At the recent American Academy of Facial Plastic and Reconstructive Surgery meetings in Chicago, Amy S. Anstead, MD; Steven H. Dayan, MD. presented their research, "Botulinum Toxin A Can Positively Impact First Impression". Their research showed that first impressions of a person are influenced by facial appearance and improved by Botox treatment. Photos were taken of the study participants before and after the treatment with the botulinum toxin A, then the photos were randomly divided into books with each subject represented only once per book. Evaluators who were unaware of which pictures had been treated or not treated with Botox completed a survey rating their first impression on various measures of success for each photo in the book. Subjects who received the injections improved first impression scores for scales of dating success, attractiveness, and athletic success The authors did not find any positive correlation between botulinum toxin A injection and increased scores regarding social skills, financial, or relationship success. Dr. Dayan's recent book is entitled "Instant Beauty".

Here's the catch, a national TV show ("The Secret Lives of Women " on WE network) is doing a show on "Trophy Wives", and are requesting a volunteer trophy wife (don't ask me for the exact definition, but you know who you are, or who your friends are) to be treated with fillers (Restylane, Juviderm, Radiesse, Elevess, and/or Preville Silk) and/or Botox. The lucky "T.W." will be treated by Board Certified Facial Plastic Surgeon, Michael A. Persky, MD. Contact at:(818) 501-3223 or drpersky@aol.com

I, like all of you, was and continue to be deeply saddened by the local Metro link train crash in Chatsworth on Friday, September 12, 2008. I know that many survivors suffered facial and other lacerations, some of which may result in permanent scars. I would like to offer those involved in the accident with scars Fraxel re:store laser treatments at no cost. The treatment is relatively painless, quick, and involves anywhere from one to a series of treatments until the scar is maximally improved. The treatment can blend scars so that they are nearly imperceptible. Please call my office to set up an appointment. I hope that everyone heals well and that this service will be not be necessary. Be well.

To those of us that would rather not have needles and shots, there may be some good news on the horizon. PSP eReports tells us that researchers at the University of Massachusetts Lowell Nanomanufacturing Center have developed a skin cream based in part on botulinium toxin, which, according to the patent application recently submitted to the US government, could be administered topically or as a transdermal patch. It had been thought that Botox could not pass through the skin. But the researchers have discovered that the toxin passes through with ease if it is attached to a nanoparticle in an emulsion. The nanoemulsion also keeps the toxin stable, they claim, giving the cream a possible shelf life of up to 2 years. I know many patients who will be happy when this new product hits the market. Stay tuned.

Lumigan 0.03%, manufactured by Allergan as a glaucoma eye drop is gaining popularity as an eye lash enhancer. As noted below in the "warnings" section, one of the side effects is the growth of eyelashes. Patients are seeing imrpovement as soon as 3 weeks. The product is available from physicians by prescription only. Instructions for use for eyelash growth: Remove Lumigan dropper cap and dip eyeliner brush into bottle. Apply with eyeliner brush as you would eyeliner, once daily until lashes are desired length (it may take 1-3 months to achieve the desired length), then once weekly for maintenance. If irritation occurs, stop for 1 week then start again every other day. Rinse after each use and keep brush in clean baggie or replace cap over brush. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor. Warnings: Lumigan® (bimatoprost ophthalmic solution) 0.03% has been reported to cause changes to pigmented tissues. When used for glaucoma as eye drops on the eye, the most frequently reported changes have been increased pigmentation of the iris (the colored portion of the eye), periorbital tissue (eyelid) and eyelashes, and growth of eyelashes. Pigmentation is expected to increase as long as Lumigan® is administered. After discontinuation of Lumigan® pigmentation of the iris is likely to be permanent while pigmentation of the periorbital tissue and eyelash changes have been reported to be reversible in some patients. Patients who receive treatment should be informed of the possibility of increased pigmentation. The effects of increased pigmentation beyond 5 years are not known. For additional Important Information about Lumigan® call 818 501-face.

