Sculptra Cosmetic to Hit Ventura (and the Whole USA) Soon

Sculptra is an injectable filler that has been used for HIV-positive patients who suffer facial wasting.  It has been an exciting product because it stimulates the patient's own body to produce more of his/her own collagen.  The Sculptra itself does not provide the bulk; the patient does!

Savvy physicians have realized that there was no reason to limit the use of Sculptra just to HIV/AIDS patients.  Routine aging, sun exposure, and weight loss can contribute to a hollow facial appearance in healthy adults.  Sculptra can "reinflate" areas of HIV-negative faces too:

• to lift the eyebrows
• to camouflage bags around the eyes
• to inflate the cheeks
• to minimize folds and lines around the mouth....
• to straighten the jaw line...

Because of Sculptra's success in the treatment of facial aging in healthy patients, the FDA will soon grant Sculptra the right to be marketed for cosmetic use.

(This is similar to the way the FDA treated Botox.  Initially, Botox was FDA-approved only for purely medical uses, such as facial spasms.  However, with its proven track record and with additional research validating its success and safety in cosmetic situations, Botox was given an additional official indication:  wrinkles.  So, it is legal for Botox's manufacturers to market the product for the "frown lines" between eyebrows.)

Of course, there are a number of fillers on the market that are FDA-approved for cosmetic use.  But none helps you to create your own collagen to the degree that Sculptra does.

Even more importantly, none lasts as long as Sculptra:  at least 3 years.  Let's compare the common fillers in terms of longevity:

• Non-animal stabilized hyaluronic acids (like Restylane and Juvederm):  6-9 months  (Don't be fooled by the advertisements, which purport longevities of a year or more.  These products do not typically last even three seasons.)
• Evolence (the new collagen):  6-9 months
• Radiesse (calcium hydroxylapatite):  8-16 months  (I used to think that this product would last 1-3 years.  Then, I recognized that it wasn't ever lasting 2-3 years, so I told my patients that its longevity was probably 12-18 months.  However, now, I am pretty certain that the product disappears in less than a year in at least half of patients.)
• Sculptra:  at least 36 months  (By the way, I used to think that Sculptra lasted only 2 years.  This is the only product that I initially "undersold."  Now, I confidently tell patients that the can expect 3 years, or even longer.)

So, now you know why I've been raving about Sculptra to all of my patients in Ventura County, California.  Sculptra can create a fuller, fresher, and more youthful appearance, and the result should last as long as some "mini-facelifts."

With FDA approval of Sculptra's cosmetic indications, expect to see a lot of advertising for this product.  It is great, and its manufacturers know it.  So, they're going to get the word out.

Sculptra really is the ideal treatment when patients say, "I still feel like I am 35.  But I look like I'm 50!  I'd love to have plastic surgery, but I can't take time off work."  With just a few injections in a few 30-45 minute sessions, Sculpta can produce natural results that won't make you look like Joan Rivers.  I promise.

Ventura Patients Ask, "Botox or Dysport?"

Botox finally has competition in the battle against wrinkles.  Dysport has been clinically tested and utilized in Europe and South America with promising results.  (By the way, Dysport may end up being renamed Reloxin; the marketing is still being fine-tuned.)

 

After reviewing the available literature on Dysport, this much can be said so far:

 

 

1) Dysport and Botox have similar mechanisms of action:  neuromuscular blocking toxin.

 

2) Dysport has less of a protein load than Botox.  Clinically, this means that Dysport will probably result in the formation of fewer antibodies against it.  Antibodies are what our bodies use to detect and destroy foreign proteins.  Hence, the assumption is, if fewer antibodies being formed, the clinical effects of Dysport should last longer than those of Botox(?).  That being said, some clinical trials indicate that Botox has longer lasting results; of course, those studies were sponsored by Allergan (the makers of Botox).

 

3) In at least a couple of clinical studies, Dysport seemed to "spread more" after injection.  If this is true, increased spreading could be both a good thing and a bad thing.  It is good when large areas need injections (such as the forehead for wrinkles, or the underarms for sweating); more spread, fewer injections required, and less likelihood of potential discomfort, swelling, or bruising.  The increased spreading is a bad thing when an injector wants to do extremely fine work.  Only an experienced injector who has a good understanding of more complex musculature (around the eyes, between the eyebrows) would be able to avoid affecting “good muscles” and prevent untoward side effects (blurry vision, droopy eyebrows).

 

4) A unit of Dysport does not equal a unit of Botox.  Some studies show that 20 units of Dysport didn’t provide as much wrinkle reduction at the glabella (the area between the eyebrows) as 20 units of Botox.  However, the comparison wasn’t fair.  A unit of Botox is probably equivalent to 2, 3, 4, or even 5 units of Dysport.  The optimum dosages for Dysport will need to be determined.

