Dr. Leslie Baumann, MD, FAAD on Revolutionizing the Dermatology Industry on a National Level
The internationally renowned dermatologist, whose research set the industry standard for skincare practices, discusses the Baumann Skin Typing System and how she juggles being both a doctor and a marketer
Dr. Leslie Baumann, MD, FAAD, is an internationally renowned board-certified dermatologist, researcher, bestselling author, skincare expert, and entrepreneur. She attended Baylor College of Medicine before doing her dermatology residency and joining the faculty at the University of Miami, where she was a Professor of Dermatology for 13 years.
Dr. Baumann was involved in the initial clinical trials and development of botulinum toxins such as Botox, dermal fillers, and dozens of other cosmetic procedures. She wrote the first and bestselling textbook on Cosmetic Dermatology (McGraw Hill 2002, 2009, 2022), which is now in 8+ languages and used to train dermatologists around the world.
She is also known for the Baumann Skin Typing System, the skin typing system used by doctors worldwide to prescribe custom skincare routines. It was the basis for her New York Times bestselling book The Skin Type Solution (Bantam 2006) and e-commerce skincare retail site, used by medical practices nationwide to generate personalized skincare routines and sell medical-grade skincare brands.
The Continuum sat down with Dr. Baumann to talk about her impressive career and how she juggles being both a doctor and a marketer.
How did you decide on dermatology and, specifically, cosmetic dermatology?
As far back as I can remember, I wanted to be a doctor. I’m an avid reader and love biographies. Growing up, I read about many female CEOs in the cosmetic industry, such as Elizabeth Arden, Estee Lauder, Mary Kay Ash, and Helena Rubinstein. I think that kind of steered me toward dermatology.
I did my dermatology residency at the University of Miami. When I graduated, the Chairman of Dermatology, Dr. William Eaglstein, asked me to join his faculty and specialize in Cosmetic Dermatology. Back then, Aesthetic Medicine did not exist, but he’d just been to a conference where Dr. Alastair Carruthers had talked about using a toxin to treat wrinkles. Although many thought this was an insane idea, Dr. Eaglstein had the foresight to believe that there was something to this substance called “Botox,” and he wanted his department to conduct the Phase 2 FDA research trials. If that was going to happen, he needed someone in the department who was a cosmetic dermatologist.
I was very intrigued. As I said, I’d read all those books about the leaders in the cosmetic industry, and as a hobby, I collected vintage creams, compacts, and advertisements, so it made sense. I said I’d do it but told him, “If I do this, I want to be the Director of the Division of Cosmetic Dermatology and be a separate cost center.” He laughed because, at that point, I was basically the director of myself, but he agreed.
I turned it into the largest university-based Cosmetic Dermatology Research Center in the US. We did all the major research trials for products like Botox, Dysport, Daxxify, Juvederm, Restylane, Voluma, and Sculptra. Dr. Eaglstein has such foresight.
When you were doing the trials on Botox, did you know you were doing something revolutionary for the field?
Oh, yes. At that point, Botox was only FDA-approved for medical purposes like a crossed-eye condition called strabismus. It was injected into the muscle near the corner of the eye to relax it, and the eye would turn straight. That’s actually how Botox Cosmetic started because the ophthalmologist Dr. Jean Carruthers, who was using Botox on her patients, noticed that crow’s feet wrinkles went away. She was married to a dermatologist, and they started speaking at conferences about this, and that’s when my boss became interested. It was strange to be one of the first to do Botox and filler injections because there was no one to teach me. Since I wrote the first textbook, there was not even a book I could read on the topic.
Your other big contribution is the Baumann Skin Type System which is now used by dermatologists around the world. How did you come up with that?
I would have patients coming in for skin consults, and it would always take me 45 minutes or more because I love talking about skincare and never get tired of talking about skin care. I asked a lot of questions to really understand what a person’s needs were and how to match them with the right ingredients and products and customize a skincare routine. I was still at the University, and they certainly didn’t want me spending 45 minutes with each patient. I had to figure out a way to make my clinic go faster.
I’d had this mentor who’d told me that every week, you should give yourself an hour of thinking time. I took that hour one day to think about how I could speed up my skincare consultations. I realized there were four main things I was asking about: how hydrated their skin was, which had to do with how much oil they would make and how their skin held on to water; how much inflammation they had, which had to do with acne or rosacea; the evenness of pigmentation, which had to do with whether it was even and if they needed skin lightening ingredients for dark spots; and, of course, whether they needed anti-aging ingredients.
As I was mulling this over, I looked at my bookshelf and saw a Myers-Briggs Personality Type book. I’ve always loved the Myers-Briggs test; I’m an ENFJ. I realized it was the same idea: four personality traits can be mixed to make 16 types. It’s the same thing with these four important skin concerns—mix them, and you get 16 skin types. Once I had the categories, I could have information and regimens set ahead of time.
