An additional Hyaluronic acid for filler injections gaining global recognition is produced through the identical corporation which produces Botox injectable, Juvederm. It’s also Food and Drug Administration approved, filler used to correct mid to strong dermis wrinkles. It is effective in facial lines in the 1/3 of the facial skin similar to nasolabial folds as well as oral commissures

As soon as any Hyaluronic acid filler is injected it maintains the needed form by simply attracting and holding your body’s moisture. (It can do this for a few months before additional treatments will be needed.)

One of the differences between Hyaluronic acid fillers is that it can come in not one but two formulas Ultra and Ultra Plus to deal with different wrinkle regions that need to be filled. Furthermore the foundation of the filler injection is even gel vs a granular gel utilized by various other fillers. It has also been tested and demonstrates hardly any hypertrophic scaring in patients of color.

The actual treatment approach is identical to alternative injectables along with a comprehensive examination before the treatment. An injection area is going to be measured and cleaned clearing away all make-up and It will be injected using an ultra-tiny needle. The particular treatment may take roughly 17 mins and just after the injection the medical professional will rub the area to help even out the gel around the treatment region.

Immediately after a Jevederm treatment:

• Keep away from extra sun, demanding exercise and liquor for a twenty-four hour span to lessen the chance of irritation and erythema.
• Final results continue for approximately six months even so, other treatments will be needed following this to maintain prolonged final results.
• Listed here are a number of contraindications regarding Hyaluronic acid products which encompass these:
• Patients with a background of anaphylaxis or different intense allergic reactions.
• Clients with a sensitized background to gram-positive microbe proteins.
• Lower immune may perhaps have an higher chance of infections.
• Essential safety for expectant mothers and people under the age of 18 haven’t been identified.

Jevederm & Botox is a post from: Botox Patient

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Botox manufacturer Allergan’s CEO calls tax impact to company “pretty marginal”…

(Reuters) – Botox maker Allergan Inc (AGN.N) is actively fighting a proposed U.S. cosmetic surgery tax, but sees a marginal impact on the company, Allergan’s chief executive told Reuters on Friday.

Healthcare legislation pending in the U.S. Senate includes a 5 percent tax on elective cosmetic surgery procedures, nicknamed the “Botax” after Allergan’s popular wrinkle-fighting injection.

The impact would be “pretty marginal” for Allergan overall, CEO David Pyott said in an interview.

He said adding 5 percent to the average $440 cost of a Botox procedure would have a “very marginal” impact on demand, but could have a “larger” effect on breast implant procedures that cost upward of $5,000, he said.

Still, the company is lobbying to have the tax killed because “we really feel strongly this is bad policy,” Pyott said.

“I think it’s a dangerous precedent. It’s extremely discriminatory against women,” who make up about 90 percent of cosmetic surgery patients.

“Why not have a tax on drugs for male balding or for erectile dysfunction? Why are we picking on women?” he said.

Many patients are middle-class, working women and not just the wealthy, Pyott said. He pointed to an American Society of Plastic Surgeons survey that showed 60 percent of people planning to have cosmetic surgery lived in households with annual income below $90,000.

The tax in the Senate bill is estimated to raise roughly $5 billion over 10 years to help pay for a healthcare overhaul costing $849 billion. It is not included in health legislation that passed the House of Representatives.

Among Allergan’s products, the tax would apply to Botox, wrinkle filler Juvederm, eyelash drug Latisse and breast implants, Pyott said.

The tax would apply to cosmetic procedures that are “not necessary to ameliorate a deformity” related to “a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease,” according to the bill.

Sales of Botox rose about 3 percent in the third quarter to $328 million following declines in previous quarters that the company blamed on waning use of cosmetic procedures during the economic downturn. Allergan’s breast implant sales amounted to $69 million in the third quarter.

Allergan would not pay the tax directly, but doctors would be required to collect it from patients.

The company’s lobbying efforts include a website and Facebook page to rally tax opponents. The website calls the plan “a tax on self-improvement.”

More than 10,000 people have signed an online petition opposing the tax and more than 7,500 letters have been sent to senators, Pyott said.

The tax was added recently to the Senate healthcare bill as lawmakers looked for new ways to help fund wider insurance coverage and other changes.

“We needed money to make the bill work while using a funding mechanism that would allow us to stay within the healthcare arena,” said Jim Manley, a spokesman for Senate Majority Leader Harry Reid.

