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Botox Patient: Looking into the crystal ball for 2010

Botox Patient — Wed, 09 Dec 2009 20:05:18 +0000

The editors of Consumer Guide to Plastic Surgery are gazing into the crystal ball once again to see what’s in store for 2010.

Even More Botox-Like Products Will Come to Market.

First there was Botox Cosmetic; then 2009 brought the Botox alternative Dysport. In 2010, expect to see a few more Botox rivals, including a topical form of the popular wrinkle relaxer and at least one more injectable. A couple of injectable Botox cousins are in development, but PurTox will likely be the next to get a nod from the Food and Drug Administration (FDA). The main difference in these injectables seems to be how long the results last and how quickly the products start to work on your crow’s feet.

Fat Injections to the Breast Will Be Used Cosmetically.

After being condemned by plastic surgery associations, fat injections to the breast were deemed OK for “touch-ups” after breast reconstruction in 2008. But these once controversial injections may soon play a role in cosmetic breast augmentation. Taking fat from a part of the body where there is too much (your thighs or butt, for example) and injecting it into your breasts where there is too little, may replace the need for breast implants when done in conjunction with a breast lift. Some kinks still need to be worked out, but fat injections to the breast are likely here to stay.

Surgeons Will Invent – and Perfect – Body Contouring Surgeries to Follow Massive Weight Loss.

More and more people are undergoing bariatric surgery to lose weight, only to be left with hanging fat and flab in highly visible areas. As plastic surgeons put on their thinking caps to better address these issues, expect to hear about many new procedures, including the corset trunkplasty. This new surgery targets above-the-belly-button flab, to recreate an hourglass silhouette in formerly obese women and get rid of love handles in men who have lost massive amounts of weight. This area has been ignored by many traditional body contouring procedures that target the lower abs, buttocks and/or thighs. We will hear more about corset trunkplasty and other innovative body contouring procedures in 2010.

Fat Freezing Heats Up in 2010.

Fat freezing (or cryolipolysis) may give liposuction a run for its money in the coming years. This technology works by freezing fat cells and breaking them down. Zeltiq is in clinical trials now, and results look promising. Stay tuned.

Cohesive Gel Breast Implants Receive FDA Approval.

These so-called “gummy bear implants” have been making their way down the pike for some time, and they just may get the long-awaited FDA nod in 2010. Filled with cohesive silicone gel, these leak-resistant implants – used in Europe and Brazil – are being studied in the United States. Gummy bear implants have the positive attributes of silicone gel, but the gel doesn’t migrate. This is a good thing, because if the shell should fail, the gel wouldn’t leak into surrounding tissue.

Minimally Invasive Cosmetic Procedures Experience Rebirth.

As our economy starts to show signs of life again, more people may opt for cosmetic surgery procedures, reversing the steep decline of the last two years. Don’t expect the numbers to reach their record highs anytime soon, though. There will likely be a slight increase in plastic surgery procedures – especially minimally invasive ones such as injectables that allow people to put off more invasive (and expensive) procedures like face lifts until they really need them (and can better afford them).

Botox Patient: Looking into the crystal ball for 2010 is a post from: Botox Patient

Botox Patient: Botox for excessive underarm sweating

Botox Patient — Tue, 08 Dec 2009 21:48:35 +0000

FDA approved Botox back in 2004 to treat severe and excessive underarm sweating known as primary axillary hyperhidrosis.

The hyperhidrosis procedure was at first meant for those who’s excessive sweating cannot be managed by strong topical agents (treatments that are applied to the surface of the skin) such as prescription antiperspirants. Botox for hyperhidrosis involves the injection of about 20-25 drops of Botox directly into the skin where the sweating problem occurs. Often times, in the span of 48 hours after the hyperhidrosis treatment, some people have shown remarkable results of up to an 80% decrease in excessive sweating in the sweating problem area. In the span of a week later, the sweating problem maybe resolved in a sizeable percentage of the people. Bad odor coming from excessive sweating of course also disappears as the two are like the conjoined twins of the sweating world. Cutting one sweating problem away will invariably lead to the death of the other in most cases.

The hyperhidrosis treatment has a few killer drawbacks. It is cost prohibitive as the procedure is quite a bit more then the average person can afford. Furthermore, to add to the cost, Botox for hyperhidrosis, is a temporary fix. Yes, you read that correctly. The hyperhidrosis procedure has to be repeated in 6-12 months for the maintenance of the sweating problem. There have also been heavier sweating in other areas after the treatment for excessive sweating. This sweating ‘karma effect’ has been reported often by patients of the hyperhidrosis procedure.

Another limitation of the Botox is that it can only really be applied to the armpits or underarm area as a solution for sweating. For example, with palm sweating or palmar hyperhidrosis, Botox is really too painful of a procedure to be practical. The discomfort of the process of the hyperhidrosis treatment in other areas of the body confines the procedure to the armpit area. So painful is it in other areas, most doctors will not even list it as an option for other areas of the body that excessively sweat.

Botox Patient: Botox for excessive underarm sweating is a post from: Botox Patient

Resylane + Juvederm + Filler Injection Tips for Medical Spa Physicians.

Botox Patient — Fri, 27 Nov 2009 18:50:03 +0000

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

via Medical Spa MD: Juvederma, Restylane, & Filler Injection Tips for Physicians.

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

Do it yourself Botox: People are injecting themselves with fake Botox.

Botox Patient — Sat, 07 Nov 2009 17:15:12 +0000

People are risking death or serious injury by using an illegal Botox equivalent without prescription, a CBD cosmetic doctor warns.

Dr Mario Soteriou, of Cosmetic Image Clinics, said self-administering the goods obtained at a new US-based online store was equivalent to playing “Russian roulette”.

He said neither the Botox equivalent nor the dermal filler sold on the website was approved by the Australian Therapeutic Goods Administration, which also decrees the products must only be administered under medical prescription.

The website also sells needles and an instructional DVD to enable buyers to self-administer the do-it-yourself Botox equivalent, with the promise of wrinkle free skin.

The dermal filler is also being marketed with a DIY guide for plump lips.

Dr Soteriou, who has specialised in cosmetic medicine since 2000, said he was “severely shocked” by the shonky website.

He said injectable treatments such as Botox and dermal filler should only be administered by qualified practitioners.

“The big problem with these drugs is that we don’t know what they are made of and they can’t guarantee you safety or results,” Dr Soteriou said. “Self-administering them is essentially like making a life decision without putting any thought into it.

“I wouldn’t even advocate for doctors and nurses to be injecting themselves.

“You are also risking your own death if you have an adverse or severe allergic reaction to the drugs.”

Dr Soteriou believes the website is a “money grab” and fuels people’s desperate desires for quick-fix anti-ageing products.

“I’ve never heard of these products before and I attend a lot of medical conferences to ensure I’m up-to-date with the latest in facial rejuvenation techniques,” he said.

via Medical Spa MD: Fake Botox or not, Discount Medspa is going to jail!

Botox Patient: Posted from Laser Treatment MD

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