Walk through any beauty aisle or scroll social media for more than a few minutes, and it can feel like you’re already behind. Peptides. Red light therapy. Exosomes. Devices that promise in-office results at home. There’s a sense that if we’re not doing all of it, we’re missing something.
But the more time I’ve spent learning from cosmetic dermatologists who treat skin every day, a different picture starts to come into focus.
One that’s more intentional, more structured—and, as a result, far more reassuring.
Mary Lupo, MD, FAAD, is a board-certified dermatologist, adjunct professor of dermatology at Tulane University School of Medicine and founder of the Lupo Center for Aesthetic and General Dermatology in Lakeview. I’ve been a patient of Dr. Lupo’s for more than a decade, and every appointment is part treatment, part education. She’s constantly walking through what’s new, what’s worth it and what isn’t – without losing sight of the fundamentals.
More recently, I sat down with her for a two-part episode of my FUELED Wellness + Nutrition podcast. To broaden the perspective, I also spoke with Deirdre Hooper, MD, a board-certified dermatologist with Audubon Dermatology specializing in cosmetic, medical and laser dermatology.
Both are part of a strong community of cosmetic dermatologists – from different practices across New Orleans – who meet regularly to share insights, learn from one another and approach this work with a level of support that is surprisingly collaborative in a competitive field.
And that collaboration shows up in how they think about skin.
“You look good because you are good,” Dr. Hooper told me. Not as a motivational statement, but as a physiological truth. Our skin reflects what’s happening on the inside – our nutrition, alcohol intake, hormones, stress, sleep, inflammation. And if any of these are off, no single product, treatment or device can make up for it.
From there, both Dr. Lupo and Dr. Hooper consistently come back to the same four core elements that shape how skin ages – and how we treat it: daily skincare, neuromodulators, fillers and devices.
Everything else – peptides, red light therapy, PRP – builds on this foundation. As Dr. Hooper says, you can add all the extras you want, but if the foundation isn’t there, they can only do so much.
What Goes on First
The Treatment Layer
This is where skincare has really shifted.
Traditionally, routines started with cleansing, then moved straight into hydration or active ingredients like vitamin C or retinoids.
Now, before moisturizer, before serums, before anything else, dermatologists are starting with what Dr. Lupo refers to as the ‘treatment’ layer.
These are “cell-signaling” products – meaning that they are formulas designed not just to sit on the skin, but to influence how skin cells actually behave.
Dr. Lupo’s long-time go-to is Plated Intense by Skin Science, an exosome-derived topical product. Exosomes are microscopic messengers released by cells, carrying signals that support repair and reduce inflammation.
She uses it every morning, applying it to clean skin and allowing it to fully absorb before moving on to the next step.
More recently, she’s added Re-Q – a newer product that works through a different pathway, targeting cellular senescence – when cells slow down and become less responsive over time. She uses Re-Q at night as the first step on clean skin, aligning with the body’s natural repair cycle during sleep.
“If you improve how the cells function,” Dr. Lupo explained, “everything layered on top – skincare, devices, all of it – works better.”
This is a shift from how most people think about skincare. It’s not about simply layering more and more products – it’s about starting with topicals that influence how the skin functions at a cellular level.
Plated Intense by Skin Science, an exosome-derived topical product. Exosomes are microscopic messengers released by cells, carrying signals that support repair and reduce inflammation.
Using Re-Q at night as the first step on clean skin aligns with the body’s natural repair cycle during sleep.
Drugstore Finds That Actually Deliver
Not everything in a dermatologist’s routine comes with a high price tag. Some of the most consistently recommended products are simple, accessible – and inexpensive.
When it comes to retinoids, Dr. Hooper prefers prescription options like tretinoin or tazarotene.
But if you don’t? “Get yourself to the drugstore and get adapalene gel – in products like Differin or La Roche-Posay Effaclar,” she says.
For hydration and barrier support, Dr. Lupo emphasizes that expensive isn’t necessary.
After applying a hydrator like hyaluronic acid, she recommends sealing it in with a simple occlusive layer – and that can be as basic as:
- CeraVe ointment
- Cetaphil ointment
- Aquaphor
This approach – often referred to as “slugging” – helps lock in moisture and prevent water loss, especially as skin becomes drier with age.
The Skin Barrier
More Than “Moisturizing”
For years, most of us probably thought about skincare in one dimension: moisturizing.
Dermatologists now frame it differently. The focus is the skin barrier – and making sure it’s functioning the way it should.
