Leading Dermatolgist Joshua L. Fox, M.D. explains New Lasers for Skin Rejuvenation


New York, New York, January 2009 – Diet, exercise and healthier living may make us feel younger but too often our skin tells the true tale of our age, despite our best efforts to mitigate the damage to our skin that can make us look much older over time.  Aging skin, with its “loose” feel, sagging, fine lines, enlarged pores, sallow complexion, and creases — is caused by many factors, including too much sun with too little sunscreen, wind, cold and pollution, plus cigarette smoke, stress, poor nutrition, facial contortions, and alcohol, among other things.


While many people still opt for invasive techniques like surgical face lifts, aggressive resurfacing, or deep chemical peels to combat the signs of aging skin, many are now turning to minimally invasive procedures to rejuvenate facial skin and take years off that image in the mirror.  According to the American Society of Plastic Surgeons, minimally invasive cosmetic procedures for the face increased considerably in 2007, with laser skin resurfacing treatments increasing by one-third over the prior year.  These treatments increased by more than 100% from 2000 through 2007.  In addition, members of the American Academy of Cosmetic Surgeons report that of the top five most performed non-invasive procedures at their practices, the estimated percentage increase from 2002 to 2007 was highest for laser resurfacing, at more than 128%.


One key reason that the number of these procedures has increased so dramatically is the development of high-energy, extremely accurate lasers which have enhanced the ability of physicians to improve sun-damaged skin, scars, wrinkles, brown spots and other conditions with minimal to no downtime.


“These new laser skin resurfacing techniques can take years off your appearance” says Joshua Fox, M.D., a leading dermatologist and founder of Advanced Dermatology and The Center for Laser and Cosmetic Surgery. “Our patients typically see a significant improvement in the look and feel of their skin. In addition they see fewer wrinkles.  Laser skin rejuvenation can be done in one to just a few treatments, depending on the technology, and patients are able to return quickly to their normal activities.”


Dr. Fox lists nine revolutionary laser technologies that have changed the way physicians can help their patients improve their aging skin. They are:


1.• Fraxel®. This multiple treatment approach requires no preparation for the patients, who simply get a topical anesthetic and feel light pressure during this safe and gradual laser procedure that stimulates the body to replace aged and photo-damaged skin.  It also shrinks the pores and is the first and only laser approved for treatment of the discoloration of melasma.  It can be used throughout the body.  Although there is some redness, most go right back to work.


2.• Thermage®. Non-invasive and not truly a laser, Thermage uses a radio-frequency unit to tighten and lift skin without any of the downtime of a surgical face lift.  A gradual effect is seen over a couple of weeks, allowing patients to be confident that no one will know they had any work done.  It is used most often to lessen joules and nasolabial folds but has been used on eyes, cheeks and the body also.


3.• Pixel® Fractional CO2.  An updated CO2 laser with new technology to be less aggressive and results in much less patient down-time. The physician tailors the skin resurfacing procedure to each person’s unique needs.  The pixel technology can be used on light, medium and deep settings depending on the amount of improvement and the number of days for complete rehabilitation along with the number of treatments desired.  It does not have the previous CO2’s high risk of discoloration, long healing times and prolonged erythema.  It still offers some skin tightening benefits which increases with a second or third treatment.  The results can be quite dramatic.


4.• Medlite Peel®.  This laser’s dual wavelengths can be used to rejuvenate the skin from acne scars and lip wrinkles to eliminating the blotchy discolorations and age spots on the face.  The “peel” technique, often gives a person fresh new skin and may lessen under eye dark lines and facial age spots.  The rejuvenation alone has no down-time while the laser peel will require extensive makeup to cover the one-to-two weeks of facial peeling.  Many work throughout this healing time.


5.• Smoothbeam®.  This deep penetrating laser is helpful on all skin types to lessen acne scarring and in promoting collagen production for some wrinkles.  There is no down-time so it is a patient-favorite among the practice.  It requires several treatments to achieve the most positive results.


6.• IPL laser therapy.  Not officially a laser it is a process called photo-rejuvenation for the face and body, IPL improves the appearance of photo-aged skin, removes age spots (sun-induced freckles), most benign brown pigments and redness caused by broken capillaries with essentially no down-time. It requires multiple treatments and its wavelengths are less specific than a laser.


7.• Gentlelase/APOGEE lasers. These lasers’ 755 nm Alexandrite wavelengths are highly absorbed by melanin, making it a top choice for removing unwanted pigmented hair with minimal to no pain and may even help epidermal pigmented lesions such as age spots, sun spots and freckles.  There is no down-time.


