FRAXEL IN PERSPECTIVE

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

Tags: , , ,
Posted in Non-surgical aesthetic enhancement, Non-surgical aesthetic procedures, The New New Face, Non-surgical aesthetic enhancement | Comments Off

BROWN SPOTS

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

Tags: , , , , ,
Posted in Age management medicine, Non-surgical aesthetic enhancement, Non-surgical aesthetic procedures | 1 Comment »

WHY EXFOLIATIONS?

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

Tags: , , , ,
Posted in Non-surgical aesthetic procedures | Comments Off

HORMONE REPLACEMENT REVISITED

December 16th, 2008

by Richard M. Foxx, MD

When discussing “hormone replacement,” the most important element is to be clear about the terms that are used. Almost nowhere else in medicine is there such confusion in terms.

The ill-conceived and subsequently discredited Women’s Health Initiative (WHI) study did not employ “estrogen” or “progesterone” as hormone replacement. Rather it used Premarin®, derived from the urine of pregnant mares and containing up to 40 percent horse-specific estrogen (for which we humans have no intrinsic neutralizing enzyme), and medroxyprogesterone acetate, known as Provera®. A synthetic “progestin” rather than true progesterone, Provera possesses a host of unwanted side effects including masculinizing properties.

WHI was not a ”hormone replacement” study, but rather a study that explored replacement of hormones with hormone-mimicking drugs.

Literally millions of women stopped using hormones when the WHI findings were released in 2002. As a substitute, they were offered drugs like Prozac and Zoloft to control their hot flashes and slow the degradation of the quality of their lives.

Now a rehash of the old, flawed analysis has come out and all of the old bogeymen have been resurrected. I expect women will throw their hormones away and run for the hills, or run for Zoloft or Prozac. Trouble is, replacing one drug with another made no sense at all in 2002 and even less now.

An alternative approach is to replace the hormones that are lost in menopause with true natural hormones among which may be estrogen and progesterone. These are also called bio-identical in that they are exactly the same as the hormones produced in human bodies. Non-equine bio-identical estrogen has been virtually exonerated in breast cancer as has natural (bio-identical) progesterone.

Each patient is different, and of course this is not to be construed as medical advice. It is important for women to discuss their own particular situation with their own doctors. It is important, however, to know and to understand there may be safe alternatives out there that will improve the elusive quality of life.

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

Tags: , , , , , ,
Posted in Age management medicine | Comments Off

HOW TO AVOID THAT HOLIDAY SKIN HANGOVER

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

Tags: , , , ,
Posted in Non-surgical aesthetic enhancement, Non-surgical aesthetic procedures | 3 Comments »

PAIN MANAGEMENT

October 1st, 2008

PAIN MANAGEMENT

Richard M. Foxx, M.D.

When I was a boy growing up in New Jersey I found myself in the dentist’s chair with some regularity. My dentist was a rather large and intimidating woman, a refugee from Eastern European and with her accent and steel-rimmed glasses I imagined her to have been some kind of interrogator in the Third Reich. Perhaps, I fantasized, she had gotten out just before her camp was liberated, burned her SS uniform, blended into the population, and moved in down the street to terrorize me.

She did not believe in putting her instruments away after they were cleaned and the operatory tables were covered with all manner of stainless steel devices with screws and plates, instruments I would not see again until I watched Jeremy Irons in DEAD RINGERS years later. I was in terror before she began and anesthesia was not in her vocabulary so I was a wreck before she started and I suffered through interminable drilling sessions with white knuckles.

With that kind of experience, when I grew up and became a physician I understood on a very visceral level how important pain relief and a reassuring demeanor were to the totality of being a healer. It’s almost the first issue in our minds when faced with a medical or surgical procedure.

Pain relief has been as important to me in cosmetic and laser medicine as in almost anything else. It’s either the first or second concern patients have. The other is: “Am I going to look like myself after I have the procedure?”

Anything I do on the face, or anywhere for that matter, demands my complete concentration. If my patient is nervous and uncomfortable and unhappy it distracts me and detracts from my patient’s experience and possibly effects the result. So my answer is always the same: “I won’t start until you’re comfortable and I will spend as much time as is necessary to make sure you’re comfortable.” It’s not hype. You can understand now why I feel that way.

It doesn’t always take all the anxiety away, but it goes a long way in that direction.

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

Tags:
Posted in Non-surgical aesthetic enhancement | 3 Comments »

LIP RESTORATION

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

Tags: , , ,
Posted in Non-surgical aesthetic enhancement, Non-surgical aesthetic procedures | Comments Off

THE NEW, NEW FACE

August 28th, 2008

THE NEW NEW FACE

Richard M. Foxx, MD

NEW YORK magazine enjoys an often well-deserved reputation as one of the major arbiters of “the look” so when they write a cover story on one of the latest trends in aesthetics you tend to give it more than a quick read. The lead article in their August 11, 2008 issue, called “About-Face,” deals with the judicious and careful use of fillers, lasers, and BOTOX® to create a face of “indeterminate age.”

Recreating the face of your youth by placing fillers in the hollows under the eyes, the so-called “tear troughs,” is clearly the solution to the gauntness left by the changing anatomy of the bony skeleton and the decrease in collagen and elastin that occurs with advancing years. Think Madonna or Kim Cattrall (although no one is really saying what they had done).

Calling the result “The New New Face” the article summarizes the philosophy of famed NYC dermatologist Pat Wexler, MD, and other noted NYC cosmetic derms in saying: “The New New Face is really your old face.” According to Doctor Wexler “…you need volume to keep a face looking young.” This is, in fact, what I have been doing here at The Medical and Skin Spa, lecturing about, and teaching other doctors for some time.

Madonna’s dermatologist, Frederick Brandt, MD, talks about the aging face as losing “youthful convexities.” And the convexities, he goes on to say: “are the fullness and the roundness. A facelift…doesn’t do anything for volume loss, and a lot of people still don’t understand this concept.”

An idea whose time has long-since come, tear trough filling, or mid-face plumping, is exactly what was described in the last issue of NEW BEAUTY.

This kind of what is euphemistically referred to as a “correction” was not really possible until the advent of really long-lasting fillers such as RADIESSE®. In the right hands, the improvements that can be effected with this long-lasting product (that will last far more than a year) are truly amazing. When I lecture on it or train doctors one-on-one, I often refer to “the WOW factor” because patients looking into a mirror for the first time after the treatment is performed are usually compelled to say some variation of that.

The article goes on to discuss what they call “the overinflated-lip craze.” Their conclusion is that it is finally over. Thank goodness. It was over for me even before it took off. My constant belief is that true beauty come from balancing all of the elements of the face: general health, supplements, good product use, and judicious use of the magic treatments at our disposal.

More on overinflated-lips in articles to come.

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

Tags: , , , ,
Posted in Non-surgical aesthetic enhancement | 1 Comment »

Newer Entries »