The skin barrier regulates hydration, protects against environmental stressors and supports overall skin function. When it’s compromised – from over-exfoliation, harsh products or simply aging – our skin becomes drier, more reactive and less able to repair itself.
“The skin barrier is what keeps water in and irritants out,” Dr. Hooper said. “If that’s not working well, everything else becomes harder.”
That shifts the daily skincare routine from one step to three:
Treat. Hydrate. Seal.
Hydration is where most people underestimate what’s happening.
Ingredients like hyaluronic acid, glycerin and sodium hyaluronate are humectants – meaning they bind water and pull it into the skin. This is different from a traditional moisturizer. It’s not just softening the surface – it’s increasing water content within the skin itself.
But that water doesn’t stay on its own. “If you don’t seal it in, it can evaporate,” Dr. Hooper said.
That’s where occlusion comes in.
Occlusive products are creams or ointments used to create a barrier that locks hydration in place and reduces water loss. This becomes increasingly important with age, as skin naturally loses its ability to retain moisture.
For occlusion, Dr. Lupo keeps it simple. After the hydrator – often a hyaluronic acid serum – she recommends sealing it in with a cream-based moisturizer. And it doesn’t have to be expensive. “You can trap it in there with an ointment or cream as inexpensive as CeraVe, Cetaphil or Aquaphor – this approach is called slugging.”
The key, she emphasizes, is order: treatment then hydration, followed by occlusion.
And sunscreen comes last – always. More on that below.
Retinoids
Still One of the Most Effective Tools
For all the newer categories, retinoids remain one of the most consistent recommendations in dermatology.
Applied regularly, retinoids support collagen production, improve skin texture and help normalize skin turnover. The key is finding a retinoid routine that you can stick with.
“Use what your skin can tolerate, and use it regularly,” said Dr. Hooper.
She recommends what she calls the “moisturizer sandwich” – moisturizer first (the occlusion layer noted above), then retinoid, then another layer of moisturizer. It buffers irritation and makes the product more tolerable long-term.
Start with a pea-sized amount. If sensitivity is an issue, Dr. Hooper recommends starting with just the T-zone and build from there.
Prescription options like Tazarotene and Tretinoin are her top recommendations. But if you don’t have a dermatologist, she keeps it simple: go to the drugstore and buy adapalene gel, available widely over the counter, from a few different brands. “It’s more effective than a lot of over-the-counter retinol creams,” she said, “and a lot less expensive.”
Sunscreen
Still Non-Negotiable, Now Pulling Double Duty
Daily sunscreen isn’t new. What’s evolved is what sunscreen can do.
Traditional sunscreens work by blocking or absorbing UV radiation to prevent damage. But no sunscreen blocks 100 percent of exposure.
Newer formulations take it a step further.
They still protect – but they also include DNA repair enzymes, designed to help the skin address damage that occurs despite protection.
UV exposure creates damage within skin cells, including DNA mutations. These enzymes assist the skin’s natural repair processes, helping correct that damage more efficiently.
“These formulations help support repair at the cellular level,” Dr. Lupo explained. “DNA repair ingredients are primarily recommended for people with a history of skin cancer, but I extrapolate that if you’re repairing DNA to prevent skin cancer, you’re repairing DNA for aging at the same time.”
It’s not a separate step. It’s still your sunscreen – just upgraded.
Taken together, daily skincare comes back to a simple sequence: treat, hydrate, occlusion, followed by sunscreen. It’s a routine built on function, not excess – and consistency matters more than complexity.
With this foundation in place, the conversation shifts to the next layer: hormones, aging and the treatments that shape how skin changes over time.
Sunscreen, Upgraded: What “DNA Repair” Actually Means
Sunscreens with DNA repair enzymes function as your primary sunscreen – with the added benefit of enzymes designed to support the skin’s natural repair processes.
UV exposure doesn’t just cause visible damage. It creates microscopic injury within skin cells, including DNA mutations that contribute to aging and skin cancer risk.
DNA repair enzymes help the skin:
• Identify damaged DNA
• Support repair pathways
• Improve how efficiently cells recover
Dr. Lupo and Dr. Hooper’s top picks for sunscreen with DNA repair:
• ISDIN Eryfotona Actinica Ultralight Mineral Sunscreen SPF 50
• Neova Silc Sheer 2.0 Photo Finish Tint SPF 40
These products aren’t an add-on. They replace your regular sunscreen, offering both protection and repair in one step.
Neuromodulators
Strategic, Not Frozen
Neuromodulators – Botox, Jeuveau and similar products – work by relaxing the muscles that create dynamic wrinkles, the lines that form with repeated movement.
