Targeted Treatments for Spider Veins, Cellulite & More!

Airdate: 11/10/11

Are you embarrassed by spider veins on your face and legs, cellulite on your thighs, or prematurely-aged skin on your chest, arms and hands? Surgical skin specialist Dr. Richard Baxter joins the Paula's Choice Research Team to share what you can (and can't) do to reduce these problems and more!

Paula Begoun: Hello, I'm Paula Begoun, the Cosmetics Cop, and I am, actually I'm in Mexico. I am in Los Cabos and keeping you beautifully informed wherever I am in the world and Desiree Stordahl, my assistant and producer is in Seattle, as is Bryan Barron, my coauthor and better half most of the time, who is back from his honeymoon from New Orleans, and hopefully not a little worn for the wear.
00:00:36 How did it go, Bryan? Did you have a wonderful time?
Bryan Barron: Yeah, we had a very, very nice time. It's a historic city, we did tons of stuff. We ate some incredible food. Probably some of the best food I have had anywhere I have ever traveled to. And it is so different. Even though both Seattle and New Orleans, given their coastal locations, are heavily seafood-based menus in the restaurants, it is just a very different presentation and method of cooking.
00:01:06 And even different tasting seafood there. It was quite yummy. So it was a really, really beautiful trip.
Paula Begoun: So did you have soft shell crab?
Bryan Barron: We did.
Paula Begoun: Cajun style? Oh my gosh. And did you have those Gulf oysters, those huge mammoth Gulf oysters?
Bryan Barron: You know, we did, but we kind of wimped out in a sense. We did them as oyster shooters.
Paula Begoun: Yeah, that's not wimping out. That's the real the deal, oyster shooters. You mix your own spicy. And did you do a Cajun martini and then we will be done talking about food as I am sitting here being very hungry.
Bryan Barron: You know, I didn't do a Cajun martini but I did do a Cajun Bloody Mary.
Paula Begoun: Well that's close. That's close.
Bryan Barron: And then I got to walk around with it because you can walk around with your drinks pretty much anywhere in that town.
Paula Begoun: Can you believe that?
00:02:00 Yeah, I love New Orleans. I'm glad you had a good time. Welcome back safely. Desiree, how are you doing over there?
Desiree Stordahl: I'm doing great. Just holding down the fort here in Seattle.
Paula Begoun: So we are talking tonight about, god, being here in Mexico and knowing the beach is right out there, and these thighs have to go present themselves at some time to the bright sunshine, I actually think this is just the most appropriate topic. We will be talking with Dr. Richard Baxter here in just a few minutes.
00:02:38 Dr. Baxter has to be one of the edgier doctor interviews we have done, not just because of, well cellulite isn't an edgy topic at all, but Dr. Baxter is a fascinating guy. He is a board-certified plastic surgeon. He has been practicing plastic surgery in the Seattle area for 20 years. He is the founding medical director of a clinic called Calidora.
00:03:06 There are a few in the Seattle area and a few in Southern California. I think it is Southern California. It might be Northern California. About six or seven of these altogether that do all kinds of dermal injections and Botox but not plastic surgery. Lasers, IPLs, everything pretty much non-invasive. He is also author of a book. You know, I don't even know if I want to, it's called "Age Gets Better with Wine: New Science for Healthier, Better and Longer Life," and from what I can tell this guy, Dr. Baxter, is a wine enthusiast.
00:03:39 He's - that's got to be the edgiest book. I couldn't quite tell if I was supposed to go get a bottle of Merlot to do the show. And then he is also founding medical director of the treatment of a machine called LipoSonix which is actually incredibly appropriate for the talk tonight because it is FDA approved technology for non-evasive fat reduction, meaning it zaps your fat from the outside without inserting a needle and beating you up.
00:04:10 Although it doesn't replace liposuction, we can ask Dr. Baxter about that in a little bit. And it is actually a little controversial. You type it in and you get all kinds of things in Google. But let's talk about cellulite. We are also going to talk about sclerotherapy. The topic right now is pretty much thighs. We will get to the chest a little bit.
00:04:31 But just to be clear, so we know what we are talking about before we get Dr. Baxter on the phone, cellulite is not about fat. As a very chubby-sized woman, and it is very hard for me to accept the fact that it is not, but it isn't. It absolutely - it will look worse when you are heavier, but 85% of women are going to get cellulite. It is just the way it is. It seems to have something to do with hormones.
00:05:02 They are not really quite sure, but that's who gets it is post-pubescent women after they get their periods. If you are going to get it, sometime within the next twenty years after you get your period, most likely 85% of us are going to have cellulite. And the reason it doesn't have anything to do with fat is because we know that fat in certain areas of the body like the face are responsible for making a face look young.
00:05:32 The thing about if you were to look at yourself, depending on your age, in your 20s versus your 40s or 50s, it is the fullness of the face, it is the fat content of the face that actually makes you look younger. But on your thighs, for some reason, after women go over the age of whatever, because it varies between 18 to 30/35 is when cellulite starts showing up, but after puberty the nice structure of the thighs for women changes. The structure of the skin actually changes, becomes less elastic, the way the collagen lines up makes it so that whatever fat is laying underneath the skin pops through.
00:06:18 Not a pretty picture. It is what it is. That's just life. In terms of diet, healthy diet, we don't even have to talk about that, right? The healthier diet, the less fat, the stronger your skin, all of that. Cellulite creams, forget about it. Forget about it. Save all that money.
