FoxxMD Blog

Madame Marie Curie

1867-1934

Although not actually seen until the invention of the electron microscope in about 1935, viruses have been around since the beginning of time.  They are very small critters, smaller than bacteria, and consist of a core of DNA or RNA surrounded and protected by a protein covering.  They infect our bodies by entering and taking over our cells and causing a host of symptoms from the common cold to Ebola.

Viruses have been in the news lately with the identification of a deadly family of viruses called coronaviruses.  Coronaviruses have been responsible for several outbreaks around the world, including the severe acute respiratory syndrome (SARS) pandemic of 2002-2003 and the Middle East respiratory syndrome (MERS) outbreak in South Korea in 2015.

All coronaviruses are not deadly.  Some can cause mild respiratory infections like the common cold.  The virus that has been in the news, however, is designated 2019 novel coronavirus.  Or 2019-nCoV if you want to be precise.  It has also been named Covid-19.

What makes Covid-19 a problem is that there is no immunity to it yet, either by vaccine or by having had it.

Coronaviruses are small, round objects that appear under the electron microscope to be studded with projections that resemble golf tees.  When they were first seen scientists thought the array of projections looked like a crown.  The word for crown in Latin is “corona”  so they were termed “coronaviruses.”  That may not be very original but it explains that unusual term.

At this time we don’t think this coronavirus was created as some doomsday weapon by a mad scientist in a laboratory. Viruses can change or mutate over time all on their own. Occasionally, a disease outbreak happens when a virus that is common in an animal such as a pig, bat or bird undergoes changes and passes to humans. That is thought to be the most likely explanation for how the new 2019 novel coronavirus came to be.

These viruses can be transmitted from one person to another through droplets expressed when an infected person sneezes, coughs or breathes.  Simple measures — such as washing your hands, disinfecting frequently touched surfaces and objects, and avoiding touching your face, eyes and mouth — can greatly lower your risk of infection.

The incubation period for the coronavirus (the time between exposure and the development of symptoms) is somewhere between 10 days and two weeks.  During this incubation period the infected person has no symptoms and so can pass the virus on to you without either of you knowing.  The infection ultimately shows up as a respiratory infection with mild to severe flu-like symptoms but the exact symptoms vary depending on the type of coronavirus.

In patients with cardiopulmonary disease or a weakened immune system, the viral infection can easily progress to a more severe lower-respiratory infection such as pneumonia or bronchitis.

The possibility of pneumonia brings up the question of the advisability of being inoculated with a vaccine that prevents pneumonia.  Most physicians recommend pneumonia vaccine for patients over 65 in any case but you should check with your doctor for your particular situation.

Basically, symptoms of infection with Covid-19 include cough, fever and shortness of breath.  Diagnosis may be difficult with only a physical exam because mild cases of the new coronavirus may appear similar to the flu or a bad cold. A laboratory test can confirm the diagnosis but that can take time and at this point is only being offered at a few centers..  A lot of the research being done now is geared to developing a more rapid test.

Right now there is no vaccine to protect against the coronavirus.  Avoidance is the best method of prevention.  Producing a vaccine takes months but at this point we think one of the vaccines for SARS may become useful.  Time will tell.

Face masks are impressive, but most of the ones you see on the news don’t filter out the ultra-small viruses.  There is a very effective face mask that’s designated N95 but even that doesn’t work on men who have beards.  You can find N95 masks on line.  They are bulky and you won’t look like a TV doctor.   As of this writing, however, I don’t recommend everyone walk around wearing an N95 mask.

Right now there is no specific treatment for the virus. People who become sick from this coronavirus should have their symptoms treated with supportive measures by a physician.  For severe cases there are additional options for treatment including research drugs and therapeutics.

There is no specific drug or medication that can cure 2019-nCoV so the best step to take is to keep from getting it.  Believe it or not that comes down to the things you were told in fifth grade health class.  The Center for  Disease Control (and common sense) recommends:

• Wash your hands frequently.  Not the “lick and a promise” my Mother warned me against, but an actual 20 second wash with an antibacterial soap.  If you can’t estimate 20 seconds, sing “Happy Birthday.”  To yourself.  That takes about 20 seconds.  Remember, you are not just shaking hands with one person, you are shaking hands with everyone whose hands they have shaken in the past hour or so.
• If soap and water aren’t available, use an alcohol-based hand sanitizer. I keep one in my desk drawer and in the center console in my truck.
• Hugs.  I love hugs but it’s a good idea to pass on hugging random people for the next few months.
• Cover your cough and sneeze with a tissue and throw the tissue away!!!
• Avoid touching your eyes, nose or mouth with unwashed hands.
• Stay home when you’re sick.
• Clean surfaces and objects touched by other people with antibacterial wipes.  This includes telephones, cellphones and things laying around on your desk at work that you share.  Also supermarket carts.  This is a big tip that is often overlooked.  Viruses don’t live long on external surfaces but you can’t be too careful.
• You don’t have to turn yourself into some kind of recluse or a germaphobe.  Just remember the good advice from that fifth grade health teacher.  (Mine was my baseball coach, Art Lustig.  He always had good advice.)

