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!

More imitation Botox stuff...

Remember, back in November, we brought you the story of a Texas lady who was illegally selling fake Botox and filler products under the the name "Discount Med-spa"?

Well, it seems that her conviction and sentencing had no effect, as here's yet another website selling bogus imitation Botox under the name Pretique. (link)

This material is to be avoided.

I have no idea what this product is. And no idea what's really in it, how it's manufactured, how potent it is, or any other quality control information. It's certainly not anything remotely legal, and is in no way associated with any of the authentic manufacturers of botulinum for cosmetic uses, like Allergan. It's a scam.

Avoid the use of these knock-off products. They could, like the people who used one of the other imitation products, known as "Tri-tox", put you in the ICU on a ventilator.

And that's not a good way to spend your summer vacation!

(Thanks to medicalspamd.com for the heads-up on this.)

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 evidence of the benefits of Botox

We've always known that Botox is an effective wrinkle fighter. But now, new evidence shows it can actually prevent wrinkles from forming in the first place.

According to research from Dr. Roger Dailey's group at Oregon Health and Science University (OHSU), patients who begin receiving Botox injections between their 30s and 50s were able to prevent wrinkles from forming in the glabella (frown) and forehead regions, as well as eliminating existing wrinkles. To my knowledge, this is the first time I've seen scientific evidence of the long-suspected prophylactic effect of Botox.

In addition, after about two years of regular Botox therapy, Dr. Dailey and associates found that patients could reduce the frequency of Botox® Cosmetic treatments, and still receive most of the same wrinkle-smoothing cosmetic benefits.

Dailey studied 50 women ages 30 to 50, who received regular Botox® injections for two years. "We found that after the patient received Botox® Cosmetic injections every four months for two years, the frequency of the injections can be changed to every six months and still achieve good results," Dailey said. "This demonstrates patients have the ability to achieve good results with broader treatment schedules and ultimately at a lower overall treatment cost.

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.

Spring Specials 2010

Yes...they're here!! Plastic Surgery specials for Spring 2010 (Feb - Apr).

You can find all the details on our website (link)

Included are discounts on breast augmentation, Botox, Juvederm, microdermabrasion and laser hair removal.

Now you can get the best - for a little less! Yay!!

Do-It-Yourself Botox Site Busted in Texas

This story from WFAA-TV in Dallas / Fort-Worth....

Undercover officers raided the home of a Mansfield (Texas) woman who they say was selling "do-it-yourself" wrinkle treatments.

Police confiscated boxes, computers and more at the home of Laurie D'Alleva. Texas Attorney General Greg Abbott charged the woman with illegally offering prescription drugs -- including botulinum toxin (Botox) injections -- without a license.

The legal action also alleges that D'Alleva operated illegal Web sites to market her products. The state obtained a restraining order to keep her from selling the drugs and shut down her Internet sites, Discount Medspa and Ontario MedSpa.

The sites included video demonstrations of how to use the prescription drugs, along with customer testimonials about the results they were getting. Doctors caution that self-injecting or taking any drug without the authorization of a doctor can be harmful -- even deadly.

The state said D’Alleva falsely claimed that her membership in the "Texas Medical Council" authorized her to sell prescription-only products. There is no such organization. According to court documents, undercover investigators bought a “Newbie Starter Kit” from D'Alleva which contained the prescription Restylane in a filled syringe. They also purchased Dysport and Freeze, both of which contain purified neurotoxins, which are used for wrinkle-reduction.

Comment: I don't know what "Freeze" is - it's certainly not an FDA-approved Botox product. People must have short memories: remember the "Tritox" business in South Florida, where some self-injectors of a home-brew botulinum product ended up in the ICU on ventilators?

Don't self-inject. Don't use unapproved, untested compounds, just to save a few bucks.

Senate Dems propose a 5% cosmetic surgery tax

As part of the 2000 page Senate proposal for health care reform released today, Senate Democrats are proposing a 5% tax on cosmetic surgery. More details can be read in the New York Times report (here). The way this proposal is worded, non-surgical cosmetic procedures such as Botox, Restylane and Juvederm, laser treatments and pretty much any cosmetic treatment performed by a licensed professional would be taxed as well.