00:06:40 There isn't a cellulite cream on the market. I mean if they were giving it away for free it wouldn't be worth your trouble to even open it and apply it. There is no research showing that any of the more than 200 different ingredients that can show up in various cellulite creams - there have been all kinds of reviews of these.
00:07:02 I'm hardly the only one who has reviewed these products and said this is utter nonsense. The cellulite creams are nonsense. You can't rub away cellulite. There aren't ingredients that will eliminate it. Yes, having a healthy outer skin, that's great, but there's really not much you can do with any skincare product about the elastin in your skin or really restructuring skin in any way to hold back fat. You might want to consider - people, you don't want to consider this, but people do consider, they think tanning is a way to hide cellulite.
00:07:36 But ironically when you get a tan you are actually damaging the structure of your skin so the cellulite will actually look more noticeable. Those deposits of fat that are not being held back by the skin when the skin becomes, because of its structure, the skin will become more damaged. Not a good idea.
00:08:02 So, when it comes to taking care of your skin and your thighs and your chest and your face and wherever, healthy skincare is healthy skincare and it is always first and foremost about not irritating the skin and it is absolutely foremost about not getting sun damage. And it is about using healthy ingredients, antioxidants, all of that, skin repairing ingredients. And it works for the thighs too, just not the way we wish it did to get rid of cellulite.
00:08:32 So, as depressing as that sounds, because I have made it just sound like you can't get rid of cellulite, there are things that you can do and absolutely losing weight and eating healthy is - by the way, you can drink gallons and gallons of water, and drinking water is not going to detox your body and get rid of cellulite. Cellulite has - I don't even know what you would be detoxing, like you could drink fat away? And you can't drink and repair skin structure. I don't even know what they are even claiming when they say it is going to detox and get rid of your cellulite.
00:09:04 It doesn't. None of that works. But now we have Dr. Richard Baxter on the phone and he is going to help us figure out what is available to take care of our cute thighs. Dr. Baxter, are you there?
Dr. Richard Baxter: I am here. And thank you. I've been an admirer of yours for a long time so it is a real treat to be here.
Paula Begoun: Oh, well now I feel even better about my thighs I think. I'm not sure though. So, okay, I've got to ask. First of all, you are very well known, particularly in the Seattle area.
00:09:35 You have done an amazing amount of work in these different areas with your spas and this relatively controversial LipoSonix. I didn't realize you were the founding medical director of this procedure, getting rid of some amount of fat without anything invasive. But you wrote a book about drinking wine? I just, really?
Dr. Richard Baxter: Well, yeah, we could do a whole show on that, you know.
00:10:02 But it's a fascinating thing. And what led to it is if you start looking at anti-aging from kind of a broad perspective and really get into the science of it, what really works, what is really interesting, and where is it going, you find that all of these stories converge around something having to do with red wine. People who have a glass of red wine with dinner really do live longer than people who don't drink.
00:10:29 They are healthier. They have lower rates of all the diseases of aging. And they have a measurably higher quality of life. So it is a really interesting thing and it has just opened doors to a lot of interesting research into the biochemistry of all of these different things in wine and so it has been a lot of fun. It is definitely a fun thing to talk about.
Paula Begoun: So, I do want to talk about cellulite, but I've just got to ask this as I am thinking I wish I had a Cabernet in my hand right now, so let me just understand this.
00:11:03 You are saying people live longer who drink a glass of wine, and I take it is red wine.
Paula Begoun: And even if I eat an unhealthy - I mean is this a Mediterranean diet thing? Or as long as it is red wine it doesn't matter what else I'm eating? What do you mean by that?
Dr. Richard Baxter: Well it sort of goes back to the French paradox, you know, the idea that the French live longer despite being smokers and eating foie gras all the time. And that is kind of where it all started.
00:11:34 And it turns out there really is something there. Obviously it is better if it is part of a healthy diet. And that is the Mediterranean diet. It is really a lifestyle and you think of wine as one of the foods in the Mediterranean diet and it starts to make a lot more sense.
Paula Begoun: Oh, actually having spent a lot of time in France, it really is some of the most incredibly unhealthy, from what they talk about with the healthy diet.
00:12:05 I mean I remember in the movie about Julia Childs. Bryan, what was the movie with Meryl Streep --?
Dr. Richard Baxter: "Julia & Julia" was the movie.
Paula Begoun: Yes, "Julia & Julia." Meryl Streep and Amy Adams, right. And one of the lines that Amy Adams says that, Meryl Streep says it has so much butter in it, it makes my heart stop.
00:12:35 But you are right, butter and meats and heavy sauces and foie gras, and they eat lard, and interesting. Okay, I've got to get that book and have a glass of wine with it. So tell us, I want to know about this, as somebody who just had actually extensive liposuction as a result of breast reduction and revision I was having, what is this LipoSonix and how does it differ?
00:13:11 What is the pricing? What does it do? Could I have really of not had such pain around my body and just done this LipoSonix?
Dr. Richard Baxter: Yes, you know, I don't think it is as controversial as you say. But it has been kind of a long process getting it through the FDA trials. And so it has been on the market in Europe and in Canada for a few years.
00:13:35 And just got its FDA clearance last month. So the company has changed ownership a couple of times. It is now owned by Solta who also makes Fraxel and Thermage. So, they have yet to roll it out. They are just kind of gearing up their marketing for it and so forth. But having been involved from day one with the company, I am really excited about it. It actually does--
Paula Begoun: So what does it do?
Dr. Richard Baxter: So what it does is it uses what is called high intensity focused ultrasound, so the idea is that you pass ultrasound waves across the skin over a broader surface but you focus them down at one point. And that point would be say about a half inch below the surface of the skin, right in the middle of the fat layer.