You also want to keep your body as strong as you possibly can so as to resist getting any virus.  That’s why it’s very important to get enough sleep, drink enough water, and take about 1000 mg of vitamin C daily.  You can get chewable vitamin C or you can find those small yellow packets of Vitamin C powder that are mixed with water.   I recommend you drink one every day.  I also recommend you take 5,000 units of Vitamin D daily.  I also like to take echinacea if I feel I’ve been particularly compromised.  That’s good, but don’t take it for more than two weeks at a time.

Stay tuned.  More developments are happening daily.

Some of the magic of Christmas stems from its ability to resurrect old memories, bring them to the surface from the murky depths like deep sea divers retrieving precious antiques from ancient shipwrecks.  They appear unbidden.  Called forth by the crackle of a piñon fire, the scent of baking cookies, a few notes of an old carol, each brings a flood of remembrances.

Time evaporates.  Memories from a Christmas decades past are as fresh and new as if they happened yesterday.  Seen in the mind’s eye people long gone are alive again.  The smell of Grandma’s perfume.  Of a dear Uncle’s cigar.  A laugH.

When I was growing up I had six cousins roughly my age and every year on Christmas Eve we would gather in the attic at my Aunt Esther’s old Victorian house in East Orange for a sleep over and wait-for-Santa party.  No one slept but I still remember all of us going outside to look for the Christmas star.  It’s been years since I’ve seen those cousins but they live on in my mind’s eye.

When I went off to college, Christmas break became a time to catch up with high school friends.  And bask in the glow that you get by being a college student wandering your old high school haunts.

Mostly because I was new to the area I was tapped to be Santa Claus at the nurse’s party the first year I started practice in Newport Beach after I got out of the Army.  The staff talked about that and teased me every Christmas for years.

Being an obstetrician, I always seemed to be on call on Christmas day and invariably it seems I spent part of every Christmas in the delivery room.  Even had a Christmas baby named after me once.

As Santa to three kids I kept the mystery alive as long as I could.  Read everyone THE NIGHT BEFORE CHRISTMAS on Christmas Eve and only realized years later that I was the person I kept the tradition alive for.  Even to eating the cookies that were left for Santa by the fireplace, careful to leave some crumbs and a thank-you note.

Lots of shimmering images.  The Christmas recitals at Harbor Day followed by hot chocolate and cookies.  The boat parade of lights in Newport Harbor, green lights lining the forestay and the backstay of LUCKY PUFF.  Michelle, our oldest, making cinnamon buns with icing on Christmas morning.  From scratch.  Brian, the middle kid, the champion decorator and cosmic light wizard.

The first Christmas JoAnn and I spent together we went back to the Cape, to Duxbury, a small town straight outta TOWN & COUNTRY, where her sister, Leona, and brother-in-law, Kevin, had a house near Plymouth close by the Atlantic Ocean.  Not far from where the Pilgrims landed.  It brought THE PREPPY HANDBOOK to life.  A scene from Currier and Ives.  Big fire in the fireplace, garland on the mantle, candles everywhere.  JoAnn’s Mom, Doris (who became my adopted Mom), and Max, her career Naval officer Dad enjoying every moment with their sometimes raucous family.  Kevin always had a parade of college friends that dropped in for one of the famous Kavanagh Irish coffees.

We got married near there, seventeen years later, ten days before Christmas, on a cold, blustery day at the chapel at the Naval War College in Newport, Rhode Island, where JoAnn’s Dad had been stationed.  The lure of New England was irresistible.  There still is nothing to compare with walking in to THE BLACK PEARL, an old restaurant on the water in Newport, home of the world’s best clam chowder, on a snowy winter’s day with the windows frosted up, a fire in the fireplace, the smell of damp coats scenting the air.  When you sit own in from of a bowl of that chowder (chowda to the locals) and a Bloody Mary, all’s right with the world.

And the Christmas mornings in Newport Beach when our three kids would come over to our little condo in Newport for brunch and Max the dawg and Vincent the cat would crowd in to see what they could panhandle.

