Blog

Although facial implants offer an excellent long term solution to cheek hollowness, many patients desire a less invasive procedure.  For those patients we recommend a dermal filler.

The goal is to increase volume, and the best way to achieve that is with the patient’s own fat.  Autologous fat transfer involves the harvesting of fat through liposuction of the stomach or buttocks.  The fat is purified and then injected into the subcutaneous area of the cheek. The procedure may be performed in the office or under sedation in the OR.

If liposuction and fat transfer isn’t a desirable option for you, other good choices are wrinkle fillers like Radiesse or Juvederm.  With any of these options, it’s crucial to have a qualified practitioner do the injections.  These treatments seem simple, but a successful cosmetic result often depends on the skilled injection technique of a knowledgeable surgeon.

Researchers associated with the American Society for Aesthetic Plastic Surgery (ASAPS) recently gathered information on 687 patients who had received Botox and/or dermal filler treatment. 

While a summary of the full results can be found in this document; some of the noteworthy findings include the following:

Most respondents described themselves as healthy individuals.  95 percent of patients said they incorporated exercise into their lives, and 78 percent cited healthy eating habits.

• Nearly 70 percent of the respondents who had been treated with Botox also opted for dermal filler treatment.
• 72 percent of the respondents chose Botox to treat glabellar lines – the vertical lines that appear between your eyebrows.  
• 63 percent of the respondents chose dermal fillers to treat facial wrinkles and folds, mostly the nasolabial folds or ‘smile lines’ that travel from the nose to each side of the mouth. 
• Within the respondents, the average or ‘typical’ patient was “a married, working mother between 41-55 years of age with a household income of under $100,000.”
• 66 percent of the respondents said they received Botox treatment 2-3 times per year.
• 87 percent reported that they discussed their treatments with others, and 70 percent said they received support from the people they told.

Last week, the Food & Drug Administration granted clearance to Medicis Pharmaceutical for their new wrinkle reducer, Dysport. Plastic surgeons and dermatologists may have the drug available for cosmetic use in just 30 – 60 days.

Dysport will compete with Botox, as both drugs perform the same basic function – neuromuscular blocking to relax and prevent wrinkles. Dysport however, is said to be more diluted than Botox and thus more cost effective for providers. The recent FDA approval of dysport also came with a unique warning label describing the risks associated with the botulinum toxin.

Rather than rebranding the drug ‘Reloxin’ as planned, Medicis decided to retain its original European name, Dysport

The April 30th announcement coincided with a 3 percent drop in Allergan’s (maker of Botox) shares, and a 14 percent increase of Medicis’ shares. Analysts and industry professionals expect Dysport to carry a slightly lower price tag than Botox, and say it could capture as much as 30 percent of the current market.

For more information on wrinkle treatments in Chicago and Munster, Indiana see our homepage.

Botox injection can work to smooth out facial wrinkles; that’s been firmly established. But that isn’t the extent of its current useage.  If you do a little research, you’ll discover that physicians use Botox for many other interesting purposes.

As reported in the Journal of the American Academy of Dermatology, researchers from Allergan Inc. conducted surveys about sweating, revealing that almost 3 percent of the U.S. population (7.8 million people) believe their sweating to be excessive. At the time of the survey (in 2004), less than half of the respondents had sought medical help for the problem. Botox blocks the localized release of a specific chemical that stimulates sweating, and so the FDA approved it for this use years ago.

Many doctors use Botox to treat headaches, and their basic procedures are hardly different than those of wrinkle treatment. It isn’t entirely clear how the Botulinum toxin provides relief; it may work to inhibit certain pain-transmitting nerves. But evidently, many people suffer from fewer headaches after being treated with Botox.

Last March, the New York Times published a story on the off-label use of Botox to help those who have suffered a stroke and have trouble relaxing certain muscles. According to the experts, “only about 5 percent of the stroke patients who could benefit from its use ever get it.”

Patients with even more obscure conditions have found success using Botox. In Feb 2008, USA Today reported that radio personality Diane Rehm (of National Public Radio) had received routine off-label treatments of Botox for a vocal disorder called spasmodic dysphonia.

