Botox makes you happy. So does a new Lexus, but I can’t prescribe that.

Botox® temporarily freezes dynamic lines such as crow’s feet and forehead wrinkles. When Botox is done well, it can raise your eyebrows and make your face appear well rested, younger, happier. Botox also makes it difficult to furrow your brow or frown.

Too much Botox freezes your face, making it expressionless (which could be seen in both winners and losers at the recent Golden Globes: Were they happy? Sad? Shocked? Who could tell?).

Because Botox can make people look better, it’s no surprise that people who get Botox are happier afterwards. A review in the Journal of Drugs in Dermatology actually looked at the cost of treating depressed patients with Botox. Here’s the reasoning: If you cannot frown because of Botox, then your mind will interpert this as you feel less angry or sad. Preliminary studies showed that people treated with Botox had more positive emotions and felt less depressed after their treatment.

While the logic is easily followed (and is emphatically supported by people who ordinarily pay cash for their Botox), the science is absent. There are no studies that show Botox improves depression as compared to placebo, therapy, or antidepressants. Much more research would have to be done to show that there is a real benefit (it would be  interesting to compare Botox to simply giving people $500 in cash and teaching them to frown less).

Depression is a disease and is never fixed quickly. Treating depression always requires effort, often requires therapy, and sometimes requires medication. I doubt that medication will be Botox. Or a new Lexus.

Photo: Geekadman Flickr.com

Grace Miller* is a 76 year-old woman who came to see me for a skin screening exam. I knew her age and history because I perused her electronic medical record at my desk before I met her. She was a midwestern girl who came to San Diego years ago with her husband, who was in the Navy, and decided to stay rather than fight another Chicago winter. He has since passed-away and she now lived alone in the house they built overlooking the Pacific.

She had sandy-brown hair and sparkling blue eyes and wore a beautiful gold sweater and stone necklace. Dangle earrings sparkled under the exam lights. Her appearance belied her age — she looked 20 years younger than 76.

She had a few crows feet around her eyes and lines around her mouth. Her eyelids were slightly overhanging and her neck had soft wrinkles. Her jewerly and designer bag suggested that she had the means to live comfortably. She laughed when I asked her what her secret was to looking young. “I’ve used Oil of Olay for as long as I can remember,” she admitted, but that was all. As I examined her, she thought aloud about my question:

She avoided excess sun, but never wore sunscreen.

She never smoked.

She walks regularly, but does not adhere to any prescribed diet.

She has never used antioxidant, antiaging, or antiwrinkle creams.

She has never had Botox.

And she looked fabulous.

“The secret,” she replied after thinking it through, “I guess it’s not wasting a lot money trying to look young, but spending plenty of money to look beautiful.” I’ve got to write that down, I thought.

No antioxidant cream, low glycemic diet, sunscreen, or cosmetic procedure will stop you from aging. Anti-aging, aging backwards, age-defying, and age reversal are unreal concepts and false promises made up in board rooms on Madison Avenue.

Do you want to know the secret to looking young? Walk away from the antioxidant cream counter and walk into the shoe section. If you want to look young, then be beautiful — it is a much better use of your money.

*Grace Miller is not her real name.

**I received no free women’s shoes to write this post.

Photo: Litmuse (flickr)

Have you ever looked in the mirror and noticed how much you’re starting to look like your mother or father? It happens to all of us: much of aging is determined by the genes we inherited from our parents.

But surely not all wrinkles, sagging, and brown spots are due to “bad genes.” So, how much of aging is due to choices we’ve made over a lifetime and how much is out of our control?

The way to answer these questions is to study adult twins. Twins have identical DNA but experience different lives. Different habits and life experiences over years should affect they way they look. A study of what causes aging in identical twins published in the journal Plastic and Reconstructive Surgery examined how a lifetime of good or bad habits made twins look younger or older compared to their once identical counterparts.