One Christmas Eve JoAnn and I decided to go to Midnight Mass that was going to be sung in Gregorian chant by the Norbertine Fathers at St. Michaels Abbey, high up on Saddleback Mountain in Orange County.  Way off the beaten path.  Loren, our youngest, was about seventeen. “What are you guys doing tonight?” he asked.  When we told him he cancelled the plans he had with his friends and never one to ignore the lure of a new adventure, he joined us.

Midnight Mass just about anywhere has the ability to make your hair stand on end.  When conducted by group of two dozen or more monks replete with white robes and cowls chanting the medieval words in Latin a cappella in a small wooden church lighted only by candles without a word spoken it transports you to a whole other place and time.  Druids. Stonehenge.  Mistletoe.  Merlin could have walked in, staff in hand, without attracting even a sidelong glance.  Outside, after the mass, the stars crackled in the velvet sky.  Somewhere up there, you knew, was the Christmas star.

Christmas has the ability to change.  And remain the same.  The superficialities change, the places, the faces.  What doesn’t change is the feeling of magic, of a special time of year two millennia ago when the world shifted on its axis.

Our family is scattered now from New Hampshire to Yorba Linda to Pasadena to Bayberry Bend on Cape Cod.  Montana.  New Mexico.  Some of the treasured faces have been lost.  Sam the dawg’s furry face.  There are some new ones. This year will be a little different.  We will resurrect some of the old traditions, JoAnn and I, and maybe start some new ones.  That’s the thing with tradition.  You don’t realize it’s happening until years later when someone says: “Do you remember how Mom always did this…”

The important thing is not to spend too much time looking back and not too much effort thinking about the future but to be present in the moment, in the here and now.  And know, really know it’s perfect just as it is.  Because it is.  And it will be even more perfect in time to come.

We just brought a tree in tonight from Rodriguez, the local nursery.  Carried it home in the back of the red truck.  The living room smells of pine.  Christmas is about three weeks away.  For a few precious moments I was a kid again.  The kid who always loved Christmas.  We’ll watch a Hallmark tonite, sip on an eggnog, pack the worries away for another day and dream happy dreams.

JoAnn and I wish all of our friends and patients a blessed Christmas and memories to last long after the tree and the lights and the tinsel are put away for another year.

Merry Christmas.

Gotta go…

These days it seems everyone and his cousin is “doing faces,” injecting people with just about everything that comes down the pike.  If you have ever spoken one-on-one with me you know i’m an old-fashioned kind of doc, that it’s important to me that my patients understand what I do, have an active role in deciding what should be done and value the results.

In the spirit of those goals I hereby offer you a short guide to evaluating your injector—questions to ask before that needle is is put into your face.

First I strongly suggest you check the doctor’s reputation and if possible even speak to one or more existing patients.

The first step in any pre-treatment consultation is to find out what you think needs improvement.  I usually put a mirror in the patient’s hand and ask the million dollar question: “What do you see?” You only have one face.  Take your time.  You’re worth it.

Here are the questions you should ask…

#1. What do you (the doctor) think? This is the time to make sure you and the doctor/injector are on the same wavelength.

#2  What do you recommend?  The doctor should tell you what he will attempt to do and the products and amounts he or she recommends.  The products should be FDA-approved.  The treatment should be individualized for you.  This is no place for a Procrustean bed where the same treatment is done for everyone regardless of the issues.  (Not long ago I actually watched a fellow physician do exactly that.  She did the same treatment on six patients regardless of how they presented.  Scary.)

#3   How many of these treatments have you done?  This is one place where experience counts.  As with any eye-hand activity, the more you do the more facility you develop.  There’s a corollary question here:  Do you enjoy doing this?  Why?

#4  Can you show me some before and after photos?  This is critical.  Looking at the before and after photos will give you an idea of what he or she thinks is beautiful.

#5  How do you keep me comfortable while you’re injecting?  Every successful injector should understand that patient comfort is key.  You want to get an idea of exactly how important it is to your doc.

#6  What are the side effects?  There is nothing we do in medicine that doesn’t have the potential for side effects.  Your doctor/injector should tell you what they are and how they will be prevented and managed.  Corollary question: Who can I call if you have a question at night or over the weekend?

#7  How much will this cost?  This is usually the first question asked at the first phone call.  “What do you charge for???”  But it’s really the last question that should be asked after you’ve gotten all your other questions answered. It’s no fun to sit in the chair while the needles are going in and worry about how you’re going to pay.      

My answers? The most critical part of the visit is the time spent with the patient deciding what should be done.  I’ve literally performed well over 5,000 treatments with Botox, Xeomin, Juvederm, Restylane, Radiesse and Belotero.  I’m proud of my before and after pictures and always excited about sharing them.

Pain prevention is integral to what I do and I go out of my way to make each patient comfortable.  I tell each patient exactly what I will do and how long it will take.