8.• V-Beam. These lasers work by focusing a beam of light to a target in the skin such as enlarged blood vessels or hemangeoma, thus removing the vessels and irregularities without scarring and lessening the risk of bleeding.  There is mild redness and swelling but one can go back to work usually within the next day or so.  It is also helpful for scars, stretchmarks and facial rejuvenation.


9.• Erbium Laser. One of the latest tools available for the treatment of wrinkles, acne scars, aged and sun-damaged skin, the Erbium is a cool light laser that resurfaces the skin. This method results in less post-procedure redness, less swelling and faster healing time and much less risk of side effect than with other strong laser skin resurfacing methods. The Erbium laser can be used on the face, neck, chest and hands.  You can expect up to a several days of down-time from this procedure depending on the depth of the peel.  People say how smooth and fresh their skin looks and feels.


“Patients should speak to their physicians about their specific age and environmentally-caused skin concerns,” Dr. Fox says.  “By using one or more of these new laser skin rejuvenation methods, healthy, active adults can now look as young as they feel.  We have found that by mixing the lasers together we are able to achieve the best results for our patients.”


Leading dermatologist Dr. Joshua Fox explains benign growths

New Hyde Park, NY, February 2009 – The skin is the organ most exposed to the outside environment and it provides our first line of defense against a wide range of toxins, bacteria, viruses, foreign bodies, and diseases that could have serious and sometimes lethal impact. The many tumors and rashes that appear over time on different parts of the skin can be traced to more than 200 diseases, most of which are treatable, and most of which are completely benign. But it is the risk of malignancy or another life-threatening disorder, and the want to look beautiful, that makes it important to know when a growth or skin eruption requires medical assessment or can be treated simply.

Skin lesions may appear as pigment changes, such as a patch, as bumps, lumps, moles, warts, as flaky or crusty patches, or manifested in a wide number of other types of abnormalities. Joshua Fox, M.D., founder of Advanced Dermatology, P.C. in New York and on Long Island, and a spokesman for the American Academy of Dermatology and the American Society of Dermatologic Surgery, helps to clarify what we need to know about the changes we see on our skin.

MOLES: Most people are aware of the need to examine moles which appear benignly throughout life, and to check for new changes that occur, particularly in parts of the skin exposed to sunlight. Melanoma is the deadliest form of skin cancer taking about 41,000 lives worldwide, although it is far less common than the other skin carcinomas. The incidence of melanoma continues to grow at alarming rates among light-skinned people. According to the American Cancer Society, 60,000 people in the United States developed melanoma in 2007, and more than 8,000 died of the disease. The most suspicious moles are either congenital nevi, moles from birth, or dysplastic nevi, usually larger more irregular moles with irregular shape and or/color, which are found in an estimated ten percent of the American population.

WARTS: Warts are very common growths that occur on various parts of the body as a result of the human papilloma virus (HPV). “These are benign growths that affect all skin types and may go away without treatment, although if they persist, many people seek medical help to remove them due to irritation or just the unsightly appearance. The wart or virus also may promote certain skin cancers like some squamous cell carcinomas and cervical cancer,” Dr. Fox explains. They can be treated chemically, via cryotherapy, or with lasers, or surgically removed in a dermatologist’s office.

KERATOSIS PILARIS: Another type of common skin lesion is keratosis pilaris, in which the cells that normally flake off from the skin’s surface instead become trapped and plug hair follicles. They appear as hyperkeratotic, rough raised bumps based in hair follicles which can multiply in an area like the arms, thighs, buttocks, back and occasionally the face. “This is a common occurrence, particularly among teenagers,” Dr. Fox says, “and is not cause for serious concern.” Moisturizing is the first line of treatment for keratosis pilaris. He also suggests taking long baths and gently rubbing the skin surface with a course washcloth or buff puff. However, in some people this can cause irritation and/or discoloration. If the condition doesn’t go away, there are many effective topical treatments available with or without a prescription.

Seborrheic keratosis is a growth that appears usually over the age of 40, and can become irritating and itchy. It usually appears as brown keratotic stack on a lesion anywhere on the body. There are no particular topical or at-home treatments for this form. A dermatologist can treat areas with cryosurgery (freezing), dermatologic surgery or lasers to eliminate the discomfort and unsightliness.

