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.

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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.

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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.

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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

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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.

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The weight is coming off. But something else is changing too, and nobody warned you about it.

GLP-1 medications like Ozempic, Mounjaro, and Wegovy have reshaped the conversation around weight loss in a way that nothing has in decades. What that conversation often leaves out is what happens to the face, the hair, and the skin in the process. Dr. Dustin Portela and Austin Lee are seeing it in clinic every week now, often from patients who never connected their new medication to what they are seeing in the mirror.

Ozempic face is real, and the biology behind it is worth understanding. The fat pads that give the face its structure and volume are among the first things to go during rapid weight loss. When that happens quickly, skin that spent years supported by subcutaneous fat suddenly has nothing to hold onto. The result is hollowing around the eyes and temples, deeper folds, and a face that can look older even as the body gets healthier. For patients who also carried excess weight for years, there is a second layer to this: chronic inflammation from obesity damages collagen over time, so the structural support was already quietly eroding before the weight came off.

Hair loss is even more common, and even more misunderstood. Telogen effluvium, the shedding that follows a metabolic shock, typically shows up three to four months after starting a GLP-1 or escalating the dose. By then, most patients have forgotten what changed. The good news is that for most people it resolves on its own within six to twelve months. The hosts walk through what can help speed recovery, including oral minoxidil, finasteride, red light therapy, and PRP, and what to watch for if the shedding becomes chronic.

The episode also covers what the emerging research is finding about GLP-1s and skin conditions like psoriasis and hidradenitis suppurativa, where the anti-inflammatory effects of weight loss appear to be driving meaningful improvement. There is even a retrospective study suggesting a lower incidence of breast cancer in women taking these medications, which opens a broader conversation about how interconnected metabolic health and immune surveillance really are.

None of this is a reason to avoid GLP-1s if your doctor has recommended them. It is a reason to know what to expect and to have a plan.

Product of the Week

CeraVe Invisible Mineral Sunscreen SPF 50

A broad-spectrum mineral sunscreen with no white cast and a cosmetic feel that punches well above its price point. Available at most major retailers for around $10 to $15.

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Some skincare myths are easy to knock down. The ones in this episode are trickier, because the prosecution actually has a case.

Round two of Derm Myth Court brings three myths that feel more defensible than last week's, which makes them more dangerous. Dr. Dustin Portela and Austin Lee trade sides again, and the debate format earns its keep here because at least one of these arguments is genuinely contested.

The vitamin D and sun exposure debate is the most substantive of the three. Yes, UVB exposure triggers vitamin D synthesis in the skin. Yes, many people are deficient. The prosecution has real ammunition, and the hosts don't pretend otherwise. What the defense works through is the part the argument always skips: how much UV exposure is actually needed, why that varies dramatically by skin tone and latitude, and why you can be doing UV damage in winter months without getting any meaningful vitamin D benefit in return. The Swedish study that anti-sunscreen advocates love to cite gets a close reading, and the confounding factors are worth understanding.

The oily skin debate is more one-sided but comes up constantly in clinic. The logic that oily skin produces its own moisturizer sounds reasonable until you understand what moisturizers are actually doing that skin oil isn't, and why barrier dysfunction shows up just as readily in rosacea, acne, and seborrheic dermatitis as it does in dry skin. The answer is not the same moisturizer for everyone, but it is still a moisturizer.

Sunscreen contouring closes things out. The trend, popularized on TikTok and endorsed in at least one notable celebrity Instagram post, involves deliberately skipping sunscreen on certain facial areas to achieve a natural tan contour. The hosts walk through what cumulative UV damage actually looks like in uneven distributions over time, which is not what anyone is picturing when they try this at 25.

Product of the Week

Dean Skincare ActivCE Vitamin C Serum and All-Trans Retinol

A stabilized vitamin C with green tea polyphenols for morning use, paired with a 5X retinol for nighttime. Available at shop.drdustinportela.com with discounts for first-time buyers.

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Some skincare myths are easy to dismiss. Others are built on just enough real science to sound credible, and those are the ones that spread.

For the first episode of Derm Myth Court, Dr. Dustin Portela and Austin Lee take three of the most persistent myths in dermatology and put them on trial. The format is simple: one host argues in favor of the myth, the other defends against it, and then the actual science delivers the verdict. It is more entertaining than a lecture and more useful than a scroll through your comment section.

First up is the claim that sunscreen causes cancer. The prosecution has real material to work with: there are studies showing certain chemical filters like oxybenzone are absorbed into the bloodstream, and skin cancer rates have climbed alongside sunscreen adoption. The defense dismantles both arguments methodically, including the animal studies on endocrine disruption that get cited constantly online and why the math on human exposure makes those findings almost entirely irrelevant.

Beef tallow is next, and it gets a fair hearing before falling apart on its own merits. The ancestral skincare argument, the fatty acid claims, the vitamin A comparison to retinol: each one gets taken apart. What remains is a product that is essentially an occlusive, costs significantly more than a jar of Vaseline, has a shelf life that is not always obvious, and carries a real risk of contact dermatitis when essential oils are added to cover the smell.