00:14:24 And where all those ultrasound waves converge you get a real intense burst of energy and it actually breaks the fat cells. It also uses what is called a thermal mechanism. So it actually puts some heat in there and so the expectation is that you would see some collagen shrinkage and potentially, anyway, some tightening as a result of that. So we know that it is very predictable. It is very controllable. You can really be precise with the layer that you are treating. And the phrase they use in Europe is "one treatment, one hour, one dress size."
00:15:03 So it takes about six weeks or more to get to that full change, but that is the concept of how it works.
Paula Begoun: But the notion of "one treatment, one dress size," if I have five treatments I am a size negative four? That doesn't sound real - a marketing little phrase.
Dr. Richard Baxter: I think that is more of a marketing phrase than anything else. But you know the trials that we did in the US were only looking at the anterior abdomen.
00:15:39 And, you know, we did get measurable reduction very predictably, whether that translates to a full dress size or not I guess remains to be proven with more studies. But it is a really interesting technology. It is completely different than other things that are out there right now.
Paula Begoun: So why doesn't the American Society of Plastic Surgeons like this machine? They don't endorse it or recommend it.
00:16:08 I don't exactly remember what they don't like about it. What don't they - why are they not happy with this machine?
Dr. Richard Baxter: Well I think they have just not come out one way or the other on it because it wasn't FDA approved. So I don't think the ASPS has taken an official position on it. We are all waiting for more studies and more data.
Paula Begoun: Ah, okay. So does your machine replace liposuction?
Dr. Richard Baxter: Well it does smaller volumes than you can potentially do with liposuction. Although by doing different layers and doing some more work with it we may be able to extend the capability of it. But, you know, at the upper end of volume reduction it will probably always be something like liposuction.
00:17:02 But the advantages there, liposuction is surgery. I think a lot of people don't really appreciate that fact. They think of it as a minimally invasive walk in/walk out kind of procedure, which it can be, at least in reasonable volumes. But a lot of people just don't want to have surgery, you know. And so they are never even going to make the appointment to come in and talk about body contouring. So this is an option that is completely non-invasive, not even any injections. And so I think kind of helps people to think about it or to consider it that might not otherwise. But it's not going to [unintelligible] like liposuction.
Paula Begoun: Can I get this done on my thighs?
00:17:43 Like does it work on thighs and arms? Where can you have it done?
Dr. Richard Baxter: Well, all of that remains to be proven. So right now its FDA clearance is for abdomen because that is where the studies were done. The other areas would be considered off-label at this point.
00:18:00 That doesn't there is anything improper about it. It just means that we don't have a lot of data to really discuss it in detail. But, you know, most Botox, the only place approved for Botox is the one area between the eyebrows and it is certainly used a lot of other places off-label.
Paula Begoun: Right. Right.
Dr. Richard Baxter: So it will work the same way.
Paula Begoun: So LipoSonix in Europe, are they doing it on thighs in Europe and Canada where it has been approved for awhile you said?
Dr. Richard Baxter: They are, but they haven't really presented a lot of data or published very much on it.
00:18:32 I think most of the work has been kind of refining the treatment protocols to make it more comfortable, less of an intense kind of procedure to go through. And treat different layers to get larger volume reduction. So that is most of what I have seen talked about.
Paula Begoun: So does it hurt? Does LipoSonix hurt?
Dr. Richard Baxter: It can. It depends on the energy settings. And the new protocols, I think, are going to be very comfortable. In the clinic trial we didn't --
Paula Begoun: Are you doing them at your Calidora spas?
Dr. Richard Baxter: Well, we hope to at some point, yes.
00:19:15 But you know the FDA clearance just came out and the company hasn't really shipped any machines out the door just yet.
Paula Begoun: So we just need to keep going back to your website at and see if it is time to book an appointment. How much will it cost?
Dr. Richard Baxter: It will probably be less expensive than a comparable liposuction procedure, but still in the range of $2,000 to $4,000, somewhere in there.
Paula Begoun: Ooh, it's pricey. It's pricey.
Dr. Richard Baxter: Well, you know, it depends what part of the country you are in. In New York that would be considered a bargain probably.
Paula Begoun: Do you need more than one treatment or is it like liposuction and you get it done once?
Dr. Richard Baxter: Well the intent is to do it once to get the effect that you want.
00:20:07 But that wouldn't preclude doing more treatments to do other areas or to get additional fat reduction.
Paula Begoun: So if you do liposuction on thighs does your cellulite get better?
Dr. Richard Baxter: Not specifically. You know, cellulite is so, it's so many different things. You did such a great job of describing it in that intro because it has all of those different factors. It has the collagen bands under the skin, that causes the dimpling, and then the little lobulations where the fat under the skin lives that are kind of pushing up into the skin which is more evident because the skin itself is thinner.
00:20:51 And so it has all of those different things and doing liposuction can address part of that problem by removing some of the fat and just the fact that it is a surgical treatment, you will get some healing and more collagen in there that might give you a little bit of smoothing. But we don't really consider liposuction a cellulite treatment.
Paula Begoun: So I come into one of your Calidora spas or I come into your clinic up in the Seattle area and I am looking at my - and I want you to do something about my thighs and make my cellulite look better. What do you tell me to do? Help me out, doc. I need help and I am turning to Dr. Baxter to help me out or at one of his spas.
00:21:40 What would happen next?
Dr. Richard Baxter: Well I wish I could tell you there was a cure for cellulite. There are things that help but because they all address only one or the other of the issues there isn't going to be any definitive sort of treatment. I mean that is the sort of short answer. There are things like accent laser which is a non-invasive treatment that will give some toning to the skin. And different lasers that kind of address that aspect of the issue.
