Botox Patient » Juvederm

The What’s-What of Botox Immunity

Botox Patient — Mon, 27 Sep 2010 20:40:56 +0000

Who among you knew that there was such a thing as Botox immunity? It’s not one of the more known info about Botox, that’s for sure!

But yes, there have been cases of patients having a Botox immunity. They get the shots but don’t see the results. Too bad, eh? Well, here’s the skinny on this little known fact about this often-used drug.

Causes:

OVER-DOSAGE: physicians say that this is the most common cause of Botox immunity. When too much of the drug is used, the body starts developing antibodies that counteracts its effect. Note, though, that this usually happens when Botox is used to treat other conditions like cerebral palsy where large dosages are really used for treatment.

SUBSEQUENT TREATMENTS: the effects of Botox are said to be cumulative if you go in for your next treatment before the drug completely wears off. This will be tantamount to over-dosage that builds-up through procedures in intervals of 2-3 months, spanning a period of years.

UNDER-DOSAGE: in case you can’t see any results after, there is a possibility that the Botox used for your treatment was watered down. In this instance, immunity is not the problem – your Botox provider is ripping you off using an over-diluted drug! You can either go in and demand your money’s worth or consider that as a lesson learned and find an honest and experienced physician who will inject you with the right potency.

Quick fixes:

You can have your blood tested for the antibodies

This will set the record straight and you can act according to the results. If you do not have the antibodies, then chances are you’re being duped by your physician. If you have the antibodies in your system, then read on because we have some tips to deal with that…

Try other Botulinum toxin products

You have a choice between Dysport and Myobloc. Dysport is derived from Botulinum Toxin Type A (like Botox) but they have different inactive ingredients that may just do the trick. Another (more) possible option is Myobloc since its active ingredient is the Type B strain of the toxin. The latter is what they usually recommend to patients that are found to be immune to the Type A drugs.

Try Non-surgical Cosmetic Procedures

You have several options on the non-surgical cosmetic medicine front. A few of the treatments that you can consider are fillers, Restylane, Juvederm and laser resurfacing. They’re all intended to decrease the appearance of wrinkles. Some people say they’re not at par with Botox but, we think, considering your specific circumstance, you’ve got nothing to lose!

The What’s-What of Botox Immunity is a post from: Botox Patient

Jevederm & Botox

Botox Patient — Mon, 17 May 2010 21:24:19 +0000

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

Injectables for aging earlobes

Botox Patient — Thu, 24 Dec 2009 08:24:22 +0000

Not exactly the first body part we think of when battling signs of aging, but why shouldn’t our ears get equal attention?

The earlobes can be just as symptomatic as the face or
neck in the battle to slow down aging. Years of sun exposure and gravity-exacerbating earrings can leave earlobes looking droopy, thin and even wrinkly.

While there’s no anti-aging aging cream specifically for earlobes—that we know of—your doctor can use the fillers usually used for facial lines to improve their appearance.

“If the earlobes are of a generally good size and shape but your earrings are starting to droop, a good option
is to use injectable filler such as Restylane, Juvederm, Radiesse or Sculptra to plump them up and add support,” explains Mount Sinai School of Medicine assistant professor and board-certified plastic surgeon
Matthew Schulman. “If the earring hole is slightly stretched, this will actually make the hole smaller.”

The recovery period is almost nil: results are immediate, and you can wear your earrings again immediately.

Injectables for aging earlobes is a post from: Botox Patient

Blue Collar Botox

Botox Patient — Thu, 03 Dec 2009 17:12:26 +0000

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

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

Botox, Restylane, Juvederm and other filler injections with less pain.

Botox Patient — Fri, 13 Nov 2009 19:05:27 +0000

Botox, Restylane and Juvederm filler injections with far less pain.

Before being injected with your chosen dermal filler, you’ll probably receive local anesthesia, for which you’ll have to wait to work before you get the enhancing injection. The waiting is annoying; the pain more so. But doctors are working on new techniques that make getting an injectable treatment less painful and time-consuming.

A team at UT Southwestern has been combining 2% lidocaine with Radiesse, Restylane and other hyaluronic acid fillers. Tissue is immediately numbed and immediately treated—simultaneously—giving the patient a faster and more comfortable wrinkle-filling experience.

“There is significant time savings in not having to wait for traditional dental block anesthesia to take hold,” explains UT Southwestern plastic surgery chairman Dr. Rod Rohrich, “and the procedure is more pain-free with shorter recovery time.” His team’s findings appear in the journal Plastic and Reconstructive Surgery.

Although the aforementioned formulas require manual mixing, manufacturers have begun offering fillers with lidocaine already built in, like Hydrelle and Prevelle.

This couldn’t come soon enough for most of the medical spas and plastic surgery offices I know. And if you’ve ever had Botox or Restylane injections you know what I mean.

Botox Patient: Posted from Medical Spa RX: Wholesale Botox

Botox, Restylane, Juvederm and other filler injections with less pain. is a post from: Botox Patient

Medical Spa RX: Botox from Canada

Botox Patient — Sat, 07 Nov 2009 17:23:29 +0000

From Medical Spa MD: Medical Spa RX has had it’s first physician who has reordered Botox 5 times. In fact, there are a number of them. Woot!

Oddly enough, I consider 5 reoders of Botox significantly significanly more impressive than only 4. (I don’t know why. Perhaps because Medical Spa RX has only been offering Botox for the last 4 months so 5 orders would be more than monthly.)

Medical Spa RX has been shipping orders for something on the order of 4 months now so 5 orders is telling me that we’ve got a number of physicians who switched to Medical Spa RX very shortly after we launched it and have been using it exclusively. (My clincs usually orded Botox or Restyland monthly so that’s where my logic lies.)

We’ve been extremely diligent in makeing sure that Medical Spa MD Members are being taken care of by Medical Spa RX and as far as I’m aware we’ve never yet had a single complaint about the service or product.

I should note here that Medical Spa RX and Medical Spa MD are completely different. Medical Spa RX is Select Partner who offers exclusive services to our Members. (Any technology provider or service company who can provide meaningfull value to our Members is welcome to apply.)

For those physician or medical spa Members who have not yet ordered your Botox through Medical Spa RX and are in a position to do so, I’d highly recommend giving them a chance by placing a small test order of whatever you use most, Botox, Restylane, Juvederm of Dysport.

Also, if you haven’t heard about the group buy option, there’s nothing like it to harness buying power.

Botox Patient: Posted from Laser Treatment MD

Medical Spa RX: Botox from Canada is a post from: Botox Patient