Take the Dysport Challenge until September 30

Dysport remains Botox's biggest competition.  Both are terrific for...

• frown lines
• forehead wrinkles
• crow's feet
• bunny lines
• eyebrow lifting

Why choose one rather the other?

1. Some patients like one rather than the other
2. • My wife actually prefers Dysport.
   • A few patients prefer Botox.
   • On the other hand, my mother thinks, "They are the same."
   • Most of my office staff agrees with my mom.
3. Price
   • Dysport is cheaper than Botox
   • Dysport comes with rebates

So, if Botox and Dysport are pretty similar, why not get $150 in rebates with Dysport?

• Receive treatment with Dysport by September 30, 2010
• Register at www.dysportusa.com
• Print the Dysport Coupon Rebate Form
• Mail the rebate form and the treatment receipt to Medicis Aesthetics (the Dysport distributors)
• Receive a $75 check
• If you loved the Dysport, get another treatment in 3-6 months, and get another $75 check
• Even if you prefer Botox, get your Botox in 3-6 months, and get another $75 check

That's confidence in the Dysport product!

Being Consistent with Botox Prevents Wrinkles Even with Less Frequent Dosing

According to recent research from Oregon Health Sciences University, consistent treatments with Botox or Dysport have a wrinkle preventing—or prophylactic—effect.  Patients who begin receiving injections every 3-4 months while in their 30's, 40's, and 50's are able to prevent wrinkles from forming and eliminate many existing wrinkles.

Moreover, after 2 years of treatment at 3-4-month intervals, patients can potentially cut the frequency of their Botox or Dysport treatments by half.  After patients receive Botox or Dysport every 3-4 months for 2 years, the frequency of the the injections can be changed to every 6 months and still achieve good results.

So what should the average person think about this study?

• Younger patients, even in their 30s, should consider starting Botox or Dysport to prevent hyperdynamic wrinkles.
• Patients should try to be consistent (every 3-4 months) for the first 2 years when using either Botox or Dysport.  While such frequent treatment may deter some patients from starting a regimen, eventually they should be able to achieve good results with broader treatment schedules and ultimately at a lower overall treatment cost.

Botox for Marionette Lines? Nope. Choose a Filler Instead

Hi, Dr. Pickart.  I was talking with someone about getting rid of marionette lines, and she was given Botox for that area.  Does that sound right to you?

Anyway, I was going to tell her about Sculptra.  Do you think that 1 vial may be enough for that area?

-Janet F.

Dear Janet,

Actually, the best treatment for marionette lines is NOT Botox.  I do sometimes use Botox to turn up the corners of the mouth, but Botox has NO EFFECT on the marionette lines themselves.
 
I would recommend a filler for marionette lines.  Sculptra is my favorite because it lasts the longest (at least 2-4 years).
 
Regarding how much Sculptra, it depends upon...

• the depth of the marionette lines - Shallow will obviously require less than deep.
• the patient's response to Sculptra - Younger patients respond more vigorously, with more collagen production, compared to older patients.

So, how many vials?  A young patient with mild folds and with a vigorous response to Sculptra might need just 1 vial.  However, an older patient with deeper lines and with less brisk collagen production might need 3-6 vials.  Make sense?
 
Sincerely,
Mike Pickart

The Nefertiti Lift with Sculptra Aesthetic Rather than Botox

About one year ago, I reviewed a published article considering the "Nefertiti Lift" (http://www.pickartplasticsurgeryblog.com/2008/12/the-nefertiti-lift-can-botox-tighten-an-aging-jaw-line.html).  The Nefertiti Lift is a technique for using Botox to rejuvenate the aging jawline and neck.

• My immediate conclusion was...  "I'm skeptical."
• My conclusion one year later, after having tried the Nefertiti Lift on a number of patients:  "Bogus."

However, I have since discovered that Nefertiti Lifts are possible with certain non-surgical techniques.  Botox just isn't the right product.  Sculptra Aesthetic can--non-surgically--rejuvenate some poorly defined jawlines, baggy jowls, and loose neck skin.