00:22:11 But I would have to tell you if you are really looking for a definitive cure for cellulite there's nothing that really stands out right now as being the great thing. And I wish I had better news but that's kind of where we are right now.
Paula Begoun: So what about things when you go into, I take it not your spas, but when you go into a lot of spas, I would say probably most all spas around the world, and they do things like body wraps and lymphatic massage or drainage or they run, oh gosh, now I am blanking out on the name of that machine that they roll over your body.
Dr. Richard Baxter: Oh yeah, well you know Endermologie, that's kind of where it all started. We actually had the first Endermologie machine in the Northwest a long time ago now, and it does work. It is that roller suction massage that really kind of beats up the tissue. And you can get temporary effect after a series of treatments.
00:23:14 But, again, it's still not a permanent change and so they tried to make it better by adding lasers to heat and adding radio frequency with is like Thermage, again, to put some heat into the tissue. And all of these different things. And I haven't been convinced. We were actually involved in the clinical trials for one of them and in fact we couldn't get it to do anything at all. So, you know, I think all of those are in the category of a temporary effect.
00:23:40 You know body wraps in particular, you may get some effect that will last you a few hours but if you are just going for a spa treatment and that is all you expect, that would be great. Fat drainage is kind of interesting though. I was looking that up and actually found a research paper where they found some benefit in lymphatic drainage massage.
00:24:05 But what they were doing was an hour and a half long massage every day for ten days. And they didn't say how they measured the results and how long the effect was. But, you know, sign me up for the hour and a half massage ever day studies. I want that one.
Paula Begoun: Well, and some of it is what I have always assumed with Endermologie and massages and wraps and stuff, well not wraps so much because that is more compression, but the lymphatic drainage and the Endermologie is just the swelling effect. I mean beating up the thighs.
00:24:37 You make the skin swell, the fat dimples are going to just kind of smooth over with the swelling, because there is very little, if any - in fact I couldn't find any long-term studies on any of the Endermologie or lymphatic drainage supposed treatments for cellulite.
Dr. Baxter: Yeah, they are just not out there. Or some variation of that, you know.
Paula Begoun: What about Mesotherapy? Where you are injecting, what is it, [soto]-something, [colene] something? I never remember the name of that.
Dr. Baxter: That has a very controversial history as well.
00:25:24 There are two ingredients that are used. They are basically from bile. Because bile helps you digest fat and so they have an effect on fat tissue. And so the main ingredient is called deoxycholate and the other one is a mouthful. It is phosphatidylcholine.
Paula Begoun: That's the one, yes.
Dr. Richard Baxter: That's the one. So what was controversial about it, the idea has been around forever. But when they started adapting it to body contouring and making all sorts of dramatic claims about fat reduction and cellulite improvement, and they were using these ingredients from compounding pharmacies.
00:26:05 Because they are not FDA approved for that use. And that gets into a little bit of a kind of subtlety of regulation because as I was talking about before, you know, off-label is perfectly fine, but with these the FDA specifically came out and said no, it's not off-label, it is not approved for that use, which is different. And there are a number of problems with them. It does involve a lot of injection over a period of time and there can be complications like infections and it causes quite a bit of inflammation sometimes which is really how it works.
00:26:40 Now interestingly, there is sort of a next generation version of one of these ingredients, the deoxycholate, that is in FDA trials for reducing fat under the chin. And they seem to be getting some good results. They are doing the studies the right way. They are getting objectively measured end points and so we may see some version of that come back. But I just haven't been impressed that it really is a predictable and safe thing for cellulite or body fat reduction.
Paula Begoun: Well, and for cellulite, because it is not about fat, it wouldn't do much, right? Because that is about breaking down fat? Not about -
Dr. Richard Baxter: I was just going to say, maybe the idea is that the inflammatory response is kind of stimulating some tissue remodeling that helps smooth things out.
00:27:32 But I don't think I buy it.
Paula Begoun: So, what about lasers, IPLs, although that seems like such a big area to do, lasers and IPLs on, or Thermage. What about those things? You said that some of the Endermologie machines were actually sticking lasers and Thermage on them. Is any of that helpful? Any of that do anything?
Dr. Richard Baxter: Well, like I said, the versions of it that we were working with didn't seem like they do much at all.
00:28:05 And I was actually really surprised they got FDA clearance. But they are all just making claims for temporary improvement in the appearance of cellulite. And really nothing more than that. So, I think that has probably gone as far as it can with that idea. They have just tried combining everything they have and it is still not really getting to the end point.
Paula Begoun: Nothing like swelling up the thighs. Maybe I should just beat my thighs up before I go out on the beach tomorrow.
00:28:35 So let me just remind everybody who we are talking to. We have Dr. Richard Baxter on the line. He is a board-certified plastic surgeon in the Seattle area. He has been around doing his work for 20 years. He is founding medical director of Calidora skin clinics; there are several in the Seattle area and a few in the California area. Website is They do everything there. Everything that a plastic surgeon isn't doing.
00:29:03 All kinds of dermal injections and Botox and lasers and really extensive the skin clinics doing non-invasive procedures for every part of the body for looking younger. He is also the author of a book about drinking wine, hard to believe, "Age Gets Better with Wine." It is his science and research on what it means to drink wine responsibly and be healthy and young.