 

5) At this stage no significant "red flags" have been raised about the safety of Dysport.  Of specific concern, allergies and infections have not been seen to a clinically significant degree.

 

6) I still haven’t seen the pricing for Dysport.  I hope that it will be cheaper.  In the United Kingdom, a 500-unit vial of Dysport costs about 45% less than a 100-unit vial of Botox.

 

 

As always competition is a good thing.  The emergence of an alternative drug to Botox should spur on pricing competition that will benefit both patients and physicians alike.  Also new research and development is already under way to provide the next "bigger and better" product.  (Mentor, now owned by Johnson & Johnson will be releasing PurTox soon….)

Victoria's Secret "Beauty Secret Firming Bra" is a Bust

We all know that a good bra can help mimic youthful, uplifted breasts.  Wonderbras do look great!

However, can a bra truly give your breasts a lift, even after you take it off?  Can you just wear a bra long enough, so that your breasts will defy gravity on their very own?

It sounds to good to be true, and you're probably right.  The Victoria's Secret Beauty Secret Bust-Firming Bra is another product demonstrating that many companies have more clever staffers in marketing than in research & development.

These Victoria's Secret bras supposedly increase the moisture in the skin of the breasts.  With increased moisture, the skin is more plump.  The increased tumescence of the skin firms the breasts, and indirectly provides the lift.  All you have to do is wear the bra for at least four weeks, eight hours a day, to see an "18%" boost in skin firmness--according to Victoria's Secret.

But, come on!  Where did Victoria's Secret come up with this stuff?!  What hyperbole!

If the skin of your breasts is dry, by all means, purchase a good moisturizer.  Well-hydrated skin looks better, and will be bit more plump.

But if you are really interested in making your breasts look firmer, find yourself a plastic surgeon who is certified by the American Board of Plastic Surgery.  No anti-wrinkle, skin-firming cream on the market is going to firm up the skin enough that you will obtain a significant difference in how the breast looks and feels.

As for this particular bra, none of my patients have tried it, and I will not be recommending it.  I have no idea how it might work.  But, geez, it’s a nice idea if a company could develop a product that would significantly firm and lift the breasts.  Then, I could close my practice and open a lingerie store!

Ventura's 15-minute Nose Job

Hi, Dr. Pickart,

Have a quick question.  Do you do non-surgical nose jobs?  I researched it, and I heard that it involves using injectables such as Botox or Radiesse to shape and to contour the nose.  I am very interested!!!  :)

Sincerely,

Britney

Dear Britney,

I absolutely do non-surgical nose jobs!  I can customize an approach that...

• We can complete in 15 minutes in my office.
• No IV.
• No incisions.
• No stitches.
• No time off work.
• No general anesthesia.
• Just injectables under local anesthesia (like novocaine).
• Except for mild swelling and bruising, you'll be back to normal (albeit with a cuter nose) as soon as you walk out of the office.

Here are the 3 options for a non-surgical nose job:

Botox:

• Botox is a muscle relaxant.  It works by relaxing muscles that cause wrinkles or that distort anatomy.
• Botox is, by far, the most popular non-surgical treatment in the USA and in my office.
• At the nose, Botox is good for dynamic depression of the nasal tip.
• Translation:  When some people smile or frown, they activate muscles in the middle, upper area of their upper lips.  These muscles not only raise their central upper lip (with its bow), but also pull down the tip of the nose.
• Some people who have this anatomy, like it; they think that a dynamically droopy nasal tip is cute.  Other people with this anatomy hate it.
• If you had this anatomy and you disliked it, then I would use Botox to relax the offending muscle.
• Cost:  about $40-50 per treatment.
• Duration of the effect:  3-4 months.
• Therefore, cost per year:  $120-200.

Juvederm/Restylane:

• These products are technically known as hyaluronic acids (HAs).  HAs are natural substances, found in skin, bones, joints, etc.  Elsewhere in medicine, they are commonly used by orthopaedic surgeons to minimize pain in knee arthritis.
• How do they work in plastic surgery?  HAs are clear jellies that function like chemical sponges.  They get bigger by holding in water.  They are used to plump up tissues that are deflated, to fill in folds or wrinkles that are caused by a loss of baby fat or bone, to correct "caved-in" deformities from injuries, etc.
• Juvederm and Restylane are very similar products.  I tend to favor Juvederm, because it is softer than Restylane.  However, both are excellent.
• Both HAs are relatively soft and easy to mold.  It can help to reshape a nose, especially if...
  • there is a depression from a previous injury (to fill in the concavity thereby smoothing the nasal contour)
  • the patient has a flat nose without adequate projection (to augment a nasal tip)
  • the goal is to augment a nasal bridge (such as when a patient's nose projects normally but when thee bridge is low, giving the false impression of a nasal hump)
• Juvederm and Restylane are extremely safe.  I have never heard of an allergy.  None of my patients have ever had an infection.
• Also, both Juvederm and Restylane have an antidote.  If you hate the look of the non-surgical nose job, then you can just dissolve the HA away!  Nearly foolproof!
• Cost:  $450-500 per syringe.  One syringe is usually enough.
• Duration of the effect:  6-12 months.

