Non-surgical rejuvenation of the eye area

While our surgical operations for the upper and lower eyelid can yield some pretty impressive improvements, not everybody wants to jump directly to surgery right away. Many patients want to know, "Doctor, what can you do for me without getting invasive?"

the answer: quite a lot, actually. The secret is to combine several non-invasive techniques in an artistic way.

For example, when we look at the eye area, we commonly see the combination of:
a) crow's feet,
b) texture changes in the lower eyelid skin,
c) lowering of the brow position, and
d) the "tear-trough" groove, running diagonally downward from the inside corner of the eye, around onto the top of the cheek.

We can use non-surgical methods to address each of these concerns. The combination is synergistic - working together nicely better than any one treatment by itself.

Crow's feet can be significantly reduced with the use of Botox or Dysport. A small dose of Botox (or Dysport) just beneath a low lateral eyebrow can elevate it in a subtle way. Filler injections, such as Prevelle Silk, can be used to fill in the valley of the tear trough area, making it much less prominent. Finally, a light chemical peel or laser can be used to resurface the lower eyelid skin, improving the texture.

Naturally, these options may not be as powerful as their surgical counterparts, but for many thirty and forty-somethings, it's really all they need at the moment.

And none of these options requires a trip to the operating room under anesthesia!

Xeomin approved: but for functional uses only

Xeomin - another botulinum A toxin product - was approved earlier this month by the FDA. In an interesting twist, the FDA approved the drug for certain muscle spasm syndromes - cervical dystonia and blepharospasm - but not for cosmetic purposes yet. That all-important cosmetic approval will probably come at a later date.

Dystonias are neurological movement disorders featuring involuntary twisting and repetitive movements or abnormal postures. About 3 people per 10,000 have this problem, according to epidemiology studies.

What's interesting about Xeomin is that it doesn't have the associated complexing proteins previously needed for Botox and Dysport. The lowered protein load may theoretically reduce the incidence of allergic reactions and the potential for antibody formation.

According to Merz Pharmaceuticals, the manufacturers of Xeomin, more than 84,000 patients have been treated with Xeomin worldwide since 2005. The U.S. is the 20th country to approve the drug for the treatment of cervical dystonia and blepharospasm.

One week only: botox & filler discounts galore

Here's an incredible deal for our loyal readers and friends: 25% off of your next Injectable service for you and your friends. But act fast - this fantastic special is good from now only until August 20, 2010!

This special may not be combined with any other specials or discounts. The minimum purchase is for 25 units of BOTOX Cosmetic, an equivalent amount of Dysport, or one full syringe of the filler of your choice.

Please call to set up your appointment (407) 339-3222, or email us at: theteam@drfiala.com.

It's like a Back-to-School sale on beauty!

Dysport: "Love or leave it" challenge extended thru September

Good news for patients who like Botox and Dysport: Medicis, the makers of Dysport, is extending their "Love it or leave it" challenge, which we detailed here, (link) until the end of September 2010. You can save up to $150 with the promotion, if you qualify for it.

According to the company, of the 49,000 people that have tried it, 90% reportedly voted "love it" for Dysport. Of course, that's a corporate press release...maybe they voted that way because of the cash rebate, we'll never know!

New Dysport promotion: save up to $150

Dysport, as most readers of the Plastic Surgery Blog know, is the new competitor to Botox. Like David taking on Goliath, they have announced an exciting new marketing promotion, called the "Dysport Challenge". It just started March 1, and runs until April 30, 2010.

It's actually quite a deal, especially if you are someone who likes the wrinkle-fighting effects of either Botox or Dysport.

Within 14 days after your first Dysport treatment, you must sign up for the Dysport Challenge, download your Dysport Coupon Rebate Form from dysportusa.com (link) and mail the rebate form and itemized receipt.

If you love it, you can get another $75 rebate on your second treatment of Dysport. Even if you didn't like Dysport for some reason, and prefer the effect of Botox, you can still get a $75 Rebate Check from Medicis, the makers of Dysport, on your Botox treatment!

Technicalities:
You must wait a minimum of 3 months between your first and second treatments.
First treatment must occur between March 1 and April 30, 2010.
Your second treatment must occur between June 1 and September 30, 2010.
Itemized receipts must be submitted with forms.

Dysport - now here

Dysport - the recently approved competitor to Botox Cosmetic - is now being shipped to U.S. physicians. We have both products in our office now, and are testing Dysport, seeing how it compares to Botox, the market leader. So far, there are some subtle differences, but both seem to work well in relaxing dynamic wrinkles of the face.

It will take a little education for patients to get used to the fact that the drug doses are measured differently. Botox units are not the same as Dysport units, even though they sound similar. It's a bit like measuring someone's height in feet, compared to measuring it in yards. Same height, just different numbers. Dysport comes in a 300 unit bottle, Botox comes in a 100 unit bottle - but the clinical effect is approximately the same, as far as we can see, with a 3:1 ratio.

Dysport is priced so that it is a little less expensive than Botox (at the 3:1 conversion ratio), so patients who wish to save a little money while they are fighting their wrinkles may want to give Dysport a try.

Counterfeit Botox

As we've discussed earlier, Botox injections are the most popular cosmetic procedure overall in the U.S. But Botox is expensive - and Allergan, the manufacturer, has been steadily raising their prices each year.

This has created a black market for Botox, with counterfeit and imitation Botox knock-offs. These imitations are not FDA-approved, and vary widely in their potency, quality, and source. But they certainly are cheap....

Many of these imitators originate in China. Brand names such as BTX-A, Botutox, Estetox-A, Refinex, Novotox, Canitox, QuickStar and Linurase are commonly seen knock-offs.

A recent review of these products showed their potency varied widely: from zero potency (no effect at all) to 5 x the indicated potency (way too much).

Counterfeit Dysport is also beginning to show up as well.

Allergan has put holographic stickers on the bottle, in an effort to deter counterfeiting.

If the Botox price quoted appears unusually low, watch out for:
- over-dilution (watered-down) with fewer units of Botox per syringe,
- use of grey-market / black market Botox imitators

If the price seems "too good to be true", ask to see the official Botox hologram.

Can Botox be purchased from Canada? According to U.S. Federal regulations, physicians or corporations can not legally import large quantities of Botox (or any other medication) from anywhere, even if the Botox product was legitimately made by Allergan. Cross-border drug importation is a BIG DEAL to the FDA, who frowns on this practice. Despite this, there are some people that take the legal risk of Federal-level drug importation & trafficking prosecution, in order to save a few dollars of expense.

Caveat emptor.

Reloxin - receives FDA approval today

Botox competitor "Reloxin" (sold in Europe as "Dysport") received its FDA approval today.

The FDA decided to approve both the cosmetic indications (for wrinkles) and the functional indications (cervical dystonia) at the same time - and decided that the drug should be sold under the same name for both categories. So, it's now officially "Dysport" - just like in Europe.

We're waiting for details to be released about the pricing, marketing incentives - such as potential combinations with Medicis' line of fillers, and so forth. These details will be key to the success or failure of the product, I believe.

The next 6 months should prove to be very interesting, to see how pharma giant Allergan responds to the "new kid on the block". I'm expecting sparks to fly!!