00:29:35 It is really an astounding premise and lord knows it is definitely something you can read over a glass of wine. He is also founding medical director of a new treatment, a machine that has been recently approved by the FDA for non-invasive fat reduction called LipoSonix. Actually, you know, I can't remember Dr. Baxter, what website was I on that it had a very impressive little slide presentation of exactly how it works.
00:30:06 Was that the
Dr. Richard Baxter: It might have been But it would probably also be now on the Solta website, so, because they are the company that owns the technology now.
Paula Begoun: And that again, because they haven't started shipping, if you are up in Canada listening to us or in Europe, there are definitely physicians doing this procedure there. And you can always check back on Dr. Baxter's website at
00:30:42 And he will definitely be one of the first ones I'm sure to have the machine in his office when it is available. Let's talk real quickly, Dr. Baxter, about sclerotherapy. You know, I am going to sound like a beauty junkie. I actually have done sclerotherapy a couple of times. And, you know, it definitely hurt like hell. There is no question about it.
00:31:07 I did get yellow markings. But I read that it took a long time to go away; it actually didn't take - those little yellow marks that were left behind, that kind of looked like a bruise, actually went away pretty fast for me. But, what was disappointing was it looked good for about 6 to 9 months and then slow but sure over the next year in a half, in the exact same area, I mean some areas did stay clear, but for the most part they came back which was just -
00:31:45 And I'm thinking, I don't want to go through that again. So can you explain what sclerotherapy is and why my veins came back?
Dr. Richard Baxter: Well, I'm not sure why your veins came back, but they can do that with any treatment. So the idea of sclerotherapy is to treat these fairly small and superficial veins, often called spider veins, and primarily on the legs, and if you inject a solution into the sort of theater vein - usually there is kind of one right in the middle and all of the others radiate out from that.
00:32:18 And if you inject something that is irritating to the vein you will cause it to collapse and sort of scar closed. The other thing you can do, of course, is a laser treatment which is accomplishing the same thing differently. The laser energy goes through the skin and is absorbed by the little red blood cells inside the capillary or in the vein and then causes the same kind of reaction from the heat. You know, there's no perfect way to eliminate them completely and sometimes they do come back.
Desiree Stordahl: Did we lose you, Paula?
Paula Begoun: What? Can you hear me?
Desiree Stordahl: I thought we lost you for a second. But actually I wanted to step in to remind listeners that they can call in with questions at 347-426-3783 and we will be taking questions soon.
Paula Begoun: Did we lose Dr. Baxter?
Dr. Richard Baxter: I'm here.
Paula Begoun: Oh good I would hate to lose you, Dr. Baxter. I still have many questions. So, what causes these little veins to show up on thighs?
00:33:22 I'm not talking, we are not talking varicose veins. We are talking those little radiating, kind of purple/red/bluish veins that cluster on the thighs and spider around. What causes those?
Dr. Richard Baxter: Basically it is a change inside the vein where there are little valves that kind of keep the blood flowing in the same direction. And if the valves break down then the blood backs up. And it is just something that happens with aging and sun damage and all of the things that damage skin have that effect of blood vessels under the skin as well.
Paula Begoun: So, there is nothing I can do to prevent it?
00:34:05 I mean I didn't think...I mean I used to think it was that I am a klutz and I bump into things and I used to think it was because I bumped into everything, but you know I bump into things so much and I don't have spider veins every time I bump into something. So, it just happens? Does it just come with age? Is there, I don't know, compression --?
Dr. Richard Baxter: There isn't any magic way to prevent it. And I am just remembering seeing somewhere there were supplements that were advertised to kind of protect vein health and the idea of being that they would prevent these things from forming. And I haven't heard much about that recently.
00:34:49 I doubt that there was really a whole lot of evidence to back it up. It would be nice, but I don't think there is much we can do to prevent it other than just the same things that we are doing for healthy skin.
Paula Begoun: So sclerotherapy, you can have it done, so in other words it came back, it showed back up, just those areas where I have unhealthy veins, so I can get it done again if I want to put up with getting, going through the process.
00:35:19 Because it wasn't that expensive. So there's no problem with getting it done again. It's not dangerous? It's just salt water, right, going into the veins pretty much?
Dr. Richard Baxter: Yes. It is usually what is called hypertonic saline which is a concentrated salt water solution. There is a new product that is FDA cleared called Asclera which has been used in Europe for quite a long time. And it is pretty effective. I don't know if it is dramatically better than hypertonic saline and it is certainly a lot more expensive. But it is something that is out there and available now.
Paula Begoun: By the way, doc, I've got to tell you, you are an incredibly measured - I can't tell you how much I appreciate the way you think about medicine and aging and just your approach is just so -
00:36:14 I don't know, I can't even think of a good word for it. I mean you are less edgy, maybe more the names of things you are working on are edgy. But really you have the most incredibly balanced approach to medicine, plastic surgery treatments. Just really, really impressive. I have got to thank you for that. Desiree, let's take a couple of calls before we let Dr. Baxter go. I think Sharon is asking about massage therapy for cellulite. Can we talk to Sharon?
Desiree Stordahl: We've got Sharon on the line. Go ahead Sharon.
Sharon: Yes, that is my question. I have been told by a couple of blogs that you can actually get the body wraps and massage therapy and that will help cellulite and the spider veins on your thighs.
00:37:09 Now is there any kind of truth to that at all?
Paula Begoun: Go for it, Doctor. I will let you make it hurt.
Dr. Richard Baxter: You know, there's very little that is published on it. And that is kind of my approach to these things. I look for actual studies where they had objectively measurable ways to evaluate what the results were. And there is a pretty lax standard for just claiming you are improving cellulite.
