Ask a Dermatologist/Surgeon: Dr. Tony Nakhla
Ask a Dermatologist/Surgeon: Dr. Tony Nakhla
Once the top injector in Orange County, his skincare line Eighth Day is about creating a new beauty philosophy.
I have one metric when it comes to skincare that I hold God-tier to the rest: Does it make my skin look and feel better? Sure, I’m enticed by celebrity endorsements, ornate packaging, luxe smells and science-y language, but at the end of the day, if I don’t see noticeable results, no amount of seemingly convincing factors hold their weight. Eighth Day, a new skincare line from leading reconstructive skin cancer surgeon, wound healing expert and clinical researcher Dr. Tony Nakhla, admittedly caught my attention with its sleek packaging, but was able to find its way into my routine because of its effectiveness — which I tested over a two week period.
My skin looks and feels more hydrated, I have fewer dry spots and rough patches and — and this is a big one for me — less redness, blotchiness, or discoloration. That, and I’ve finally found a serum that actually lives up to its promise of firming skin. Simply, my skin looks better.
I get sent a lot of products as one of the perks of my job, and when I find one I like, particularly one not from a big luxury conglomerate, I want to learn more about how it was formulated and what sets it apart. But chatting with Dr. Nakhla also provided an opportunity to ask some of my burning questions, like how to know what prospective surgery is best for you and what’s the deal with serum, a foundational part of my skincare that five years ago, I’d never even heard of. To get these and other vital answers, plus to learn more about the making of the skincare line that is now canon to my routine, I sought out the good doctor for a chat.
To start off, I’d love to learn a little bit more about your background; the kind of things that aren’t in your bio online. How did you find your way into doing what you do now?
I am the son of immigrants that came from Egypt as religious refugees. My family left Egypt in the 70s and came here. My father passed away when I was pretty young; he had a drug and alcohol problem. I grew up in a single-parent home, pretty poor, in North Jersey. My ultimate role model was my uncle, who was a pediatrician. I knew I wanted to go into medicine because I wanted to follow in his footsteps. I got into medicine at a pretty young age. While I was in medical school years later, I realized that there were only a few fields that allowed me to explore my creative side. One of them was the field I'm in now, which is mainly about reconstruction. A lot of it is detailed work. I identify a lot with chefs, people who work in millimeters. I found my field to be really suited to my personality.
My greatest strength is also my greatest weakness: the ability to identify a crack in the wall, a perfect surface and I find the little crack. My eye goes toward the imperfection. That’s how I am with my patients and the work that I do. Oftentimes, I'm really focused on the minute detail and I'm a tough critic of myself. I've been in private practice for 15 years, working on both cosmetic and reconstructive patients. I really loved the idea of bringing somebody back to themselves again. I'm guided by the belief that you look best when you look like yourself. That sounds simple, but if you take a walk down the street in Newport Beach or Beverly Hills, you’ll see the culture is leading us in a different direction. I think that beauty is this universal truth. You look great when you look like your most unique self. That became the focus of my work.
Early on, you were doing more cosmetic surgery like injectables and fillers. I believe I read you were the top injector in Orange County. What led you away from that?
I had this ah-ha moment when I was working with HIV patients who had lost the fat and volume in their cheeks from HIV medications, doing fat transfer and Sculptra, an injectable for facial fat loss. And I really loved that work because it wasn’t about taking somebody and enhancing them; it was about taking a face and bringing it back to what it was. It’s very different. It’s a very different way to view plastic surgery, but I preferred it. Little by little, my practice started to shift more towards the reconstructive side. Now, I’m almost entirely focused on facial reconstruction post-skin cancer surgery. I treat a lot of complicated facial wounds and advanced tumors on the face, always with the idea that I want to bring this person back to what they looked like before. That's been my beauty philosophy.
Now, because of social media and the culture at large, there’s so much more awareness and interest in beauty and skin. The global beauty market grew 10% in 2023 alone. From your time in this field, when do you feel like the shift happened from skin health being an annual appointment with a derm to what it is now?
There was a time when dermatology was purely medical, treating rashes, lumps and bumps. Back in the day, syphilis was the primary focus with dermatologists. They were primarily “rash doctors.” With the advent of Botox and some of the laser procedures that came out, the world of dermatology became partially aesthetic. Now there are dermatologists who have become completely aesthetic. There are fewer dermatologists who focus on medical dermatology than there are cosmetic dermatologists. The answer for that is simply financial. And it’s much more glamorous to be in cosmetic dermatology, right? If you come to one of my conferences, everybody’s beautiful. It’s almost like they choose the best looking people to go into derm now.
That said though, there's also the influence of Big Pharma and the laser companies and the manufacturers of all these injectables and Botox, all these companies that come and wine and dine everybody, put on a beautiful show and pay off all the major institutions and directors. People start drinking the Kool Aid, and I'm talking about the professionals themselves. Their spouses, even. It’s not uncommon for me to see a colleague of mine from 15 years ago that literally looks like a different human being, because they’re doing the same stuff to themselves. I think even culturally among dermatologists, plastic surgeons, and not to mention the nurse injectors who barely get any training that end up treating a lot of people, the whole perception of what beauty is has been influenced. Influenced and, to a certain extent, tainted. It trickles down to the patient, ultimately.
