Dr. Antony Nakhla

A.N.: I started out in Beverly Hills at a cosmetic dermatology practice on Wilshire. I was doing liposuction, fat transfer, and lots of filler. Then I started seeing patients who needed reconstruction: I was doing liposuction and fat transfer for HIV patients who were losing fat in their faces. Men on certain antiviral medications lose volume in their cheeks, their temples; it’s called facial lipoatrophy. There was something really special about restoring somebody back to themselves, and it was a population of people no one wanted to take care of. Within that practice I also had a following on the cosmetic side. I found myself going through the motions but not loving what we were promoting. I didn’t like this chase-down-every-wrinkle, blow-up-every-lip mentality. The more I looked at the cosmetic enhancement work of some of my colleagues, I felt like people were starting to look worse. Patients were doing too much and starting to look like different people. I felt more comfortable with the restoration type work. I liked the idea of ‘how do I get you to look like you?’ So, I started seeing more skin cancer patients. I love fixing a problem and bringing someone back to who they are, as close as I can. They should call it ‘restorative’ surgery—you’re putting someone back together.

A.N.: Before I do anything I think about: What’s the least amount I can do to get the intended result while keeping this person looking like themselves? That’s my job. In liposuction, it’s not how much fat you take out; it’s how much you leave in, so the patient doesn’t look hollow. With Botox, it’s about micro droplets, so the face can still move and have expression. It’s the same with filler. With threads, how do you place them in a way you can’t tell anything happened? My philosophy is that the person I’m dealing with is already perfect. It’s a remodel, where the structure is kept; it’s not a tear down. Those proportions, symmetry, asymmetry; that’s what makes the person. It’s so small, but if you start altering the proportions of someone’s cheeks or lips or eyebrow height, they can look like a different person. It’s crazy.

A.N.: That’s true, and I’m an advocate of the procedures I listed above. It’s how they’re done and how you approach them. There’s a way to utilize the tools out there and remain unique to yourself. My philosophy is that you are the most beautiful thing, as you are made. Removing every single uniquely identifying characteristic—that’s not my vibe.

A.N.: A lot of times in reconstruction, allowing a wound to heal on its own, with the use of bio-identical dressings, will result in a perfect scar. It dawned on me that a lot of the work I was doing could be applied to the cosmetic side, to get patients to use less filler and more of the stuff that mattered.You don’t have to look far to find what your skin needs; it’s already there. Healing these incredibly difficult wounds got me thinking about aging skin like wounded skin— wounded by everything: sun, age, time—and asking how do we trick those cells to heal themselves? Not with foreign ingredients or something that sounds cute but doesn’t work, but by using the unsexy stuff that actually works: growth factors, amino acids, peptides. I focused on what I was already doing with patients to fix a hole in their face: using materials derived from placental or chorionic membranes—ingredients the body recognizes as innate, and readily absorbs—to heal skin. The question was, how could I bring that to skincare, and get these types of ingredients into products in meaningful levels? It became an expensive science project, which it still is.

A.N.: Exactly. Sometimes it’s a body hack: This thing causes this cell to secrete its own hyaluronic acid or its own collagen. How do we hack the system and get the body doing what it does best? And if you’re going to apply something topically, it better be loaded with that you want your skin to encounter and formulated in a way it can receive it. We’re not putting on scuba gear to go look for magic algae or a special pearl at the bottom of the sea, we’re using the most obvious thing—duh, our skin already has the molecule it needs to repair itself, so let’s replenish that.

A.N.: The ingredient list. And it’s not a stock formula. It’s custom. There’s so much in there. It’s like a protein shake.

A.N.: The best vehicle to deliver ingredients is a serum, and ours has the highest absorption rate; the ability to penetrate is second to none. The reason why people use it and realize their skin is better overall, but can’t really pinpoint why, is because a lot of what’s happening is at the dermal level where skin is remodeling itself and the scaffolding is being put back together. It’s like good nutrition: You start feeling better right away, but the process of repair and renewal is ongoing if you are consistent.

A.N.: We’re like snakes: We’re constantly exfoliating, but we’re micro-exfoliating, and the faster we can get that cell turnover to happen, the faster we can reveal the healthy new skin underneath.

A.N.: Totally. This is about supercharging your routine by exfoliating away dead skin cells that are serving no purpose. The trick was, how do we do it a little bit every day, without irritation?

A.N.: We’re using ingredients that are pretty well-known—lactic and glycolic acids—but at clinical strengths that can be sort of unbearable if not balanced by calming and soothing ingredients. Balancing these acids was a real formulation challenge, to get the benefit without inflammation. That’s where the precision and process of creating a custom formulation comes in. It’s very nuanced chemistry to get it to where you want it to be: strong enough, but gentle enough, to do the job.

A.N.: It’s for anybody, including younger patients with overactive oil glands, acne, and clogged pores, or those with dull, dry skin, who want to get down to that fresher, baby layer of skin. I tell my patients to test it a little on the back of their hand to get a feel for it. It’s definitely an experience.

A.N.: Yes. People build a tolerance, so maybe once a day or every other day to begin, and then, ideally, you want to use this twice a day. It gets your skin accustomed to renewal, repair, turnover. We’re talking about micro-exfoliation—skin that’s not even useful; it’s already dead. It’s just sitting there making you look dull. And boring. Just kidding.

A.N.: Step 1 is to look at the ingredient list. Forget the name, forget the packaging. Look at the INCI [the ingredient list]. When an ingredient is at the top of the INCI, it means it’s present in a significant portion of the formula. When it’s way down at bottom, it means it’s present at less than one-percent—it’s not really doing anything for you. With our Tonic, for example, we made sure lactic acid is the number-two ingredient—which means it’s present at clinical strengths. If whatever the company is touting on the front of the box is not present at the top of the ingredient list, don’t use it. Step 2 is to try to do things in as few steps as possible. When you use the right products, you don’t need ten serums, you need one amazing one. Step 3 is consistency. With less steps and greater compliance, you’re going to do much better than if you have one-hundred products you don’t use.

A.N.: We only want to build heroes. We don’t plan on a gigantic lineup, just the things you need and some of the bells and whistles different skin types require.

A.N.: I would have run for office. I wanted to do something in the political realm as it relates to my heritage and where I’m from [Egypt], championing women’s rights, human rights, and religious freedoms. Those are the things that matter to me. I probably would have gone to law school and run for office, and I might still.

A.N.: It’s nice to be important but it’s more important to be nice. [Laughs] My mom used to tell me that in Arabic, and my cousin still says it.