Archive for the ‘Non-surgical aesthetic procedures’ Category

MODERN MEDICAL MIRACLES IS THE CATEGORY

Monday, July 20th, 2009

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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THE ARTIST’S EYE

Tuesday, April 28th, 2009

THE ARTIST’S EYE

Richard M. Foxx, MD

Placing your face in a stranger’s hands requires a high degree of trust. You want to know that person is a careful, conscientious professional with a highly-developed sense of proportion. So how do you do that?

First, ask who exactly will be doing your procedure.

In most cases your choice would be a physician. In fact the Medical Board of California views many of these procedures as “the practice of medicine” and is quite specific as to who exactly may perform these non-invasive procedures. If performed by a nurse or physician assistant, California requires supervision by a physician capable of performing the procedure.

Of course not all practitioners are alike. Most physicians approach the attainment of cosmetic dermatologic goals from a doctor’s point of view. But just like music, writing, or painting, cosmetic dermatology requires a combination of training and inborn skills and talent. In the final analysis, a great result takes more than just an injection of BOTOX® or RADIESSE®, it takes knowing where and how to use these and other elements such as lasers and light therapy in a synergistic blend. In short, it requires an artist’s eye.

Second, ask how many procedures your professional has done. Numbers alone are no guarantee of a good result. As in sports, it’s not only practice that makes the champion; it’s practicing the right moves. But numbers are a good indication of previous success.

Third, ask to see before and after pictures. This is where you get a chance to judge for yourself if your doc’s sense of beauty and proportion match yours. Ask also to see pictures of patients who match your age and concerns and, if possible, ask for testimonials.

Getting the right answers to those three questions doesn’t guarantee that you will come out the other end looking perfect, but it’s a good place to start and if you get the right answers, it’s an unbeatable way to put your mind at ease.

It would be wonderful if all we had to do when we didn’t like something about our appearance was to fix that one issue. We could get out the magic eraser and remove the line or the fold or plump here or there and everything would be perfect. But we can’t, and that’s where the artist’s eye comes into play.

The face is a canvas of infinite variability where absolutely everything is interconnected. Our appearance is the sum total of a bunch of little things. It’s like one of those spreadsheet programs where if you change one thing here you get a cascade of unintended consequences there and over there. Seldom does just doing one thing work. In most cases, in fact, achieving a beautiful result that does not look overdone requires many small incremental steps.

As someone who has been involved in the creative process his entire life both with writing and with photography, Doc Foxx is able to approach each patient’s concerns with an artist’s eye.  From there he is able to select the correct modalities necessary to get as close to the desired result as possible.

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FRAXEL IN PERSPECTIVE

Wednesday, March 4th, 2009

FRAXEL® IN PERSPECTIVE

Richard M. Foxx, MD

After more than two years of experience with FRAXEL I continue to be impressed by the results—both short and long term.

While out and about I recently encountered a casual friend I had not seen in over a month. A contemporary, he originally signed on about for the treatments about six months ago because of extensive sun damage, brown spots, and actinic keratoses from years in the sun at the beach. I knew he had a good result when I saw him four weeks after his last treatment and took pictures but I was not prepared for the tremendous improvement he continued to have in skin coloration, texture, and improvement of fine lines. I was impressed. So was he. More importantly, so was his wife.

Another patient presented for follow up photos the other day four weeks after completing the series. A fair-skinned strawberry blond in her 50’s, she had multiple brown spots, many fine wrinkles under her eyes and around her mouth, and large pores. I was amazed at the improvement. The brown spots were gone, the peri-orbital wrinkles were 90 percent or more improved, and the wrinkles under her eyes were undetectable.

Since we opened this office, my litmus test for any piece of equipment I bring into the office is simple: Will I be pleased when I take my after pictures or will I be squirming in my seat doing a little soft shoe and trying to find improvement that isn’t there?

With FRAXEL I was impressed the first time I saw the system demonstrated. The more I looked into it, the more impressed I became. The impressive safety record sealed the deal and we began to do treatments in January of 2006, before any other office in the desert.

Since then I have never regretted the decision. I wish I could say that about every decision I ever made.

Doctor Foxx is the Founder and Medical Director of The Medical and Skin Spa, a medical skin clinic in Indian Wells, CA, at Hyatt Grand Champions Resort, one of the country’s only resort-based medical spas.  He may be reached at drfoxx@medicalandskinspa.com or at 760-674-4106

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BROWN SPOTS

Thursday, February 12th, 2009

BROWN SPOTS

Richard M. Foxx, MD

Perhaps the single most common question I get from patients concerns brown spots. They seem to plague everyone, particularly here in SoCal. And the problem definitely increases with advancing years.