Besides these therapeutic uses, surgeons and dermatologists are finding even more cosmetic uses for Botox. Dr. Lawrence Reed recently told an ABC news affiliate that “we’re at the tip of the iceberg where Botox is going to be used.” Reed has apparently been pioneering some interesting new cosmetic applications.

For acne, Dr. Reed injects Botox just below the skin: “It decreases the muscle pump and blocks the production of oils, so we use it for acne,” he claims. Other patients of Dr. Reed found success using Botox to relax certain muscles and actually make their eyes appear larger, and to supplement laser skin resurfacing.

A few words of caution: If you’re considering Botox for any off-label use, make sure you choose a qualified physician. Despite the optimism surrounding Botox as a ‘wonder drug’, there have been complications and side effects associated with off-label use and inexperienced providers

A medical study on the safety of the wrinkle relaxer ‘Reloxin’ was just published in the March-April issue of Archives of Facial Plastic Surgery.  The drug was evaluated for use on moderate to severe forehead wrinkles (or glabeller lines), and the results sound optimistic.

The FDA has not yet given its approval for Reloxin to be sold in the U.S., but spokespersons from Medicis Pharmaceutical say clearance is expected late this year.  Reloxin has the potential to become a real competitor for Botox in the U.S. cosmetic surgery market – a market which allowed Allergan Inc. to net $1.3 billion in revenue last year with Botox.

One California dermatologist who participated in the study commented to Bloomberg news, saying “the side effects are the same as Botox” and “many of our patients liked it even better.”

The composition of both Reloxin and Botox is very similar; they each contain a particular ‘botulinum toxin’ that has been proven to relax the muscles that cause wrinkles in the face.

Reloxin has actually been sold overseas under the name ‘Dysport’ for about 15 years, but Botox has still managed to claim over 80 percent of the worldwide market for the neurotoxin.  One market analyst speculates that “Reloxin may be priced 15 percent lower than Botox” which could allow it to take a significant share of that market.

Last week, spokespersons from Radiesse and Bioform Medical Inc. reported that 1 million syringes of Radiesse dermal filler have been shipped since ‘02.

Radiesse being the staple product of Bioform, is most commonly used to fill nasolabial folds, wrinkles and correct facial lipoatrophy.  The filler has been marketed for cosmetic and therapeutic use in Europe since 2002.  In 2006 FDA approval for aesthetic facial treatments was granted in the United States, expanding Radiesse’ use beyond therapeutic treatments to include subdermal implantation.

At this time, about ten thousand cosmetic surgery and dermatology practices have used Radiesse – a landmark achievement that cements the company’s position as one of the global market leaders in cosmetic surgery products.  The only comparable fillers with such widespread appeal are those made of collagen or hyaluronic acid, both of which have been on the market longer.

Over the last six years, the United States FDA has received about 900 reports concerning injectable wrinkle-filler complications.  Now as consumer demand for fillers has reached an all-time high, officials have decided to organize a discussion with a panel of outside experts to go over possible changes in labeling of the products.

Those in question are fillers like Radiesse, Juvederm, Restylane, Perlane and others that continue to enter the market.  While it may sound alarming, the complications and side effects associated with these products are extremely rare.  There are well known issues like minor swelling and then there are serious allergic reactions, with the latter being a subject of FDA interest.

According to a recent MSNBC news article, Allergan spokeswoman Caroline Van Hove said “no serious problems were seen in clinical trials of Juvederm, and the most common complaint since its approval was swelling in 0.4 percent of patients.”

Also, Food and Drug Administration officials noted that the “reports had several limitations such as failing to say when the problems started.”  The majority of industry professionals will attribute most reported complications to unqualified persons administering the injections.

Safety and proper training is of the utmost importance with almost any cosmetic procedure, so we recommend that all patients seek a trained and knowledgeable Illinois plastic surgeon with the right qualifications.

For more information on the FDA panel discussion, the briefing is located here.