If I wanted my staff to help me do this, however, I needed to make sure they would diagnose the skin types correctly. So, we set about creating a questionnaire and what would become the Baumann Skin Type System, which led to the book and partnerships with dermatologists nationwide and now our e-commerce store.
I joke that the day I came up with this was the last time I took an hour of thinking time because I’ve been too busy since.
“Our goal is to change how people shop for skincare because now they can shop using their Baumann Skin Type.”
The first thing you had to do to make sure that other people could use your system was to create a questionnaire. This isn’t like a Cosmo quiz; it’s real science. Can you explain how you came up with it?
There is actually a lot to questionnaire science, and I had a number of Ph. D.s help me out. We started with 300 questions, and it took about two years of testing and learning to narrow it down to the core questions that would accurately diagnose the skin type.
I’ve spent years validating the questionnaire. We would compare quiz question answers to sebum secretion rates, evaporation of water off their skin, and skin color such as redness and brown melanin pigment. We took biopsies, did genetic testing, and compared the results to their answers on our quiz. We honed down to the questions that could accurately predict the objective measurements. We’ve even validated it in other countries like China and India, and have additional validation studies going on in Indonesia and Africa.
I know there are glamorous and engaging skin-type quizzes out there—but they are not accurate. For example, you cannot ask, “Is your skin oily or dry?” because studies show that 80% of people are wrong about whether their skin is oily or dry. Instead, we ask a series of questions to tease that out. Every time somebody tries to pitch me on marketing, they always want to change my quiz to have fewer questions or fewer words, but I can’t do that without revalidating the quiz, which can take years. How you ask a question—what words you use—can affect the responses, so in order to have a scientific quiz to diagnose the skin type, you must validate it. Whether a doctor is using the questionnaire with patients or someone is taking it themselves online, I need to know that they’re going to get the proper diagnosis so that they are prescribed the correct custom routine.
The quiz is just the starting point to get people to the proper skin care regimen and products. How did you do that in the beginning?
In the very beginning, I had all these premade information sheets that I would give to patients with regimens on them. You can imagine that I had 16 piles of papers from which I would pull. That’s when I thought—it would be less messy if it were in a book.
That is how The Skin Type Solution book was conceived. You’d take the quiz, go to the chapter for your skin type, and then learn which products were right for you. In the book, I had a whole bunch of products listed by price, with one $ signifying your less expensive drug store brands and $$$ marking your pricier department store products.
The book was a huge hit. Thirteen publishers had a bidding war over the idea. It was right after The Wrinkle Cure by Nicholas Perricone had hit the best-seller list, and publishers were excited about skin care. We got a great deal at Random House (Bantam Del) and a lot of media attention. I was on Good Morning America and other television shows, and the book ended up being a New York Times bestseller. It was published around the world. It really proved our concept, but new products are coming out all the time, and you can’t republish a book every second. It was tough to keep it up-to-date and relevant.
Around the same time, you started working with doctors who would use your system and sell products to their patients based on the Baumann Skin Type System. How did this work in the early days?
At first, doctors would buy franchises to use the system. It was pretty low-tech in the beginning. They had my quiz and a little ring with 16 laminated cards, so once they told someone what their skin type was, they could have a list of products to recommend.
As we started working with more doctors, it became clear that this wasn’t custom enough. Some doctors preferred one brand, and some liked another. I wanted a way to customize it so doctors could pick only the products they wanted within each regimen.
My husband is a tech guy, and we began working on a software-based solution. It was important that the software recommended products to cover all of the “barriers to skin health present in each of the 16 Baumann Skin Types: dehydration, inflammation, uneven pigmentation, and high risk of skin aging. Let’s say that you have rosacea, which is redness of the face, but you’re also aging. A lot of the anti-aging products aren’t going to be good because they’re going to irritate your reactive skin. We needed to figure out a way for software to capture this and truly customize everything. And remember, this was before AI.
We had applied for and were awarded a patent around the solution that we conceived. It took ten years to write the software and set up the infrastructure in a binary hierarchy conducive to machine learning. Now that artificial intelligence is prevalent, we have the perfect infrastructure to have accurate data input with correct skincare product recommendations and truly custom skincare routine advice. I think that this scientifically based infrastructure is why our e-commerce store is so successful.
Every attribute of a product has a strict definition, and every product is tagged with relevant attributes. The products and the skin types have very strict rules they must follow, which are used to match products to skin types. The best part is that the routines have been tested in dermatology practices around the country over the last ten years. We know these 40,000 skin-care routine templates give much better outcomes than when cameras are used to diagnose skin type because these cameras are inaccurate. This is why we are the leader in AI-generated custom skincare routines.
“There are 64 possible customer journeys, so it was a lot of work to create all of the follow-up emails, but I want people who come into our community to feel connected.”
Tell us about your e-commerce store. Are you selling direct-to-consumer, or do you go through doctors’ offices?
We do both. We call it direct-to-patient (D2P) if you come to us through your doctor’s office and direct-to-consumer (D2C) if you found us on your own.
