FACIAL GENESIS

Posted on September 6, 2011 by

Richard M. Foxx, MD

Healthy, clear, luminous skin without blotchiness or brown spots and with small pores has been at the top of every patient’s wish list since we opened in 2003.
Patients instinctively understand that the appearance of the skin is the single biggest factor others use to judge our age.

The fact is that years of unprotected sun exposure, the kind that most of us had when we were younger, almost always results in the broken vessels, large pores, and brown spots that characterize older skin.

To address these concerns, we evolved an innovative treatment series in 2005 that combines the best features of our Signature Anti-aging Facial Skin Treatment with comfortable and effective high-tech laser treatments.

We call this unique approach FACIAL GENESIS. Built around the classic 1064 YAG laser by CUTERA™, FACIAL GENESIS is a three treatment series that results in clear skin and small pores without discomfort and without downtime.

Each treatment session begins with our very effective Signature Anti-aging Facial Skin Treatment with Dermal Planing. This is a one-hour treatment that gently removes dead cells, oils, and bacteria with absolutely no discomfort.

Following this the skin is treated with the comfortable 1064 YAG laser by Cutera® in a 30 minute procedure that puts the laser energy below the skin’s surface. This laser is tuned to a frequency that heats and vaporizes blood cells, lessens the appearance of broken vessels, and reduces the redness in dilated capillaries. At the same time, the laser energy stimulates collagen growth which results in improved pore size.

The third phase of the session employs Intense Pulsed Light, or IPL. Applied to the skin in a 15 minute treatment, this light energy heats the cells that hold the brown pigment and causes those cells to release the pigment.

No anesthesia or numbing medicine is required as the entire treatment is very comfortable. Patients typically feel a gentle warmth from the laser and a very slight sensation from the pulsed light.

At the conclusion of the procedure we always apply Anthelios™, our favorite UVA-UVB blocking sunscreen. We usually finish up with a touch of TRUE mineral makeup, where appropriate, and send the patient back to work or to play without any downtime. Improvement can be seen in one treatment but three treatments are necessary for a full effect.

As JoAnn says: “Facial Genesis does a lot of good things for your skin all at once. It’s maintenance of the best kind.”

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Creativity and Facial Aesthetics

Posted on October 2, 2010 by

“Life cannot be captured. The human heart cannot be captured. The moment of creation itself is fleeting.”
Richard Gere as Parker Wilson in HACHI, A DOG’S TALE

Creativity is a process that can’t be looked at too closely; it is changed by the very act of observing.

Since the publication of my novel, SPIRIT RANCH, I have discovered that working to make a face more youthful or writing a novel have more in common then might be imagined at first glance. There is a transcendent moment with both acts, a point in time where preparation, study, experience, and heart all come together. The result is out there for all the world to see, an intimate baring of the soul, a point where explanations stop and the finished product is left to stand on its own. Or fall.

When it works it is like a perfect moment in sports, an achievement that, once experienced, draws you back again and again.

This much I do know: Creativity begins with passion, a fire to do something, to place your mark where there was nothing. Unless you are Mozart, an extensive groundwork has to be in place often requiring years of study and of preparation. What is ultimately seen as effortless is actually the confluence of many forces. Lucille Ball used to say that what made I LOVE LUCY so successful was that she practiced and rehearsed so much the finished product looked spontaneous.

The moment of creation is wildly exhilarating and humbling at the same time. At the end you are left wondering where it all came from because when it works out you realize that you were somewhere off to the side while it was going on, at once an observer and an instrument of the Ultimate Creator, privileged and blessed to be part of the result.

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HOW LONG WILL THAT FILLER LAST?

Posted on May 5, 2010 by

Richard M. Foxx, MD

Perhaps the most common question patients ask about wrinkle fillers (after “will I look natural?” and “will it hurt?”) is “how long will it last?” And the answer, of course, is it depends upon how you define “lasts.”

Wrinkle fillers are used to minimize the folds that run from the nose to the corners of the mouth, the marionette lines that bracket the chin, and to replace the lost volume in the cheeks. A correction is usually at its peak the first week after it is performed and begins to lose its effectiveness over time in a somewhat linear fashion such that a filler that would be expected to last a year will be somewhat less than half absorbed in six months. Patients who smoke, have a high metabolic rate, or are very athletic will note the volume of their correction will diminish more quickly.

Hyaluronic acid-based fillers such as Restylane® and Juvederm® typically last from seven months to a year. Fillers such as Juvederm are approved by the FDA to last “up to a year.”

The calcium-based fillers such as RADIESSE® are generally thought to last a year or more. There are other, longer-lasting fillers such as ArteFill that will last even longer but those products can have other problems that preclude their use in my office. Products such as Sculptra® are not wrinkle fillers but are, instead, collagen builders and can last up to two years but require at least three initial treatments over a month and a half.