We've talked about cosmetic surgery taxes before, pointing out how they are unfair to consumers. (see earlier blog here).

Why? Because they are a tax primarily on women, who represent 90%+ of our cosmetic surgery patients - and it's unfair and unconstitutional to disproportionately tax a single group. It's sexist!

Also, this is not a "tax on the rich" - the vast majority of our patients are average, middle-class Americans who are simply trying to fix a physical feature that bothers them.

Although the patient would be taxed, get this, according to the proposal, the physician would be financially liable if the tax were not paid. Unbelievable!

You can read the actual text of the bill here (click for link)

If you would like your voice to be heard about this tax on women, please contact our Democratic State Senator for Florida, Senator Bill Nelson at:
716 HART SENATE OFFICE BUILDING WASHINGTON DC 20510
(202) 224-5274
billnelson.senate.gov

Super Latisse & Botox combo deal

Hot off the press....

I just spoke with our Allergan reps: we will be one of the select few practices in Florida to offer this unbeatable combo bargain.

Buy Latisse (Allergan's eyelash growing treatment) for only $99 per box (regularly $120) and receive a rebate of $50 on a Botox treatment performed before the end of November, with the manufacturer's coupon. Call the office for details, at (407) 339-3222.

Fine print: Limit of 2 boxes of Latisse. While supplies last. Not combinable with other offers.

Save Money! Look Great! - New Internet Discounts

I'm pleased to announce two new specials for our Botox and filler (Juvederm, Restylane, Sculptra, etc.) patients.

Special #1: Bring a Friend and Save.

Book a filler or Botox appointment for yourself and a good friend at the same time. If the friend is a new patient to our practice, we'll give you a credit of 15% of the value of your friend's first completed treatment, which can be used for your own botox or filler treatment, or used in our medi-spa, either on the same day, or sometime in the future.

One small restriction: The credit can not be applied to surgical procedures.


Special #2: Internet special for loyal patients

Have you had three or more treatments with Botox in the past 15 months with us? Or three or more treatments with injectable fillers in the past 15 months in our office? Then you are a loyal patient and we'd like to give you a reward. Just mention the internet-only password of "PSB" when you come in, and we'll give you 50% off your next maintenance treatment with botox or fillers, up to the average dose that you usually get.

This is only for our loyal patients, as defined above.

See, it pays to read PSB - the plastic surgery blog!

New service: Same Day Botox

We're pleased to announce a new service for our patients. We call it "Same Day Botox" - and just like the name implies, we're opening up a limited number of appointments each day for people that want to have their treatment with Botox or any of the injectable fillers that same day. Just call early in the day to set this up.

Patients who have scheduled appointments for these treatments will still be seen at their usual times.

Talk about "instant gratification"! Call us for details: (407) 339-3222

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.

Are you the typical Botox & Filler patient?

Here's an interesting press release from ASAPS (American Society for Aesthetic Plastic Surgery), discussing a new survey in which Botox Cosmetic and fillers like Restylane and Juvederm were now "mainstream" topics of discussion amongst patients, and not any big "secret". This matches with our experience - our female patients openly discuss their treatments, much like they were sharing make-up tips! What I find interesting in this survey is that 7 of 10 Botox users also have HA fillers done.


Survey Shows Majority of Respondents Openly Discuss Use of BOTOX® Cosmetic and Hyaluronic Acid Dermal Fillers

NEW YORK, NY (June 1, 2009) — Despite what some may think, people aren’t hiding their use of BOTOX® Cosmetic and hyaluronic acid dermal fillers. In fact, according to survey statistics released today by The Aesthetic Surgery Education & Research Foundation (ASERF), the research arm of the American Society for Aesthetic Plastic Surgery (ASAPS), nearly nine out of 10 respondents (87 percent) openly discuss their BOTOX® Cosmetic and hyaluronic acid dermal filler treatments with others, with seven out of ten (70 percent) receiving support from the people they told.

