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

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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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Active FX laser skin resurfacing is gaining popularity at medical spas, laser clinics and plastic surgery centers. It’s main competitors are Thermage, Fraxel, and other skin tightening or laser skin resurfacing treatments.

Here’s an overview of Active FX and some links to more information.

The goal of laser skin resurfacing is simple: replace damaged skin with new, fresh skin. Techniques for skin resurfacing have made enormous advances, allowing nearly everyone to achieve close to flawless complexions. Many systems allow for light, moderate or deep laser resurfacing. The primary targets of laser skin resurfacing include:

• Fine lines and wrinkles of the face, especially around the upper lip, cheeks and forehead
• Loose eyelid skin
• Crow’s feet around the eyes
• Pucker marks (smoker’s lines) and frown lines
• Brown spots and splotchy, uneven skin tone
• Scars, especially acne scars
• Loose skin around the neck and jowls

How it Works

The gold standard of laser resurfacing systems, the UltraPulse® CO2 laser delivers thousands of tiny laser pulses in a pattern over the skin. Each pulse heats a column of tissue eliminating pigment discolorations at the surface and creating a zone of heating deep in the tissue. Unique to the UltraPulse Encore, these zones of heating shrink collagen and tighten the skin immediately*. The CO2 laser also offers the benefits of heating deeper layers of skin tissue, thereby stimulating collagen remodeling, tightening* the skin further. Patients can select from a range of treatments depending on the needs of your skin and lifestyle.

What is ActiveFX “fractional” laser resurfacing?

ActiveFX is a fractional laser procedure performed in a single treatment with minimal patient downtime. During the procedure, a high-energy beam of laser light is used to smooth out lines, wrinkles and scars, remove brown spots and other irregularities, and tighten the skin. It also stimulates formation of new underlying collagen to continue improvement over time. With fractional laser treatment, only a fraction of the skin’s surface is treated by the laser, leaving small “bridges” of untouched skin. This technique makes the healing process much faster and enables you to get back to normal activities sooner.

Is ActiveFX right for you?

Treated areas should be washed twice a day with cool water and a mild soap. Use our lotion twice daily to treated areas for 3 to 5 days or until healing is complete. Treated areas should be protected from direct exposure to sunlight. Sunscreen with SPF greater than 15 should be used at all times on the treated areas.

ActiveFX is ideal for you if you:

• Have a busy lifestyle or cannot be away from work for a long time
• Want noticeable results with minimal downtime
• Want to treat dyschromia, fine lines, wrinkles and skin laxity*

What you can expect from ActiveFX

Most physicians perform the procedure in the office with a topical anesthetic cream that is applied 30-40 minutes before the ActiveFX procedure begins. There is little to no pain associated with the procedure – most patients say they feel warmth similar to sunburn. You can drive yourself home after the procedure. With a gentle washing and moisturizing regimen, your photodamaged skin will begin to flake off within 2 days. After about 3-5 days, your doctor will probably let you wear make-up. Pinkness should be gone in about a week.

ActiveFX benefits

ActiveFX treatment produces a dramatic effect on the skin:

• Causes immediate skin tightening*
• Reduces wrinkles and fine lines, and softens deeper frown lines
• Noticeably improves skin tone and texture
• Stimulates new collagen formation and plumps the skin

The results of ActiveFX laser treatment are long-term and, with proper sun protection, can persist for many years. Most effects of treatment become visible right away, whereas others – such as new collagen formation, which leads to continued inner tightening – build up gradually and become more evident over time. Therefore, most people look even better 3-5 months after the procedure.

Additional Information on ActiveFX

http://www.aesthetic.lumenis.com/wt/page/activefx

http://www.lumenis.com/wt/page/pr_1170434066

http://www.skinandhealth.com/details/wrinkles_treatment#wrinkles_co2

Redness after IPL & Laser Treatments: DeepFX & ActiveFX

Reliant UltraPulse Fractional CO2 Laser

Active FX: Physician User Group ~ Medical Spa MD

Active FX: Laser Skin Resurfacing is a post from: Botox Patient

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They’re are a growing number of ‘home laser hair removal‘ devices appearing on the market. This article on do it yourself laser hair removal supposes that medical spas and laser clinics are feeling the heat.

Want to get rid of some unsightly hair, but don’t want to spend the big bucks for electrolysis or a laser clinic? Now, you can buy your own laser and do it yourself.

And people are.

The growth of the at-home cosmetic-device market, which includes personal lasers, has some professionals buzzing. At an annual conference hosted by the American Society of Plastic Surgeons, Barry DiBernardo, a New Jersey plastic surgeon, delivered a talk in Seattle about the pros and cons of the DIY market on the ASPS’s “Hot Topics” panel.