The answer then should always be “it depends.” And the solution, for almost everyone, is to proactively address the longevity issue by replacing the product before it is all gone. There is simply nothing that will make it last longer.

Richard M. Foxx, MD is the Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA. He may be reached at 760-674-4106 or at drfoxx@medicalandskinspa.com

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AESTHETIC MEDICINE – RETHINKING PEELS

Posted on March 11, 2010 by

Richard M. Foxx, MD

Back in the good old days, say about 10 years ago, there were only a few ways to fix sun-damaged skin—peels, or ablative laser skin resurfacing using the CO2 or Erbium laser. Those lasers usually required some form of sedation or even anesthesia and were associated with several weeks of downtime during which the skin healed from what amounted to a deep second-degree burn. They often left the treated skin a lighter color.

If you didn’t want to undergo that kind of therapy the alternative was for your aesthetician to do a peel and peels became the stock-in-trade of aesthetic medicine for brown spots, large pores, softening lines and wrinkles, as well as for improving acne. For a while it seemed that every skin care guru was devising a proprietary peel, from Jessner to Obagi, using tri-chloro acetic acid (TCA) and other acids in some arcane combinations.

With the advent of the non-ablative lasers such as CUTERA’s™ Genesis and XEO and the Intense Pulsed Light (IPL) systems, skin improvement could finally be achieved without downtime. When fractional skin resurfacing with FRAXEL and other technologies was developed in about 2002, lasers took another giant step forward and it became possible to achieve, without downtime, many of the results previously only possible with the ablative lasers.

Aesthetic medicine is nothing, however, if not dynamic. What is hot one day is not the next and peels, it seems, are now coming back into vogue. Formulated with many innovative ingredients along with TCA such as azelaic acid, salicylic acids, and glycolic acid, the new generation of peels such as the VI Peel are more effective with less downtime. Even more important is the idea that these peels can offer a less expensive and yet viable alternative to laser therapy for certain skin problems.

And as with all aesthetic and laser medical procedures it is important make yourself as knowledgeable as possible, to review before and after pictures, to know who is doing the procedure, how it will be done, and to know how many your Doc’s office has performed.

Richard M. Foxx, MD is the Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA. He may be reached at 760-674-4106 or at drfoxx@medicalandskinspa.com

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LOOK BETTER, FEEL BETTER, LIVE LONGER

Posted on January 7, 2010 by

Richard M. Foxx, MD

For years the medical profession has been aware of the benefits that accrue when patients take the time and make the effort to care for themselves. In the last few years, however, we have become increasingly aware of the improvement in general health when we take the time to improve our appearance.

Not long ago a group of physicians in the UK published several papers showing that patients who used effective cosmeceutical products and who underwent regular maintenance treatments were more likely to eat healthy foods and follow a workout program. The result was a general improvement in quality of life and a decreased incidence of depression.

Just recently, researchers from the University of Southern Denmark tracked almost 1800 sets of twins and found that perceived age was significantly associated with survival. Not only was there an association between perceived age and physical and mental functioning, they also found the bigger the difference in perceived age, the more likely it was that the older-looking twin died first.

That’s a good nugget to remember next time someone says that aesthetic medicine is all about fluff.

Richard M. Foxx, MD is the Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA. He may be reached at 760-674-4106 or at drfoxx@medicalandskinspa.com

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OF HORSE BLANKETS AND GREY HAIRS

Posted on December 8, 2009 by

by Richard Foxx

Temperatures rarely go below the high 30’s during the night in what passes for winter here in California’s low desert and most times it’s mid 40’s.  It’s a far cry from the near-zero temps and snowy days up in Montana where friends at Horse Prairie Ranch, and everyone else up there for that matter, turn their horses out to fend for themselves once winter sets in.  The animals are hardy, and they’re none the worse for it.

But somehow, when you get out of bed in the morning and go outside with the dog and realize it really is cold, your thoughts turn to the guys out in the pasture so you give up after a few nights like that and begin blanketing them.  It’s more for us than for them but after you do that you don’t feel quite as guilty turning the heat on in the bathroom when you shave.

Horses in pasture are always a little dusty.  Sometimes they are downright dirty.  You brush their coats before saddling them and between brushing and combing manes and tails you don’t often have time to take a close a look at their coats.

It’s a different story when you take the blankets off in the mornings.  Their coats are usually clean.  When I took Macarena’s blanket off the other morning I marveled, as I often do, at the coppery color of her chestnut hair, exactly like a newly-minted penny that gleams in the sun.  Except this time I noticed that her wonderful red-gold color was flecked with some grey hairs.  A lot of them.