“In a similar survey issued four years ago, we dispelled the myth that Hollywood and corporate wives were the typical BOTOX® Cosmetic patient,” says ASERF President Laurie Casas, MD, a plastic surgeon practicing in suburban Chicago. “Now, demographic and perception data trends show us that aesthetic injectable treatments have continued to evolve into mainstream and accepted options for the everyday woman.”

Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent). In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine.

“Interestingly, among BOTOX® Cosmetic patients, nearly seven out of 10 respondents also received treatment with hyaluronic acid fillers with the majority of respondents being treated with JUVÉDERM®,” says Dr. Casas. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ‘surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used.”

Additional findings of the survey found that 72 percent of respondents received BOTOX® Cosmetic injections to treat their glabellar lines – the frown lines in between the brows, while 63 percent of those surveyed received hyaluronic acid dermal filler injections to treat their nasolabial folds – also known as the “parentheses” – the lines around the nose and mouth. A few of the most frequently cited reasons to receive treatment with BOTOX® Cosmetic was “to look more relaxed, less stressed” while patients reported choosing treatment with hyaluronic acid dermal fillers to “look more rejuvenated.”

Best new concept at ASAPS 2009 - Revance therapeutics

Sounds like science fiction, right? - a wrinkle-fighter that works without needles...

One of the coolest products in development that I heard about at the ASAPS meeting belongs to a company called Revance therapeutics, based in Palo Alto, California. They seem to be the first ones to have cracked the problem of getting large molecules into the skin. Usually, large molecules can not be absorbed transdermally, so relatively few medications can be compounded in a gel or patch formula.

While there are countless applications for this drug-delivery technology, their first commercial application using this technology is with botulinum toxin (aka Botox), creating a gel that you put on the surface of the skin, in the area of the animation wrinkles, and presto! - you get the expected Botox-like relaxation effect - no needles involved.

It's still in clinical testing, and is not yet FDA approved, but the presentation I saw of their phase I results for wrinkles in the lateral canthal (crow's feet) area were impressive. The stuff works! Applying the gel in the armpit area also works to reduce excessive sweating, again without the multiple injections we currently use.

Besides working for Botox, the same technology could be applied to a number of other drugs. Imagine, for example, using this idea with insulin - diabetics wouldn't need to use needles.

This could be a real game changer, folks.

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!!

Reloxin - a potential challenger to Botox Cosmetic?

"Reloxin", a form of botulinum toxin, and potential competition for Botox, could go on sale in the U.S. soon.

The FDA is currently evaluating the product, which has been sold in Europe for approximately 15 years under the name Dysport. It's a wrinkle-fighter, similar to Botox, and it also has a good track record of success and a good record of safe use.

Medicis, the U.S. distributor, said it is hoping for FDA approval of their application in early 2009.

It will be interesting to see how this situation works out. Will the newcomer try to under-cut the price of Botox? Will patients be willing to try the newcomer, or stick with the original? The dosing of Dysport and Botox is not directly comparable - so it wouldn't be a simple 1:1 substitution - but both have been shown to be effective for dynamic facial wrinkles.

Botox, made by Allergan, has been the No. 1 cosmetic medical treatment in the United States for the last few years, according to the American Society for Aesthetic Plastic Surgery (ASAPS) procedural statistics.

Special offers on injectables

Good news for those patients who are fans of Juvederm, Restylane, Evolence and Botox: the manufacturers seem to be trying to out-do each other with special offers, rebates and coupons. That means savings for you.

Here's some of the current special offers:

Botox cosmetic
- Schedule your initial botox treatment before February 28, 2009 and receive a $50 rebate coupon from Allergan. Make your follow-up treatment between May 1 and July 1, 2009 and receive a second $50 rebate.


Juvederm Ultra and Juvederm Ultra Plus injectable gel
- Schedule your Juvederm treatment before February 28, 2009, and receive a $100 rebate coupon from Allergan with your second syringe of Juvederm.


Evolence collagen dermal filler
- Schedule your Evolence treatment before December 31, 2009 and receive a $50 rebate coupon for each syringe used, up to $150.


Restylane and Perlane injectable gel
- Schedule your Restylane or Perlane treatments before February 28, 2009, and get the "buy-one, get the second half-off" special.

It seems like the time to get those wrinkles treated, doesn't it!