The long awaited FDA approval of Sculptra for facial cosmetic use was announced yesterday. Company spokespersons from pharmaceutical company Sanofi-Aventis announced yesterday that federal clearance had been given to use their dermal filler Sculptra in cosmetic procedures. Although (off-label) cosmetic use of Sculptra has been happening for years, the original FDA approval of Sculptra was for treating lipoatrophy; i.e. facial fat loss, in AIDS patients. People in the industry are excited to get official clearance for this long-lasting dermal filler.

The Food and Drug Administration gave clearance for the following cosmetic purposes:
-Correction of mild-severe nasolabial folds
-Wrinkles and contour irregularities

Regulators based their evaluation of Sculptra on a study of 233 patients that had received treatment with the filler for their nasolabial folds. According to the official press release, the aesthetic results of Sculptra “were maintained up to 25 months after the last treatment session.”

I look forward to using Sculptra to replace lost volume in the faces of my patients in the near future.

Tune in to Sirius Radio, Channel 114 (Doctor's Channel) on Thursday July 30, 2009 at 4:00pm PST (7:00pm EST) to hear Dr. Michael Persky discuss "What's New in Facial Plastic Surgery?" with popular New York City cosmetic dermatologist Doris Day, MD.

You may call in to ask your personal questions live.
Dr. Day has a weekly show on Sirius Radio (Thursdays, 3:00-5:00pm PST, Channel 114) where she discusses a wide range of medical and cosmetic topics.

Dr. Persky is honored to be included as a guest of the show.

Ortho Dermologics announced on June 8, 2009 that Evolence is the first collagen injection product proven to last over one year. The long lasting effect allows physicians to give their patients the natural look of collagen at a great value.

Another advantage of Evolence over other fillers is that there is much less swelling and redness, with the least chance of bruising of all injectable fillers so that patients can have the treatment during the day, and carry on social activities immediately.

In addition, the company is offering a $150 rebate. To find out more about Evolence, where to find a local physician, and the rebate go to:
http://www.evolence.com/email/evolence-experience/july-2009/july-2009.html?utm_source=Q3Newsletter&utm_medium=ViewOnline&utm_campaign=Email%2BNewsletters.

Award winning Emmy writer/director/producer and professional baseball announcer, Ken Levine, wrote a beautiful piece about the late Walter Cronkite. Here is what Ken said:

"He told us that President Kennedy had died.
He told us that we had landed a man on the moon.
He walked us through national conventions.
No one was elected President until he said so.
The Viet Nam War ended when he said it was time to go.
He reported on the bombings of London.
And the Olympic skiers in Squaw Valley.
There were never any articles about his hairstyle.
We never knew whether he was Republican or Democrat.
He reassured us in times of national crisis.
Celebrated our triumphs and called us on our shortcomings.
He had no agendas.
He wasn’t folksy or perky.
He was the voice of reason.
The conscience of the country.
He was just… Uncle Walter. The most trusted man in America. And now that voice has been silenced. We’ve lost the last true journalist the broadcast industry will ever see. Just how monumental is his passing?
Name me one person, anybody, who could be called the most trusted man in America now. I can’t think of one either.
God bless you, Walter Cronkite. You were the best that ever was.
And that's the way it is."

Those of you old enough to have watched Mr. Cronkite know that he always signed off, "And that's the way it is. " You can follow Ken Levine on Twitter.

Allergan Inc said on Thursday that its popular Botox wrinkle-smoother "worked as a treatment for adults suffering from chronic migraines", according to late-stage clinical data.

Allergan said, "data from its phase III clinical trials showed a significantly greater decrease in headache days among patients receiving Botox, compared with those receiving a placebo. The treatment was well tolerated in patients suffering from chronic migraine."

Based on this top-line analysis of its studies, Allergan hopes to file a supplemental biologics license application with the U.S. Food and Drug Administration for the use of Botox in chronic migraine by mid-2009.