I know she’s getting on, coming 19, but to know it on an abstract level and to see it in the concrete are two different things.  I can accept the grey hairs on my head and accept the grey hairs on Sammy’s muzzle but it brought me up short on her.  I’ve had her for about 13 years.  She was, as Rudyard Kipling once wrote about a pony called the Maltese Cat, the pluperfect polo pony.  She elevated my game orders of magnitude better, like a 15 handicap golfer suddenly playing to a five.  She saved my life at least three times, or at least saved me from serious harm.  She and I are telepathic together.

She knows what it means.  She speaks a different language but she knows now that I know, too.  And that’s always been enough between us.

Gotta go…

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PASSION

Posted on September 16, 2009 by

Richard M. Foxx, MD

www.medicalandskinspa.com

Standing in the shade of a 300 year old live oak at the crest of a hill in Buellton this weekend, surrounded by endless rows of Pinot Noir grapevines heavy with ripe fruit, I learned once again what passion is all about.

This time it came in the form of Richard Sanford, perhaps my oldest and very dearest friend.  The not too distant ocean breeze ruffled his hair as he leaned against an ancient oak table, a glass of ruby-colored Pinot Noir in one hand, and talked about what it meant to be a wine maker, that we were about to drink wine that had been pressed from these grapes last year, and the long journey that had taken him to this spiritual place on an extraordinary day.

I first met Richard almost 40 years ago.  We were both sought-after ocean-racing navigators, competitors, but both passionate devotees of an arcane, pre-GPS avocation that was as much art as science.  When time for sailing became a luxury we stayed in distant touch through mutual friends.  I knew that he was following his dream of starting an organic winery north of Santa Barbara and I cheered him on from afar, and cheered louder when President Reagan chose his wines to be served at his first inaugural.

We reconnected almost 25 years ago when my BW, JoAnn, and I began an annual pilgrimage (it always felt that way) to his eponymous winery and watched as it grew and prospered.  Philosophical conflicts with his investors eventually resulted in his leaving Sanford Winery about the same time JoAnn and I opened The Medical and Skin Spa.

His passion for growing grapes in a sustainable, organic environment drove him to start over and to open Alma Rosa Winery in Buellton, CA, with his wife and soulmate, Thekla.  My passion for the art of cosmetic medicine and the support of my soulmate emboldened me.  The parallels of our lives continued.

Being a farmer is a little like going to the roulette table several times a year and betting everything you have on the red.  But as a vegetable farmer you have the possibility of pulling out your crops if they develop disease, or infestations.  As a grower of grapes you are dealing with plants that take at least three years to reach their potential.  You can’t pull them out and start over.  Multiply that by about a thousand if you are an organic grape grower.  No fungicides, no pesticides to fall back on.

With a dedicated staff, working around the clock many days, Richard and Thekla gradually and painstakingly brought Alma Rosa to its present day, richly-deserved award-winning status.  They make extraordinary Chardonnays and a memorable Pinot Gris, true, but their Pinot Noirs are pure magic.

Which brought us to last weekend.  Walking through the pre-harvest vineyards, tasting the grapes from the vine, realizing their flavor is as far from table grapes as a Verdi aria is from rap, having the rich juice cover your hands and drip down your chin, having Richard talk about the fortuitous interaction of grape with mold with grape genetics, you get a rare and precious peek at passion, that extravagant emotion.

And you realize that passion is what propels some of us, the lucky ones, over the bumps, around the potholes, past the disappointments, and beyond the mid-night terrors.

If we are extraordinarily lucky we get to share it with others.

Richard M. Foxx, MD is Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA, a lover of fine wine, and devoted to passion in his life and his work.  Visit his website at: www.medicalandskinspa.com.

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COSMETIC MEDICINE AND HORSES

Posted on August 25, 2009 by

Richard M. Foxx, MD

What does cosmetic medicine have to do with horses?

At first blush the answer is “nothing.”  The real answer for me, however, has turned out to be “everything.”

Even though I wasn’t born in a saddle on a ranch, horses have always been part of my life.  When I was about 12 and I could earn some money delivering groceries I rode my bike into the Orange Mountains near where we lived and rented a horse and rode until my money ran out.  “Cowboy” was always the occupation I wrote down first when my teachers asked us what we wanted to be.

Sometimes it takes years for a dream to come true.  The army, residency, and work put this particular dream on hold for decades until about 30 years ago when I decided it was now or never and since then I’ve never looked back.  Horses will forever be a part of my life.

This is not another “Everything I’ve learned I’ve learned from a horse” article.  But I did immerse myself in their world and the approach to life I’ve developed being around horses became a perfect complement to the philosophy I evolved in my spiritual and metaphysical journey that took me from Zen through Tibetan Buddhism and Taoism; the idea that we are all interconnected, the principle of being in the moment, the value of being congruent.