The 186 pairs of twins in the study looked remarkably alike, but there were differences. As you might expect, the longer people smoked, the older they appeared compared to their non-smoking twin. Also, the more sun exposure people had, the older they appeared compared to their sun-avoiding, sunscreen-applying twins.

Being divorced or taking antidepressants also made people appear older, suggesting that a stressful life can take a toll on your appearance.

Some things in life, like the genes you inherited, you cannot help, but choices you make can make a difference. Make 2010 the year you wrestle control over bad habits like smoking and excess sun and resolve to fight the ubiquitous stress of life by eating well, sleeping well, and exercising —  you’ll save yourself a lot of money in Botox later.

Photo: Simon Whitaker, flickr.com

There are some lucky people who don’t get poison ivy or oak. If you’re like me, you do. Here are some poison plant pointers:

Ivy block cream prevents poison ivy or oak, but only if it is applied 15 minutes before exposure. It doesn’t work after you’ve been exposed.

The intensely itchy, sometimes frighteningly-bubbly rash is an allergic reaction to oil, urishiol, found on poison ivy, oak and sumac plants.

You can wash off the oil with soap and water. Do not use laundry detergent, alcohol, or expensive poison ivy soap — any ordinary bar of soap will wash off the oil. However, the oil is quickly absorbed into your skin, like olive oil into nice piece of Italian bread, so time is of the essence. Once the oil is absorbed in your skin, you cannot get it out no matter what you use.

• You can wash off 50% of the oil within 10 minutes
• You can wash off 10% of the oil within in 30 minutes
• After 1 hour, no amount of washing will make any difference. Nothing will prevent the soon to be rash.

Whatever you do, don’t touch your groin in the first hour or so. You could end up in the hospital; I’ve seen it.

After one hour, you cannot spread poison ivy to someone else. Scratching or breaking the water blisters does not spread the poison ivy or the rash.

The rash lasts for 2 weeks, sometimes less if it is not severe. No cream or treatment, however expensive, can shorten the duration. The rash must run its course.

Once your arms and face turn into wet tapioca pudding, use a drying astringent like Domboro soaks to dry it out.

Once the blistering dries up, apply a topical steroid like hydrocortisone 1% cream or anti-itching lotions like topical Calamine or Benadryl. Cool baths with collodial oatmeal will also help. Super hot showers will relieve the itching, but only temporarily, and in the end, only makes it worse.

If you have a severe case of poison ivy, defined by your mother doesn’t recognize you or you are unable to sit, stand, or lie down, then see a dermatologist for prescription drugs to help.

Photo: Jim Frazier (flickr)

Post by Dr. Benabio, copyright The Derm Blog 2009.

Last week one of my patients complained that she gets facials every month for her wrinkles, but that she still has prominent wrinkles around her eyes and mouth. “What,” she asked, “is she doing wrong?”

Facials are the third most popular treatment in spas after nails and massage. They come in many flavors like: mineral masks, steam treatments, microdermabrasions, LED light treatments, blu-light, and even oxygen facials.

Facials can be beneficial; they extract clogged pores, exfoliate dull, scaly skin, and give you a deep, invigorating cleansing, leaving your face smooth and silky. But facials cannot treat wrinkles, broken blood vessles, or brown spots.

Facials are done by aestheticians who are not licensed to practice medicine. Aestheticians cannot administer treatments that penetrate the skin or have  biologic effects (by definition, this would be considered medicine and must be administered by a licensed practitioner such as a physician or registered nurse).  Deeper problems such as wrinkles require invasive treatments which cross the line from cosmetics to medicine.

Facial massages or electrostimulations, which are supposed to tone your skin, don’t. Toning or building muscle requires intense and repeated activity. Just like building biceps, firming musles on your face would require working out. The problem is that wrinkles on your face are caused by contracting muscles — crow’s feet are caused by contracting muscles around your eyes; frown lines are caused by furrowing your brow; lip lines are caused by contracting the muscles around your mouth. Any treatment then that firms facial muscles would only make wrinkles worse.