I’m a firm believer in telling each patient what everything will cost before we start.  The priceless ingredient is value.  I want my patients to be confident they will receive the best value for their money.

Who can you call after the treatment if you have a question? Me.  All of my patients have my personal cellphone number.  I insist they call if they have any questions.  Any time.

And yes…I still love doing this.  I loved it when I did my first patient back in 2002.  It felt like magic.  I’ve loved it ever since.  It’s the perfect blend of creativity, art and science.  Almost nothing gives me more professional pleasure than seeing a patient after I’ve completed a treatment look in the mirror and say: “Wow!”

Gotta go…

Meditation may be one of the most misunderstood of all mind-body practices.  Now, having written that, I’m going to try to explain it and in the process make it a little more accessible.

If being a child of the 60’s is a qualification, I’m very qualified.  It was a time of exploration.  I was in the Army for part of that time, searching for answers to questions we couldn’t even articulate.  After I was discharged I moved to Southern California where it was happening.  I took the opportunity the times provided to study Buddhism, Taoism, Hinduism, Kabbalah, shamanism. You name it.  I learned Yoga.  And along the way i learned to meditate.  I’d like to say I was a conscientious meditator but it was something I did on an occasional basis.  And ultimately I stopped. Kids, a practice, a mortgage.  You know.

One of my all-time favorite mentors was the late David Viscott, MD.  A brilliant psychiatrist in Los Angeles, he was a big proponent of meditation.  That was about twenty years ago.  Using some of his techniques I flirted with it again.  And then stopped again..

It has remained something I always promised myself I would do again “someday.”

Someday happened about a year ago and I found myself on the floor of my closet one early morning (where I had been doing my Yoga stretches for years) and saying to myself: “Okay, Doc, you need to go back to meditating.”

Meditation is said to have a lot of benefits.  It helps to bring clarity to the mind.  It slows the pulse.  Lowers blood pressure.  Helps combat stress.  It’s been said to rejuvenate chromosomes by restoring the little telomeres at the on ends of the chromosomes that are associated with youthfulness.  The evidence for telomere length as a major player in the aging process has become so strong that researchers are looking to use telomeres as a biomarker for age-related diseases.  People who are feeling stressed might be able to improve their telomere length and telomerase activity by meditating, possibly influencing gene expression and alleviating stress levels.  There’s sine evidence that it can rebuild DNA

And there’s more.

It has recently been shown  to assist in gene expression.  Your fate is in the hands of your DNA, to be sure, but there hare many studies that have recently come out that report that even with the chromosome deck stacked against you, you can modify the expression of your genes by meditating.  The field is new and is called “epigenetics.”

Dr. Dean Ornish, a respected researcher in medicine, has done some studies that indicate cancer risk may be reduced

Okay…there are a lot of good reasons to meditate.  So how do you do it?  With a 5,000 plus year history, meditation carries with it a whole long baggage train of misconceptions.  You need to sit on the floor in the full lotus position.  You need a turban.  You need a mysterious mantra, a word or a phrase in Hindi, that only a guru can give you.  You need to wreathe yourself in incense.  You must have flute music or Tibetan gongs playing in the background.

No.  No.  Not at all.  All of that’s fun, but it’s just not necessary.  All you need is a quiet place where you can sit comfortably.  A chair is okay.  The floor of my closet is carpeted so that’s pretty comfortable.  You can sit on a flat pillow if you want to.  I cross my legs.  No way am I going to get this horse-wrecked body into a full lotus position.  It’s pretty quiet at 5:30 in the morning, before JoAnn is awake.  When Sam the dawg was younger he would come into the closet and lay next to me.  But he’s been gone for a while now so it’s just me.

Fair warning.  There are just about as many styles types and schools of meditation as there are gurus  What I do, what I’m writing about, is one style of meditation I find works for me.

SIDE NOTE: They say the Buddhist monks developed Yoga as a way to increase their body strength so they could maintain their meditating posture for hours.  Sounds like a good idea.

I started out really simply, doing something called Mindful Breathing.  Some call it mindfulness meditation

ANOTHER SIDE NOTE: Mindful Breathing is not Pranayama breathing.  Pranayama has to do with tapping into the vital life force.  There are several types of pranayama breathing.  While I’m all in favor of tapping into any vital life force I can, all I’m doing here is concentrating on my breath.  Mindfully.  (If you’re interested, there’s a wonderful DVD that was made by Andrew Weil, MD, about eighteen years ago that is the clearest description of the types of breathing I have ever heard.)