But the goal isn’t to eliminate movement.
“It’s about using it strategically,” Dr. Lupo said. “You don’t want to look frozen. You want to look like yourself – just more rested.”
That comes down to the provider’s expertise in understanding how muscles pull and interact.
Every expression we make is the result of muscles pulling in different directions, explains Dr. Lupo. Over time, certain patterns start to dominate, creating lines that settle into the face even at rest.
Done well, neuromodulators subtly adjust that pull. Relax the muscles that drag the brow down, and the brow lifts naturally. Soften the downward pull at the corners of the mouth, and the face shifts from tired to neutral. Treating areas like the platysma in the neck can further improve overall contour.
“It’s about placement and dosing,” she said. “You want to soften, not erase.” Neuromodulators shouldn’t change how someone looks. They minimize existing lines, help prevent deeper creases from setting in and create a more rested baseline expression – without taking away natural expression.
Less, placed well, is what makes the difference.
Fillers
Shape and Proportion, Not Just Volume
Fillers are where most of the hesitation lives – and often for good reason.
“Bad filler is filler you notice,” Dr. Lupo said. “Good filler, you don’t.”
That line gets to the core of how she approaches this category. The goal isn’t to add volume indiscriminately or chase individual lines. It’s to restore structure, proportion and shape – often subtly, and always in a way that still looks like your face.
Fillers aren’t one single category. The most commonly used include hyaluronic acid fillers – such as Juvederm and Restylane – which replace lost volume, and biostimulatory fillers – like Sculptra and Radiesse – which stimulate the body’s own collagen production over time. Each serves a different purpose, but all are tools to restore the underlying framework of the face.
Technique matters as much as the product itself.
One of the biggest mistakes Dr. Lupo sees is placing filler too close to the center of the face.
“The biggest mistake I see is putting filler too medially,” she said. “Youth is about structure – it’s lateral, not medial.”
When filler is placed too centrally in the cheeks, says Dr. Lupo, it can create heaviness, widen the appearance of the nose and lead to the overfilled look that people associate with “bad filler.” It’s also where much of the fear around fillers comes from – the duck lips, the distortion, the sense that something looks off.
Instead of focusing on the mid-face, Dr. Lupo’s focus is more laterally – the outer face – where subtle placement can restore lift and proportion without adding visible bulk. It’s less about filling lines and more about supporting the structure of the face.
“Done well, filler doesn’t call attention to itself,” says Dr. Lupo. “It just looks like a better version of the same face.”
Estrogen
The Conversation We Often Skip
For women especially, hormones are one of the most significant – and often overlooked – drivers of skin changes.
“As estrogen declines, our collagen also declines, elasticity declines, hydration declines,” Dr. Hooper said.
This shift affects everything: thickness, resilience, moisture, overall structure.
Systemic estrogen – when appropriate as part of hormone replacement therapy, such as a patch or cream that influences system-wide hormone levels – has the most significant impact.
“The data is clear,” Dr. Lupo said. “Estrogen affects every system of a woman’s body – and skin is part of that.”
For women who can’t or choose not to use systemic therapy, topical estrogen is another option, applied directly to the face in small amounts. While not as powerful as systemic therapy, studies suggest it can improve skin thickness, elasticity and hydration.
Testosterone, on the other hand, comes with tradeoffs.
“Testosterone has benefits – muscle, energy, libido.” Dr. Lupo said. “But for the skin? Almost all of it is negative: Oilier skin. Breakouts. Hair thinning. Facial hair growth. I mean really, wrinkles and whiskers? Talk me off the ledge!”
Which brings us to the bigger point: if hormones are part of what’s driving changes in your skin, they should be part of the conversation with your physician.
Devices
Where Technology Fits
Devices are often where the skin conversation starts to feel the most advanced – and the most overwhelming. Lasers, radiofrequency, ultrasound, tightening treatments, resurfacing. The promise is real: these tools can reach deeper layers of the skin in ways that topical products simply can’t.
“When we talk about ‘lasers,’ that’s a huge category,” notes Dr. Lupo. “Everything from light treatments to actually removing layers of skin – it all depends on what you’re trying to improve.”
Most in-office devices are designed to do one of a few things: stimulate collagen, improve tone and texture, or tighten underlying structure. Some work by delivering controlled heat into deeper layers of the skin, triggering a repair response that leads to new collagen formation over time. Others resurface the skin more directly, helping with texture, pigment or fine lines.
