Last week we looked at acne treatments.  Essentially, controlling the bacteria on the skin, opening up the pores to release the excess sebum and controlling the inflammation will all improve active acne.

But there are a lot of myths about acne passed down from generation to generation of teenagers.  So today we’ll go through and debunk the main acne myths.  Finally, we’ll look at acne scarring next week and what can be done to improve that.

Myth #1 – Acne is caused by poor hygiene.

There is no proof that acne is caused by poor hygiene.  Scrubbing with soap, brushes, or alcohol-based products can actually dry the skin out further and/or traumatise the skin surface leading to more flaking of the epidermis and more clogging of the pores, making acne worse.

Myth #2 - Blackheads are dirt trapped in your skin.

Black heads are not dirt!  Blackheads are simply sebaceous plugs stuck in the pores that are exposed to air.  The oxygen in the atmosphere actually oxidises the tyrosine (an amino acid in the keratin plug) to melanin.  Melanin is black, and so the keratin plug becomes a “black head”.  No amount of cleansing will get rid of black heads, or prevent them.  If anything, excess scrubbing will make it all worse.

Myth #3 – Acne is caused by diet.

Again, there is no evidence linking chocolate, sugar or fat in your diet to the development of acne.  Not that you should now go and binge on mountains of chocolate and doughnuts, because a healthy diet will help you in lots of other ways.  But don’t let anyone tell you that it will make your zits worse.

Myth #4 – Acne is caused by stress.

The stress of ordinary living does not contribute to acne.  However, severe anxiety and depression can sometimes require treatment with medication that can cause acne, but that is the drug, not the stress.

Myth #5 – You should squeeze your zits!

An absolute NO!  Squeezing the excess oil out of your pimples may be morbidly fascinating, and perhaps a lot of fun, but ultimately you are causing more inflammation which in turn leads to more scarring.  The less squeezing the better!

Myth #6 – Acne is just another harmless teenage phase.

Yes and no.  Some teenagers can have very mild acne, or no acne at all.  But for a significant number of teenagers, it can be quite prominent and the psychological effects of their appearance, and of the subsequent bullying, can be psychologically damaging.  There have been cases of depression as a direct result of the patients acne.  So you can’t brush it off.  Acne should be taken seriously and treated properly.

Next week, a last look at acne, looking at acne scarring and its treatments.

Until then, stay safe and enjoy life.

Last week we looked at treatments that covered the first two causes of acne - hormones and increased sebum in the glands that this caused.

This week, the last installment - looking at skin flaking and the bacteria that inhabit our skin.  But remember, that often it is not just a case of using one treatment alone, but often in combination, that makes the biggest difference in the results of the treatment.

3. Flaking skin cells
Treatment: Moisturisers, AHA’s, Chemical peels, Retinoids
Moisturisers seem to be the opposite to what is required for acne.  Intuition says that the less oily the skin the better.  When the skin is dry, the top layer of old cells flakes off and some of the cells get trapped in the pores, and that blocks them.  But water-based moisturisers help to keep the skin from drying out, and less cells flake away, and less pores are blocked.  AHA’s are alpha-hydroxy acids, fruit acids that help to remove the old dead layers of cells and hence keep the pores open.  Glycolic and lactic acid are the most effective at this.  They also act as moisturisers themselves.  Chemical peels, when done correctly, remove the top layer of dead cells from the surface of the skin.  This removes the cells from around the pores and keeps them open, and also has the added bonus of improving your complexion by unmasking all of the younger, plumper cells of your skin.

4. Inflammation and bacteria
Treatment: Antibiotics, Retinoids
Antibiotics, like minocyclin or doxycyclin, kill the bugs that feed off the oil clogging the pores, reducing the inflammatory by-products that the bugs produce.  This reduces the huge inflammed pustules that flare up in more severe acne.  These antibiotics can be found in tablet or topical forms.  Retinoids have anti-oxidant, anti-inflammatory, and antibiotic properties, reducing the inflammation in the pustule and killing the bugs that are contributing to them.

With so many different treatments available, it is important to talk to a doctor about these.  Your medical history, and other medicines need to be taken into account before these can be prescribed to you.  If you need to make an appointment then please call us.  We’d love to help.  Sometimes there is a little trial and error in finding the best combination for you. but do not fear or give up.  Acne can be treated!