I set the timer on my iPhone to five minutes, crossed my legs, and kept my back straight and my head looking forward.  You can keep your eyes open or closed.  Dealer’s choice.  I closed my eyes, put my hands on my thighs with the palms facing up (seemed like a good thing to do as the statues of the Buddha show him with his palms facing up and his thumb touching his middle finger) and began to breathe.  I resolved to be in the here and now.  To feel the carpet, to listen to the silence.  My plan was to breathe slowly, in through my nose, out through my mouth.

I started with the in and the out breaths the same length.  Shortly after I began meditating  I saw an article that says that prolonging the out breath longer than their breath is good for stress relief.  So I do it that way now.

“They” tell you that you have to clear your mind when you meditate.  Good luck.  Telling yourself to clear your mind is the same thing as telling yourself not to think about your nose.  What do you think about?  Your nose.  That’s all you think about.

So I’m all set.  .  I know why mediation is good.  I have an idea about how to do it.  I’m going to meditate and change my life.  Here goes.

Enter the monkey mind.

The Buddhists talk about “the monkey mind,”  They characterize the monkey mind as being  “unsettled, restless, confused; indecisive.”  The  monkey mind is always lurking about, swinging from neuron to neuron in your brain, waiting for the time that you begin to meditate.  The monkey mind is determined to make you think of the phone calls you have to make, the bills you have to pay, the tank of gas you need to get.

The solution to the monkey mind is to give him something to distract him.  That something is making him watch your breaths.  When he sends you  a distracting thought, send him back to the breathing.  You can even visualize it.  It works.

There’s no “right way” to meditate.  And I can’t tell you what will happen to you while you meditate.  But I will say that when the timer goes off the first time you try it, it will surprise you.  In a pleasant way.

The question of how often should you meditate comes up about as often as how long do you have to meditate before you see a result.  The first question is easier to answer.  I personally recommend you meditate every day.  As with any habit, a little bit every day is much better than a long session once a week.  It can be as short as five minutes.  At this point I’ve settled on a 15 minute session once a day in the morning.

How long before you see an effect?  The only honest answer is no one knows.  Everyone is different.  If it takes about 13 weeks of going to the gym and working out before you start to see an effect, that may becomes a workable time frame.  Thirteen weeks?  Gee, that seems like a long time.  But here’s a flash.  The 13 weeks will go by if you decide to sleep an extra 15 minutes every morning or if you decide to get up and meditate.  Why not meditate?

I know of nothing else you can do that has the potential upside that meditation has.   And is free. You don’t need special shoes, a helmet, workout gloves or a gym membership.  With that kind of ROI how can you go wrong?

There’s a delightful little book (for those of you who like books about things like this) called START HERE NOW by Susan Piver.  I recommend it.

Gotta go

Treating people’s faces has always meant so much more to me than just making them look more youthful.  I know the part I play in making people feel better about themselves.  I especially understand what part counseling plays in the overall result.  But there are still times that the impact  I have on someone’s life gets lost in the shuffle. 

A few weeks ago a patient came in who hadn’t been in for a while.  Life had rocked her with a few very hard blows and her face, as it often does, reflected her problems.  We talked about what needed to be done.  We spoke about some of the other things she could do to help her manager her stress.  I was gratified that when she left the office she looked years younger.   Equally important, I felt that I had passed along some of the tools she needed to move on.

A few days later I got this from her in an email:

“Thank you from the bottom of my heart for helping me feel more like myself when I look in the mirror.  Some people may not understand they feel it is just being vain but when your whole world has been turned upside down and you do not even recognize yourself in the mirror anymore, it is a small step in putting the pieces back together, finding myself again and moving forward.  So I thank you for your care and compassion in what you do.”

I was humbled.  Believe me, one email like that goes a long way.  Compassionate is always what I wanted to be.  I feel it’s the numero uno requirement of a healer.   Maybe it goes back to when i decided to be a doctor, when I was about ten, and two doctors saved my younger brother’s life when he was hemorrhaging after an tonsillectomy, in his bedroom down the hall.  Maybe it was when my Dad got sick and I watched him fade away when I was barely 18.  Maybe the influence of my Grandma.  Whatever, I was flattered.  And humbled.

“Be kind.  Everyone you meet is fighting a hard battle.”  Plato said that, or maybe Philo of Alexandria, or Buddha. Nowadays it is so easy to insulate ourselves from our fellow travelers behind an iPhone screen or an .anonymous post on FaceBook.  I think it’s important not to do that, not to cut yourself off from the world.. 

We can’t be perfect.  We can’t be wonderful and kind and compassionate all the time.  But it’s a pretty worthy goal.  Our black Lab, Sam, who passed a few weeks ago, was that way.  JoAnn and I had a lot of names for him.  We sometimes called him Buddha Dog because he had a kind wag and a gentle way with all creatures and always left people feeling better than when he found them.  We figure if he could do it for fifteen years we could at least give it a shot every day.