That’s the part that gets attention – the visible change. What’s easier to miss is that these treatments are working with the skin you bring into them. “If the skin isn’t in a good place to begin with,” Dr. Lupo explains, “you’re not going to get the same result.” Or, as Deidre Dr. Hooper puts it, “They’re important tools and can be remarkably effective, but they should be viewed as one component of a comprehensive regimen, not a stand-alone solution.”
That’s where the skincare foundation comes back in. The daily routine. The barrier. Consistency with retinoids. Sunscreen. All of it influences how the skin responds to any device-based treatment. In other words, devices can amplify results – but they can’t create them out of nothing.
Devices also aren’t typically one-and-done. Many require a series of treatments, followed by maintenance over time. And what you’re doing at home in between sessions matters just as much as what happens in the office, which has helped shape a growing category of at-home tools that aim to extend or support what’s done in-office. LED masks and handheld devices are designed to deliver specific wavelengths of light to the skin at lower intensities, making them more accessible for regular use at home. They’re not replacing in-office treatments, but they can complement them.
Used appropriately, devices can be among the most powerful tools available. They allow dermatologists to reach below the surface of the skin and influence how it rebuilds and repairs itself over time. But increasingly, the conversation isn’t just about what’s available in the office – it’s about what people are trying at home as well.
Red Light Therapy
What It Actually Does
Of all the at-home devices, red light therapy is one of the most talked about – and one of the easiest to dismiss. It can feel a little too good to be true. Light shining on our face, improving our skin?
As Dr. Hooper explains, though, the premise itself isn’t far-fetched. Light affects the skin – we know that clearly from ultraviolet exposure, which drives aging, pigment changes, and skin cancer. But light exists across a spectrum, and different wavelengths interact with the skin in vastly different ways. Some trigger damage. Others appear to support repair.
Red light falls into that latter category.
Rather than injuring the skin to force a response – the way many lasers and resurfacing treatments do – red light works through a different pathway. Specific wavelengths penetrate into the skin and are absorbed at the cellular level, particularly within the mitochondria, explains Dr. Hooper. That’s the part of the cell responsible for producing energy. When mitochondrial activity improves, the theory is that cells are better able to carry out normal functions – including repair, regeneration, and collagen production.
She’s clear, though, about where the science stands.
In controlled settings – those that she describes as lab or test-tube environments – this effect is measurable. You can see changes in how cells behave, including increased energy production and signaling that supports repair. But when you move from those controlled environments into large-scale human studies, the results are less definitive. The signal is there, but it’s not nearly as strong or consistent.
It helps explain why red light therapy can show benefit, but not in the dramatic way many people expect. Both Dr. Hooper and Dr. Lupo emphasize the same point: red light therapy may have some benefit, but it’s not a miracle tool.
“If you’re using it consistently, you may see some improvement,” Dr. Lupo says. But that benefit tends to be gradual and cumulative – not immediate or dramatic.
That consistency is where most of the value lies. Unlike in-office procedures with a defined endpoint, red light therapy depends on repeated use over time: committing to multiple at-home sessions per week, often for months, before changes become noticeable.
Red Light Therapy: What It Can – and Can’t – Do
Red light therapy has become one of the most talked-about at-home skincare tools – and one of the most misunderstood.
As Dr. Hooper explains, light interacts with the skin across a spectrum. Ultraviolet light causes damage. But red and near-infrared wavelengths appear to support repair.
There’s likely some benefit Dr. Hooper explains –
but it’s not a replacement for in-office treatments.
Those changes may include:
• Slight improvement in tone
• Increased brightness
• Gradual softening of fine lines
For those interested in trying it at home, Dr. Hooper points to Red Therapy Co. and Mito Red Light Therapy for Home as two brands recommended by researchers involved in the science used in these devices. “And interestingly, these are not two that my Instagram tells me about at all,” says Dr. Hooper.
Peptides
Where They Fit, and Where to Be Careful
Peptides are everywhere right now – in serums, creams, injectables, and increasingly, in conversations that make them sound like a shortcut to younger skin.
At their core, though, peptides are not new or mysterious. They’re simply short chains of amino acids – the building blocks of proteins. And in the context of skin, that matters because proteins like collagen and elastin are what give skin its structure, firmness, and resilience.
What peptides can do, at least in theory, is act as signaling molecules. They send messages to cells – encouraging them to produce more collagen, repair damage, or regulate inflammation. It’s less about adding something to the skin and more about directing how the skin functions.
That’s where they show up in everyday skincare.
In the treatment layer we talked about earlier – the first step after cleansing – products like Plated exosomes or Re-Q are designed to work at that signaling level. Rather than simply hydrating or sealing the skin, they’re intended to influence how the cells behave underneath.