Innovative British journalist Ms. Kate Spicer traveled to the U.S. this summer to investigate the latest facial cosmetic non-invasive treatments. She began in New York City, where she received Botox and Sculptra injections by doctors including Madonna's cosmetic injection physician Fredric Brandt, MD. She then traveled to Los Angeles, Beverly Hills, and Encino. Having consulted with multiple physicians, she decided to have her periorbital area (upper and lower eyelids) treated with Fraxel re:pair in my office. The one hour documentary entitled, "Super Botox Me" was aired across Europe in August by the BBC's channel 4. An edited version can be seen on You Tube by searching under "Persky Fraxel". In the documentary, Ms. Spicer had actually initially decided to have another Los Angeles cosmetic surgeon perform fat transfer and blepharoplasty. When I heard, plus the fact that she had recent Sculptra injections (which take about three weeks to show their full effects), I called Kate's producer to let them know that I would be remiss as a physician if I didn't let them know that putting fat graft transfers on top of newly placed Sculptra could result in permanent problems. After speaking with the other physician (who consulted with colleagues of his), Ms. Spicer decided to be treated with the non-invasive, safe and effective Fraxel re:pair eyelid treatment. Due to her time constraints of getting the documentary done, her post treatment pictures are very early after the treatment; she had not yet completely healed. Please take a look at an edited version of my participation in the documentary at http://www.youtube.com/watch?v=n5_x3jjRZI0. If you are in Europe, the entire documentary, “Super Botox Me” can be seen by going to: www.channel4.com/video/super-botox-me/catchup.html.

You will soon be hearing of the results of Fraxel re:pair laser from patients who have had the treatment, as well as from the media. I have now treated about 40 patients, 39 have had phenomenal results. One patient did not get the tightening of skin that we had hoped for, nor the overall improvement desired. People are different and we all have slightly different skin health, and we all recover and heal uniquely. My patients and I have found that there is an overall younger appearance of 5 to 10 years. Patients say that they are hearing, "You look rested and healthy". We are seeing tightening of the forehead with a slight elevation of the eyebrows. The affect on the upper and lower eyelids is remarkable making the eyes look younger, in the majority of cases the results are nearly as good as or better than actual eyelid surgery. The most consistent finding is increased fullness and lifting of the cheeks and midface area. This reverses the process of volume loss and sagging that we unfortunately see as the aging process travels through our late 30's, 40's and in those lucky individuals, 50's. The treatment does not get rid of "jowls", but helps a bit. In patients with lax neck skin there is marked improvement. The treatment is not a face or neck lift, and does not replace those surgeries. Overall tone, texture, and color of the skin are very nicely improved. Pore size is improved as well. The results on brown pigmentation have been spectacular, as have the results on acne scarring (both color and evenness of the skin surface). I look forward to continued improvement in patients treated with fraxel repair for up to 6 months after their treatment as there is continued new production of collagen. My only caveat that Fraxel re:pair laser is an extremely powerful laser technology so please choose your physician most carefully. Be well.

I am one of a limited number of U. S. physicians trained and certified to inject Evolence, the brand new collagen product brought to us by Johnson and Johnson. From my experience with Evolence the strengths are that it is FDA approved to fill nasolabial folds (laugh lines), it stimulates platelet aggregation which helps to decrease bleeding and bruising from the injections, patients look good immediately after the injection with minimal swelling and therefore can return to normal social activities immediately. It is a natural collagen product derived from pig tendon, manufactured by a company in, of all places, Israel. Unlike previous collagen products, it is cross linked with the natural sugar ribose which prevents the breakdown of the product. In studies against hyaluronic acids (Restylane, Juviderm) it has been shown to last as long, and even be present up to 12 months after injection. Pig collagen is genetically so similar to human collagen that in tests of over 500 patients there were no allergic reactions. No allergy skin test is required before using this collagen product. Studies have shown that similar to hyaluronic acids, Evolence stimulates fibroblasts and natural collagen production after it is injected. On the down side, "something's not Kosher" about injecting pig collagen into humans (there have been discussions with both Jewish and Islamic clergyand scholars). Vegans and vegetarians have not voiced their views yet. Not that there is anything Kosher about injecting Botox or any of the other injectables currently used in cosmetic surgery. Also, the product is firm and therefore it is not advised to inject into lips. It is injected through a 27 gauge needle which is slightly larger than the needles used for hyaluronic acids. The studies averaged about 3 syringes (3 ml) to correct the nasolabial folds which can potentially become costly. We will be hearing a lot about Evolence in the near future as it is promoted by powerhouse Johnson and Johnson. It will likely become another of the many popular injectable facial fillers available to those who desire to look more youthful.