As someone in this field, can you look at a celebrity or an everyday person who has had work done and identify what they’ve had?
I can, and most professionals can, just look at someone and see what they’ve had done; lips, smile lines… I think in the case of a lot of celebrities that started having a lot of stuff done, it turns out that that stuff actually ages your face. Lower face filler, jawline, chin — a lot of that can actually masculinize a woman’s face and give the impression of older age. If you look at younger celebrities who have cosmetic work done, especially in the lower face, even in the cheeks (Megan Fox is a good example), they actually look older. In the case of those that are “aging in reverse” now, there was probably a period of time where they had too much going on and it was overdone and they took a break. A lot of this happened during Covid, by the way. The time period during Covid when people couldn't get Botox and fillers, they finally came to the office and looking at them, a lot of people just felt like they looked better. Less of everything had them looking younger and more refreshed and embracing how they looked.
For people that are considering having some of these surgeries, as you mentioned earlier when you talked about “Big Pharma,” a lot of these doctors want you to have more because the more you have done, the more money they're making. So how does the prospective client pick what is best for their face from the menu of options?
It comes down to trust. You have to trust the provider that you’re seeing. Trust in their aesthetic sensibility. I have a lot of male patients that trust me and I talk them out of things. I personally don’t like Botox in men’s foreheads. I don’t like how it looks. Whoever you see has to be somebody that you share the same aesthetic sensibility with, you trust them and they should talk you out of things that are not right for you. It really just comes down to trust.
I need not tell you, there are endless products on the market today. It seems like every celebrity is launching a beauty brand, but you obviously come to this with unique expertise. What gap were you seeing in the market that you felt Eighth Day could help fill in?
I was focused on the luxury customer who was coming in with products that were devoid of anything in them. My patient is somebody who wants to spend the most amount of money and get the best. What was happening, and still happens, in the sect of luxury skincare is — unlike other verticals in luxury, where if you buy a watch and it’s the most expensive one, I can tell you why — you receive very fancy, expensive packaging, highly perfumed products that are primarily preservatives and fragrance, with no active ingredient.
Yes! And these traits often convince me to buy and use said product, only to get no visible results.
Right! And on the other end, it wasn't uncommon for patients to buy skincare items in my office that were active and performing, but the experience was off. It was clinical-looking packaging or something that smelled like fish oil; the playtime on the skin, the way it made you feel. I wanted to focus on the customer, give them this clinical skincare, but also not skimp on the things that I also care about: the experience. I also wanted to create something that felt modern for the luxury customer who’s not just interested in a department store beauty counter. Someone like you, like me, someone who wanted to use skincare but didn't want it to be overly feminine, overly masculine, just unisex. That was the hole that I found. I wasn't going to do it if I didn't really believe in what I was doing, but also if I didn't feel like I could really disrupt that category. That was the aim.
Let me ask you about the regenerative serum in particular, because when I was growing up, I always knew: wash your face, throw on moisturizer, call it a day. Maybe some SPF. What are the specific benefits to a serum, especially for men who often overlook serum? What is your argument for serum and its importance?
Before I answer that, I want to tell you as a dermatologist, as somebody who uses topical skincare products myself, it’s very hard to get a topical skincare product to do anything for your skin. Let’s start there. It’s hard to get something over the counter, that’s not prescription, to perform, to do something to change your skin.
And why is that?
The amount of active ingredients that you need and the percentages that you would use to actually change somebody’s skin require custom formulation, really thinking about what the ingredients are doing and a vehicle where it actually affects your skin. Moisturizers are primarily humectants, these things that sit on top of the skin and cause your skin to draw out water from deeper layers to the top layer, or they act as an occlusive, where it closes up your skin. Or it acts to simply soothe the outer layer or provide an emollient effect. Serums, acids, products that come in that lighter format are more readily absorbed by skin. In order for you to really get an active ingredient to perform, it’s very hard to do that with a thick, heavy product sitting on the outer layer of your skin. Serums and more watery-type products are actually a better vehicle for you to treat skin concerns with an active ingredient. And that's why serums are more active because you don’t need all that thick stuff at the top.
Talk to me about the actual process of getting this made. It’s one thing to have an idea of a product, and it’s another thing entirely to add this into all that you do on a daily basis with your practice. What were some of the challenges going from having the idea to launch this to having this be something people can actually go online and buy?
Let’s call it an expensive science project, because that's what it was in the beginning. The hardest part is that most skincare is white-labled. You go to a contract lab and they have this amazing vitamin C, so you slap your name on it. Creating a custom formula was the only thing I wanted to do. In the beginning, I made a lot of mistakes. I didn’t really know where I was going with this. I just wanted to do it, I wanted to build it for the joy of building it. A lot of founders who think that way really end up focusing on the near term, not the “whatever it takes to sell it” goal. The goal here was: build something custom and research ingredients that made sense for the human body and human skin. In the luxury realm in skincare, the focal point has been fantasy, storytelling. Like, “some pearl from the deep Japanese sea was found and we made a product out of it. One Amazonian berry that is only found in this jungle — we have to kill a small tribe and it now works.” Something really crazy.