00:37:41 And there is not a whole lot of science behind it and there is almost nothing that is available to say whether things like massage therapy or the body wraps help. Now they may give you a temporary effect that you are satisfied with. But I would not be expecting any sort of real long-term and significant change from that kind of thing.
Sharon: Okay.
Paula Begoun: Actually, the one thing I can tell you, massage therapy, it feels great. Maybe you are so massaged and relaxed you don't care about your cellulite so much. But there is an irony that they are claiming that massage therapy will help the vein, will help two such really disparate conditions, cellulite and spider veins, but the primary thing is - and I should have said this in the beginning.
00:38:37 But let me make it perfectly clear to everybody who is listening is if cellulite treatments worked, who the heck would have cellulite? I mean lord knows I wouldn't. And I do a lot of stuff to my body. I mean I just, I can't imagine somebody staring you in the face and making that claim. And you would want to ask that person to drop their drawers, and can I see your thighs please? Do you have --?
00:39:10 I remember once I was at some kind of skin beauty spa thing, some kind of conference, and they had all of these Endermologie machines. And I was interviewing one of the women who was doing the procedures, and of course the person sitting on her bed, on her treatment table that she was rolling was like this size 4 gorgeous, beautiful leggy model. And I said, but can you drop your - she is all dressed the person doing the treatment.
00:39:44 I said, so, can I see your thighs? Her thighs I am not so interested in. I don't think she would recognize cellulite if it hit her in the face. But can I see your thighs? I thought the woman was going to hit me.
Sharon: Exactly.
Paula Begoun: Sharon, do you have any questions for Dr. Baxter?
Sharon: That was the main one.
Dr. Richard Baxter: I say go for the massage anyway, just don't expect a big improvement in cellulite.
Paula Begoun: Oh, definitely. Don't go for the facial either, just massage the body neck down.
00:40:19 So, Sharon, do you use Paula's Choice products? We always give away products when we take your call.
Sharon: Yes I do.
Paula Begoun: And so is there something new you have wanting to try that I could send your way?
Sharon: Maybe the Resist line. I have oily skin. I'm 40 years old. It's kind of, sometimes it kind of goes between dry and oily.
Paula Begoun: Which products of mine are you using?
Sharon: Right now I'm using the 5% Weekly Smoothing Treatment. And the Skin Balancing Cleanser. And that is all I have used right now. I didn't know what else on the Resist line.
Paula Begoun: Sharon, what are you using to wash your face with? What are you washing your face with?
Sharon: The Skin Balancing Cleanser.
Paula Begoun: Oh, so you do use that cleanser.
00:41:21 And then are you using any of my toners or any of my other moisturizers or --?
Sharon: I was using the Skin Balancing Toner and have run out of that. And the Resist with the SPF.
Paula Begoun: And are you still using the Resist with the SPF?
Sharon: Yes.
Paula Begoun: Okay, so here is what I want - and are you still having normal to oily skin or are you pretty - where do think --?
Sharon: It's evened out.
Paula Begoun: It's evened out. Oh, I love hearing that. Okay, so I want you to stay using the Skin Balancing Cleanser. I am going to send you a new Skin Balancing Toner. The toner for combination skin, for my skin it is sometimes the only moisturizer I use.
00:42:08 Now when I say moisturizer what I mean is it is going to give your skin skin-identical ingredients and antioxidants and on and on. And it just is a beautiful way to follow up after cleansing. And then what I want you to right now the 5% AHA is great and the once a week 10%, but at night you really need something else and I would like you to try my new Resist , I'm going to get the name wrong. Desiree or Bryan, what is the name of the hydrator that I can never remember.
Desiree Stordahl: Clear Skin Hydrator.
Paula Begoun: Yes, I'm very proud of that new product.
00:42:48 And I think you will find that you won't have that in-between dryness and oiliness thing going. So let me get those products out to you and you will let us know how you are doing, Sharon. Thanks for calling.
Sharon: And do you have a serum in the Resist line or is it just in the oily line?
Paula Begoun: Ah, I knew you weren't going to let me go without getting you a serum. I will send you my - I have one in each line.
Sharon: Actually I have not used a serum so I am not even sure about them.
00:43:20 I have just heard about them.
Paula Begoun: I think you should give it a shot. I love my serums. I think I sometimes get a little addicted to it. Don't overdo it. This little thing I am going to send you will last a very long time. Desiree, will you make sure that Sharon gets a Resist, oh actually, let's do the Skin Balancing Mattifying Serum. I think she will appreciate that better. Sharon, thanks for calling.
Sharon: Thank you.
Paula Begoun: Take care, dear. Desiree, let's talk to Mary, I think from New Jersey, she is asking about stretch marks.
Desiree Stordahl: I've got her on the line. And, also, to remind callers once again the number to call in is 347-426-3783. And Mary, go ahead.
Mary: Yes, hi.
00:44:04 How are you? My question was is vitamin C and AHAs, are they good for stretch marks?
Paula Begoun: Dr. Baxter?
Dr. Richard Baxter: Well, you know stretch marks are a lot like cellulite in that they are such a common problem and there are so many solutions being offered to help with stretch marks. But not a lot that are really effective. If they are kind of in that early stage where they are still sort of reddish pink, there are laser treatments that can help fade them and maybe get a little bit of collagen rebuilding. Because that is what you really need; it's a tear in the dermas of the skin - it is under the surface.
00:44:40 And so you have to actually rebuild the skin there and that is a really tough thing to accomplish. Vitamin C helps with collagen production but it is not going to make collagen grow where it is not going to grow anyway. So I have no real objection to using something like that. I would just not expect dramatic results from it.