Botox Patient: Allergan’s CEO comments on proposed new “Botax” is a post from: Botox Patient

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3. Cosmetic Surgeons enlist patients to fight Botox Botax.

Your plastic surgeon of dermatologist may be asking for your help to fight the Botox Botax shortly. Here’s what the ASDS (American Society for Dermatologic Surgery) is giving it’s members to solicit the support of Botox consumers:

The U.S. Senate health care reform bill  (Patient Protection and Affordable Care Act) contains a proposed 5 percent tax on “elective cosmetic medical procedures.”  While this may look like an attractive option to Senators looking for ways to pay for health care reform, we know that:

• Cosmetic medical procedures taxes are an unreliable and risky revenue source, which has proved to be a failure at the state level;
• A tax on cosmetic surgery discriminates against working women;
• The definition of cosmetic procedures is arbitrary and almost impossible to administer; and
• enforcement would necessitate review of patient medical records by tax collectors, a clear invasion of privacy.

Please enter your zip code below to be connected to an automatic email system which allows you to send a quick message to your Senator asking him/her to vote against this tax.

Cosmetic Surgeons enlist patients to fight Botox Botax. is a post from: Botox Patient

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Via Tyler Cowen, it turns out that the proposed tax on cosmetic surgeries (like Botox) might be highly regressive:

… look around. See that cosmetic surgeon down the street? The walk-in Botox clinic next door? That’s because cosmetic surgery spread from the rich and famous to the rest of us because of increasing access to credit. That’s right- the deregulation of banking that happened in the 1980s meant more and more Americans were taking out credit- either on credit cards or with medical credit companies like GE’s “CareCredit.”

What this means is that cosmetic surgery is now primarily consumed not by the rich, but by the working and lower-middle classes, sometimes even by the poor. According to the American Society for Aesthetic Plastic Surgery (ASAPS), about 1/3 of cosmetic surgery is consumed by people who make less than $30,000 a year. About 70% of it is consumed by people who make less than $60,000 a year. It is mostly women (90%) and mostly white, middle-aged women (80% and between 35-55 years old).

It would be interesting to know if these trends vary depending on the procedure. I would suspect, for instance, that nose jobs and facelifts are common among the affluent and highly-educated, whereas breast implants, which still carry something of a class-based stigma, are a more heavily downscale phenomenon. And I would imagine there are interesting regional variations as well. (Perhaps some of these questions are addressed in the forthcoming book from the author of the post quoted above.)

Riffing on the data, Tyler writes that “cosmetic surgery is not just a zero-sum game but rather it leads to better matches, more matches, and more people who are happy with their looks or with the looks of their partner(s).” I would go halfway with him, and say that it’s certainly a rational response to a culture where airbrushed images of perfect beauty flood the airwaves and supermarket aisles, where male instincts about sex are increasingly influenced by the siliconed imagery of hard-core pornography, and where high divorce rates (which are especially high among the working class) ensure that large numbers of women find themselves re-entering the dating pool in middle age. Whether it’s something to be welcomed, though, is another question entirely.

Question: Should Botox, Restylane, Juvederm, liposuction and cosmetic surgery be taxed like you luxury car?

Blue Collar Botox is a post from: Botox Patient

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Restylane, Juverderm and filler injections tips for physicians running medical spas and laser clinics.

The following is from a string of emails that were circulating among some of Medical Spa MDs Members. I’ve edited this somewhat to make it readable and get rid of all the extraneous copies. I’m also not displaying the identity or email addresses of the physicians in this thread.

Note: Some of the comments below might be out of order from the original thread. Emails’ somewhat difficult to follow as a thread but you’ll get the gist.

Filler Injection Discussion & Tips: Restylane | Juevederm | Evolence

1. When I use the “push ahead” technique, I feel that I get better “plumping” per cc of filler.  I learned this from Kevin (thanks Kevin).

2. When I use the “push ahead” technique, the filler fills a few millimeters in front of the needle tip.  You need to realize this to be able to put the material exactly where you want it.  Sometimes you have to “feel” the injection because you can’t “see” the plumping.

3. I mix 0.1 cc of lidocaine with epinephrine with my Juvederm.  This helps with bruising (epinephrine) and when the lidocaine goes away and the Juvederm attracts water, the two effects cancel each other and there is not as much enhancement after the injection due to the hydrophilic nature of the Juvederm.