Next week we will talk more about acne myths, and coming in the future, we will cover acne scarring as well.

So, don’t forget … stay safe and enjoy life.

Last week, we looked at acne, and what causes it.  If you missed it, here is the recap:

Acne is caused by:
1. Androgens - the “male” hormones, that start to flood the body of every teenager (even girls) around puberty, and then linger into adulthood.
2. Increased sebaceous gland activity and “oil” production, caused by the increased androgens
3. Flaking of the skin cells which lodge in the neck of the gland, and trap the increased oil in the gland itself
4. Leaking of the oil into the surrounding skin and inflammation caused by the activity of a particular type of bacteria in the skin, causing pustules “White heads”!

There are a number of acne treatments that are available that target specific causes of acne.  Sometimes, people will respond to targeting just one cause of their acne - that is, some people’s acne will virtually disappear if the bacteria are targeted, or if the hormones are targeted - but usually it is a team effort, requiring the targeting of all four causes to get the best results.

So how do you treat them?  Lets start with each cause and work through the different treatments.  We will deal with the first two today and next week cover three and four.

1. Androgens.
Treatment: The Pill
When it comes to androgens, sorry boys, you luck out on this one.  It is very easy to block the overactivity of androgens in women, with the oral contraceptive pill.  Most pills will smooth over the hormonal surges in women, and some of the newer generation pills have progestagens that specifically block androgen activity.  Of course, girls don’t really need lots of androgens but boys do.  The other unwanted side effect of the pill in boys is the whole growing-boobs thing.  But there are other ways that men can have their acne treated.

2. Sebaceous Gland Activity
Treatment: Retinoids, Benzoyl Peroxide
Both retinoids and benzoyl peroxide work on the activity of the glands, and also help to dissolve the oil plug that gets stuck in the neck of the gland.  Retinoids are derivatives of vitamin A, and also act on acne in other ways.  They help renew the skin - people who use retinoids on their skin end up with rosy, healthy complexions.  It can make your skin photosensitive so you only use them at night.  Benzoyl peroxide is a medicine that works to reduce the activity of the glands and dissolve the oil plug.  It is the main ingredient in Proactiv, a very popular acne treatment.  It’s main downside is that it is a peroxide - like bleach - so it can bleach your hair or clothes or bed sheets if it gets too close to them.  But it works well.

Next week, we'll go over the treatments for skin flaking, and the oil and inflammation, and in a couple of weeks we'll go over some of the myths and acne treatments.

Until then, stay safe and enjoy life. 

It was one of the many firsts in your life growing up.  First day at school, first wrist watch, first sleep-over, first crush, first time shaving, first period (for the girls, not for me of course) … and the first pimple.  My sisters took great delight in pointing my first pimple out to me.  They also offered to squeeze it for me.  I was touched ...

But acne doesn’t just cause you grief in adolescence.  It also makes cameo appearances throughout your twenties and thirties, and the results of all that picking and squeezing - the moonfaces of acne scarring - are with you for life.

Acne can also be severely debilitating.  Severe acne can result in disfiguring scarring, and the decreased self-esteem and self-confidence that some teenagers can feel can lead to long term emotional damage.  Sometimes, acne has been linked to teenage depression.

We have been over acne before, but I think that it’s time for a review.  New treatments have even stronger evidence behind them than before, and I see more people every day for their acne looking for that magical cure, but still getting confused with the myriad of “treatments” that are out there.  So for the next couple of weeks, we’ll look at what exactly causes acne, some of the many myths there are about it, and the ways to keep those mini-eruptions under control, and soften the appearance of the craters of acne scarring.

Firstly, what exactly causes acne?  There are many things that contribute to the process.

1. Increased production of sebum by the sebaceous glands in the skin.  The sebaceous glands open up near hair follicles, and produce the oily sebum which helps keep the skin moist and lubricated.  Androgens, the hormone responsible for the development of arm pit and pubic hair, increase the size of the glands and their oil production, which is why acne is worse during puberty, and why boys are usually affected more than girls.

2. Flaking of the skin cells near and in the opening of the sebaceous gland.  These skin cells form a keratin plug, which blocks the gland.  The oil gets stuck behind this plug, causing the acne lesion (a zit).