Radiesse:

• Radiesse is technically known as calcium hydroxylapatite.  It is a calcium-based putty.  Similar products have been used by orthopaedic surgeons to help with the healing of broken bones and by ENT doctors to help with paralyzed vocal cords.
• How does it work in plastic surgery?  Very similar to the hyaluronic acids.  The putty fills in tissues that have deflated, folds that have become deeper, concavities from trauma, etc.
• I like Radiesse when an augmentation needs to be a bit stouter.  Radiesse is a thicker, bulkier product than Juvederm and Restylane.  It tends not to mold quite as well as the HAs, but it can provide a firmer, more durable correction.
• So, a patient with thicker skin may be a better candidate for Radiesse than an HA.  Young men have thicker skin, so I tend to use Radiesse in this group; however, older women have thinner skin, so, for them, I tend to recommend the HAs.
• One area of thick tissue on most faces is the chin.  Radiesse is my preferred product for a non-surgical chin augmentation.  Frequently, increasing the prominence of the chin makes the nose look smaller.  In effect, enlarging the chin balances the face so that the nose no longer looks disproportionately big.
• Radiesse is extremely safe.  No allergies.  No infections.
• But no antidote.  You have to be sure of this one!
• Cost:  $750 per full-size syringe.  For a focal area, a small syringe costs just $375.
• Duration of the effect:  8-16 months.  (I used to think that Radiesse would last 12-18 months, but this was probably an overestimate.)

 
Britney, you and I should really talk about your goals, before we jump into anything.  The goal is to customize the right product for you!!
 
Sincerely,
Mike Pickart

P.S. Thank you for recent referrals for breast surgery.  Glad that your breast augmentation went so well!!

More Trouble for Botox...

It’s been a tough week for Botox.  First, the FDA approved a competitor drug called Reloxin. Then, the agency said both drugs, along with a third called Myobloc, should carry "black-box warnings" to alert patients and doctors to serious safety risks.

What do I think of this ruling?  Nonsense.  This is cover-your-butt politics.

Botox, Reloxin, and Myobloc are each based on chemical ingredients collectively known as botulinum toxin.  While this chemical mix does cause the serious illness botulism, be assured that the overwhelming majority of people who get Botox and similar drugs don’t get botulism.

Nevertheless, some apparent cases have been reported, particularly in children being treated for cerebral palsy.  Remember, however, that these children are not healthy to begin with; they are much smaller than adults; and they are receiving dosages much higher (sometimes 10-fold higher) than the cosmetic dosages used in the face.

(By the way, the use of poisons for medical therapy has a long track record....  A common blood thinner called Coumadin is also the active ingredient in rat poison.  The curare drugs are not only Amazonian arrow poisons, but are also important anesthesia agents for muscle relaxation.  Many of the chemotherapies used to treat cancer are poisonous in excessive dosages.)

So, do I still think that Botox, et. al., are safe when used in healthy adults to treat facial wrinkles?  Yes.  Do I still use Botox on my office staff, my personal friends, my wife, and my mother?  Yes, yes, yes, and yes!

In the FDA's statement, the agency did admit that it has not seen serious problems with approved cosmetic uses of Botox or Reloxin.  Nevertheless, the shizophrenic FDA does require the black-box warning for all uses of the drug.

The bottom line:  Some lawyer is trying to cover the FDA's butt with this advance warning.  Ignore him.

Reloxin: Botox's Worst Nightmare - Competition!

Better than Botox!

Well, you've seen that advertisement before, and you've got to know that no cream can live up to that kind of marketing hype.

But did you know that the makers of Botox are now truly scared?  A European muscle relaxant called Reloxin was approved by the FDA on April 30, 2009.  Reloxin is not necessarily better than Botox, but is probably equivalent.

Whether U.S. plastic surgeons will readily embrace this new and slightly unfamiliar European cousin remains to be seen.  However, there is a big incentive:  Reloxin will almost certainly be much cheaper than Botox.

How did Botox become the most popular cosmetic procedure--by far--in the USA?

• Consistent, reproducible wrinkle reduction, especially around the eyes
• An excellent record of patient safety with very few side effects
• Aggressive marketing, with a lot of name-dropping in the popular media

What is Reloxin?