SKIN TAGS: Skin tags are an annoying type of growth that about half of all people develop as they age. These are small pieces of hanging flesh that develop in areas that are prone to rubbing against clothing or other skin; or are moist areas such as the upper thighs, under arms, neck, and under women’s breasts from underwire bras. Another common site is the eyelid. “Most skin tags are small, but they continue to grow and often become painful or annoying because of their location,” according to Dr. Fox, who recommends a visit to dermatologist to have them removed if they are painful, irritating, bleeding, infected or get caught in clothing.

MELANOMA/SKIN CANCER: It is so important to be familiar with the moles on your body and to perform regular self-examinations of your skin. Melanoma often develops in a pre-existing mole that begins to change or in a completely new mole. Melanoma is a serious skin cancer and the mortality rate is remarkably high considering the fact that it is nearly always curable in its early stages; however, this high number can be attributed to the late diagnosis of the disease in which the cancer spreads to other parts of the body. Melanoma most often appears on the trunk of men and the lower legs and arms of women, although it can be found on the head, neck, scalp or elsewhere. Melanoma represents approximately 5% of all skin cancers in the USA, but accounts for about 75 % of all skin cancer deaths. The World Health Organization estimates that as many as 65,161 people a year worldwide die from malignant skin cancer, approximately 48,000 of whom are registered. The American Academy of Dermatology (AAD) estimates that in 2009, about 116,500 new melanoma cases will be diagnosed in the U.S. with 8,420 deaths (~1 death every hour). Incidence rates are at least 16 times greater in Caucasians than African Americans and 10 times greater than Hispanics. Moreover, even though skin cancers are not as prevalent in individuals with darker skin, they can have more morbidity and fatalities since they may go undiagnosed for longer. Researchers estimate that 1 out of 50 people in the U.S. in 2010 will be diagnosed with melanoma at some point in their lives. Specifically, among Caucasians, the rate of increase of melanoma incidence is 3-7% each year. Melanoma grows from pigment cells (melanocytes) in the outer layer of the skin (epidermis) and mucous membranes and tends to spread out within the epidermis before moving into the deeper layer of the skin (the dermis). In its advanced stages it can spread to other organs of the body. Frequent self-examination for the ABCDE (Asymmetry, Border Irregularity, Color, Diameter and Evolving) characteristics of abnormal moles is suggested.

These are the most common types of growths that may appear over time on the skin, and the majority are no cause for concern. Many other types of benign lesions are also possible such as dermatofibromas, cysts, freckles, fibromas, keloids, lipomas, and granulomas, as well as many more rare types. While an assessment of anything unusual or a mole that is irregular in shape or size is critical, many other skin lesions can still cause a discomfort, pain or embarrassment you don’t have to live with. Dr. Fox notes that there are a wide range of treatments available which you can discuss with your dermatologist. “Many patients don’t realize that most of the treatments can be performed at the time of the consultation visit so you go home without the problem you may have endured for months or years. Usually there is little to no mark left behind. It’s especially important to become educated to the changes that occur on your skin,” says Dr. Fox. “You need to recognize what you are prone to, how you can prevent it, and what options are available to treat it­, as well as which lesion can get you into trouble.”



Leading dermatologist Dr. Joshua Fox urges

patient education and research before scheduling


New Hyde Park, New York, February 2009 – With nearly 12 million surgical and nonsurgical procedures performed in the United States in 2007, cosmetic surgery has become both big business and a mainstream part of American life. Many more Americans than ever before are seeking to improve their facial features, remove unflattering spots, flatten their tummies or expand their breasts. In fact, the American Society for Aesthetic Plastic Surgery says the overall number of cosmetic procedures has increased by more than 450 percent since it started collecting statistics in 1997.


But, warns Joshua L. Fox, M.D., a leading dermatologist and founder of Advanced Dermatology, PC, and The Center for Laser and Cosmetic Surgery, setting your sights too high and having false expectations can make the process and its results less than beautiful. Dr. Fox says patients considering surgical cosmetic procedures need to be well informed, have realistic expectations and avoid common mistakes…Or they may be disappointed. Following are nine misconceptions about cosmetic procedures:


1.  I’ll be in and out today. “While it’s true that many cosmetic procedures are done on an out-patient basis, that doesn’t mean that you’ll be in and out in a few hours and then done,” Dr. Fox says.  “Cosmetic surgery is just that — surgery — and you’ll probably be tired, sore and uncomfortable for several hours or even several days after you get home depending on the procedure, of course.”  Non-surgical cosmetic procedures, like Botox fillers, microdermabrasion, laser hair removal and some other laser procedures are quick, with minimal risk with the patient back to work in as soon as a few hours.