Sculptra works by stimulating a patient's body to make collagen.  The manufactured collagen provides volume.  The subsequent inflation helps the patient's tissues stand up at attention.  To some degree, the face and neck are, therefore, lifted.

I have grown more and more pleased with the results from Sculptra.  Nevertheless, I am not throwing out my scalpel.  For most "waddles," the surgical face/neck lift is still the gold standard.

Dr. Pickart To Host More Training Sessions for Sculptra Aesthetic

Dr. Pickart is the only Board Certified Plastic Surgeon in Southern California who trains other physicians on the appropriate techniques for Sculptra Aesthetic.  He has recently returned from...

• Denver, Colorado
• Lawrence, Kansas
• Oklahoma City, Oklahoma
• Houston, Texas
• Galveston, Texas
• Lake Charles, Louisiana
• Lafayette, Louisiana
• Los Angeles, California
• Beverly Hills, California
• Burbank, California
• Encino, California
• Rancho Mirage, California
• Newport Beach, California
• Huntington Beach, California
• Pasadena, California

He will be hosting additional training sessions for physicians in his office in Ventura, California.  Please call if you would like to be included:  (805) 648-4567.

ATX-101: FDA Approval for Dissolving Fat (?!)

Maybe, I shouldn't have been so quick to disparage injection lipolysis.  Kythera Pharmaceutical's ATX-101 just might prove me wrong.

Back in November 2009, I called attention to the farce of injection lipolysis and mesotherapy, also known as...

• LipoZap
• Lipostabil
• Flabjab
• Lipomelt
• Lipodissolve
• Fat-Away

http://www.pickartplasticsurgeryblog.com/2009/11/whatever-happened-to-lipozap.html

Mesotherapy, injection lipolysis, LipoZap, etc., involved injecting bile acids beneath the skin to melt fat--or at least that was the hope.  Compelling advertising enabled LipoZap centers to spring up throughout the United States and Europe.  As is so often the case, clever marketing preceded any clever science.  Without appropriate testing for safety and efficacy, many patients were swindled, and some were seriously harmed.

Enter Kythera Pharmaceuticals.  Led by executives and researchers from the established biotechnology industry (such as Amgen and Allergan), Kythera seems grounded in science and safety.  ATX-101 is Kythera's fat buster.  Preliminary trials have been completed for dissolving lipomas--benign fatty tumors, affecting 2% of the population, which can be painful and cosmetically displeasing.

The traditional treatment for lipomas has always been surgical excision.  However, surgery always entails risks, such as scarring, infection, damage to critical structures like nerves, etc.  The hope is that ATX-101 will significantly reduce the size or eliminate lipomas without the need for surgery.

If ATX-101 were to work on lipomas, then I don't see why it shouldn't work on those stubborn fat deposits that we have inherited from our parents.  Analogous to current lipoma treatments, stubborn fat is now removed with surgery--liposuction.  Wouldn't it be nice to sign up for a few injections rather than a surgical procedure (albeit a minor one)?

Evolence Discontinued

The economic downturn continues to particularly hurt "cosmoceutical" companies.  Evolence is the latest victim.  Ortho Dermatologics (a division of Ortho-McNeil-Janssen Pharmaceuticals, which is itself a division of Johnson & Johnson) has discontinued Evolence.

What is (was) Evolence?

• A soft-tissue filler based upon porcine collagen (from a pig)
• Excellent safety record:  Unlike bovine collagen (from a cow) which caused multiple allergies, Evolence was never associated with a single allergy.
• FDA approved on June 30, 2008:  The federal government was satisfied with its safety and efficacy.
• It has been used similarly to Juvederm and Restylane, especially at the nasolabial folds (connecting the nostrils to the corners of the mouth).
• Less swelling and bruising than Juvederm and Restylane
• Similar longevity as Juvederm and Restylane

If Evolence was similar to Juvederm and Restylane (and with less bruising), why wasn't it more popular?

Lumpiness.  A number of my patients noted that Evolence was not as soft or smooth at its competitors.  While the lumps were never visible, they were palpable (and apparently annoying).