Other treatments such as oxygen facials and mineral treatments have no evidence to support them, (unless you count “Madonna said so” as evidence). Save your money and have your daughter apply a mud mask the next time you go to the beach.

Photo: Arkansas Shutterbug (flickr)

It is a medical breakthrough. No, not a cure for cancer, but for the short lashed. The FDA has approved a prescription medication that makes your eyelashes grow.

We have known for years that prostaglandin medications used to treat glaucoma have an interesting side effect –they make patients’ eyelashes grow. Now a prescription drug is available that is specifically for treatment of hypotrichosis of the eyelashes, (which means sparse lashes).

Eyelashes are hair, just like the hairs on your head and legs. Not all hairs are created equal though; eyelashes are designed to grow a certain (short) length, then stop. The number and thickness of your lashes is determined by your genetics.

Latisse (bimatoprost opthamlic solution 0.03%) is a prescription drug made by Allergan, the makers of Botox. It’s a prostaglandin, an active biologic compound named after the prostate gland, the first place they were found. Latisse has been shown to increase the number, thickness, and darkness of lashes.

Latisse can be applied to the upper eyelashes only and should not be applied directly into the eye. It takes about eight weeks to notice results, and it can take 16 weeks to see the full effects of the drug. Unfortunately, you have to continue using Latisse to maintain the results; if you stop using it, then your eyelashes will go back to the way they were before you started treating them.

Side effects of using Latisse include disoloration of your eyelid. Fortunately this appears to be reversible; the color fades when affected people stop using it. Latisse can also cause darkening of the iris in your eye. Your eye color is genetically determined, but medications can change the color. Latisse might cause increased brown pigmentation of your iris. This side effect, unlike the darkening of your eyelid however, is permanent.

Latisse costs about $120 dollars a month and, of course, is not covered by health insurance. It is apparently already popular among the celebrity crowd: reports say Jenny McCarthy has been using it.  The question is how long will it be before someone starts applying it to their eyebrows? I could be the poster boy.

Photo: Nicholas Kenrick (flickr)

Put your foot into a tub of water and let hundreds of fish nibble on the dead skin on your feet. Who thought this was a good idea?

Rough scaly feet is one of those little problems in life for which no one seems to have a good solution. The skin on the bottom of your feet has the thickest outer layer anywhere on your body. It is designed to protect you from the endless trauma of walking. Without that extra thick layer of skin, every little stone that you stepped on would tear right through. The friction from wearing your new Jimmy Choo Zip Gladiator Sandals would cause painful, water-filled blisters on the balls of your feet.

Constant friction from shoes and repeated wetting and drying of your feet lead to excess skin growth — your skin is compensating to keep your feet protected. The result is often thick, scaly, rough skin. Repeated drying out of the skin from wearing sandals can lead to impressivly thick, cracked skin on the heels. Thick yellow rough skin is not only unattractive (no matter how pretty the strappy shoes are), it is uncomfortable. Rough skin catches on your socks and sheets and can give your partner an unintentional exfoliation while lying in bed.

There are no shortage of tools to try to remedy this problem. Ancient civilizations used pumice stones to smooth skin. (Interestingly the shoes they wore look like today’s hot summer sandals, and ancient Romans apparently knew that pretty sandals don’t compensate for ugly feet.)

After thousands of years of using pumice stones, the PedEgg was invented in 2007. The PedEgg is basically a cheese grater mounted on a plastic egg. The blades are designed such that it is difficult to cut yourself, but not impossible, despite their claim that it won’t tear a balloon.

Now there is the fish pedicure. Salons starve these little fish, then put your feet into a bath of tepid water and allow the toothless fish to nibble away at whatever little flakes of dead skin they can get at. Apparently the tingling sensation is rather pleasant. The problem is, there is no way to sterilize fish. (Well, not without cooking them anyway, and cooked fish are not very good at eating). Many states have already banned the practice, and it is unlikely to be available anywhere here in the US. So for now you will have to make do with your PedEgg (you know you have one). Just be sure you sterilize it before you grate any Grana Padano cheese with it. Please.