“We have to make sure that the patients are getting good, safe treatments. If they are getting good, safe treatments, then whether they are doing it at home or not, I’m not as worried,” DiBernardo told Wired.com by phone. “What I’m worried about is that they are seeing things in the Skymall on the airplane and spending hundreds of dollars, thousands of dollars on something that is not going to work or is unproven.”

New cosmetic lasers and medical devices including DIY lasers (do it yourself cosmetic lasers) are expected to explode into a $1.3 billion market 2013, up from just $296 million in 2008, according to the analyst group Medical Insights.

The growth in the market appears to be coming from light-based products that claim to either remove or grow hair on the human body. The Silk’n Hair was the first at-home laser device to be approved by the FDA, in 2006, although it didn’t come on the market until early 2008.

The laser hair removers damage the hair follicles that are in their growth phase, generally leading to some permanent reductions of body hair. DiBernardo questioned whether the lasers used in the home devices were powerful enough to get the kind of results that clinics achieve.

“In general, these devices are low-powered versions of the doctor versions. We’ve been doing laser hair removal since 1998, so we know that they work and how well they do,” he said. “I think these home devices have some effect, but they legally can’t have the power of what we fire at people.”

From nother nice post from Wired:

Technorati Tags: laser hair removal, laser treatment, do it yourself laser hair removal, laser clinic, medical spa, cosmetic laser, home laser hair removal, diy laser hair removal

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What happened in medical spas, skin clinics and laser treatment centers in 2009?

Cosmetic enhancements circa 2009 can be divided into three basic categories. Non Invasive includes wash and wear injections and resurfacing treatments such as IPL & laser treatments and chemical peels, and clinical skin care. Minimally invasive falls somewhere in between surgery with visible scars, and the non invasive category, and can be performed in a doctor’s office. Invasive procedures involve surgery done to reshape or refine parts of the face and body, typically involving an office or hospital setting and anesthesia. Most common are breast augmentation, liposuction, mini face lifts and pretty much anything that involves a scalpel.

In the overall scheme of things, there is no ideal time frame to jump on the Botox® bandwagon, although the trend is certainly towards doing things earlier as a preemptive strike for maintenance and to forestall the day when everything goes south. But there will come a time when creams stop doing enough to make you content with the way you are aging, and you start to wonder what else is out there. You don’t have to take it lying down (although lying down does make sagging disappear – try holding a mirror above your head).

The next logical step from wrinkle creams and sunscreen are chemical peels, laser treatments, and intense pulsed light treatments (IPL) that can even out skin tone and improve texture.

Botox is brilliant for lines around the eyes, forehead and mouth. Dermal fillers such as Restylane, Evolence and Radiesse are de rigeur for plumping furrows, creases and deeper folds. Brown spots and sun damage can be helped with a course of Fraxel or Pearl. For slack skin, tightening devices such as Thermage and Titan can deliver a subtle lifting effect on droopy brows and necks. The final stage before considering surgery tends to be a combination of several of these to maximize the anti-aging results.

Of course, when the non invasive treatments stop delivering what you really want in terms of sagging, sinking and bulges, you might consider a short scar face or neck lift and some minor eye rejuvenation surgery to reduce excess skin and fat deposits.

Botox Patient: Posted from Laser Treatment MD

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Thermage is FDA approved for tightening and thickening skin without surgery. This non-invasive choice is particularly attractive for patients who don’t want to undergo the more drastic effects of a traditional surgical facelift and its associated recovery period.

Thermage uses a radiofrequency (RF) technology to heat the deep layers of the skin while protecting the skin’s outer layers with a cooling cryogen spray. This deep heating promotes immediate collagen contraction beneath the skins surface and generates new collagen growth over time.

Thermage: Key Points

• Thermage is approved by the FDA for skin tightening and collagen growth.
• Thermage provides an alternative to traditional surgical face lifts.
• Thermage not only treats existing conditions, but is also a preventative treatment for future problems including wrinkles, loose skin and collagen loss.
• Thermage can treat any area of the body but is most commonly used on the face, around the eyes and forehead, cheeks and jowls, and the neck. Results actually increase over time. With maximum results usually achieved up to 6 months after the treatment.
• Thermage “Vectoring” can be used for more specific results. Vectoring uses a second, double row of pulses to tighten skin along specific lines or “vectors”. In this way we can perform eyelifts, neck lifts, bags around the eyes, crows feet, or any part of the face where loose skin is unwanted.

Thermage: Key Benefits

• Thermage tightens skin and stimulates new collagen growth.
• Thermage can be performed in 2-3 hours under local anesthetic.
• Thermage actually “tightens” skin rather than stretching skin.
• The results look completely natural
• The cost is less than traditional, surgical facelifts
• The results are very long lasting or permanent.
• Additional treatments can maximize the effects or just maintain results.