2. It will heal quickly.  Wounds may heal faster or more slowly depending on the type of procedure.  “Immediately following a surgery with cutting, your wound may be warm, red, swollen and tender while the healing begins,” Dr. Fox says. After a few days, he says, the wound may begin to look wet and white or yellow as the skin around the area thickens and the wound gets smaller. Finally, a slow process of “maturation” begins, as the wound gets stronger. This process can last from several weeks to much longer.

3. I will have no marks left.Patients undergoing cosmetic procedures want to improve their appearance and keep scarring to a minimum,” Dr. Fox says.  “As cosmetic surgeons, we work very hard to reduce scarring, but patients must take some of the responsibility by remembering that sun damage can slow or even prevent the healing and fading of scars.”  At the very least, he urges patients to initially keep scars out of the sun or protect them with sun block. “With correct care and protection after surgery, most scars fade and become barely noticeable.”  Other things patients must do include the following recommendations:

a)  follow all instructions carefully

 b)  avoid trauma or home remedies to the area;

c)  avoid smoking as it slows wound healing;

d)  use moist wound healing technique

e)  avoid potential allergens like Bacitracin®, Neosporin®,  or Polyporin®, unless infection is suspected.

4. There will be no discomfort. By its nature, cosmetic surgery is superficial and does not generally cause much swelling or bruising. However, any surgery carries with it the risk of discomfort or pain, swelling and other complications. The patient’s pain or discomfort, of course, will vary depending on their own threshold for pain.  There are many methods to reduce pain include a Zimmer cooler, ice packs, gating technique, better instrumentation, and buffering the local anesthetic.  Of course, if it is a larger procedure an anesthesiologist or a nerve block, as well as oral antianxiolytic and narcotics may be helpful.

5. It is safe/there won’t be any complications. While most cosmetic procedures and surgeries have predictable results and are very safe, it is important to remember that complications can arise whenever a procedure takes place. Cosmetic surgery complications, although rare, can range from scarring, infection, skin depression or discoloration to, even on rare occasions, fatalities.  The effects of surgery can sometimes be traumatizing to patients both physically and psychologically. “The risks of cosmetic surgery will differ depending on the individual and the procedure,” Dr. Fox says, “so make sure to ask your physician a lot of questions beforehand so that you will know what to expect and be able to minimize risks.”  “It is critical to ask your surgeon to explain what sort of recovery you will face, what complications may arise, and how you can reduce discomfort or pain,” Dr. Fox says.   Ask your doctor how to minimize risks.  For example, which medications may or may not be introduced during surgery and what you can do to lessen bruising.  Also, ask your medical doctor if you are healthy enough to have the procedure you are electing.  Choosing a cosmetic surgeon with a lot of experience also lowers the risk of complications.

6. The more procedures I get, the better I will look. “Again, it is important to remember that any surgery carries with it inherent risks and potential complications, and the more surgeries, the more risk.” According to Dr. Fox, some general risks, although rare, for cosmetic surgery include Some people feel the need to have cosmetic procedures when they look great – dubbed “cosmetic surgery junkies”.  A good cosmetic surgeon will tell you that nothing is required in that situation.

7. It won’t cost too much. Several factors determine the cost of cosmetic surgery,” Dr. Fox says, “including geographic location, the surgeon’s expertise, the number of areas treated, amount of time and effort required of the cosmetic surgeon and, in the case of a larger procedure, the cost of the anesthesiologist’s services as well as operating room and lab fees. Ask about all costs surrounding the surgery before you schedule it.”   Some practices will package the fees as one inclusive cost or may have their own out-patient surgery center – which may lower the total cost.

8.  I just need to fix this tiny spot. The most important thing to remember about any type of medical beauty procedure is that there is no way to completely eliminate the risk of complications, so if you’re looking to fix something tiny, you and your physician may be able to consider alternatives to surgery like laser or other spot treatments.”

9. All laser and cosmetic surgeons are equal.   As with any field, experience matters and can make all the difference between technique, expertise and knowledge.

Dr. Fox says that education and research are the keys to avoiding false expectations from cosmetic procedures. “One of the best ways to achieve your goals and at the same time limit your risk and assure a positive result of your cosmetic surgery is to educate yourself,” he says. “Do your homework before you schedule the first visit to a cosmetic surgeon, research each procedure and its inherent risks, look up your doctor and/or his website, and learn about your cosmetic surgeon’s background and experience. In addition, it is ideal to have a full medical checkup prior to embarking on major cosmetic surgery.