for people who know exactly where you sleep. The episode closes with a question that is less clinical and more revealing: would they choose dermatology again? The answer from both hosts is yes, though Dr. Portela adds a caveat that has more to do with the state of healthcare than the specialty itself. Part 2 continues the format with more scenarios. Product of the Week DENE Skin Care The same line Dr. Portela and Austin use in-office with their own patients. The Activé Repair Cream and Sheer Shield Sunscreen are available on the DEEN website. Sign up for the email list for current specials and discounts. Follow Us Dr. Portela TikTok Instagram YouTube (Reactions) YouTube (Educational) Pinterest Austin Lee, PA-C Skinfluence Podcast Instagram

Most skincare marketing is built on a foundation of real science stretched just far enough to become fiction. A cell study becomes a product claim. An ingredient supplier's dossier becomes a brand's clinical proof. And somewhere along the way, consumers end up paying $200 for a moisturizer that contains something the company cannot prove exists. J.C. Dombrowski came to skincare through a genuinely unusual path: a background in marine biology and shark conservation, a stint studying the biomedical applications of spider venom, then R&D work at Amorepacific on brands like Laneige, Innisfree, and Tata Harper, followed by a role as head of R&D at an indie beauty brand. That experience, sitting at the intersection of ingredient science, claim substantiation, and marketing, gave her a fluency in exactly how brands mislead consumers without technically lying. Dr. Portela and J.C. dig into some of the most pervasive examples. The EWG and Yuka app come in for a thorough takedown: both treat dose as irrelevant, which is the one thing toxicology insists you cannot do. The European Union's famously long banned ingredients list, often cited as proof that American regulators don't care about safety, turns out to include controlled substances like barbiturates, amphetamines, and rocket fuel. Nobody is putting those in a face serum. The conversation goes deepest on exosomes, currently one of the most aggressively marketed ingredients in skincare. J.C. has spent more time than perhaps anyone outside of academic research trying to get brands to prove their products actually contain them. Her conclusion: they cannot, and they cannot because it is biologically impossible. Exosomes require storage at negative 80 degrees Celsius. Skincare preservatives are specifically designed to destroy biologically active material. The characteristics that actually define an exosome, including endosomal origin, intact lipid bilayer, and specific protein markers, are things no topical brand has ever proven to her satisfaction. The real risk for consumers, she argues, is not harm but overspending on something that simply is not there. The episode ends with something more constructive: J.C.'s thoughts on what is actually worth paying attention to, including encapsulation technology and intelligent penetration enhancers, and a nuanced conversation about where dermatologists and cosmetic chemists can learn from each other rather than fight online. Guest Info J.C. Dombrowski Instagram: @jc.dombrowski TikTok: @jc.dombrowski

There is nothing wrong with a teenager who wants to take care of their skin. The problem is that the skincare products flooding social media feeds, the ones showing up in Sephora haul videos and dermatology influencer posts, were not designed for them. They were formulated for adults trying to correct years of sun damage, declining cell turnover, and diminishing collagen. Selling those products to a 13-year-old is a lot like prescribing a medication for a condition they don't have. Dr. Dustin Portela and Austin Lee, PA-C, break down what actually happens physiologically when teens start using products designed for aging adult skin. Teenage skin turns over faster, produces more oil naturally, and hasn't accumulated the oxidative damage that drives the need for actives like retinol, AHAs, or vitamin C serums. In most cases, Dr. Portela explains, kids are wasting money. But in his clinical practice in Idaho, he also saw real consequences: perioral dermatitis, eczema flares, and disrupted skin barriers from teens layering retinoids and exfoliants they simply did not need. The deeper issue isn't just dermatological. Both hosts speak as parents, and the conversation moves into the psychological dimension of the trend. Social media creates enormous pressure on kids to look a certain way, buy certain products, and maintain routines that signal belonging. The filters, the studio lighting, the sponsored posts from dermatology influencers: none of it reflects what healthy, real skin actually looks like. Dr. Portela references Jonathan Haidt's book "The Anxious Generation" as essential reading for any parent trying to navigate this. So what does a teenager actually need? The answer, according to both Dr. Portela and Austin, is straightforward: a gentle cleanser, a moisturizer, and sunscreen. If acne is present, options like salicylic acid, benzoyl peroxide, adapalene, or prescription tretinoin are clinically appropriate and worth discussing with a board-certified dermatologist. Everything else, the serums, the exfoliants, the hyaluronic acid layers, is largely unnecessary. The episode also offers something practical for parents: guidance on how to navigate the moment when a teenager insists they need the product every friend at school is using. Sunscreen, they both agree, is the one step consistently skipped in these elaborate teen routines. It is also the most important one. If you want to prevent the discoloration, sun damage, and skin aging these products claim to treat, start with SPF every morning. Product of the Week Aire Skin Store A dermatologist-curated marketplace carrying vetted, clinically-backed skincare brands including EltaMD, Skinfix, and Dune Skin Care. Listeners receive 10 to 20% off not just on first purchase, but on every repurchase. Link in show notes. Follow Us Dr. Portela TikTok Instagram YouTube (Reactions) YouTube (Educational) Pinterest Austin Lee, PA-C Skinfluence Podcast Instagram