Thermage: Benefits in comparison to traditional surgical face lifts

• No cutting. No stretching. No stitches. No scars.
• Thermage requires no physical recovery time.
• The skin is tightened rather than stretched, eliminating the pulled look that can happen with traditional face lifts.
• The chance of complications or infection is almost nil.
• Thermage can be combined with other treatments like filler injections and Pointé Lifts for more dramatic effects.

Possible Complications with Thermage Treatments:

Thermage complications are very rare. The device contains three computers that constantly monitor the amount of energy being delivered. However, as with any medical treatment there exists the possibility of other results, including:

• Burns; in clinical trials for Thermage less than 1% of patients received any burns. (There were only two that healed completely and without complication). At Surface, we have never seen a burn.
• The effect is less dramatic than the client wants: However, Thermage can be used as a treatment more than once. Results can be improved or enhanced with additional treatments like Botox or Surface Pointé Lifts.

NOTE: Thermage has received mixed reviews from both patients and physicians. In our opinion this is because of the way that Thermage has been marketed to physicians as an "add-on" to their practice. Thermage results are highly dependant upon the treatment you receive. While Thermage is now widely available, our recommendation is that you only have a Thermage treatment from a physician who specializes in non-surgical cosmetic medicine and has a laser clinic, skin clinic, or laser treatment center with experience with this treatment.

Botox Patient: Posted from Laser Treatment MD

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When it comes to the cosmetic laser field, we can sometimes feel adrift at sea with little more than a compass and the stars to guide us. We're either doing laser treatments according to our laser manufacturers' guidelines, which are conservative and often inadequate to produce excellent clinical results. Or we're trying new laser treatment settings without the benefit of knowing what other doctors have tried.

If we discover something important, we have no forum to discuss this information with our colleagues. Many of us experiment in our clinics, but we don't share our problems, successes, failures and thought processes with anyone. As a result, we make little progress because we don't benefit from others' advances and insights.

This has flattened our learning curves. Innovation-if and when it comes-is slow. This needs to change. And it begins with doctors simply talking to each other. Participating in Internet-based user groups is one of the easiest ways to do this. Such a forum allows us to share our ideas, experiences and opinions so that we can learn from each other.

The collective intellectual capacity among us, as cosmetic laser providers, is tremendous. If we all worked together, we would discover and share treatment protocols that are more effective and less painful, and produce fewer complications. We would discover better ways to reduce and treat complications when they do arise. Our field would become stronger, and we'd become better practitioners.

Unfortunately, cosmetic laser practitioners have little clinical exchange compared to other specialists, such as cardiologists. These physicians have thorough initial training with a three-year residency and a one- to three-year fellowship. They have mentors, classmates and large practice groups so colleagues can talk to one another. Publications and newsletters keep cardiologists abreast of developments in the field. They stay in touch with their academic training centers, attend meetings and are members of professional associations. In short, they communicate and connect.

What Do We As Cosmetic Physicians Have?

Contrast this to cosmetic laser medicine. Unlike cardiologists, we don't have highly developed professional networks. Nor do we have the formal advanced training. Our main professional association is the American Society for Laser Medicine and Surgery (ASLMS), which hosts a yearly meeting and produces a monthly journal. The ASLMS is a great professional society, but it doesn't serve all of our needs.

Another source of education is the laser companies, which provide clinical training, Webinars and Web sites. The trainers teach the basics, but they're limited by company protocols, which are reviewed by corporate attorneys, and designed to prevent problems rather than to get excellent clinical results.

The laser companies' Webinars are lectures designed to sell lasers, not provide advanced training. Luminaries are paid to do the Webinars, but there's no access to them for detailed follow-up questioning.

What's more, we have to sit at our computers for two hours listening to basic, redundant information to glean one useful, advanced clinical tip. The content of the Webinars are not made available in any other format?-written summary, cassette tapes or CDs-so it's not widely accessed.

If we go to aesthetic laser manufacturers company Web sites for resources, the information is basic and limited. The marketing material, of course, is fresh and current, but the clinical material is dated and sparse.

Other resources are trade publications that keep us abreast of issues in aesthetic medicine. But these magazines don't get into the details of treatment protocols and how to get the best results.

Finally, we have independent blogs, such as MedicalSpaMD.com. This blog, in my opinion, is one of the best ways to get information and find out what other providers are thinking and doing. Some doctors who blog on MedicalSpaMD are experienced users who share their expertise and opinions?, all of which are extremely helpful. But the drawback is too few physicians blog about specific topics.