3. Air (or lack of).  When the pore opens and air can get to the sebum plug, the oxygen in the air reacts with the sebum protein to turn it black.  This results in a black head.  Black heads are not dirt!  Thats a myth (more on that later).  If the pore remains closed, the sebum remains white, forming a white head.

4. Bacteria and inflammation.  White heads that are red and inflamed are caused by two things.  The oil in the sebaceous gland can leak into the surrounding skin tissue.  The oil is actually irritating to the skin cells, and so the surrounding skin becomes inflamed.  The bacteria that live on our skin, P. acnes, can get into the sebaceous glands and change the sebum into even more irritating by-products.  This can turn an ordinary white head into an engorged, red, angry little cyst.  This is called papulopustular acne.

The treatments for acne basically involve fighting one or more of those causes.  Acne scarring is a bit more difficult, but can still be treated.  Next week, we’ll go through the treatments for acne and acne scarring.

Until next week, stay safe and enjoy life!

Mothers … We wouldn’t be here without them.

I know that sounds like a statement of the overwhelmingly obvious.  But stop to think for a minute.  We tend to take our poor old mums for granted.  We rarely consider what a profound impact that they have on our lives, intentionally, accidentally, or purely through osmosis.

Mothers, as our primary carers during our formative years in childhood, are largely responsible for the person we become.  Part of that is genes, certainly physically.  But a lot  is also to do with how they raised us.  Much of that was probably automatic, repeating much of what their mother did to raise them.

Of course, that’s usually the opposite to what they wanted to do, since almost every woman usually says to me, “I really don’t want to become my mother.”  But despite this, every generation tends to follow much the same pattern, and have similar likes, similar laughs, and similar views to their mum.  Like it or not, you are your mothers child.

On Mothers Day, it is time to look beyond the imperfections, to celebrate and appreciate the good characteristics that she imparted to you, as well as all those things that she did for you, without asking or receiving thanks in return.  When you have children of your own, particularly one that doesn’t sleep unless he’s cuddling you, you soon learn to appreciate all that your mum actually did for you.  The endless cooking, washing, cleaning.  The stinky nappies, being your nurse when you were sick.  Hugging you when you fell over and carved a giant wound into your skin, even though you were bleeding all over her good pants and leaving your snotty tears on her shoulder.

Being your mothers child also means that your looks will often change like hers did.  Looking in the mirror one day, to find the exact same squint or dimples as you mother has, is not unusual.  My point here is two-fold.

I don’t want to sound crass, but if you know what is going happen ahead of time, then you can work to prevent those changes.  If you see early signs of those same wrinkles that you mother has, early treatment can soften their appearance, and slow their progression.  So if you know of a physical feature whose development you’d like to impede, come and see us, and we will talk with out about what can be done.

But as a gift to your mum, bring her along to.  She might be interested in softening all of those worry lines that you are responsible for!  And what better way to say, “Thanks Mum” than to pamper her with a treatment that really will help to soften the signs of a life well lived.

Please give us a call to make an appointment for you and your mum.  It would be our pleasure to talk with you about the best treatments for you.

Stay safe and enjoy life.

Perfection ...

A lot of time and energy is spent pursuing something that doesn’t actually exist.  Yet it is a very powerful ideal – we all dream of the perfect job, the perfect partner, the perfect lover.

What about the perfect face?  Is it possible to achieve?  The short answer is no.  There is, of course, no such thing as the perfect look either.  In fact, it is the subtle defects that actually make us human, and beautiful.  There are tiny asymmetries in every natural face, in the shape and size of our eyes, mouth, lips and teeth.  Even the most beautiful model does not have a perfectly symmetrical face.  Take a look at what happens when you artificially produce perfect symmetry in a face, and compare the result.

Can cosmetic medicine make your face look perfect?  No!  Not even cosmetic surgery can make your face perfect.  The more surgery that a person has the worse they often look (take Michael Jackson as an example).  Cosmetic medicine cannot achieve the ideal either.  So if perfection is what you are after when you come to Phoenix, you will definitely be disappointed.

Rather than promise perfection when you come to Phoenix, we will help to soften the signs of a life well lived.  Wrinkles won’t go completely but we will help them to soften, and to slow their progress. We can help to partially reverse the signs of aging, such as the sagging of the facial tissue, and loss of volume, but we certainly don’t pledge to completely reverse them.  Scarring from acne or deposits of fat can be smoothed over and shrunk down most of the time.