4. I use Juvederm Ultra under the eye and above the lip.  I use Juvederm UltraPlus everywhere else.

5. I constantly complain to my Juvederm Rep about the 0.8 cc syringes.  I use lots of Radiesse because you get almost twice as much material for the same price.  Volume, volume, volume.  Please complain to your rep, maybe we can get them to change.

6. I hear the Evolence is very good.  We will be getting trained and start using it next month.

Thanks for the filler tips.Can you explain how you get the Lido with epi mixed into the Juvederm syringe? –PD

Fluid Dispensing Connector from Braun Medical Inc (you can get from PSS)

BD 1 ml Luer-Lok Syringe

This syringe allows you to get very precise amount of lidocaine (swish back and forth 20 times).

I use this syringe to put exaclty 1 cc of saline in my Botox Bottle. When I reconstitute the Botox (this gives it full strength per unit). The chances of intravascular injection might be lower with push ahead because the material will push the vessels out of the way as you advance –  Jeff

Hi Jeff,–I agree w/ #6.  I seem to get good augmentation, less redness, swelling and bruising with Evolence.  I use it for deeper fills in cheeks, NLF, etc.  Don’t use it for lips or under eyes.  I do same with Lido w/ epi.  I tend to use Juvederm in lips.  Perlane / Restylane for other areas.  I agree w/ why Allergan uses 0.8 cc syringes. I’ve moved away from Radiesse.  I feel that the duration is not that much longer than a good correction with the HA’s.  Besides, I believe a fair amount of the volume of Radiesse is a gel carrier, thus needing touch-ups at 2-3 months.  Perhaps that’s why the went to the larger syringes? — Don

The push ahead technique also moves small blood vessels out of the way, so you may notice less ecchymosis is overall pts. — Greg

Jeff: –”Push ahead” has a higher risk of vessel cannulation & potential for vascular effects – skin necrosis in glabella, even potential for retro-grade flow to eye (causing visual loss).  I wouldn’t recommend that technique for the periorbital area.

Restylane is recommended for the tear troughs;  it’s less hydrophilic than juvederm – which means less post-treatment swelling.–Tom  –  [note from Jeff:  Tom is a plastic surgeon]

I would not use push ahead around the eye, I agree with Tom’s comments. It works great for NLF. I was actually taught this by a PS — Greg

Thanks Jeff for your kind comments. However I must make a few points in regards to fillers:

1) There are some areas that one has to still do the retrograde injection either b/c the purpose was to make a straight line (eyebrow lift and vermillion border and the bow-tie (the vertical lines connecting the base of nose and the upper lip border) AND when injecting the most inner 1/3 of the tear-trough to avoid risk of filler getting into the orbital space due to its close proximity to the orbital rim.

2) On the glabellar injection, it is best to first push and pull the needle thru the space underneath to break up the tissue before actually injecting the filler both in an anterograde and retrograde pattern

3) I ONLY use the 1/2 inch needles in all my injections

4) One can inject even Radiesse and/or Perlane via an 1/2 inch 30 gage needle. Why is this noteworthy to mention?? When I work on the lips and Marrionette’s lines, I ususally first build the Vermillion border with Radiesse or Perlane (I get the best “lifting outcome” with heavier filler). I push the 1/2inch needle all the way forward then slowly and steadily inject while withdrawing (retrograde method). Then I re-evaluate how much of a correction I already get of the Marrionette’ line and lifting up of the lip body. My next step is to inject into the most lateral lip section (about 1 cm distance) starting at the corner (using Perlane or Restylane or Juverderm). This time I inject slowly as I push forward (anterograde). Often I ended up correcting about 50% of the marrionette’s line by going after the lip’s border and most lateral body. Besides, the patient loveto see that they now could see their lip body all the way to the corner and more “smiley shape”. The last step is the trickiest one, I use either Radiesse or Perlane on an 1/2 inch 27 gage needle. First placing my left thumb at the patient’s lower half NLF’s I retract the skin upward (about 2-3cm upward) then I approach my needle in an upward (vertical) position at about one centimeter lateral and one cm below the mouth corner of that same side. Then I aim diagonally toward the corner and start injecting anterograde just 1-2 mm below the imaginary horizontal line of the mouth corner (about 0.2 cc), then I withdraw the needle and reaim straight up and inject just below the horizonal line (0.2cc) then I do it one more time aiming diagonally outward (0.2cc). What was I attempting to do?? I was laying down a new flooring along the imaginary horizontal line. After the injection, release the left thumb. You will be surprised to see the retracted portion just rest right along this new floor, thus the Marrionette’line has been corrected. This is different from the common fanning technique of using the filler to “blow up” around the Marrionette’s line. If you look carefully at those company’s issued photos, the area around the Marrionette’s line now appeared very swollen and puffed up. It is aesthetically unpleasant. It looked like the patient was beat up below the mouth. It reduced the profile of the chin.