Paula Begoun: Yeah. I think that - you know, it's interesting. Dr. Baxter, we had another physician on some time ago and her comment in terms of getting -
00:45:19 She basically, I mean I can't imagine any real doctor saying you could do much about getting rid of stretch marks. They are incredibly difficult types of scar for the body building up. But Dr. Baxter, what about getting in front of the problem, say when you are pregnant, which is the most typical type of stretch mark, and what about massaging the skin to help it stretch, to improve its flexibility. Does that make sense to you?
00:45:54 Or is that just something nice to do to your tummy and make you feel you are doing something so you are not depressed about getting stretch marks after the baby comes?
Dr. Richard Baxter: Well, I think that is a real interesting idea to try to prevent them, instead of trying to figure out how to correct them once they have happened. I think the physiology of stretch marks has to do with the hormonal changes that occur during pregnancy that weaken the connective tissue. So they are more prone to tearing anyway and you combine that with a fairly rapid pace of expansion, I just have a hard time imagining that the massage is going to make a big difference.
00:46:33 You know people used to talk about massaging coconut oil in and if they didn't get stretch marks they said ah-ha, solved the problem. And their next pregnancy they get stretch marks anyway. But I think it is a really interesting idea to try to figure out ways to protect the skin while it is expanding rapidly like that. And maybe it is as simple as massage. I would be surprised, but that would be cool.
Paula Begoun: I would be surprised, too. I kind of thought that sounded - but it sounds like a nice thing to do. So, Mary, you can throw that stuff on your skin, but I think, I don't know, I think you are still going to have stretch marks. But, Mary, are you using - we always give Paula's Choice products to our callers. So, Mary, what products...are you using Paula's Choice right now?
Mary: I'm using your 2% BHA on my husband every night.
00:47:24 And it seems to be working.
Paula Begoun: You are using it on your husband? Why are you using it on your husband?
Mary: He has dry skin and it is really helping him.
Paula Begoun: And so, I'm sorry, I just find that so funny. I ask you what products you use and you are putting it on him.
Mary: I use Alpha Hydrox for myself at night.
Paula Begoun: Wait, you are using Alpha Hydrox but on your husband you are using my products?
Mary: I'm using your products on my husband; it's working good.
Paula Begoun: I'm sorry, Mary, this is the best call.
00:48:08 I'm sorry. I don't even know where to go.
Mary: But I am interested in your Resist line.
Paula Begoun: I want you to be. And tell your husband I say hello. So, Mary, tell me what your skin type is.
Mary: I need exfoliation.
Paula Begoun: No, no, what skin type do you have?
00:48:35 Are you normal to oily, normal to dry, Rosacea, sensitive, sun damage?
Mary: Normal to dry. Sun damaged. I'm sun damaged and normal to dry.
Paula Begoun: All right. So what I am going to send you, Mary, I am going to send you some of my Resist products. I'm going to send you my Resist Cleanser and Toner. And you do need sunscreen, absolutely, 365 days a year, religiously. Throw it on your husband, too.
00:49:02 I'm going to send you the Resist SPF 25 Cellular Defense. I can't remember - I never can remember the name of my products. I can't believe it. And I'm also going to send you the Barrier Repair Moisturizer from the Resist line as well as the Resist Antioxidant concentrate. Throw that on yourself, too. And you can also stick that stuff on your husband as well and you guys can share my skincare products.
Mary: Can I get the Resist AHA that you have, the one with all the antioxidants?
Paula Begoun: You can, but you are not using the 2% BHA that your husband is using?
Mary: No, I'm using it on him.
Paula Begoun: Okay, yes you can. I'm skeptical with just starting with that, so I'm going to send you the Weekly Resurfacing Treatment, the system, that's what you are asking about. And what I would like you to do is I would like you to start with the 5% lotion and wait a few weeks.
00:50:12 I would say two or three weeks until you try the 10% once a week treatment. I would like you to break your skin in a little slowly before you jump into the 10% strength. Okay? Will you do that for me?
Mary: Okay. Mm-hmm. I will.
Paula Begoun: You have a lot of products. I want you to take good care of your skin. And don't cheat your husband. Share the Resist line with him. Take care.
Mary: Paula says hi -
Dr. Richard Baxter: You know, that's great. We get patients all the time who bring their boyfriend or husband in and say I think he needs some Botox here or he needs some filler her, you know.
Paula Begoun: You might as well share skincare products.
00:50:51 But I'm sorry, that was just so funny when she said she doesn't use my products, she throws my products on her husband. I thought that was great. So, Dr. Baxter, before I let you go, I just want to remind everybody who this wonderful physician is that we have been talking to, Dr. Richard Baxter. He is a board-certified plastic surgeon practicing in the Seattle area. He is founding medical director of Calidora Skin Clinics with locations in Seattle and California.
00:51:19 Really extensive procedures, non-invasive procedures that aren't associated with surgery but with all other aspects of looking beautiful. He is author of "Age Gets Better with Wine." A very interesting approach on looking at what red wine means for a healthier you. The subtitle is "New Science for Healthier, Better and a Longer Life." He is also Founding Medical Director of a new treatment, non-invasive treatment for fat reduction; LipoSonix maybe will replace liposuction. It is non-invasive.
00:52:00 You get your fat kind of zapped away from the outside in. You can visit Dr. Baxter at his website, or his skin clinics at Dr. Baxter, you have been great. Thank you so much for taking the time to talk to us. Will you come back and make us smarter, healthier people? We have to have you back on just to talk about the wine thing.