The best way to think of cosmetic medicine is to think of taking a few years off your appearance.  If you look like you are 55, there is no way we could make you look 25 again.  But we might be able to make you look like you did when you were 45.  If you have treatment when you are younger, we might be able to slow down the appearance of aging, to leave you looking “thirty-something” for a lot longer.

We would love to be able to show you how we could soften the signs of your life well lived.  If you would like a chat with us, free of charge and obligation, please do not hesitate to call us.

As always, stay safe and enjoy life.

We don’t often see soldiers as the typical patient for cosmetic surgery procedures.  Rugged looks with scars from their battle wounds and drunken stories that accompany them - more the stereotype that is associated with the typical soldier.

But in an article published this week, the White House and the US Armed Forces are funding research into the use of a procedure on wounded soldiers to help improve their healing.  This miraculous new cure is actually not new at all, but is something that has largely fallen out of favour for the lunchtime makeover, and isn’t routinely done by Australian cosmetic physicians.

Fat transfer was one of the earliest fillers used on the market.  Like we use hyaluronic acid today to fill lips and restore lost volume to the cheeks and jowls, fat transfer was used to pout lips and reverse sagging.  It was much better than other early fillers.  The collagen that was initially used was from cows, and had a high allergy rate.  It didn’t tend to last very long either.  Fat, taken from parts of the patient’s own body, was then reinjected into whichever area required the volume.  As it was from the same patient there was no risk of allergy.  It was variable in it’s success though, and was fairly operator dependent.  As better products like hyaluronic acid and the other more permanent fillers became available, fat transfer fell by the wayside.

But since then, researchers have noted that fat grafting has benefits to the surrounding tissue, with some research showing that scarring seems to improve when fat is then grafted underneath the tissue.

While it certainly isn’t going to affect the average person wanting their lips done, the possibility of fat grafting aiding wound healing will certainly aid the physical and mental recovery of returned servicemen.  Eventually the techniques will filter through into the civilian world as well, with burns victims and other patients with horrific scarring able to benefit from improved cosmetic recovery.

Of course, it is timely that we honour the efforts of generations ago, in their fight for freedom.  In 1915, five brigades of Australian and New Zealand soldiers, fighting for the British Empire, landed on the shores of Turkey to liberate the straits of the Dardanelles and open up the Black Sea.  It was supposed to be a surprise attack, swift and decisive, to weaken the Turkish forces (allied with the Germans) so that the British navy could attack a key headland further north.

But either through bad planning or sheer bad luck, the landing craft missed their target, and instead of the larger beach, they landed on a much smaller beach and were completely disorientated.  The landing of the second wave of troops into the intended area then lost its impact, and without the key element of surprise, they were under constant fire.

Instead of the battle lasting days, the stalemate dragged on for over 8 months in inhumane conditions.  The ANZAC’s lost 2500 men, with over 8000 casualties.  It was a defeat for those brave and untiring soldiers that so desperately tried to capture the land for King and country.

That such a massive defeat, resulting from military bungling, could become an integral part of our nationalism and our folklore, says a lot about the psyche of Australians.  “Mateship” is a term that gets loosely bandied about in our culture, but the actions of the ANZAC’s really symbolised what it meant to stick together and fight for what’s right, even in the face of overwhelming adversity.

War is never something that is glorious.  But we have the freedom today to have a home, earn a living, get our wrinkles treated or our lips done, all because of the sacrifice of those diggers before us.  If nothing else, we owe them our respect.

“They shall grow not old,
As we that are left grow old,
Age shall not weary them,
Nor the years condemn.
At the going down of the sun,
And in the morning
We will remember them.
Lest we forget.”

Stay safe and I’ll see you next week.

Skin cancer detection and the preservation of beauty

We all know that the sun is bad for us in too high a dose.  Days on end lazing around at the beach and getting burnt to a crisp are obviously terrible for the skin.  You may look brown eventually, after you get over the second-degree burns, but the price is high and is paid years down the track.

Too much UV light, be it from the sun or from your local solarium, cause changes in the structure and function of the skin.  At the not-so-dangerous end of the spectrum, the collagen and elastin fibres of the skin are damaged and the skin loses its volume and bounce.  Wrinkles and sagging skin are the end result.  At the more severe end of the spectrum, the UV light triggers the skin cells to grow out of control.  Skin cancer is the end result.