Photo: Deckchua

“Those lips that Love’s own hand did make”

Shakespeare is referring to lips that the goddess of Love crafted with her own hands. Lips have always been an important feature in beauty, across time and cultures. Smooth, full lips can be attractive suggest youth and sensuality. Because we look at lips when people talk, they are a prominent feature on the face. Here are 5 tips to have beautiful lips.

Lip plumpers

Young women don’t have wrinkles, but they sometimes like to have fuller lips. Lip plumpers are an ingenious cosmetic trick to give you fuller lips. The skin on your lips is thin and the lips have an impressive blood supply. Lip plumpers are hot pepper or other irritants that penetrate this thin skin and cause dilation of the blood vessels. When the blood vessels dilate, the lips fill with blood like balloons, giving you an instant fuller look. They have the added bonus of giving your kissing partner a tingling sensation that he will certainly feel long after you stopped kissing him.

Exfoliate

A second cosmetic concern for lips is that they can be flaky or scaly. This can happen from excess dryness (chapped lips) as well as from sun damage. Use a fine scrub or mild exfoliator to buff your lips to a smooth pink. This should be done in moderation though, as it is easy to over exfoliate lips and develop irritation that will be neither attractive nor good for kissing.

Moisturize and Protect

Once you have exfoliated your lips, it is important to moisturize them. Because the skin is thin and because your lips are subject to constant wetting, they dry out easily.  Use a lip balm regularly throughout the day to keep moisture locked in and prevent dryness. Always choose a lip balm that has a sunscreen. The thin skin on lips accumulates sun damage over the years leading to hard scaly spots (called actinic chelitis) and even skin cancer such as squamous cell carcinoma.

Stop smoking

This seems like a no-brainer, but it is important to mention here. Smoking is bad for lips for two reasons. First, smoking causes wrinkles and lips are prone to developing fine vertical lines that give lips a crepe paper look and make it nearly impossible to get a nice smooth line of lipstick. The actual act of smoking can itself worsen these wrinkles as the vertical lines form from puckering your lips on the cigarette. Some people take this as far as to never drink out of straws for the same reason; I don’t think that is necessary though (unless you are working on a super thick shake from In-and-Out Burger which is nearly impossible to suck up).

Fillers and Botox

Lastly, cosmetic procedures can be done to improve problem lips. Specially fine line fillers can be used to smooth the vertical wrinkles around the lips as well as to fill the lips themselves for a poutier look if desired. Botox in small doses can also be used to relax the fine lines around the lips and can smooth out wrinkles here for months at a time. Although many MediSpa’s advertise for lip fillers, not everyone does this well. Lips that have been treated with Botox or fillers should be barely noticeable, not like two hot dogs without buns. Ask to see photos of before and after treatments to be sure that your physician can provide results that look like “Love’s own hands” created.

Photo: Ibrahim Iujaz (flickr)

Maybe it’s the economy. Or maybe it’s too many late nights watching back episodes of CSI on your DVR. Either way, you notice that there are dark circles under your eyes that didn’t seem to be there before. What causes these dark circles under the eyes, and what can you do to treat them?

After wrinkles, dark circles are probably the second most common complaint that I hear in clinic from patients about their faces. There are two main reasons for dark circles:

1. Blood or blood vessels that appear prominent in this area.
2. Excess pigment is being produced from the pigment cells (melanocytes).

The skin under your eyes is the thinnest skin on your whole body (the thickest is on your upper back). As a result, blood vessels can be seen right through the skin in this delicate area. The deep maroon color of blood appears blue when seen through the skin. Many people who have dark circles have them simply because they inherited thin skin in this area, and the blood vessels are easily seen.