Gotta go…

This article originally appeared on the Well + Good website.

Introduction by Dr. Foxx:  Botox, made by Allergan, was the first facial wrinkle relaxer to be FDA-approved.  That was more than two decades ago!  Since then two new products have been released and FDA-approved.  The newest facial wrinkle relaxer is XEOMIN (Zeo-min). I have been using it exclusively for the past six years because my patients tell me how much they prefer it to anything else.  Xeomin has now become my go-to wrinkle relaxer.

Board certification in either dermatology or plastic surgery does not guarantee a patient will get a good result.  It is more important for a patient to determine who will be doing the injections, how much experience the injector has had, and how committed the injector is to achieving a natural, refreshed look.  As I always preach to my patients, be sure to ask to see Before and After pictures…

On to the article:

I’ve just rolled onto my right side and propped myself up on my hands. And in the dimmed light of the palo santo-scented studio, just before bowing to acknowledge the light and love in every person, my yoga instructor directs the class to soften our brows. “Yeah, right,” I think to myself. Because, while some people strive to nail a perfect crow pose or get their heels to the ground in down dog, all I want is to be able to relax my over-expressive, constantly furrowed forehead. Enter… Botox?

A recent report from the American Academy of Facial Plastic and Reconstructive Surgery indicated that in 2018, 72 percent of the doctors surveyed saw an uptick in the number of patients under 30 years old requesting cosmetic surgery or facial injectables (Botox and facial fillers such as Juvederm and Restylane). This accounts for a 24 percent climb from 2017. Coincidentally, stats like these coincide with mega-gains in the clean beauty industry, which is poised to reach $25 billion over the next five years. At first blush, it may seem counterintuitive that people are cleaning up their skin-care routines with products that tap safe synthetics and naturally derived ingredients at the same time that the interest in no-downtime procedures at the derm’s office—procedures that have typically been more closely aligned with the plastic surgery world than the skin-care world—is climbing. But the reality is, there’s overlap between these factions.

Despite our undying urge to pit the two categories against one another like Britney and Xtina, they’re actually not too shabby of a pair (also like Britney and Christina). After all, one of the pillars of the clean beauty movement is more regulatory oversight from governing bodies such as the FDA, and since in-office procedures fall into the medical camp, they’re rigorously vetted by the agency before docs are allowed to perform them en masse. Not only that, but a survey by Allergan (Botox’s parent company) of 14,000 people worldwide found that the most common words people used to describe how they wanted to look after a filler appointment could be plucked directly from the wellness world: natural, healthy, strong. “I have patients who…are major yogis and don’t use anything but frankincense oil on their skin, but they’re up for Botox,” says New York City dermatologist Dendy Engelman, MD.

And when it comes to dermal fillers (which are defined by the American Board of Cosmetic Surgery as “gel-like substances that are injected beneath the skin to restore lost volume, smooth lines, soften creases, or enhance facial contours”) some of the most popular options on the market today tap ingredients that are well-worn in the wellness world. “People don’t often realize that the same tried-and-true ingredient we love in Neutrogena Hydro Boost is what we’re injecting into the skin,” says Dr. Engelman of hyaluronic acid-based fillers. Another popular filler component is collagen—talk about a wellness buzzword.

Dr. Engelman also points out that fillers made with hyaluronic acid can also be dissolved if you aren’t happy with their effects. “There’s so much relief when it’s like, ‘If I don’t like it, it can be gone tomorrow,’” she says. And yet, stigma still exists, even amongst in-the-know people—like myself.

I should probably pause at this point to say: “It me.” I’ve never had a completely clean beauty countertop, but I do rigorously research ingredients to decide whether or not I feel comfortable applying them to my skin. And despite knowing the above information, I’ve always had a little trepidation about injectables.

While every other beauty treatment—topicals, lasers, peels—is surface level, injectables hit something deeper within us—literally. “Lasers, for example, are used so much in medicine, but with injectables, you know, needles are involved,” explains Dr. Engelman. “There is a whole different psychology when there’s a needle involved.” And unlike the monthly acupuncture appointment, when needles are used in an aesthetic context, the uncertainty surrounding the final result can foster some real (and understandable) trepidation.

In the aforementioned survey from Allergan, 55 percent of participants said they were concerned that injectables would look unnatural. “Even though it’s becoming more acceptable to use dermatological solutions to counter aging, women still pride themselves on natural beauty,” explains New York City clinical psychologist Vivian Diller, PhD. Ding, ding, ding. As I sit in Dr. Engelman’s office and discuss my hesitations, it all comes back to the fact that I want to look like myself, albeit with a less crinkly forehead and slightly more rested appearance.