No matter which form of damage you end up with, the result is still ugly.  Wrinkles are ugly.  Skin cancers are ugly.  The scars after having the cancers removed are uglier still, and being dead from melanoma, well, you get the picture.  So in order to really take care of our skin and enhance our beauty, we have to be more careful with what we expose our skin to when we are young (and still, when we are not so young).  Here are some tips to keep skin cancer free, and less weathered.

1. Slip, Slop, Slap!
For the overseas readers, Australians have been brought up with the health promoting jingle sung by an dancing seagull, “Slip on a shirt, slop on sunscreen and slap on a hat!”  And it is still true.  Avoid sunlight, especially between 10 and 2 (standard time, 11-3 for daylight savings).  No UV light, no damage in the first place.
2. Don’t go to Solariums
You don’t need to be brown to look beautiful.  Spending money to strip off and have someone irradiate you doesn’t really make much sense anyway, especially when they can be just as dangerous as sunlight itself.  See the article, “It’s not all white.”
3. Wear a daily moisturiser with SPF 30+ combined
In the morning as part of your beauty routine, use a moisturiser with sunscreen.  That’s a double bonus for your skin, which will benefit from the daily extra moisture and will prevent incidental exposure to the sun as well.  It is estimated that exposure to 15 minutes of the sun each day can damage the skin, including walking to and from your car, driving or staring out the window for a while.  That’s why daily sunscreen is so important, as it covers all of those routine activities that are doing damage without us even thinking.
4. Get regular skin checks
A skin check by a competent GP or dermatologist is incredibly helpful at picking up early cancers before they have time to grow.  It is best done looking at all your skin, in your underwear.  Partial skin checks are better than nothing, but usually the spots that you are least concerned about are the problem spots, so it's best to get all of your skin surface checked out properly, to be sure.
5. Watch out for the Zap-happy therapist.
Don’t get your pigmented spots lasered or IPL’d until they have been reviewed by a doctor.  Nurses and beauticians with fancy machines have sometimes zapped a spot on the skin which later proved to be melanoma, not just a benign lesion to be blasted with IPL.  If in doubt, make sure that your skin is clear before proceeding.
6. Make sure that your doctor is not scalpel-happy
Some skin clinics have doctors that want to biopsy every square centrimetre of your skin for cancers.  Trust your gut and if you think it is overkill, then get a second opinion.  The original GP may be right, but unnecessary biopsy’s can scar, which you don’t really want.

The GP’s that run Phoenix Rejuvenation Medicine are both experienced in skin cancer diagnosis and removal.  If you have any doubt about your skin and you want to have an opinion on your moles, feel free to contact us.  We would be happy to assist you in whatever way we can.  But prevention is always better than cure, so don’t forget to Slip-Slop-Slap, and use the right products for your skin.

As always, stay safe, and enjoy life.

Botox has been a little quiet in media circles of late.  Since the uproar instigated in February by the FDA investigation into the deaths believed to be associated with botox, there has been little further in the press about botox, or any further publications from Allergan, the manufacturer of botox.

However, the smouldering interest in botox still glows and flickers every now and then, with some interesting thoughts coming from both sides of the debate.

Recently, New Scientist published a story on botox and how far it appears to move from the site of injection.  They have discussed several studies in animals that show movement of the botox to muscles surrounding the one that was injected.  Not discussed by New Scientist in the article was the dose of botox that was given, or the volume of solution used to inject.  These facts are important, as we already know that botox can move away from the injection site, and the unintentional weakening of muscles around the treatment area is a complication that all patients are told about before they undergo treatment.  Bigger volumes will move further through the tissues, and higher doses will result in stronger and longer paralysis.  But cosmetic uses only need small volumes and tiny doses, and may not be able to be compared with the research.

Other scientists are postulating that botox can also make it all the way to the brainstem.  If it does in humans, I have certainly never seen any evidence of that in my patients, and proper tracer-studies need to be done in humans before anyone enters into hysterics that botox “poisons your brain”.