Zerona is a new laser device that sounds too good to be true. Using external painless laser light while the patient lays still for 20 minutes of basting on each side: inches are lost from the abdomen, waist, hips, and thighs. As if that weren't enough to cause a stampede of lazy, overweight, indulgent Americans to their local Zerona center, it also appears to decrease fat in areas that aren't even under the laser light (arms, back, etc.). Too good to be true?

Patients undergo a series of 6 forty minute Zerona laser sessions over a two week period (e.g. M,W,F times 2). A second 6 treatment series can be repeated for added inch loss. Very early reports have patients losing a combined 2.5 to 4.5 inches from their waist, hips, and thighs after one series and from a combined 4 to 9 inches lost after two treatments.

The superficial laser light has been used for years in combination with surgical liposuction. The laser creates small pores in the fat cells causing the cells to empty their contents to be metabolized by natural body processes (though I have not yet heard of a definite mechanism, whether the material is eliminated by the kidneys, the intestines, or liver).

The other unknown is how long the results will last, and what ultimate patient satisfaction rates will be. The manufacturers and sales representatives emphasize the importance of diet and exercise during and after the treatment.

If any of you are either early users of Zerona, or patients who have had the treatment, please email your thoughts to drpersky@aol.com, as I continue to do my due diligence on Zerona. In the meantime, I'm going to stick to "My Sharona". Thanks.

As many of us age, we develop an unhappy appearance because of the "scowling" vertical lines between our eyebrows caused by years of using those muscles (hear you mother saying, "Don't make that face, it will stay like that!"). Combined with volume loss in around the corners of a down turned mouth, otherwise very "happy" men and women can take on a sad, angry appearance. But fret not anymore, with a little filler (Restylane, Juviderm, Evolence, or Radiesse) in the corners of the mouth, that unhappy turned down mouth can be uplifted into a happier place. Likewise, a few dabs of Botox between the eyebrows will take that angry scowl away, giving you no choice but to appear happier. Your actual happiness is up to you, but here's to a little superficial happiness. Be well. Dr. P

Bioform, the manufacturer of the popular facial and hand filler Radiesse has received FDA approval for mixing local anesthetic Lidocaine into its product. In clinical trials, the technique of mixing the dermal filler Radiesse with lidocaine showed an improvement in patient comfort and an increase in patient satisfaction, the company said in a statement. Radiesse is the longest lasting of temporary fillers. It is reported to last from one to two years. It is a great filler for replacing lost volume in the face in the battle against the appearance of aging. Its use in hand rejuvenation is very impressive, giving the dorsum (back) of the hand a more youthful look (less wrinkles and prominent veins). Bioform's stock price nearly doubled today after the announcement. Shares of the company were up 22 percent at $2.49, making them one of the top percentage gainers on Nasdaq. Physicians have been manually mixing a small amount of Lidocaine into syringes of Radiesse for the past few years, so I do not expect a large increase in its use among experienced physician injectors. So much for "No pain, no gain!"

You must be very truthful and not tell any lies like our friend Pinocchio. It is important to know that the great majority of your growth has been completed before having a rhinoplasty. There are bone studies that can be carried out to assess the growth maturity of a teen. If a patient has passed through puberty, their shoe size has stabilized (as well as their overall growth), and their skin is not overly thick and oily, then they are a candidate for rhinoplasty (though on the very early end of the age range). It is important that the patient really wants the surgery, and has thought about it for some time. They should not have it done unless they want it from deep in their heart. They should not have it done to "please" their parents. It will not "change one's life" and expectations must be real. Most importantly, choose a well trained, experienced, rhinoplasty surgeon whom you trust. Be well, and remember, no more lies.