CLINTON AND COSMETIC MEDICINE As Hillary Clinton, 60, basks in the spotlight at this week’s Democratic National Convention, doctors say she appears to have used some of the tools of cosmetic medicine to fight against the signs of aging. But Clinton would still benefit from more skin-rejuvenation treatments to further the process, they say. Minimally invasive injections and laser treatments are what the doctors see some evidence of, not nip-and-tuck-style plastic surgery. If Clinton has had Botox injections, though, the photo above is evidence that only a modest amount, at most, was used in her forehead. Otherwise, she wouldn’t be able to make that expression. You might think otherwise if you only looked at her smooth forehead in the photo below. Plastic surgeon Dr. Michael A. Persky of Encino suggests that the skin on Clinton’s face looks as though it was firmed-up with a Fraxel re:store laser. Made by Reliant Technologies of Mountain View, Calif., the re:store device is a non-ablative erbium fractionated aser, which rejuvenates the skin with 1 to 2 days of recovery time. Persky says: Hillary Clinton may have had Fraxel re:store treatments, a series of no-downtime laser treatments that help with skin tone, texture, and color, with minimal tightening of the skin. She also may have had Botox and dermal fillers (Restylane, Juviderm, Preville Silk). Ms. Clinton does not appear to have had any major plastic surgery. That’s the type of treatment that Newport Beach dermatologist Dr. Vince Afsahi recommends for Clinton: Many prominent women we treat in our office prefer a subtle-yet-effective transformation when they embark on a skin rejuvenation program. Because they are in front of the camera on a daily basis, non-surgical modalities for treating the signs of aging are recommended. Fillers such as Juvederm for the laugh lines, lip lines, and cheek augmentation can be used. Botox is wonderful for the crow’s feet, frown lines, and glabella [between the eyebrows]. A favorite of many of patients is laser and light based treatments such as photofacials to freshen up the skin, reduce pore size and sun spots before a big event. Most of these procedures can be done with little downtime and the patient returns to work quickly. Beverly Hills dermatologist Dr. Don Mehrabi proposes a series of anti-wrinkle Botox injections plus skin-rejuvenating laser treatments: Hilary Clinton would easily most benefit from Botox injections to the crow’s feet, forehead, and the area between the eyebrows. Her most significant improvement would be to do a fractional resurfacing procedure to even out her skin texture and get rid of the lines under her eyes. Fillers in her laugh lines and the areas around and below her mouth would be great, but the top two suggestions would be Botox and laser resurfacing. Near the convention site in Denver, Dr. Tahl Humes says that Clinton appears to have benefited from wrinkle-fighters such as Botox. “It appears that she has restored a youthful look with a combination of injectables,” said Humes, a specialist in internal medicine who owns Vitahl Medical Rejuvenation Spa in Denver and conducts training sessions on cosmetic injections and Cutera cosmetic laser systems. The Daily News of New York quoted Humes earlier this month and said, “A source tells us Clinton visited a New York plastic surgeon early this month and received injections of a ‘dermafiller’ in her face.” Persky suggested that Clinton should move on to treatments with a Fraxel re:pair laser, a newer skin-rejuvenation device that has attracted wide praise from dermatologists. For Clinton, that “would result in a healthy and rested natural appearance,” he said. For the full article go to http://inyourface.freedomblogging.com/2008/08/26/doctors-propose-more-work-on-hillary-clintons-60-year-old-face/ Stay tuned next week for equal time for Republicans, Cindy and John McCain. Be well. Copyright © 2008 Orange

The current edition of C Magazine, with the beautiful and talented Ms. Meg Ryan on its cover has an article about Fraxel re:pair laser treatment written by Shana Dishell. The photo in the article is the best published photograph of my right hand since The Los Angeles Times photo of the same right hand holding a baseball during the perfect game I pitched for Hamilton High School 3/21/71 against University High School. This is not to imply that I either pitched against or ever treated Ms. Ryan, only that her beautiful face on the cover and my right hand on page 88 just happen to appear in this month's C Magazine. Be well.