Brown spots, also known as lentigenes, liver spots, or melasma, arise when the pigment called melanin is deposited in melanocytes, or pigment carrying cells, in the dermis. We see it most often in response to long-standing sun exposure, but it may be made worse by certain environmental factors and hormone challenges such as pregnancy or contraceptive pills.

The treatment of brown spots at our office runs the gamut from a series of exfoliative skin treatments and the use of pigment-blocking products to state-of-the-art minimal-downtime laser treatments. Improvement can be achieved over a three to four month period with a series of dermal planing skin treatments which mechanically lighten the spots followed by daily use of a skin product containing hydroquinone. Hydroquinone blocks the uptake of the melanin pigment into the cells. It is not a bleach, however, and the entire process takes several months before a result is seen.

Adding pulsed light treatments hastens the process. The dark cells melanocytes preferentially absorb light, break apart, and come to the surface where they flake away. At least three to four treatments are required over three months, however, as the depth of the spots varies.

By far the most effective method at this time is FRAXEL®. Developed about seven years ago by a group at Harvard, FRAXEL works by placing approximately 2000 columns of laser energy, each smaller than a hair, in a square centimeter (about the area of a dime). Twenty percent of the skin is treated at each of four visits with 80 percent left untreated. The amount of untreated skin results in very little downtime.

The columns of skin that are vaporized by the laser are replaced by healthy new skin over the next few weeks and many of the brown spots are removed.

It is important to understand that no brown spots treatment is permanent. Any brown spot treatment program I a long term commitment and must be accompanied by regular facial treatments, the use of good products, topical anti-oxidants such as Vitamin C, and the daily use of a sunscreen with an SPF of at least 30 and UVA blockers such as Zinc, Titanium, Mexoryl®, and Parsol®.

Doctor Foxx is the Founder and Medical Director of The Medical and Skin Spa, a medical skin clinic in Indian Wells, CA, at Hyatt Grand Champions Resort, one of the country’s only resort-based medical spas.  He may be reached at drfoxx@medicalandskinspa.com or at 760-674-4106

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WHY EXFOLIATIONS?

Wednesday, December 31st, 2008

Richard M. Foxx, MD

By this time you could just about stop anyone in the street and get the right answer if you asked them to name the layers of the skin. What is less well-known, however, is the outer layer of skin, the epidermis, is largely composed of dead cells that are sloughing off with some regularity.

When we’re in our 20’s, those dead cells slough off after being on the surface for about two weeks. The result is that the outer layer of skin is constantly smooth, regular, and moist, much like baby’s skin, and the products that we put on penetrate easily into the second layer, the dermis, where they can do the most good.

The sloughing-off process, more familiarly known as exfoliation, slows with aging to the point that by the time we are in our 50’s and beyond, the dead cells remain on the surface of the skin for seven to eight weeks and sometimes more. The skin then looks dull and lifeless, and often has the appearance, and the characteristics, of wrinkled parchment.

The buildup of bacteria and oils that result from delayed exfoliation, and the resultant thickened layer of dead cells, block the absorption of product. Then it becomes a matter of putting good product on the skin and having it lay on the outside doing little or nothing, something like waxing a car before taking off the layer of oxidized paint.

Many methods of exfoliation have been tried over the centuries, from rubbing the skin with pumice or ground up peach pits to the more recent microdermabrasion where crystals of aluminum oxide are blown onto the skin and vacuumed off. The problem with microdermabrasion is that it is often too harsh for older skin resulting in an increase in small capillaries.

The best way to remove the dead cells turns out to be a process known as dermal planing, where a flat blade is used by an aesthetician to gently scrape the dead cells off along with the bacteria and oils. The process takes about 20 minutes, is completely comfortable and safe, does not injure the skin, and has zero downtime.

At our office we have been performing this procedure for more than five years. The comment we hear most from new patients is always something like: “Wow. I can breathe through my skin!”

Much like regular professional teeth cleaning is necessary even in the face of daily brushing, regular professional exfoliation should be performed every six to eight weeks for maximum effectiveness. Regardless of the products you use.

Read more about dermal planing at The Medical and Skin Spa in a feature article in THE DESERT MAGAZINE in April, 2009.

Doctor Foxx is the Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA, at Hyatt Grand Champions Resort, one of the country’s only resort-based medical spas.  He may be reached at drfoxx@medicalandskinspa.com or at 760-674-4106

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HOW TO AVOID THAT HOLIDAY SKIN HANGOVER

Monday, November 17th, 2008

Richard M. Foxx, MD

The holidays are upon us. Again. Everyone who has not put away last year’s Christmas decorations raise their hands.