Derms get this a lot, and as a result, lately there’s been a move toward “tweak-ments,” which take a less-is-more approach to injectables. In addition to the dissolvable fillers, there’s Baby Botox, for instance, which still shows fine lines the door while allowing you to maintain forehead mobility. Or, you can get tiny fillers that mimic the effects of a good-night’s sleep without any evidence of a doctor’s visit. “Little, properly placed amounts of Botox and filler are just going to make you look great and beautiful—not ‘done,’” says Dr. Engelman. “If we live in the tinier changes over time, then it’s easier to accept.”

“People should be thoughtful about who’s actually treating them,” says NYC dermatologist Robert Anolik, MD, whose office goes through the most Botox in Manhattan. If you choose wisely, you can “get that natural outcome and reduce stigma,” he says.

To start: Make sure your derm is board-certified, something Dr. Anolik says you can check by going to the American Academy of Dermatology website. Next, ask around: It can be hard to gauge a doctor’s style and how they approach fillers, so opening up with friends who are curious can help you land at the right dermatologist’s office. Once you’re there, ask questions, be open, and speak up about what you want and don’t want from the appointment.

In my experience, this bit—the dermatologist-patient relationship—is the most important part of the equation. When I visited Dr. Engelman as a patient considering aesthetics (not a reporter), she heard me, she was considerate, and was willing to take things really really slowly. To start, we tested tiny bits of Botox and droplets of cheek filler to help lift my genetically sunken-in under eyes. After the appointment, I lived with the results for two weeks before seeing her again. Feeling more confident and comfortable, I tried more this time—and I still looked like myself. Down the line, I’m guessing that I’ll make the same choice again.

But that’s kind of it, plain and simple: Participating in any sort of beauty ritual, from hair dye or nail polish through to dermal filler and Botox, is a choice, and one that doesn’t deserve the side-eye treatment. More and more women are adopting a “my body, my choice” mindset to beauty regimens that include fillers, especially among the younger generations that have grown up in the age of injectables. Merz, the aesthetic company behind a competitive botulinum toxin called Xeomin, for instance, found that women under 45 are nearly twice as likely as their older sisters to head to the derm’s office. “The generations that have grown up since injectables have been launched are now coming of age, so to speak,” says Dr. Diller. “Women in their 30s and 40s have grown up in a culture that accepts in-office dermatological intervention as part of self care.”

While the outside world might not notice that you look different after your treatment, you might feeldifferent, and, to me, that’s the power of wellness through and through. Studies have found that participants frequently list confidence levels as a key reason to book a cosmetic appointment. “We know that getting a mani-pedi or a new haircut can enhance one’s appearance, but it also can lead a person to feel better about themselves,” says Dr. Diller. “There is a lot of evidence to support the saying: ‘When we feel good, we look good’ and vice versa. Just the act of going to the dermatologist can add to a a person’s [sense of] self worth.”

And Dr. Engelman says her patients corroborate this. “After a filler appointment, many patients say they’re a better spouse, they’re a better mother, they’re a better worker because they’re holding their shoulders back and have a little confidence. It’s pretty transformative, and in a much more psychological way than anything else.”

It’s time to broaden our wellness boundaries beyond salt scrubs and sweat sessions to include anything that we do that makes us feel better about ourselves—including injectable appointments. In the same way that we celebrate what acupuncture needles can do for the body, we should laud the needles your dermatologist wields as a viable part of one’s wellness routine. Where we slow clap for hyaluronic acid in our serums and creams, it’s time to recognize that it’s equally commendable when chosen as a filler. “I want people to give themselves love and grace and no guilt about wanting to look their best,” says Dr. Engelman.

As I look at my brow in the mirror, relaxed and smooth (but still mobile!) for maybe the first time ever, I really do feel like look my best, and I’m cool with how I got here. But, just like all the best parts of my wellness practice, this experience contributed way more to the way that I feel than the way that I look (a poll of about 20 of my closest friends and colleagues revealed no one could tell I’d had a treatment done). I run because the miles cue up a chorus of angelic endorphins in my brain; I have about 900 houseplants because being in their presence keeps me feeling chill; and yep, I see a derm on the reg for whatever the situation may call for. All grace, no guilt. Hey, isn’t that what wellness is all about?

It seems that everywhere you look someone has their hand out for your discretionary money.  And most of the time it’s only a couple of bucks.  Less than a mocha latte a day they tell you.  You’ll never miss it, they tell you.

A couple of bucks a month here to Pandora.  A couple of bucks there to upgrade to some other app.  Some money to the GoFundMe account of someone you never met.  Pretty soon you’re talkin’ about some real money and you realize that there’s not a whole lot left.  And when you sit down in front of your laptop you discover you haven’t really gotten a lot of value.