The lemon juice for acne debate ends with a patient story that is hard to forget. The citric acid argument has some surface-level logic to it, and the hosts acknowledge that. But lemon juice on skin plus sun exposure is a combination that dermatologists are still treating in clinic, usually presenting as dark irregular marks on someone who just got back from a beach vacation and cannot figure out what happened.

Each myth gets a clear verdict and a better alternative.

Product of the Week

Dene Skincare Sheer Shield SPF 50, Dean Active Repair Moisturizer, and Rapid Reveal Exfoliation Pads

The three products recommended as evidence-based alternatives to what was debunked in this episode. Available at shop.drdustinportela.com with at least 15% off your first purchase.

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Most people don't follow healthcare policy. But this one is worth your attention, and the window to do something about it closes September 14th.

A new CMS proposal, if passed, would cut reimbursement by 50 percent any time a doctor performs a procedure on the same day as an office visit. On paper, it sounds like a billing technicality. In practice, it means that if your dermatologist finds a suspicious mole during a routine skin check, many practices would no longer be able to biopsy it that same day without losing money on the encounter. You'd be asked to come back. Two appointments, two copays, two weeks of waiting for answers about something your doctor told you looked concerning.

Dr. Dustin Portela and Austin Lee break down exactly how physician billing works, why the CMS framing of this as an "efficiency adjustment" misses the point, and what the real-world impact looks like across every specialty. This isn't a dermatology problem. It's a pediatrics problem, a cardiology problem, an ENT problem. Any doctor who currently handles two separate concerns in one visit would be forced to split them. For patients in rural areas who drive long distances to see a specialist, that's not a minor inconvenience. For practices already operating on thin margins after decades of declining reimbursements, it could mean staff cuts, dropped insurance plans, or closing altogether.

The good news: there is something you can do before the comment period closes. Contacting your two state senators and congressional representative directly, by phone or email, carries more weight than a CMS comment. Links to a sample letter and a tool to look up your representatives are in the show notes. If you add something personal, why this would affect your specific situation, it will land harder than a form letter.

Please share this episode. The more people who contact their representatives before September 14th, the better the outcome for patients.

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At 40, Dr. Mary Alice Mina noticed her neck for the first time. She was a dermatologist, she knew the science, and it still caught her off guard. That moment of recognition is exactly what she now builds her practice around.

Dr. Mina is a board-certified dermatologist, host of The Skin Real podcast, and one of the clearer voices in a space crowded with noise about menopause and perimenopause skin care. In this conversation with Dr. Portela, she covers what actually happens to skin during this chapter of life, why perimenopause symptoms are so easy to miss, and what women can realistically do about the changes they are seeing in the mirror.

A few things stand out. The collagen loss that happens gradually in your 30s can accelerate sharply once estrogen drops at menopause, sometimes up to 30 percent in a five-year window. The window to do something about it is earlier than most people think. Dr. Mina and Dr. Portela both practice what they preach: daily SPF, a retinoid, and an antioxidant serum cover most of the ground. Collagen supplements, creatine, and protein intake all come up, with honest takes on what the evidence actually supports versus what sounds good on a label. Everything beyond the basics is diminishing returns unless sleep, nutrition, and stress are also being addressed.

The conversation on topical estrogen and hormone replacement therapy is candid and nuanced. There is promising data and real gaps in the research, and Dr. Mina is honest about both. She also makes a point that tends to get lost: vaginal estrogen is one of the most evidence-backed and underused treatments in women's health, and many women who could benefit from it have never been told it exists.

On the in-office side, she walks through laser resurfacing, microneedling, and biostimulators like Sculptra and Radiesse for collagen restoration, with a clear-eyed take on why patience matters and why the lifestyle foundation has to come first before any cosmetic procedure can do its job.

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Summer has a way of reminding people that their skin has limits.

Every July, the same things land in Dr. Dustin Portela and Austin Lee's clinic: sunburns that crossed a line, back acne that appeared out of nowhere, rashes from sources nobody thought to question. This episode is their honest take on the summer conditions they see year after year, what causes them, what to do, and in a few cases, what not to do.

Sunburns get a proper breakdown, including the biology of why the damage keeps happening after you're already out of the sun, what actually helps during those first miserable hours, and when a burn is serious enough to warrant a trip to urgent care. The conversation on sweat acne and folliculitis is worth the listen for anyone who spends significant time outdoors and can't figure out why their skin keeps breaking out. Tinea versicolor comes up too, including Austin's admission that he deals with it himself every summer.

The diagnosis that tends to stop people cold is phytophotodermatitis. Most people have never heard of it. But if you've ever squeezed a lime into your drink at a backyard barbecue and gone back outside, you've taken the risk. The case stories here are genuinely funny, and the condition is genuinely real. Sea bather's eruption, swimmer's itch, and chiggers round things out in ways that will make anyone reconsider their relationship with warm, still water.

Somewhere in the middle, a 1933 physician decides to let a black widow spider bite his own finger to prove a point to skeptical colleagues. It goes about as well as you'd expect.

Product of the Week

Neutrogena Ultra Sheer Body Mist SPF 70 and Inner Glow Sol Defense Supplements

A water-resistant spray sunscreen for easy summer coverage, paired with a polypodium-based supplement that helps neutralize UV free radical damage from the inside out.

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