5) For those of you that use fillers on the highly vascularized and shallow areas such as the temporal, crow’s feet, undereye area lateral to the submalar area and along the lateral border of the cheek prominence (especially in those older skinny Caucasian ladies with much excessive very thin skin) I now emulate the same technique used in the hand. I would pinch to levitate the skin itself above the bony structure, then I bolus Restylane into the empty space. Then I massage it down. This elimates the risks of injecting into the vessels and nodules.

Interesting discussion.  So Kevin, how do you account for the difference in that anterograde injection you need less filler than in retrograde injections, assuming all else being equal?

Second, I am understanding one group claims anterograde injection carries a higher risk of vessel cannulation and possible intravascular injection, while another group claims that anterograde injection “pushes away” blood vessels, thus decreasing the risk. Not sure how anterograde increases risk of intravascular injection any more than retrograde.  If you push the needle ahead, transfixing a vessel, then begin injection, you can still conceivably deposit some material intravascularly, can you not?  Am I missing something here?

I also found an interesting idea of sub q bolus technique in areas of thin skin, ie crowsfeet, etc.  Anyone else try this method? ~ Don

Tom:

I do agree with you about those risks with anterograde injection. The key is always the skills in doing it, be it retrograde or anterograde. One always has to be very carefully doing anything around the eyes. However, the anterograde techinique has been advocated some of the best known experts such as Arnold Klein, MD and Kent Remington, MD. I also believed that the filler amount used was critical. It takes much more amount to get the same result with the often taught retrograde technique compared with the anterograde one. For example, I almost never required more than one full syringe in correcting bilateral NLF’s vs what was typically used ( 2 syringes) by most others. I attached the before and after of a case wherein I used Readiesse to correct her NLF’s and Marrionette’s lines with anterograde technique. The after photo was taken right after. You can still see some of needle marks. I used one full 1.3 cc syringe, 1/2inch 30g for the Vermillion border and 1/2inch for NLF’s and Marrionette’s line. Notice also there was no “puffy/swollen look” medial to the Marrionette’s line often seen with retrograde and fanning technique used by most others. ~ Kevin

All interesting comments.  The only place, I use “push ahead” is in the cheeks when doing them via the intra-oral route. (Apparently Radiesse is no longer teaching this method because may practitioners couldn’t get the hang of it but it works for me.)  I might try it in the “safe” areas such as NL folds.  We use only Radiesse and Juvederm and  I find that neither filler lasts as long as advertised in “first-timers”.  I’ve also had disappointing longevity in my older patients (>65) with both types fillers despite using numerous syringes.  I’m sure this has to do with their inability to generate collagen around the filler once the carrier gel is gone.  Does anyone know the age range of patients done in the filler studies? ~ SD

I came across this old thread way down in my inbox and read it again.  I’m not sure who wrote #4 below.  It sounds interesting but I’m having a hard time visualizing it.  Do you steadily move the needle forward  toward the lip edge as you are injecting or do you hold it in place while the area fills?  I’d love to see a drawing on where you start.  ~ SD

SD: I wrote those threads. The techniques that I described were similar to what you could see watching the video instruction on www.thederm.org by Kent Remington and his colleagues (lower face injection portion) THe only thing new from my thread was when fixing the Marrionette’s line, his doctor (Nowell Solish) injection upward and anterograde from the lower part toward the lip corner only one time vs what I now do is I do the same thing but with a fanning pattern where (with the skin lifted about 1-2cm upward with the other thumb) I laid down “three such “anchoring points” along an imaginary horizontal floor starting from the lip corner going laterally for about 3-5cm long. Here I used something firmer such as Radiesse or Perlane. Having done this, you would release the thumb letting the skin go back down. Often you will see the Marrionetter’s line is much improved because “part of that Marrionette’s line” now is positioned along the horizontal flooring that you just created. ~ Kevin

PS: It is hard for me to send over some graphic illustration but I will attempt to do this in the future

Something worth knowing. How is your plastic surgeon or dermatologist communicating with other physicians to keep abreast of the latest information about treatments?

