This comes up in my clinic more often than people expect. Usually it starts quietly. A patient will be telling me how they’re doing, and somewhere in the middle of it they’ll pause and say something like, “I just don’t look like myself anymore.”

It’s not a dramatic moment. It’s not even necessarily their main concern. But it’s real. They’re noticing things. Their skin isn’t as bright. A few new lines. Breakouts that seem to have come out of nowhere. Or a general dullness that makes them feel like something is off.

Most of them have already tried a few things by the time they get to me. They’ve switched skincare products. Tried a new supplement that a friend swears by. But it doesn’t feel like enough. They still feel like their reflection isn’t quite matching how they want to feel.

When that happens, I don’t start with a product recommendation. I start with what’s underneath. Because in my experience, what shows up on your skin is rarely just about the skin. It’s the first sign of something else: hormone changes, gut imbalances, blood sugar swings, chronic stress, or nutrient depletion. Skin is incredibly responsive to what’s going on inside the body.

So in my practice, when someone comes in wanting to support their skin, we start by asking better questions. What’s happening with sleep? What’s going on with digestion? Are they recovering after workouts? How’s their mood? Their cycles? These details matter. They help us uncover what’s affecting the skin from the inside out.

It Often Starts in the Gut

I’ve had patients spend years cycling through dermatologists, prescriptions, and skincare routines, only to discover that the key to clearing their skin was supporting their gut.

It makes sense once you see the science. The gut and skin are connected through the immune system, hormones, and even the nervous system. When your gut is inflamed or out of balance, your skin often pays the price. I ask about digestion in almost every skin-related consult. Gas, bloating, constipation, and food triggers can all be early signs that something’s off.

We usually start with small shifts. More fiber. Less sugar. A variety of plants. Sometimes we take out common triggers like dairy or gluten. If things still aren’t clicking, I may run a food sensitivity test. I use KBMO in my practice, and it’s helped pinpoint what’s quietly fueling inflammation when nothing else is obvious. For instance, one patient with long-standing acne cleared her skin by rebalancing her microbiome and removing a few surprise food sensitivities. 

Blood Sugar and Skin: A Subtle but Powerful Link

This one catches people off guard. When your blood sugar swings too high and too often, it doesn’t just affect your energy or weight. It actually breaks down collagen and elasticity.

Your body produces something called AGEs (advanced glycation end products) when blood sugar is elevated too often. These molecules damage the proteins that keep your skin firm. So when I hear, “I feel like I’m aging faster than I should,” I often look at blood sugar patterns.

Simple changes can help. Start meals with protein. Avoid eating refined carbs on their own. Take a 10-minute walk after dinner to help the body process the meal more smoothly. These may sound small, but can preserve skin tone, improve clarity, and help with inflammation.

Don’t Forget the Liver

Your skin is a detox organ. When the liver is overwhelmed or under-functioning, the body will try to offload toxins through the skin. It’s not about doing a juice cleanse or buying a detox powder. In fact, I don’t recommend either.

Instead, I guide patients toward food that gently supports detox pathways. Think cruciferous veggies, bitter greens, garlic, beets, and plenty of hydration. Turmeric is a favorite of mine. It’s both anti-inflammatory and liver-supportive.

Sauna therapy is another tool I often recommend. Just 15–20 minutes of sweating a few times per week, paired with minerals and water, can help ease the load on the liver. That, in turn, can give the skin some breathing room.

Nutrients That Quietly Make a Big Impact

I’m not someone who throws 10 supplements at every problem. But there are a few nutrients I pay attention to when a patient is struggling with skin health:

  • Vitamin C helps with collagen production .
  • Vitamin A supports cell turnover and healing.
  • Zinc reduces inflammation and helps acne-prone skin.
  • Glutathione is the body’s master antioxidant.

The best part? You can get most of this from food. Citrus, bell peppers, leafy greens, eggs, and pasture-raised meats. This is your skin’s nutritional foundation. When supplementation is needed, I keep it targeted. Just enough to support the process.

Let’s Talk About Collagen

Do I recommend collagen supplements? Sometimes.

There’s decent research suggesting that hydrolyzed collagen peptides, when taken regularly, may improve skin hydration and elasticity, especially in women over 40. But only if the basics are in place. If someone’s not eating enough protein, not getting vitamin C, and their gut isn’t absorbing nutrients well, then collagen powders won’t do much.

Hormones and Skin: A Conversation Too Many Women Miss

It’s not just about estrogen, but it often starts there. Estrogen helps maintain skin thickness, hydration, and elasticity. As levels drop as we age, skin can look and feel different. It may become thinner, drier, or more prone to wrinkles. Sometimes acne returns, especially along the jawline.

In these cases, I talk through options with patients. Bioidentical hormone therapy can be incredibly supportive for the right person. So can topical estrogen facial creams. But we look at symptoms, lab work, history, and preferences together. It’s always a shared decision.

What I Use in the Office

Once internal systems are supported, then in-office treatments start to make sense. When your body is nourished and balanced, your skin can respond more effectively.

Here are a few I recommend the most:

I don’t push procedures on anyone. But when they’re used thoughtfully, and the body is ready, the results can be really satisfying (not just cosmetically, but functionally). Skin becomes healthier, more resilient, and more reflective of how you feel inside.

Beauty as a Message, Not a Measure

I don’t believe in chasing perfect skin. I believe in learning how to listen to what your skin is trying to say. Your skin isn’t just about looks. It’s an organ. It responds to stress, food, hormones, hydration, and your daily rhythm.

If something is showing up — like redness, puffiness, dullness, or sagging — pause for a second. Your body might be asking for something. More sleep. Less sugar. Better boundaries. Or maybe more support for hormones or inflammation.

The patients I see aging well aren’t doing more. They’re just doing what actually works for them and letting go of everything else. So if you’re feeling like your skin has changed, look inside before you add another product to your shelf.

That’s where real beauty begins.