Recent reports have implicated fillers with adverse events. Once again, it is most often the person injecting the filler, not the actual filler product that is the problem. In response to the U.S. Food and Drug Administration’s (FDA) recent report of side effects linked to injectable wrinkle fillers, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) states that wrinkle fillers appear safe when injected properly, in appropriate areas and after a pre-treatment medical history and physical exam performed by a qualified physician. According to the FDA, some injections that resulted in side effects may have been performed by untrained personnel or in settings other than health clinics or doctors' offices. The reports, dating back to 2003, document problems experienced by patients including swelling, allergic reactions and infections. The report says that there is not a clear causal link between the products and the side effects, and does not specify which products were involved. The FDA is planning to consult an advisory panel about amending labeling requirements as well as changing the protocol in the way the products are safety-tested. “Cosmetic fillers have a proven safety record when injected by a properly qualified and trained physician in an appropriate medical setting,” said Dr. Donn R. Chatham, president of the AAFPRS. “While injecting dermal fillers is not surgery, it is still a medical procedure that requires the experience of a physician trained in cosmetic procedures of the face. Today’s highly competitive and marketing-driven world has attracted some who have dubious claims of expertise in injecting these drugs and fillers, and patients may be at risk. Patient safety must be paramount.” The AAFPRS reminds patients and professionals that when a patient requests a facial plastic procedure, and entrusts their face to that physician, that it is in their best interests to seek surgeons who are qualified, trained and experienced in performing those procedures. Board certification signifies that a surgeon has achieved a level of education, training and certification of a high level. And that board certification should be in an appropriate specialty. For more information about injectable cosmetic treatments, appropriate injectors and where to safely access related cosmetic medical procedures, please visit www.injectablesafety.org. The AAFPRS cautions that all procedures have the potential for adverse events and complications. Physicians should have a proper medical history of a prospective patient prior to treatment, and patients should be fully informed and educated about every benefit and risk.

I know that you have heard this before, only to be disappointed with having set your TIVO in vain, but I have been told by pretty high sources that my appearance on EXTRA discussing Fraxel re:pair has been "etched in stone" for Tuesday November 25, 2008 on NBC at 7:00 pm, for what that's worth in "Hollywood". I hope that you and your family have a loving and warm Thanksgiving.

The talented and lovely Ms. Marta Waller had Fraxel re:pair this past summer, and was kind enough to have her experience video documented. You can find the entire 12 episodes of the video documentary on You Tube (http://www.youtube.com/results?search_query=fraxel+repair&search_type=&aq=f). Dr. Persky's appearances on PBS' "American Health Journal", BBC's "Super Botox Me", and KDOC's "OC DayBreak" can also be found on the same You Tube site. Dr. Persky will appear on NBC's EXTRA this Friday, November 7, 2008 at 7 pm. Thanks to Ms. Waller for sharing her Fraxel re:pair adventure with all of us.

I was recently asked about a "quick fix" rhinoplasty on the plastic surgery patient chat line RealSelf.com. This is another case of "if it sounds too good to be true....then it usually isn't". The question involved a quick fix to narrow the bottom part of the nose. Rhinoplasty has been described as the most difficult of all facial plastic surgical procedures by the greatest plastic surgeons in the world. Sculpting the nose to blend in with the other surrounding facial features is the goal. A beautiful nose "gets out of the way" of attractive eyes, cheeks, jaw line, and mouth. Narrowing the base of the nose can be one step in a rhinoplasty, very rarely the only step. When one area of the nose is altered, the rest of nose is usually sculpted to fit the change. The most essential aspect of rhinoplasty is the proper diagnosis of what is causing the perceived problem. Once the diagnosis is made, then a properly qualified rhinoplastic surgeon can carry out the necessary maneuvers to accomplish the desired results. It is essential to choose your rhinoplasty surgeon most carefully. Everyone's nose is different, and surgeon’s skills and aesthetic senses of beauty differ. Take your time and make sure that you and your surgeon are "on the same page" with regard to your expectations and the surgeons ability to meet those expectations. By all means avoid the "quick fix". The first rhinoplasty operation is your best chance at getting the excellent result that you desire. Revision rhinoplasty is more difficult because of what has been removed as well as scar tissue.

Dr. Persky will appear on NBC television's EXTRA scheduled for Friday November 7, 2008 at 7:00 pm. He will be discussing Fraxel re:pair laser rejuvenation treatment. The appearance will be as an "EXTRA Life Changer", where the public asks questions and Dr. Persky gives answers from the web cam in his office. Please give us and NBC EXTRA your feedback on the segment. Thanks.

Plastic Surgery Practice (PSP) reports in their current e-report that "Lipotec has introduced a nonsurgical way to give patients full lips, a new method of vehiculizing hyaluronic acid called Hilurlip. The name doesn't exactly roll off the tongue, but the manufacturer is making big claims for its product. Hilurlip is an oil suspension containing particles of sodium hyaluronate, which is processed to the point at which the particle size is reduced and homogenized up to 1µm—the company claims that this enhances the product's penetration and efficacy, and can provide up to an 18% increase in lip volume. These particles expand when they come in contact with skin water, and reportedly provide long-term plumping of the lips. Hilurlip also contains the tripeptide GHK, a well-known RCS scavenger that protects the lips against photodamage and loss of collagen elasticity. The product can be incorporated into water-free lip care formulations, such as glosses and lip balms. The company advises against using the product in lipsticks. Source: Lipotec" I for one will believe it when I see it. I remain skeptical at this time about product claims of penetrating topically through the skin barrier to impose their effect. How many millions of dollars have been wasted on Strivectin anti-wrinkle cream, and its claims that it is "better than Botox"? Please comment if you have had any experience with these products.