Botox Patient: Posted from Medical Spa RX: Wholesale Botox

Resylane + Juvederm + Filler Injection Tips for Medical Spa Physicians. is a post from: Botox Patient

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Botox Patient: Posted from Medical Spa RX: Wholesale Botox

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Botox Patient: Posted from Laser Treatment MD

Do it yourself home Botox injections? ABC News want’s to talk. is a post from: Botox Patient

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From Medical Spa MD: Understanding Botox & Injectables. Injectable products are an important contributing factor to your clinic’s financial success. With new products entering the market like Dysport and Evolence, and other exiting like ArteFill, it is important that your staff be knowledgeable of the products used in injectable procedures.

Although this chapter from the Advanced Medical Aesthetics Training Manual wasn’t actually requested in the training manual I wrote for the academy students, I felt it was extremely important for , especially for medical estheticians, to know the difference amongst the various treatments used to alleviate the appearance of wrinkles and folds, and the difference between dynamic and static lines.

Medical estheticians have the most “face time” with clients, examining it with magnifying lenses, treating it with exfolliants, moisturizers, galvanic current, high frequency, various acids, etc. They understand the realm of fine lines and wrinkles and know what can be alleviated with topical treatments such as facials, peels, microdermabrasion and laser resurfacing, and what cannot.

I cannot tell you how many patients call or come into our office with no knowledge of the difference between paralyzing agents such as Botox and Dysport, and dermal fillers. We take it for granted that we know the difference, but injectable products can be very confusing to the lay person. Because the aesthetician works with the client’s skin, they should be well versed in the differences in the two categories of injectables and the products that lie within. Estheticians become your most powerful education source for your clients which ultimately leads to an upsell for them (with possible commission).

Many people think all fillers products are the same, nor do they care to understand the difference between hyaluronic acid or calcium hydroxylapetite. All they truly care about is “how long will it last” and will the “results look fake”. Only with proper education can the medical esthetician effectively and intelligently discuss the differences in the filler products, educate the patient about the effects and lasting results, and help lead the patient to the right product, or combination of products, for their expected outcome.

This information in this chapter is very important for your front desk/phone people as well!

Botox Patient: Posted from Laser Treatment MD

Medical Spa Botox is a post from: Botox Patient

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Injectable products are an important contributing factor to your medical spa, plastic surgery center or laser clinic's financial success. With new products entering the market like Dysport and Evolence, and other exiting like ArteFill, it is important that your staff be knowledgeable of the products used in injectable procedures.

Although this chapter from the Advanced Medical Aesthetics Training Manual wasn’t actually requested in the training manual I wrote for the academy students, I felt it was extremely important for the entire medical spa staff, especially for medical estheticians, to know the difference amongst the various treatments used to alleviate the appearance of wrinkles and folds, and the difference between dynamic and static lines.

Medical estheticians have the most “face time” with clients, examining it with magnifying lenses, treating it with exfolliants, moisturizers, galvanic current, high frequency, various acids, etc. They understand the realm of fine lines and wrinkles and know what can be alleviated with topical treatments such as facials, peels, microdermabrasion and laser resurfacing, and what cannot.

I cannot tell you how many patients call or come into our office with no knowledge of the difference between paralyzing agents such as Botox and Dysport, and dermal fillers. We take it for granted that we know the difference, but injectable products can be very confusing to the lay person. Because the aesthetician works with the client’s skin, they should be well versed in the differences in the two categories of injectables and the products that lie within. Estheticians become your most powerful education source for your clients which ultimately leads to an upsell for them (with possible commission).

Many people think all fillers products are the same, nor do they care to understand the difference between hyaluronic acid or calcium hydroxylapetite. All they truly care about is “how long will it last” and will the “results look fake”. Only with proper education can the medical esthetician effectively and intelligently discuss the differences in the filler products, educate the patient about the effects and lasting results, and help lead the patient to the right product, or combination of products, for their expected outcome.

This information in this chapter is very important for your front desk/phone people as well!

Botox Patient: Posted from Laser Treatment MD

Medical Esthetician Training from Medical Spa MD is a post from: Botox Patient

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Botox Patient: Posted from Laser Treatment MD

Top Medical Spa MD Blog Posts is a post from: Botox Patient

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