It seems so unfair—just at the time of year you want to look your best, the deadly combination of parties, alcohol, smoke, lack of sleep, travel, and of course stress, combine to make you look dehydrated, puffy-eyed, and blotchy with large pores and wrinkles.

There are a host of things that can be done; first-aid measures that can perk up your looks and get you back into the fray in short order. But a few simple measures taken now, while Christmas is still light years away, can go a long way toward holiday-proofing your look.

Start now to pump up your water intake and your intake of those precious Omega-3’s and Vitamin C. It takes a few weeks to load your tissues and the results will be worth it. You might even be so impressed you’ll continue to take them all year.

Make arrangements now for a good, exfoliating skin treatment that will remove dead cells, bacteria, and oils. Perhaps a non-ablative skin treatment such as 1064 Nd:YAG Laser Genesis with IPL would be just the thing to tune-up your pores and chase some of those brown spots away. A change in product to one that is more hydrating might be just what you need.

And don’t forget some of the new TRUE mineral makeup magic tricks we have.

Stress always seems to increase during the holidays, even if you’re having fun. And stress kicks up the body’s level of cortisol and all those other bad advanced glycation end products that act as fuel for the breakout fires. Make it a mini-goal to carve out a few moments for you out of every day as a stress antidote. Start now, so when the stress really builds, your relief mechanisms will already be in place.

First-aid measures after the fact can be as simple as keeping hydrated while drinking alcohol, getting as much sleep as possible, sleeping on two pillows to decrease puffiness, and applying cool tea bags for five to ten minutes to those puffy undereyes. And since dehydration seems to be such a problem, going to a richer moisturizer, or switching from a gel to a cream is a good trick to remember.

When all seems lost, something we call the “Desert Quench” that combines a no-downtime exfoliation with an infusion of oxygen enriched hyaluronic serum with peptides can restore even the most dehydrated, hungover, challenged, jet-lagged skin in under an hour.

And one more point: Have fun. And make a few good memories to share when you come back in. That’s what it’s all about, isn’t it?

Doctor Foxx is the Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA, at Hyatt Grand Champions Resort.  He may be reached at drfoxx@medicalandskinspa.com or at 760-674-4106

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LIP RESTORATION

Sunday, September 7th, 2008

LIP RESTORATION

Richard M. Foxx, M.D.

As if lips weren’t on our minds enough they jump out at you from countless ads, on the amazing faces of stars from Angelina to Scarlett, and in certain places large deep red lips stare out at you from billboards, newspaper ads, and even on car doors.

No wonder we miss them when they start to leave.

With the passage of time lips lose volume, get smaller and thinner. Eventually the skin around the lips begins to fold up and crinkle and lines began to radiate away from the borders creating the perfect place for lipstick to bleed into. That wonderful Cupid’s bow under the nose, the place where the angel touches you just before you are born, disappears and the compound curve that makes up a youthful lip gives way to a flat line.

If you dreamed there might be an antidote, your dreams have come true. There is now a virtual cornucopia of products, called dermal fillers, that can plump lips and restore lost volume, erase the radial lines and recreate some of the youthful anatomy. But here, as in almost no other aesthetic treatment, it is really caveat emptor, let the buyer beware.

Lips are about volume, to be sure, but more importantly they are about shape. Lips that are enhanced with filler should meet certain definable proportions and should definitely not wind up looking like a trout pout.

For starters, the lower lip must be 1.6 times larger than the upper lip. The area above upper lip should not protrude like a duck’s bill and the rolled edge that marks the border between the lip and the skin of the face should be recreated in a subtle way. And as Cupid’s bow is the defining aesthetic of the upper lip, it should be enhanced naturally, without exaggeration.

To make all of this happen you need a doctor whose aesthetic sense matches yours, an artist rather than a technician, and sometimes the only way to find one is to ask, discreetly, when you see someone suddenly looking more youthful. Chances are you won’t be aware of a good lip correction otherwise. You don’t want lips that flash “I’ve been done” from a mile away and need their own Zip Code.

Ask questions of your doctor. World-renowned Arnold Klein, MD, who holds a dermatology chair in his name at UCLA’s David Geffen School of Medicine spends about 45 minutes on a lip correction and advises patients to be wary of doctors who allot much less time than that.

And stay away from permanent fillers such as silicone or Artecoll in favor of hyaluronic acid fillers such as Juvederm™ or Restylane®.

Properly done, a lip augmentation can be exquisite, the perfect coda to the maturing face.

Doctor Foxx is the Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA, at Hyatt Grand Champions Resort.  He may be reached at drfoxx@medicalandskinspa.com or at 760-674-4106

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