But on the flipside, a paper published recently by two doctors from Singapore, Lim and Seet, suggest that botox might be a lot more versatile in its medical uses, rather than just being limited to wrinkle reduction.  Botox is known to reduce the activity of the specialised part of the nervous system called the cholinergic system.  The cholinergic system not only controls the activity of skeletal muscle, but also sweat glands, and many other glands in the human body.  In the 2007 publication of Medical Hypothesis, they theorise that because of the wide-ranging action of the cholinergic nervous system, botox has much more scope than just cosmesis.  For example, any syndrome involving overactivity of the cholinergic system could be targeted, like Restless Leg Syndrome, Asthma, and a range of pain syndromes.

Once the safety issues have been cleared up, further research into the wider application of botox would be welcome.  Botox is already used to treat blepherospasm (excessive squinting), hyperhidrosis (excessive sweating) and some types of headaches, such as migraine and chronic tension headaches.  Such treatments already in existence show that botox should not be limited to wrinkles, but given much greater attention as a serious medical treatment, not a Hollywood accessory.

Of course, that doesn’t detract from botox as a treatment for your facial lines, because it works very well on those too.  If you’d like more information on wrinkle treatment or other uses of botox, please make an appointment with us.

So as it stands, the future of botox still remains shrouded by a smoky haze, and we still await the FDA’s findings before we know whether it remains as a friend or a foe.  Botox – “Where are you going?”  Only time will tell.

Stay safe and enjoy life and I’ll see you next week.

Before Easter, we heard from the President of the Australian Psychological Society, who was quoted by the ABC, saying that most people who have cosmetic procedures actually have Body Dysmorphic Disorder.  To recap, here is the quote:

“A very large number of the people who set out to change what they think is some ugly feature in them are actually suffering from a psychological disorder. And the medical treatments not only don't help - the most likely outcome is they actually wind up more distressed and that particular psychological problem called body dysmorphic disorder has a high risk of suicide.”

As a said a few weeks ago, he may have been taken out of context, but certainly on face value, what he said was a bit extreme.  Even if the currently accepted figures are true, at least 95-98% of people do not have Body Dysmorphic Disorder.  People with BDD are more likely to present for cosmetic procedures, because they are obsessed with a perceived flaw and want it fixed, but at least 90% of our patients are just normal people who don’t like their saggy jowls or wrinkles.

So what is BDD anyway?  The precise definition is, “a preoccupation with an imagined or slight defect in appearance. This preoccupation causes significant distress or impairment in social, occupational, or other areas of functioning in the person's life. Another disorder, such as whole body image dissatisfaction (as in anorexia nervosa), cannot explain this preoccupation.” [eMedicine Body Dysmorphic Disorder].

In other words, BDD causes a person to obsess about something in their appearance that only they perceive as a flaw.  Their obsession is so bad that it impairs their ability to function normally in society (they don’t go to work, or don’t socialize because they think others will notice their “flaw”.)

Patients with BDD share a lot of symptoms with Obsessive Compulsive Disorder.  They spend over an hour a day trying to cover or otherwise deal with this perceived defect.  They will often look in the mirror compulsively to check their “problem”, not because they are vain, but because they are incredibly anxious about the “defect”.

Of course, people with BDD are indeed more likely to come for cosmetic work, because they think it will make the problem go away.  They are never happy with treatment, or if they are, will then begin to obsess about another area of their body that is “flawed”.

BDD is easily curable in most cases, with high doses of one of the family of medications called the SSRI’s, plus particular types of psychotherapy.  The trick is recognizing it in the first place, as patients with BDD are often ashamed of their concerns and hide the symptoms from their regular doctors.

For our prospective patients, we will always give you the best in holistic care, based on treatments and techniques with the best available scientific evidence.  We have the added benefit of being practicing doctors, and can therefore treat you as a whole person, not just someone with wrinkles.  If we were concerned that you may have BDD, we would always tell you, and recommend the most appropriate therapy for you.

The other thing to note here is what anyone can expect from cosmetic medicine treatments.  Our aim is to enhance your natural beauty.  Rarely can any treatments, solo or combined, completely remove a blemish.  People with BDD go away unhappy because they seek perfection from their treatments.  We don’t promise perfection, but only that you will be happy walking out of our office.

If you’d like to know more, why don’t you come and have a chat with us.  Obligation and cost free, but you will know a lot more than when you left.

As always, stay safe and enjoy life.