Dr. Richard Baxter: Oh, absolutely. Yes. It has been my pleasure.
Paula Begoun: All right, take care, Doctor.
Dr. Richard Baxter: Alrighty, bye now.
Paula Begoun: Bye-bye. So, that was great. So before we all go and have a glass of wine, Desiree can we take another caller?
Desiree Stordahl: We can take one more caller.
00:52:43 Let's go to Chastity in New Mexico.
Paula Begoun: Chastity. Chastity? Did I say that right? Hi Chastity, how are you?
Chastity: Yes, good, how are you?
Paula Begoun: Good. What's going on?
Chastity: I've been noticing I am getting more blackheads on my T-zone and some scattered like hard little breakouts on my jaw line and I have no idea why this is happening because I am using wonderful products.
Paula Begoun: So now this is a leading question.
00:53:16 So are they my wonderful products or somebody else's wonderful products?
Chastity: Yes, your wonderful products. Just yours.
Paula Begoun: So you are getting more blackheads. So tell me what products - so first, let's start with how old are you Chastity?
Chastity: I'm 36.
Paula Begoun: You are 36. And have you started perimenopause, new baby come along, new boyfriend? Anything hormonally charging up your skin?
Chastity: No, nothing that I can tell. Nothing that I notice at all.
Paula Begoun: And so what skincare products of mine are you using?
Chastity: My cleanser is the Clear Purifying Wash. I changed to that a couple of months ago because I had been using the Skin Balancing Cleanser and I just felt, well, maybe using the Clear Cleanser may help a little bit with the blackheads.
Paula Begoun: No, blackheads and acne - wait, just to be clear. I just want everybody to know, it is really important.
00:54:21 Blackheads and acne are not associated. The exfoliants in my Clear line for acne, they work on blackheads, which they contain salicylic acid, so that is true. But the cleanser and the benzoyl peroxide products in my Clear line have no benefit one way or the other for blackheads. So the Clear Cleanser wouldn't's a good cleanser, especially obviously if you have acne, but it is a mistake sometimes that women make thinking that products for acne are also beneficial for blackheads.
00:55:02 And other than my line that has exfoliants with salicylic acid, that is not the case. So, all right, you are using my Clear Cleanser. What else are you using?
Chastity: And morning and night I use the Skin Balancing Toner. And then in the morning I use the 2% BHA liquid. And at night, a couple of times a week, I will use the Resist 10% AHA. And then on the days, the rest of the time, I will use the Resist Clearly Remarkable Skin Lightening with the 2% BHA.
Paula Begoun: So when you started noticing a difference with increased breakouts and blackheads and these breakouts along your jaw, did this have something to do with starting to use the AHA product? Did that seem to coincide?
Chastity: No, all of these products I have actually been using now for probably a year and a half. The only thing that I introduced, I have been using your Resist Anti-Aging Clear Skin Hydrator since it first came out. I bought it like the very first day. So I have been using it since then.
00:56:18 But nothing that I'm using is new.
Paula Begoun: So everything was going fine and all of a sudden this problem shows up?
Chastity: Right, a couple of months ago. Oh, yes, my freckles, that has all formed into one nasty little brown spot. It used to be cute whenever I was a kid, it is starting to finally lighten up and I think that has to do with using the skin lightening [unintelligible].
Paula Begoun: Yes, the Skin Lightening product. Chastity, I've got to tell you, unless Bryan has something brilliant to say, I am just stumped. Bryan, any thoughts? I'm just lost here.
Bryan Barron: Yeah, I'm sorry; I wish I had a brilliant idea to throw in there.
00:57:10 But I can't explain why it is happening.
Chastity: Weird.
Paula Begoun: So here is what - so Chastity, we just have a little bit of time left. I need to ask you more questions because I want to help and it is just you are doing everything - I mean I am going to send you my Skin Balancing Cleanser; I do want you to go back to that and not use the Clear. Just in case with the acne - well, I don't know, you said it happened even before.
00:57:44 But I am going to send you my Skin Balancing Cleanser. I want you to go back to that one anyway. But Desiree is going to get your email information and I am going to see if I can do some brainstorming separate from off-air and email you and see if we can't solve your problem. I don't get it.
Chastity: That would be wonderful.
Paula Begoun: I have some ideas about using a comedone extractor and maybe getting a facial, and then I can explain to you how to make sure the facialist does what you need to have done and get some of the blackheads removed, and get some of the white bumps along the jaw excised.
00:58:23 So I have thoughts about what to do. So I am not going to leave you hanging. It is just too complicated to go into on-air. And thanks for calling. I will try to help.
Chastity: Thank you very much.
Paula Begoun: Take care. So, I'm Paula Begoun, the Cosmetics Cop. And I hate when I am the Cosmetics Cop and my last call leaves me stumped. But I promise I will be on the investigation and I will help Chastity out and let everybody know what solutions we come up with for her.
00:58:53 So until next week, next week on the 17 we will be talking about live what your skin problems might be telling you about your health. You think it might be [technical difficulty], it might be about something else. On the 24th, Happy Thanksgiving Day. We will have no show on that day. You can always listen to our shows archived with your family; sit around the fireplace after finishing dinner and listen to some of our BlogTalkRadio reruns.
00:59:21 And on the 1st we will be talking Splurge versus Steal, amazing anti-aging products for less. You don't have to spend a lot of money to look beautiful. And then on the 8th, what to do when climate changes and how it affects your skin. I'm Paula Begoun, the Cosmetics Cop. Come visit me at And on Thursdays, live, we will be keeping you beautifully informed. Take care. Good night.
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