If that makes you ask yourself exactly how much value you’re getting for your buck, that’s a good thing.

Which brings me to the subject of this little article.  Why bother looking good?  What’s the value in looking rested?  Looking youthful?  After all…you haven’t changed that much, have you?  You sorta look like you looked last month, last year.  And anyway, you’ll get around to it someday.  Before it’s too late.

Well…I’m going to give you a few good reasons.  Reasons why investing in how you look makes more sense then upgrading your Pandora account.  (Full disclosure…I use Pandora and like it.  But I use the free version.)

For starters, you’ll feel better about yourself.  And you’ll feel better knowing that you look a little more relaxed and a little more rested.

Let’s just take the wrinkle relaxers, Botox and Xeomin.  I’ve lost track of the number of patients who come in and say some version of: “Doc, everyone tells me I look mad all the time.”  And when you put a mirror in front of them and show them how much more relaxed they would look if the wrinkles in the frown area and the horizontal lines on the forehead were gone they are literally amazed.  “I never realized that,” they say.  And you won’t believe how easy it is to do.

When you feel better about yourself, your mood is better.  Your self-confidence increases.

There are a lot of medical studies that show that wrinkle relaxers, like Xeomin and Botox can lessen depression.  Yes…actual, documented medical studies.

There’s a definite evidence that shows that people who make the effort to look more youthful and actually have these treatments performed are more likely to eat well, take supplements and work out.  (And, of course, you know about the correlation between people who work out and the incidence of dementia and Alzheimer’s Disease.)

Some time ago about a thousand twins were studied in Denmark (who knew Denmark had that many twins?) and the results showed the twin that looked more youthful usually lived longer.  That’s worth a Decaf Mocha Latte with Almond Milk, don’t you think?

I’m here to tell you that you can’t escape the aging process.  But I’m also here to tell you that with a little effort you can slow that aging process and tap into all those good benefits.

You don’t have to do it all, all at once.  We are charter members of the “Baby Steps” club.

Whatever else you do, it’s worth sitting down with someone you trust who has a lot of experience in the art and science of aesthetics, like me, and talking about it.  Telling you exactly what benefits will accrue.  What the value will be.

You won’t regret it.

When I was about fifteen my Dad was diagnosed with Hodgkin’s Disease. He had just turned 40. My fun, funny, creative, artistic Dad who loved horses and baseball and boats and always had time for an off-the-beaten-path adventure had something wrong. Impossible.

Back then Hodgkin’s Disease was tantamount to a death sentence. I didn’t know that. I think my Mom she wanted to protect me, wanted me to believe he would be all right and never told me anything other than that. I believed that “modern medicine” had all the answers so I accepted what she told me.

I went off to college about four hours away from home when I was only 16. Going to college that young is not something I would recommend. To anyone. Particularly if you have aspirations of being a doctor. Pre-med was like being thrown into a swimming pool full of piranhas. The competition for medical school slots was cutthroat even that early in the game and the pressure was on. All the time. A car was out of the questions so I came home as often as we could afford the train fare which was about once every two months.

When I got a driver’s license midway through my Freshman year I would drive my Dad into the city in our Mercury sedan for his chemotherapy treatments every time I came home. I didn’t know any real doctors except the docs who saw me when I was a little kid so this was really the first exposure I ever had to “adult” medicine. The entire experience was intimidating. Overwhelming.

The first time I drove him in I met the doctor who was in charge of the chemo. I don’t remember his name or what he looked like but I do remember thinking he was about my Dad’s age. He looked me in the eye, shook my hand, and sat on the side of my Dad’s bed. There was something intimate about that. Reassuring. He took the time to make him feel special. I couldn’t hear much but I think the doc talked about the side effects he would have. I hung back, reluctant to break the connection between the two of them, the doctor and my Dad. At one point I think my Dad cried softly. I turned away. When I looked back the doctor had his hand on my Dad’s arm. And the last thing he said was: “Do you have any other questions?” And then…”you’re doing well…keep it up.”

My Dad and I didn’t say much to each other on the ride home. He put his head back on the headrest and closed his eyes. I wanted to say something didn’t have any idea about how to begin so all I did was appreciate the unspoken confidence in my driving.

I never forgot how kind and caring and gentle that doctor was. I promised myself that if I ever made it through pre-med, ever made it through medical school, I would be that doctor. Promised myself that if I ever actually became a doctor I would speak that way to patients. Explain everything. Make sure they knew everything I wanted them to know. And make sure they had a chance to ask me all the questions they had.

My Dad passed a little over a year later. I remember all the details of that day. And the lesson. All these years later, the lesson has remained.