First Complication with Dysport--But is it Dysport's Fault?

Ms. LM has suffered the first significant complication that I have ever had with an injectable botulinum neurotoxin (i.e., Botox or Dysport)--ptosis, or drooping of the upper eyelid.

Ms. LM is just 48 years old, and she has been a faithful Botox patient in my Ventura, California, office for over two years.  She has loved...

• fewer wrinkles at the glabella (between the eyebrows)
• softer crow's feet
• reduced bunny lines (on the sides of the nose)
• elevated eyebrows, with more arch 

Despite her youth, Ms. LM has not always been healthy.  She had suffered a stroke 5 years ago, which had temporarily paralyzed her entire left side, including her face, arm, and leg.  Although she has recovered nearly completely, she has admitted to persistent left-sided weakness.

Quarterly Botox has always been terrific, and has never resulted in an untoward effect.  However, this past session, I used the other botulinum neurotoxin type A--Dysport.

Two weeks later, she definitely has a left upper eyelid ptosis--a drooping of the left upper eyelid.

• Ptosis is a known complication of both Botox and Dysport.
• According to most research studies, ptosis occurs in 1-5% of patients.
• However, none of my patients have ever suffered such a complication before.  And I have injected Botox thousands of times.
• Is Ms. LM at particular risk for ptosis because of the stroke and the residual left-sided weakness?
• Then, why didn't Botox unmask the problem?  Why was it Dysport that led to the ptosis?
• Does Dysport "spread" too much?  Is it uncontrollable?
• A single case does not create rule.  However, should I temper my enthusiasm for Dysport?

For now, I have prescribed an eye drop that will minimize the drooping, and I will wait patiently with Ms. LM.  Supposedly, the eyelid will be droopy for 2-6 weeks, rather the full 12-16 weeks that the botulinum neurotoxin type A will be effective elsewhere.  In the future, at least in her case, I will use Botox rather than Dysport.

FDA Approves "Sculptra Aesthetic"

Today, the U.S. Food and Drug Administration (FDA) approved Sculptra for cosmetic purposes.  It's new name will be Sculptra Aesthetic.

I am thrilled!  For non-surgical facial rejuvenation, my patients in Ventura, California, have loved Sculptra.  It will be great to reassure them that their treatments carry a seal of approval.

(Sculptra was originally approved to treat the facial wasting associated with HIV/AIDS.  Savvy physicians have used Sculptra "off label" for cosmetic purposes.)

Sculptra is different than other facial fillers.  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!

While Juvederm, Restylane, Radiesse, et. al., have been great, no product is better for "reinflating" large areas of the face than Sculptra....

• 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...

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.)
• 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 they 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.

Dysport as Effective as Botox: Initial Report after 1 Month

Dysport has been excellent!  For the past month, in my practice in Ventura, California, I have been using Dysport rather than Botox for dynamic wrinkles of the upper face.  My initial impressions have been very positive....

1. Dysport's onset of action appears to be slightly faster than Botox's.  Many long-time Botox users noted the relaxing effects of Dysport within 1-2 days, rather than 3-4 days.
2. The results have been identical.  Dysport has effectively ameliorated wrinkles between the eyebrows, at the forehead, at the crow's feet, etc., just like Botox.
3. Dysport does NOT appear to spread excessively.  There had been some initial reports that Dysport would not stay put!  Plastic surgeons were, therefore, concerned that Dysport might migrate away from the muscle that we hoped to relax, and instead affect a muscle whose function we did not want to change.  I think that we can put this worry to rest.
4. Dysport is safe.  I have still never had a significant complication with any injectable product.  I have now used Dysport on 60-70 patients, and none have had an allergy, infection, droopy eyelid, etc.

The big question remaining is whether Dysport will last as long as Botox.  Not uncommonly, Botox wears off within just 3-6 months.  Hopefully Dysport's effects will have at least an equivalent longevity.  Expect an update in a few months....