My mother loved Evolence.  Women in their 60s and 70s have thinner skin, which tends to bruise significantly (with all of the injectable products).  When my mother had requested Juvederm, Restylane, Elevess/Hydrelle, or Radiesse, the subsequent bruising had persisted as long as two weeks.  However, with Evolence, the black-and-blue marks were smaller and resolved within a few days.

Evolence has filled a niche in my practice:  It is useful in patients who would like to minimize bruising...

• because they have a big event tonight!
• because they are older.
• because they naturally have thin blood.
• because they are on blood thinners (like Coumadin, Plavix, or aspirin).

What will be the new anti-bruising injectable filler?  In this economy, I don't know.  I certainly hope that Evolence is soon replaced.

Did I Just Get Fake Botox?

The Plastic Surgery Group of Albany has pled guilty to misleading the public regarding fake Botox.  Apparently, five of the physicians in the practice admitted that they used "Tritox" on patients who were told that they were receiving injections of real Botox.

Tritox is a version of botulinum neurotoxin type A--just like Botox.  However, Tritox is not FDA approved.  On the contrary, it is not even approved for use on human beings!

Tritox, manufactured by Toxin Research International, Inc., in Tucson, Arizona, may be a good product.  I don't know; nobody does.  We are all still awaiting research documenting its efficacy and safety.

I suppose that the New York doctors purchased the Tritox in lieu of Botox because the price point was better.  However, those doctors should not have been so short sighted.  In addition to paying their legal fees, the surgical group now faces a fine of up to $500,000, and an order to pay restitution to 150 patients, who had forked over approximately $100,000 for treatments that they thought were for genuine Botox.

Also, the individual surgeons face up to one year in prison and fines of up to $100,000.  (Frankly, these guys got off light.  I am surprised that they are not going to lose their licenses.)

How can you avoid being duped?  Ask your plastic surgeon to show you the vial.  The label on authentic Botox Cosmetic is imprinted with an Allergan hologram.  (Allergan is the manufacturer of Botox.)

The only FDA-approved alternative to Botox is Dysport.  (Check out http://www.pickartplasticsurgeryblog.com/2009/05/ventura-patients-ask-botox-or-dysport.html.)  I really like Dysport--just like I love Botox.  Nevertheless, if you ask for Botox, and if you pay for Botox, that's what you should get.

Botox in Your 20s and 30s: You Can Prevent Wrinkles

I have a friend who is just 29 years old, and she is already getting Botox.  She tells me that its for preventing wrinkles.  Is that legit?

-Sara F.

Surprisingly, yes.

Botox and the other botulinum neurotoxin type-A products (such as Dysport) can prevent certain wrinkles before they even start.

Many facial wrinkles are primarily the result of muscle over-activity.  The most common sites include...

• horizontal forehead wrinkles
• frown lines between the eyebrows (the 11s)
• crow's feet
• bunny lines on the sides of the nose

If those muscles are relaxed, and they are never excessively used, then the wrinkles at those locations will be minimized (if not prevented altogether).

So, when young adults in their 20s and 30s ask whether there is something to do to remain looking youthful, I do mention Botox.  Your friend's Botox habit is legit, Sara F!   However, please remind her about the other basics of skin care....

• Avoid the sun and ultraviolet light.
• Do exercise, and enjoy the great outdoors, but don't forget sunscreen (SPF >30), a hat, and sunglasses.
• No smoking.  Nothing is worse for your skin than tobacco.
• Moisturize.
• Brush and floss your teeth!  Gum disease is one of the causes of "smoker's lines," even in non-smokers.

"Does My Baby Need Botox?"

my wife asked.

I answered, "Obviously, no."

However, you can already tell that our 9-month-old son Matthew did inherit his father's strong corrugator muscles, which will eventually cause frown lines between his eyebrows (sometimes call 11s).  So, decades from now, he will probably be a good candidate for Botox.

Botox is extremely safe, but it has never been studied in infants.  So, Matthew, no Botox for you.  Just stop scowling.  (By the way, what did I do to p*ss you off so much?)