Aging and sun exposure causes thinning of the skin which makes this problem more obvious over time. Allergies can cause congestion of the blood under the eyes, making dark circles appear. Slow blood flow can also lead to leaking of the blood out of the vessels, leading to a brownish discoloration from the iron in the blood (called hemosiderin). Things that cause worsening of the blood flow, such as smoking, can also make dark circles worsen. Poor sleep and eating foods high in sodium can also lead to puffiness of the eyes, making the dark circles appear worse.

There are many things that can cause an excess of pigment production as well. For example, atopic dermatitis or eczema often leads to chronic redness and itching around the eyes. This chronic inflammation turns on the melanocytes leading to darkening of the skin in the affected areas. Sun exposure also turns on pigment producing cells. Getting too much sun can lead to darkening of the skin under the eyes, like a tan, which can be slow or difficult to fade, especially in women of Latin American, Mediterranean, and Asian descent.

The best way to treat dark circles is to treat the underlying problem. If you have allergies, then see your physician about allergy medications and nasal sprays to help reduce congestion. If you have itching or redness, then you might need a topical steroid to control the inflammation and prevent darkening of the skin. Most importantly, you should protect yourself from the sun and wear sunscreen everyday, especially in months when the sun’s rays are strongest. No matter what the underlying problem is, darkening of the skin from the sun will only make it worse.

Many creams that promise to clear up dark circles fail to deliver on their promises. Consider seeing a makeup specialist at your local department store or salon instead; they can recommend products that reflect light or lighten the area to improve your appearance. In most cases, your money is better spent there than on “miracle” eye creams.

Photo: Wakima, Flickr.com

While muscular arteries carry your blood away from your heart, it is the thin walled veins that bring the blood back to the lungs and heart. Because there is no muscle in veins, the muscles of your legs and feet are what squeeze the blood back up to your heart. One way valves in the veins help keep the blood moving up by preventing it from flowing backwards, down into your legs.

When the veins are damaged, as can happen from excess pooling of blood, from diabetes, and from genetic factors, then the valves fail and the blood begins to pool in the vessels. The result is dilated baggy veins that pouch out from the skin. Over time smaller veins grow to try to redirect the blood flow. These tiny vessels are the spider veins that develop.

Sclerotherapy works by causing the treated veins to scar down, sealing them tight and preventing the blood from filling them again. This is done by inserting a tiny needle into the vein and injecting a substance that causes damage to the blood vessel walls. The two most commonly used substances are hypertonic saline and detergents.

Hypertonic saline is super salty water. The high salt damages the red blood cells in the veins causing a clot to form. Once a clot fills the whole vein, the blood cannot flow back into it. The vein eventually atrophies and disappears. The advantage of hypertonic saline is that it is readily available and often works. The disadvantage is that it can be painful, and if the saline is injected into the tissue outside of the vein, then tissue damage can occur, leading to an ulcer.

Detergents are, just as it sounds, soaps. Injecting detergents into the veins also causes a clot to form and damages the vessel walls. Again, this leads to a sealing of the vessel and eventually the vein disappears. There are several detergents available for physicians to use including sotradecol, which is FDA approved, and polidocanol, which is not FDA approved at this time, but is often preferred because it is effective and less painful than other detergents. These detergents also have a low likelihood of causing a serious allergic reaction which can occur when these substances are injected right into your bloodstream.

Ironically, the larger blue veins (3 mm or less in diameter) are often easier to treat than the smaller ones. Sclerotherapy of larger blue veins usually leads to good results in just a few days. Larger veins can, however, lead to brown pigmentation of the skin. This pigment is from the iron in the red blood cells that were trapped in the vein. The brown color can take 6 months to 2 years to fade. The smaller, red spider veins are less likely to cause this brown discoloration when treated. However, they can be more difficult to treat. It often takes several treatments and can take months to see improvements. They can also regrow more easily. The more times these small red veins have been treated, the less likely that they will go away completely with therapy.

Veins higher on the leg and thigh can also be easier to treat than those lower on the leg or foot. Varicose veins on the inside ankle are notriously difficult to treat and are the most likely to lead to an ulcer of the skin after treatment with sclerotherapy.