We have a huge, air-conditioned warehouse to store the products at the correct temperature. It’s almost 7,000 square feet, and we have over $3 million in inventory made up of over 60 medical-grade brands. We do our own shipping so that all of the products you buy come in one box with information about your regimen—even when they are from different brands. We’re really the only place where you can mix products from a number of brands together into a scientific regimen that works.
We do e-commerce for over 220 medical providers. They put a link up on their website, and patients get taken to a white-label site that might look like Dr. Brown’s own e-commerce site, but it’s us handling all of it on the backend. The doctors are able to go in and preset the regimen slots with their favorite products, so their patients are not getting different suggestions online than they got in the office. It’s got so many levels of customization that it is difficult to explain; it’s based on the skin type, product attributes, how the quiz questions are answered, and the patient’s skin concerns, but also on their doctor’s preferences and experience.
People who come to our site—skintypesolutions.com—directly without seeing a doctor take our quiz and get my skincare advice and suggestions for their skin type. They get my recommendations, but at each step, they can scroll through and see all the other choices that are in that same slot. They can build their regimen and shop based on price, but they can also look for other attributes that might be important to them, like a vegan product or one that comes in eco-friendly packaging. Our goal is to change how people shop for skin care because now they can shop using their Baumann Skin Type—they just need to look for their Baumann Skin Type octagon—which is color- and number-coded—next to the products that are right for them.
We’ve been doing this for a few years now, but we just moved over to Shopify a few months ago. It’s all much easier with this platform, and our sales have shot up. We’ve grown exponentially since that move at the end of August, and it’s because we spent years building this infrastructure.
You also provide follow-up information for all people who buy a regimen online. Can you explain that and why you think it’s important?
People often think that once they start a skincare routine, they're going to be on that same routine forever, but that's not how it works. Normally, I see my patients a month after the initial consultation, and I adjust their regimen. Then, I follow up again at 60, 90, and 120 days.
I’ve tried to recreate that here in the form of customer journeys. So, on day 30, after you’ve bought something from us, you will get an email explaining the results you should be seeing and what to change if you’re not seeing them. It might also tell you that if your results have been good, it’s time to go up to a stronger product or switch to a maintenance regimen. Everyone gets an email specific to their skin type at the 30-, 90-, and 120-day mark.
There are 64 possible customer journeys, so it was a lot of work to create all of the follow-up emails, but I want people who come into our community to feel connected. I call it connected compliance because if you feel connected, you’re going to be more compliant in how you use the products, and you’re going to get better results.
I also like creating a community where people can get information from each other. Each skin type is tagged with a Baumann Skin Type Octagon that has a number and a color specific to that skin type. For example, Baumann Skin Type 4 is a dark pink octagon with the number four in it. Products are tagged with these octagons on the product pages and in the collections. We also tag reviews by skin type so you can read reviews from your “skin twins.” So, if there’s a pink octagon with a number four in it next to someone’s comment, you’ll know they have the same skin type as you which might give you more faith in their recommendation.
“There is so much bad skin care advice out there. If the data is incorrect going in, the information that AI spits out is going to be wrong.”
How have you marketed your DTC e-commerce site? What about marketing to dermatology practices?
Right now, we’re just getting organic traffic. I write a lot of blogs, and we get consumer traffic from them. We just started doing a focused Google Ad campaign. The same goes for marketing to new practices. I write a lot for professional audiences as well, and my system is now part of the major dermatology textbooks. Plus, I give a lot of lectures, so I get new practices from that.
We’re still a start-up, and we haven’t taken any money from investors, so we haven’t had a lot of money to put back into marketing.
How are you using AI on your platform?
There are a lot of brands that say they’re using AI to generate skincare recommendations, but what people need to remember is the whole garbage in/garbage out philosophy. There is so much bad skin care advice out there. If the data is incorrect going in, the information that AI spits out is going to be wrong. That’s why all of the rule-making, validating, and labeling we have been creating as part of our infrastructure over the years is so important. Now, AI can look for all those tags and give the exact advice I would give someone.
We are now using an AI bot using my books and the data set on the site. It’s really incredible how good the AI bot skincare advice is! It’s only using my data set, so I know the answers will be based on my knowledge. I’ve written at least 500 blogs and my two textbooks, and that’s what we trained it on. It’s pulling knowledge from me and not from the internet, which has so much bad skincare advice. I test it constantly with harder and harder questions to ensure it’s giving the answers I would give. We can now really reproduce a live skincare consult accurately.
At the Continuum, we always talk about brand and demand. As a doctor and now a marketer, how do you drive both brand and demand?
I like to think that my brand was really created by demand. It was the demand of doctors to give better skincare advice to patients and patients to get better advice and better products. Doctors and patients are happy when skincare routines really work and improve skin health, which is the overall mission of my company. So, really, the demand came first and led to the brand. Now that the infrastructure is in place and the marketing is beginning, I plan to change the way the world shops for skincare!
April 24, 2024
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