It’s kind of becoming its own Saturday Night Live sketch, the way in which many brands speak in this almost mythic tone.
Right, whereas in reality, it’s not as sexy as that. The stuff that works is an insulin-like growth factor. Stuff that’s more nerdy-sounding but actually performs. The thing that really inspired me from a scientific standpoint was the work that I was actually doing at my practice. In skin cancer and reconstruction, we treat very complicated facial wounds that actually have to contract before we stitch them up. We use bio-identical wound dressings, placental cell membranes, umbilical cord tissue, chorionic membrane. The ingredients from the very source of human life are extremely nutrient-rich. When you place them inside a wound, a wound contracts and starts laying down its own collagen and regenerating. It’s amazing. Thinking about the world of regeneration and wound healing and viewing aging skin as wounded skin, that became the foundation of Eighth Day, from a scientific standpoint. Aging skin is wounded by time, by the sun, by the elements. Getting the body to do what it does best — that was the focus of the science.
I wanted to find ingredients that mimicked what we were doing. The whole regeneration process. You can actually find synthetic peptides. Out of all the manufacturers that make ingredients, they make different types of peptides and growth factors, so I wanted to combine them in one serum. I also wanted all the things you normally find in serum: hyaluronic acid, antioxidants, ginger root extract — ingredients that speak the language of skin. Skin cells talk to each other in their own native tongue, communicating this idea of regeneration, healing, and repair, telling each cell to start making more collagen, making more elastin, and building the skin’s resilience and innate protective mechanisms. That’s how and why I wanted to build my regenerative serum. The customers were buying multiple serums. I researched why: Why buy hyaluronic acid, Vitamin C, a growth factor, etc… Why are there 10 serums in a line? Not being a beauty industry veteran, I started asking around. Really, it’s the tail wagging the dog. If you open up an XYZ retailer and they tell you, “We need Vitamin C,” the brand makes Vitamin C. Next fall, they make hyaluronic acid. Everyone is repackaging the same thing and a retailer is telling the brand what to make, in turn telling the customer what to use, which makes no sense. Really, it should be what’s best for the customer. How do we get 25 active ingredients into one jar, one serum, and give the customer who’s spending the most amount of money the very best? The Eighth Day serum is the serum to end all serums. We don’t need another five steps after that; it’s one and done. If we decide to update it, I’d love for us to think of skincare in terms of updates, not just give the customer more and confuse them further.
I’m a pop culture person and I saw more and more celebrities coming out with fragrances in the early aughts, then beauty, and nowadays, skincare. Because these celebrities have large social media platforms, their brands obviously get a lot of attention. I know every celebrity brand is not the same so I don’t mean to call them a monolith, but I’m wondering what your perspective is on watching people who don't have the experience like you do, who don’t have the expertise that you have, who don’t do the research that you’ve clearly done coming into this space and, in some instances, dominating it?
I think there is a customer for that. I think there is a customer who identifies with a certain celebrity or influencer and wants to use what they're using. I think it's probably more advantageous to the customer if it’s color cosmetic or fragrance, something like that. When we get into skincare, skincare is healthcare. You can die from melanoma. You can neglect your skin and considerably age from not taking good care of your skin health. I think it’s more dangerous to listen to non-experts. We don’t learn about heart health from celebrities; we learn from our cardiologist. Dermatology is its own, bonafide medical specialty. Even plastic surgeons, primary doctors, medical experts — they are not dermatologists. There is a big difference between a dermatologist and even a regular physician who is not in skincare. I find it just as arbitrary when a celebrity, or even a doctor [who’s not a dermatologist], launches skincare. I’m focused on the luxury customer who wants the best thing the money can buy.
I just read Ina Garten’s book. It talks at length about spending more on quality ingredients. There’s a subset of people who don't want to spend more money and want the cheapest option, but there are also people who understand that when you’re spending more money on something, you’re going to get a better product. When the ingredients cost more money, it's going to come together as something that ultimately benefits you.
That’s a great point. We're not for everybody and we don't claim to be. The latest headline on our interview for the New York Times said: “Aiming to make the Lamborghini of skincare.” It was a humbling moment for me and for the brand. We are trying to make something special for the customer who wants something special. I think anybody can slap their name on the product; it’s the more discerning customer who asks why. I think there’s a sophisticated consumer who doesn't believe in the hype.
The one thing I didn't say which is really crucial: I believe that science is the new luxury in skincare. As customers become more intelligent and there is more information available, the days of storytelling and attaching to a celebrity are gone. Science is the focal point and results are what matter. I think that’s what people really want. Science is the new luxury.
To learn more about Eighth Day, visit their website here.