Some formulations include peptides alongside other signaling compounds, while others rely more heavily on growth factors or exosome-derived ingredients. The goal is similar: support cellular communication and improve how the skin repairs itself over time.
Both Dr. Lupo and Dr. Hooper use these types of products regularly in topical form as part of that early treatment step.
The science, like with many newer categories, is still evolving. In lab settings, peptides clearly influence cell behavior – increasing collagen signaling, supporting repair pathways, and modulating inflammation. But in real-world use, results are more variable. Formulation matters. Stability matters. And how deeply those ingredients penetrate the skin is still an open question.
Where the conversation shifts – and where both dermatologists draw a firmer line – is with injectable peptides.
Marketed for everything from skin rejuvenation to fat loss to “anti-aging” more broadly, injectable peptides are primarily used off-label, meaning they’re not FDA-approved for those specific indications. And unlike neuromodulators or fillers – which have well-established protocols, dosing, and safety data – peptides don’t have the same level of standardization.
Neither Dr. Lupo nor Dr. Hooper uses injectable peptides in practice. And both are clear on this point: they would not recommend sourcing peptides online or attempting to inject them yourself. There’s no reliable way to verify purity, dosing, or sterility, and without medical oversight, the risks are significant.
It’s a very different category from topical skincare – with far less clarity around safety and benefit.
GLP-1s and the Face
What’s Actually Happening
It’s impossible to talk about skin right now without acknowledging the impact of GLP-1 medications.
These drugs are widely used for weight loss, and while the metabolic benefits can be significant, the changes in the face are just as real – and often unexpected.
With rapid weight loss comes a loss of facial fat, particularly in the fat pads that give the face its structure and shape. “The fat pads in the face change,” Dr. Lupo said. “And that changes how the skin looks.”
This is where the term “Ozempic face” comes from – not a separate condition, but a reflection of what happens when volume is lost quickly, especially later in life when skin elasticity is already declining.
Dr. Lupo acknowledges a truth that many women recognize immediately: significant weight loss later in life changes the way the face holds volume. That doesn’t make weight loss a negative. But it does mean the skin and underlying structure are part of what’s impacted.
It’s one reason steady, sustainable habits tend to translate differently in the face than more rapid shifts.
There’s another layer that’s less obvious.
“GLP-1s are anti-inflammatory – which sounds good,” she said. “But it also means some of our biostimulatory fillers don’t work as well. So it changes how we treat the face.”
This means that for patients considering fillers or other treatments, being on a GLP-1 directly affects how those treatments perform and what approach a provider may take.
“If you’re on these medications, you have to tell your provider,” she said. “It influences the type of fillers used to treat you.”
And ideally, the conversation starts even earlier. “Before you start a GLP-1, you’re hopefully already incorporating strength training and getting enough protein,” she said. “Because if you don’t, you’re going to lose muscle – and that’s where a lot of the problems start.”
The Bottom Line
Dr. Lupo emphasized that this doesn’t have to be complicated. “You don’t need dozens of products,” she said. “You need the right ones, used in the right order.”
It’s the same principle we see everywhere else in health: Start with the fundamentals. Be consistent. Build from there. Because no matter how advanced the options become, the foundation is still what determines the lasting result. And in this extremely technical and complicated area with so many pitfalls, we need to trust our experts who have the extensive training to provide the science-based information we need to make the best choices for our largest organ.
What Shows Up on Your Skin
The Lifestyle Layer
Dr. Hooper’s mantra, “you look good because you are good,” is a reminder that skin reflects what’s happening internally, and that quality skincare starts with what we put into our bodies.
5 key factors show up consistently:
1. Sleep
Skin repairs itself overnight. Poor sleep disrupts that process, affecting collagen production, hydration and overall resilience.
2. Alcohol
Alcohol increases inflammation and dehydrates the skin. It also disrupts sleep, compounding the effect. The result is often redness, puffiness and a more tired appearance.
3. Sugar and refined carbohydrates
A high intake of both contributes to advanced glycation end products (AGEs) – compounds that damage collagen and elastin. This accelerates loss of firmness and elasticity.
4. Stress
Chronic stress increases cortisol, which can break down collagen, impair barrier function and trigger inflammation.
5. Muscle and protein intake
With aging – or rapid weight loss – loss of muscle affects how the face holds structure. Adequate protein and resistance training help preserve that foundation.
The Takeaway
We can invest in the best products and treatments available. But what shows up on our skin is still shaped by how we’re sleeping, eating, managing stress and taking care of our body overall.