• Virtually the same chemical composition as Botox
• In Europe, popular for the same facial wrinkles as Botox
• Also, a very good safety record--equivalent to Botox's safety

For years, Reloxin has been used safely and effectively in Europe, where it has been marketed as Dysport.  Moreover, recent head-to-head tests against Botox--performed here in the U.S.A.--have already confirmed Reloxin's efficacy.

Having digested many of these research studies, I must say that I am excited....

• In all studies, Reloxin has worked (just like Botox)!
• And I have identified no significant red flags for Reloxin.  No allergies.  No untoward infections.  (Same is true for Botox.  Both appear to be very safe medications.)
• Reloxin may "spread" more; it may not stay put as much as Botox.  This may be either a good or bad thing.  When treating a large area like the forehead, increased "spread" of the muscle relaxant may enable a plastic surgeon to avoid extra "needle pokes."  On the other hand, if a plastic surgeon is trying to relax only a very specific muscle without affecting its neighbors, then Reloxin's spread may be a handicap.
• In some studies, Reloxin has not lasted as long as Botox.  (And the biggest downside to Botox is that it lasts only 3-4 months.)
• In defense of Reloxin, some of these length-of-efficacy comparisons might not have been fair.  Dosing is different for Reloxin and Botox.  If a patient has appreciated the wrinkle-removing effects of 20 units of Botox between her eyebrows, then an equivalent dose of Reloxin is almost certainly not 20 units.  It may actually be more like 80 units.

Will that 80 units of Reloxin then cost 4 times as much as 20 units of Botox?  Almost certainly NOT!  In the United Kingdom, 100 units of Botox sells for the equivalent of US$525.  However, the cost of a 500-unit vial of Dysport/Reloxin is just US$300.

I know that you are doing the math in your head right now....  When considering equivalent dosages, the British are saving 55% when purchasing Dysport/Reloxin instead of Botox!

Also, figure that most of us American Board Certified Plastic Surgeons have grown pretty comfortable with Botox.  Why would we subject our patients to "greater spread" and to unfamiliar unit dosages unless there is some pretty competitive pricing on Reloxin?

And will the manufacturers of Botox, then, have to lower their prices?

Capitalism in action!  This time, the free market is on our side.

Well, you've seen that advertisement before, and you've got to know that no cream can live up to that kind of marketing hype.

But did you know that the makers of Botox are now truly scared?  A European muscle relaxant called Reloxin was approved by the FDA on April 30, 2009.  Reloxin is not necessarily better than Botox, but is probably equivalent.

Whether U.S. plastic surgeons will readily embrace this new and slightly unfamiliar European cousin remains to be seen.  However, there is a big incentive:  Reloxin will almost certainly be much cheaper than Botox.

How did Botox become the most popular cosmetic procedure--by far--in the USA?

For years, Reloxin has been used safely and effectively in Europe, where it has been marketed as Dysport.  Moreover, recent head-to-head tests against Botox--performed here in the U.S.A.--have already confirmed Reloxin's efficacy.

Having digested many of these research studies, I must say that I am excited....

• In all studies, Reloxin has worked (just like Botox)!
• And I have identified no significant red flags for Reloxin.  No allergies.  No untoward infections.  (Same is true for Botox.  Both appear to be very safe medications.)
• Reloxin may "spread" more; it may not stay put as much as Botox.  This may be either a good or bad thing.  When treating a large area like the forehead, increased "spread" of the muscle relaxant may enable a plastic surgeon to avoid extra "needle pokes."  On the other hand, if a plastic surgeon is trying to relax only a very specific muscle without affecting its neighbors, then Reloxin's spread may be a handicap.
• In some studies, Reloxin has not lasted as long as Botox.  (And the biggest downside to Botox is that it lasts only 3-4 months.)
• In defense of Reloxin, some of these length-of-efficacy comparisons might not have been fair.  Dosing is different for Reloxin and Botox.  If a patient has appreciated the wrinkle-removing effects of 20 units of Botox between her eyebrows, then an equivalent dose of Reloxin is almost certainly not 20 units.  It may actually be more like 80 units.

Will that 80 units of Reloxin then cost 4 times as much as 20 units of Botox?  Almost certainly NOT!  In the United Kingdom, 100 units of Botox sells for the equivalent of US$525.  However, the cost of a 500-unit vial of Dysport/Reloxin is just US$300.

I know that you are doing the math in your head right now....  When considering equivalent dosages, the British are saving 55% when purchasing Dysport/Reloxin instead of Botox!

Also, figure that most of us American Board Certified Plastic Surgeons have grown pretty comfortable with Botox.  Why would we subject our patients to "greater spread" and to unfamiliar unit dosages unless there is some pretty competitive pricing on Reloxin?

And will the manufacturers of Botox, then, have to lower their prices?

Capitalism in action!  This time, the free market is on our side.