Part one was the absurd and the unexpected. Part two is the stuff that keeps clinicians up at night. Dr. Dustin Portela and Austin Lee go somewhere more vulnerable in this episode, sharing the near misses, the misdiagnoses, and the moments that quietly but permanently changed how they practice. The cases are real. The self-reflection is genuine. And the honesty about what it actually feels like to carry those moments forward is something you won't often hear from medical professionals willing to say it out loud. Austin walks through a case that should be familiar to anyone who has ever been treated for something that kept getting worse: a patient whose scaly rash had been treated as eczema for years before a biopsy revealed it was cutaneous T-cell lymphoma, a skin-confined lymphoma that takes an average of seven to eight years to diagnose. Dr. Portela follows with a drug interaction he prescribed that almost cost a patient her life, a known but poorly documented risk between tetracycline antibiotics and myasthenia gravis that neither he nor his attending had ever heard of. She survived. He has never prescribed it the same way since. The conversation on near misses is candid in a way that matters for patients too. Both hosts have caught melanomas on their way out the door, in lighting that was just slightly different, because something made them turn around. Austin recounts missing a nodular melanoma on a patient's scalp during a thorough skin check, only for the patient to find it herself. That case changed how he examines hair permanently. The did-you-know this week covers amelanotic melanoma, the pink or flesh-colored variant that doesn't follow the classic ABCDE rules and that even experienced clinicians can mistake for something benign. It's one of the more important two minutes in this series. The episode ends where it probably should: a reminder that patients who advocate for themselves, point out the spot the doctor glossed over, or simply say they don't feel right about something, are not being difficult. They are part of the process. Product of the Week CurrentBody LED Hair Growth Helmet A multi-wavelength red light therapy helmet with built-in Bluetooth headphones designed for at-home hair regrowth. Link in the show notes. The code to use at checkout is DRPORTELA Follow Us Dr. Dustin Portela TikTok | Instagram | YouTube (Reactions) | YouTube (Educational) | Pinterest Austin Lee, PA-C Instagram: @austinleepac Skinfluence Podcast Instagram: @skinfluence_pod

Every dermatologist has stories they can't tell at dinner. This is that episode. Dr. Dustin Portela and Austin Lee set aside the science and spend an episode doing something different: sharing the cases that stuck with them, the moments they didn't see coming, and a few things patients put on their skin that genuinely defy explanation. No personally identifying details. No punching down. Just two clinicians who have spent a combined two decades in exam rooms and have earned the right to say what practicing dermatology actually looks like. The misdiagnosis stories alone are worth the listen. Both hosts independently encountered the same scenario early in their careers: a nail condition that had been treated as fungus for months, or years, that turned out to be melanoma. One patient lost a toe. One lost a thumb. The cases are told plainly, without dramatizing them, which somehow makes them land harder. There are lighter moments too. Dr. Portela traces his first memorable experience with skin treatments gone wrong back to his own childhood, when his father, a chemistry teacher, decided that hydrochloric acid was a reasonable approach to a wart and discovered the hard way that paper cups are not chemically resistant. Austin's most memorable patient story involves a rosacea treatment approach that her husband appears to have personally recommended, involving a substance with no clinical evidence and a texture that defied description. It is presented with as much professionalism as the situation allows. Alongside the confessions is a did-you-know segment on Daniel Carrion, the Peruvian medical student who hypothesized that Oroya fever and a common skin condition called verruga peruana were caused by the same bacterium, then injected himself with infected blood to prove it. He was right. He died 39 days later. The disease now bears his name. The episode closes on something quieter: a story from COVID lockdowns about an elderly patient in an assisted living facility who broke down during a routine skin check. It was the first time another person had touched her in nearly a year. Product of the Week EltaMD UV Clear SPF 46 The top-selling sunscreen in Dr. Portela's office, now available at shop.drdustinportela.com. A lightweight, niacinamide-based formula that works for acne-prone and sensitive skin. Follow Us Dr. Dustin Portela TikTok | Instagram | YouTube (Reactions) | YouTube (Educational) | Pinterest Austin Lee, PA-C Instagram: @austinleepac Skinfluence Podcast Instagram: @skinfluence_pod