Most of all, I learned the value of being sensitive to non-verbal communication between horse and human, and between human and human.  Ultimately it made me more sensitive to my patients’ unspoken goals.

Horses are huge, imposing, sentient beings that, in spite of our frequent misunderstandings, help us help ourselves as we learn to develop the skills they need from us.  My journey was so transcending I decided to share my findings and the wisdom of my horses with anyone interested.  To facilitate this I’ve begun a program called THE EPONA EXPERIENCE. It will kick off this fall in the desert.

Way back when, when I was about six or so, full of dreams and full of promise, someone took a picture of me on the back of a pony.  My BW found that about twelve years ago and had it framed.  On the back she wrote: “Once a cowboy, always a cowboy.”

Gotta go.

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MY SUCCESS DEPENDS UPON PAYING ATTENTION

Posted on August 15, 2009 by

Richard M. Foxx, MD

David Viscott, MD, was an extremely talented psychiatrist who not only operated a successful LA psych practice in the 1980’s and 90’s but also found time to host a radio show. For me he was to Dr. Laura as Chateau Lafitte Rothschild is to Ripple. I listened to him whenever I could, spoke to him on a few precious occasions, and soaked up as much of his interviewing skills as it was possible to soak up from a distance.

In one of his seminars David (as he insisted everyone call him) passed out sticky labels and asked everyone come in the next morning with this sentence completed and written on the label: “My success depends upon…”

I racked my brain. This was about 20 years ago. I was still young enough to think I could make a difference and old enough to think I had all the answers. All I could come up with was: “My success depends upon paying attention.”

Oh, boy. Somehow I had hit a mother lode. I can’t even begin to count the number of times since then that not paying attention has jumped up to bite me, personally and professionally. And every time that happened I thought of that silly sentence.

As the years went by I struggled to internalize those few words and incorporate them into my way of doing things. The occasions when I have failed to pay attention have thankfully become fewer and fewer.

David Viscott passed away in 1996, at age 58.

What started me thinking about this was a comment from a patient not long ago that she liked how much of a meticulous perfectionist I seemed to be. I thanked her, rolled my eyes (to myself, of course), and thought one more time of David.

What does your success depend upon?

Gotta go…

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MODERN MEDICAL MIRACLES IS THE CATEGORY

Posted on July 20, 2009 by

by Richard M. Foxx, MD

If you were on Jeopardy the answer might go something like this: “The most effective, predictable, and clinically-proven pharmaceutical product used in cosmetic dermatology today.” The question, couched of course in the form of a question, would have to be “What is BOTOX®?”

So why is it that a product used more than four million times a year, a product that is at once reliable, dependable, and associated with fewer side-effects than just about anything else, be so badly misunderstood?

The answer to that is a little more complex. BOTOX has almost become a cliché, a symbol of what people do when they want to look younger and more relaxed. Written about almost monthly in virtually all of the “glamour” magazines, BOTOX is often lumped in the same category with dermal fillers and plastic surgery, and stirred around so much that all the casual reader remembers is a few disjointed facts.

Believing, with Madame Curie, that nothing in life is to be feared, it is only to be understood, herewith are just the facts based upon seven years of experience and over 3,000 patients personally injected by me.

BOTOX has been around since the early 1980’s. At first used to relax eye muscles in patients with lazy eyes it was up to a Canadian physician, Alistair Carruthers, to discover its application to facial wrinkles. After being used for almost 20 years and amassing an enviable safety record, it was finally approved by the FDA for use in certain areas of the face in 2002.

Unlike traditional drugs that have to be metabolized by the body before they begin working, BOTOX remains where it is injected. It is administered with a very tiny needle in or near the areas where muscle relaxation is desired and works by locally blocking the nerve impulse before the muscle can respond.

The blocking phenomenon is a chemical reaction that begins to work immediately but is usually not complete for three to five days. This explains why the full effects of BOTOX are not seen for that long. The body begins to overcome that block and finally succeeds somewhere in the third to fourth month when muscle activity returns. BOTOX does not have to be excreted in the kidneys or by the liver.

When I administer BOTOX, I start by determining exactly what each patient desires and what the facial anatomy calls for. After obtaining a picture, I apply a numbing cream for 10 to 15 minutes and then mark the areas where the product will do the most good. Prior to actually injecting, using a needle only slightly larger than a mosquito’s stinger, I apply ice to the actual injection site to make it even more comfortable.

Patients may return to work immediately.

BOTOX is an ideal way to get your feet wet and introduce yourself to the wonders of modern cosmetic dermatology.  Find the most experienced injector you can by asking around, have the brief, relatively painless treatment, and watch the years melt away.

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