In sixth grade, I knew that I wanted to become a physician from the role of medicine and nutrition played on the working farm on which I grew up. I felt called to rural medicine, because I grew up in a small town which required me to stretch as a person and participate in many activities that I would not otherwise choose but in which I learned life lessons. In 1977, I began skin treatment research and in 1989, I began the basic research to understand the skin barrier and epidermal processes that result in skin diseases, skin cancer and skin aging. I have learned that finding an answer resulted in opening up multiple new questions. I developed an understanding of the complexity of the skin and the interaction between the different cell types and structures. I take great pride in discovering how the stratum corneum and epidermis are regulated and the foundation of many skin diseases and aging, due to stratum corneum barrier disruption and inflammation. These discoveries also resulted in azelaic acid as a therapy for rosacea and novel methods to deliver active ingredients, as well as novel extraction methods for active molecules from herbs. This research required more than 4,000 hours of laboratory research. Over the years, I have tried to answer new questions as they occurred, while solving other problems in skin. This has kept me relevant in the industry. To get the best results, I always tell my clients that it is not just about prescribing a drug. Rather, being willing to change your thinking and behaviors along with in-office treatments will provide the best long-term results. There is no quick fix. I am not afraid to challenge existing dogma. I differ from many of my peers by appreciating the multifactorial processes that produce the abnormal skin and therapeutic goal of not just clearing skin, but also keeping it clear. Many professionals try to find the “super” ingredient that works for everything. However, there will probably always be a requirement for multiple ingredients considering the seven inflammation pathways and seven barrier repair pathways, which must all be modulated to optimally rejuvenate skin. Yet, there are many very innovative minds that I think someday may be able to create such an ingredient. But then it has to be delivered into cells at the therapeutic concentration without inducing damage. I think it will be years before such an ingredient could be created.

Even more lessons were learned as I played on championship sports teams, instilling that the team, not me as an individual, is what gives great success.

DERMASCOPE: How and where do you find inspiration? Carl: My parents, especially my father, were problem solvers that resulted in inventions used by pediatricians and the sheep industry today. Another inspiration is the amazing complexity and ingenuity of design in all the organisms on earth, which I greatly appreciated, initially as a child reading all volumes of encyclopedias from cover to cover. Even simple breathing and its molecular complexity, as I am scaling peaks over 14,000 feet high or swimming for adventure events. Finally, as a young father, trying to answer the “why” questions of my children, I realized I should ask the same of scientific dogma.

DERMASCOPE: What has surprised you most during your professional journey?
Carl: The key for understanding living organisms is not the appearance or morphology; it is the biochemical processes and how they are developed and controlled. For example, the difference in genome between a person with aged and young skin is only one percent, yet the differences in proteins produced is 35 percent, while glycan differences are 75 percent. It is these and point molecules that produce visible differences.

DERMASCOPE: What adaptations have you made over the years to stay relevant in the industry?
Carl: Over the years, I have tried to answer new questions as they occurred, while solving other problems in skin. This has kept me relevant in the industry. Also listening to patients. As I studied novel skin disease treatments, subjects would come back saying they wanted more “wrinkle” cream. My team then substantiated Dr. Albert Kligman’s discovery in 1988 that inflammation was a key driver in skin aging. He was the first, and we re-documented the skin aging inflammation link in 1996.

DERMASCOPE: What do you see as upcoming trends in the industry?
Carl: Manipulation of effects of proteins and glycans.

DERMASCOPE: Why do you think people come to a particular spa?
Carl: People want to be heard, then given treatments and products that work, yet are safe. Skin care professionals are expected to be a clearing house for their clients. But in skin care, often there is too little hard scientific efficacy and safety data. The client expects the professional to find out the relevant information and create the best regimen.

DERMASCOPE: Do you have a signature treatment or technique that your clients love?
Carl: I use and sell the Epionce skin care line, which has proven efficacy and safety. My clients not only love using the products because they feel good and smell good, but they see the results that we substantiated in the laboratory over the course of 16 clinical studies.

DERMASCOPE: Is there a particular moment or procedure where most professionals go wrong?
Carl: First, they become impatient for the treatment procedures and regimens and will increase dose which increases risk. Second, shift focus from client to their own needs, especially financial.

DERMASCOPE: What is your secret to keeping life in balance?
Carl: I was put here on earth with certain gifts that are to be used to serve and help others – it is not about me. To maximally do this, I need to be as healthy as possible, which means time for proper diet and supplementation as well as physical exercise and spiritual growth. I have also found many books, such as Marvin Gladwell, Ben Carson, Jim Collins, and Steven Levitt, which help me look at challenges differently.

DERMASCOPE: How did you decide that your current career is the right one for you?
Carl: I knew in sixth grade that I wanted to become a physician from the role of medicine and nutrition played on the working farm on which I grew up. I felt called to rural medicine, because I grew up in a small town which required me to stretch as a person and participate in many activities that I would not otherwise choose but in which I learned life lessons. Even more lessons were learned as I played on championship football and basketball teams, instilling that the team, not me as an individual, is what gives great success. This point was further driven home when I was awarded medals while serving in the United States Navy as a minor part in major operations to preserve the freedom we enjoy in this nation.

DERMASCOPE: What various roles and positions have you held within this industry?
Carl: CEO, chairman of the board of directors, chief scientific officer, founder of scientific entrepreneurial businesses, inventor of novel treatments and delivery systems.

DERMASCOPE: Which of these roles taught you the most or had the most impact on you and how?
Carl: The most life changing role was as an inventor seeking to find ways to become a better physician by providing better treatments and maintenance skin care products to improve health of the skin.

DERMASCOPE: What tool would your office not be complete without and why?
Carl: A proven safe and effective skin care line, a couple of chemical peels, Light-Emitting Diode (LED) and Intense Pulsed Light (IPL) devices and a radiofrequency device. Most importantly, really understanding how to use each of these alone and also together to provide the best results.

DERMASCOPE: What are the greatest pressures?
Carl: Prioritizing time for patient care, scientific study, innovating, and physical exercise. All the while, trying to improve my relationships; this, even more important now that I have a grandchild.

DERMASCOPE: What advice do you have for someone planning to start a career in this field?
Carl:First, never forget the importance of continually learning. Second, be available 24/7. Third, you are serving a total person, not just the skin organ. Fourth, listen to them with a thorough history. Finally, consider the cost effectiveness of skin care products and devices.

DERMASCOPE: Do you have any regrets?
Carl: I wish I would have had a better balance to be a better husband, mate, son, brother, and father. I performed poorly in relationships.

DERMASCOPE: Do you give to causes or charitable organizations?
Carl:Yes, double digit percentages of income to 20 domestic and international ministry and service non profits.

DERMASCOPE: What are your hobbies when not working?
Carl: Reading, travel, climb higher peaks, swim across lakes, study science, and studying the Bible.

DERMASCOPE: Do you have a personal motto by which you live?
Carl: Strive for excellence and execute precisely at every decision point every time, especially when I do not feel like it.