Several Solutions

Working with laser companies is one way to combat this problem. Laser companies can be particularly valuable in the clinical exchange arena. These companies have the resources to start, support and nurture this activity. They know who their users are, they can enlist the knowledge of luminaries, and they have company doctors and scientists who understand the clinical applications of their laser devices. It's important to mix all of these elements in the proper environment to spur the best advances and innovations from these groups.

M. Christine Lee, MD, MPH, writes that upstanding laser companies "put more money and resources into product development than in marketing and advertising. They have a corporate philosophy that's based on building relationships.investing in new technology and research.[and] nurturing forward vision."¹

It seems almost foolish not to work with cosmetic laser companies, especially since many providers are getting clinical results that are suboptimal. Furthermore, many patients are experiencing complications that can be avoided. (See RealSelf.com for patient complaints and see MedicalSpaMD.com for physician complaints.)

Although aesthetic laser companies don't provide the clinical exchange we need, we can find useful models to emulate outside our field. For example, a medical device company produces Philips NetForum. This community connects Philips users from around the globe in a virtual users meeting so they can share clinical experiences, learn from peers and optimize results.

I'm sure many innovations have occurred when users simply share ideas and explore insights with each other via this Internet clinical forum. If we had this resource, our field would advance dramatically.

What We're Doing As Medical Spa Physicians

As a physician, I have a responsibility to take my part in this call to action. As a result, we're now forming clinical exchange meetings at our Cherry Hill, N.J., clinic. We get together twice yearly with doctors from 20 to 30 other clinics to discuss what works and what doesn't. Part of our meeting focuses on business and marketing, and the other part addresses clinical issues.

We also work closely with MedicalSpaMD.com. We are active visitors to this site and frequent contributors. This Web site is so important that we've actually bought an intense pulsed light (IPL) system based largely on the opinions of the Web site's bloggers, many of whom have had experience with several IPL systems.

We're also forming Internet-based user groups on our own. These groups discuss everything from fractionated CO2 systems to injectables to treating patients with skin of color. Doctors from around the country and the world, including Greece, Australia, France, England and India, share their opinions and experiences.

In addition, we're setting up systems in which providers who attend conferences or listen to Webinars write summaries of what they've heard. These summaries can be posted on Medical Spa MD for others to learn from. Once these summaries are posted, other providers can read them and comment on the issues they're discussing. Of course, we cannot overlook traditional methods of clinical exchange. These are still important and should be developed further. Conferences, publications, newsletters and professional associations are excellent ways to communicate and exchange opinions and experiences.

Cosmetic laser medicine is still in its infancy. We haven't yet worked out the best protocols and new technology is continually emerging.

We have to quickly learn the best ways to use all of our technology for optimal clinical results. The best way to do this is to communicate with each other so we can learn what others are thinking, doing and experiencing. When we actively participate in this learning, our field will advance more rapidly and dramatically. This will benefit all of us. True to the Chinese maxim, when the tide rises, all boats indeed rise higher.

Reference

1. Lee CM. Lasers: what every patient should know, and what your doctor probably doesn't. The ultimate guide for the best skin ever. Bloomington, IN: AuthorHouse; 2006; 163.

Botox Patient: Posted from Laser Treatment MD

Clinical Exchange of Laser Treatments for Medical Spas, Laser Clinics, & Skin Clinics is a post from: Botox Patient

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Medical Spa MD is now publishing training manuals and books for laser clinics, plastic surgery centers and dermatology clinics.

These medical spa training eBooks are designed specifically for medical estheticians, cosmetic laser and IPL technicians and front desk staff, to provide a consistent environment for new hires and keep the staff informed the latest cosmetic treatments.

It’s part of an evolving plan to be able to monetize the huge community of plastic surgeons, dermatologists, laser clinics and medical spas that are part of the community at Medical Spa MD. There are more than 4,000 physician members running laser clinics, medical spas, and skin clinics, and around a million and a half targeted page views, most of which are from physicians (although non-physician numbers are growing).

Medical Spa MD is a community that was started a few years ago and I think it demonstrates how effective you can be if you have information that is not generally available, and know how to build and motivate an online community. Medical Spa MD will never make me rich, but it’s an asset that accrues increasing value over time and more than pays for itself with new opportunities.

Medical Spa RX is the sister site to Medical Spa MD and allows these same dermatologists, plastic surgeons and laser clinics to buy wholesale Botox, Juvederm, Restylane and Dysport from Canada and distribute it world wide.

But perhaps the greatest value of Medical Spa MD is simply the trust and goodwill we’ve grown among physicians. Medical Spa MD’s influence and reach is very long, as attested to the numerous leagal threats, phone calls from lawyers, and cease and desist letters we’ve received.

Botox Patient: Posted from Laser Treatment MD

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