Yesterday on the plastic surgery patient chat site RealSelf.com, Carol from La Jolla asked is Fraxel an option instead of facelift "If I don't want to do a Facelift; is the Fraxel laser a good option?" The question stirred many answers (18), so many that after participating in a 12 hour marathon charity golf tournament, I was too late and locked out from answering the question on the site. Here is my answer, "Hi Carol, You have asked a great question and obviously one that strikes controversy in the facial plastic surgery world with close to 20 responses here on RS. To answer your question precisely as you asked it, yes Fraxel repair or Deep FX are excellent options for patients who do not wish to undergo surgical facelift, but desire to look younger, healthier, and natural. Fractionated CO2 lasers will not replace surgical face-lifting (particularly in patients with large amount of excessive tissue), but are one of the best options for those who don't want to have surgery. It is a great treatment for men and women in their 40's and 50's experiencing the dredded early signs of aging, loss of mid facial volume, eyelid wrinkles, and the first appearance of jowling. In many patients who have minimal laxity of their face and neck, there is enough tightening so that face lift is not necessary. Again, depending upon the individual patient's anatomy, there is a subset of patients who will likely not need surgical face-lifting with the combination of fractionated CO2 laser, radiofrequency skin tightening such as Accent XL, and fillers. It also is effective in patients in their 60's and 70's. Great question, please join us at our next plastic surgical meeting on the Controversies Panel. Be well, Dr. P

The Internet has become a source of information for both patients and physicians. Colin Stewart of the Orange County Register online stays current with his articles about plastic surgery at feedblitz@mail.feedblitz.com. Michigan plastic surgeon Anthony Youn, MD airs his opinions and perception about celebrity plastic surgery at www.celebritycosmeticsurgery.blogspot.com/ New York City former patient coordinator for promenient plastic surgeons Ms. Peri Basel's valued opinions and tips can be read at her site itsthelatest.com. Physicians David Goldberg MD and Jason Posner MD in Florida have an informative, cutting edge blog at http://cosmeticmdnation.blogspot.com There are many excellent non-medically related sites as well. For Los Angeles' young mothers looking for information, Jennifer Levinson has a great daily email with everything a mother would need from nannies to weekend activities, see Jen's List at www.jenlevinson.com Once the children get a little older and parenting advice is needed for those tenacious teens, Vanessa Van Petten will keep you 1/2 step ahead, or least up with your teenager at http://www.radicalparenting.com/ Last but not least, author Seth Godin (The Dip, and many others) has a daily email that is often enlightening in our rapidly changing world can be subscribed to at http://www.feedblitz.com/f/f.fbz?Sub=198516.

For those of you who have ever contemplated buying 100% Silicone online and self injecting, just click on the link below and look at the photographs of this "patient's" results. She had recently paid $2300 to a physician for medical silicone injections (some physicians do use medical grade silicone "off label" for cosmetic injections in the face, I do not), she liked her results, but saw no reason why she couldn't save a few bucks and do it herself. Silicone must be surgically removed (very difficult), and it is near impossible to get it all out. Once again, often times you get what you pay for. Choose your injector carefully. To read the full article go to http://inyourface.freedomblogging.com/2009/07/02/horror-results-when-woman-injects-her-own-face/7557/ Another patient apparently had the same thought process and here are her photos http://inyourface.freedomblogging.com/2009/06/25/how-to-save-money-and-disfigure-your-face/7091/

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When performing rhinoplasty and other surgical procedures at The Encino Outpatient Surgery Center, our anesthesiologists inject Diprivan (Propofol) into the IV line to "put the patient to sleep" for the surgery. When monitored by an anesthetist in an operating room, Diprivan is a very safe and effective medication to let patients be asleep, not feel anything, not remember anything, and yet when dosed properly patients are able to continue to breathe on their own without the need for ventilator support. Most importantly, patients awake from the anesthesia quickly and without side effects the great majority of the time. Michael Jackson had been suffering from insomnia and faced with an upcoming London tour, was desperate for help in sleeping. I am saddened to hear that Diprivan was reportedly found in Michael Jackson's Bel Air home after his recent death. Unfortunately for Mr. Jackson, he again found a way to bend medical standards, and apparently "professionals" who could not say no to the allure of his fame and money. Ironically, the same drug used safely many times each day in the surgery center located just two blocks away from a home where one of the world's most famous people once lived, may have contributed to his death in combination with other drugs.