These are common general questions that are frequently asked about Accent XL treatment of fat and cellulite: 1: How much does Accent cost per area? Some practices measure the areas by the size of the palm of their hand and charge approx. $150.00 to $250.00 I have found that to be unrealistic, as the areas can vary in size and for maximum results a larger area needs to be covered. In general, bilateral saddle bags and under the buttocks (the banana) is about $500.00 each treatment. The face is $500.00 to $750.00 each treatment. Arms can range from $500.00 to $1000.00 depending on the coverage. It is always best to come in for an evaluation, and packaging is available for a further discount. 2: How many treatments will it take? It varies according to what we set for a goal and the condition of the skin as we begin, also the type of target, i.e.; fat, skin, cellulite? Hydration plays a key role in the success of the treatments. It is important to understand these will not be surgical results. We are working with changing the quality and integrity of the skin, and adipose tissue, not removing it. 3: Dose ethnicity play a role? No 4: Does the type of fat or when it developed make a difference? Yes. This can be evaluated at the consultation. "Baby fat" or "menopausal fat" respond as does cellulite and positional fat, the main characteristic of fat that responds the fastest is when it is more hydrated. 5: How long does it last? There are studies that indicate tissue changes that last into the 16th month of evaluation though ultra-sonography, with evidence that there is ongoing collagen regeneration. As we age and face ongoing environmental factors, it is likely that most tissue will continue to age. Cellulite has other variables that will affect the longevity of the treatment, but with diet and exercise, a touch up treatment every 16 months is recommended. 6: Are there any side effects? Some people experience slight nausea, and or diarrhea when the abdomen is treated, as well as potential break through bleeding between a menstrual cycle. There have been no complications or side effects in our practice that has been noted as ongoing or permanent. 7: Who is a good candidate? Anyone who would like to improve the integrity of their skin and accomplish a more youthful look, as well as those who have from minimal to extreme cellulite. Each person is consulted individually as to what will help them be more successful in achieving their goals. Diet and exercise are discussed. NOTHING, will ever replace healthy nutrition. All healthy supplementation and eating habits that are incorporated will enhance the success of the treatment. 8: Is there a guarantee? No, Places that offer guarantees actually charge for them like an insurance policy. You pay more up front and then they will give you more treatments, if you are not happy. Yet

Recently while cleaning out my desk I came across an article with Audrey Hepburn's list of beauty tips. Ms. Hepburn, an internationally acclaimed beauty, was allegedly a carrier for the Belgian Underground Anti-Nazi Movement in WW II as a teen. She learned the importance of a good heart as well as good character early. Here is her list: 1. For attractive lips, speak words of kindness. 2 For lovely eyes, seek out the good in people. 3. For a slim figure, share your food with the hungry. 4. For beautiful hair, let a child run his or her fingers through it once a day. 5. For poise, walk with the knowledge you'll never walk alone. 6. People, even more than things, have to be restored, renewed, revived, reclaimed, and redeemed; never throw out anybody. Remember, if you ever need a helping hand, you'll find one at the end of your arm. As you grow older, you will discover that you have two hands--one for helping yourself, the other for helping others (by the way, Kirk Douglas in a recent article said that helping others keeps the elderly from becoming depressed). 7. The beauty of a woman is not in the clothes she wears, the figure that she carries, or the way she combs her hair. The beauty of a woman is seen in her eyes, because that is the doorway to her heart, the place where love resides. True beauty in a woman is reflected in her soul. It is the caring that she lovingly gives, the passion that she shows. And the beauty of a woman only grows with passing years. Thank you for your wisdom Audrey, you were physically beautiful, but your soul will remain eternally beautiful.

The PSP eReport reports that 55,000 bottles of Botox A was confiscated by Chinese police. This is an excerpt from the PSP eReport: The Chinese State Postal Authority is warning Wednesday that terrorists may use mail services to deliver lethal biochemicals. "Beijing police have detained 11 suspects involved in the illegal sales and mailing of Botox bacteria," the report states. "Botox—more commonly known for its use as a cosmetic treatment—is a highly poisonous neurotoxin. Botox A can be mixed with powders, liquids, food or medicine and delivered to people by mail. Recipients could die of respiratory failure," the official warning said. More than 55,000 bottles of a Botox A powder preparation have been seized by police. Police in Xinjiang Uygur Autonomous Region have also investigated a case in which explosives were concealed in ziran, a traditional Xinjiang seasoning. The package was found on July 9 in a taxi along with a letter instructing people to use the explosives in attacks on areas around the upcoming Olympic Games. Source: Xinhua News Agency Let's hope that the only Botox in Beijing is Botox Cosmetic by Allergan, keeping a few frown lines and crow's feet away.

Fraxel re:pair laser treatment has gone global. Though the Fraxel repair laser treatment is still only available in the United States in a limited number of practices, I have been fortunate to have the privilege to treat patients from all over the world. Patients from out of town are seen the day after the procedure, 3 days after the procedure, and one week after (some patients need only stay for 3 days after the treatment). With a short 8 to 10 day visit to Los Angeles (Encino), they are able to return home looking years younger and more beautiful. Should you wish to consider a "facial rejuvenation" vacation, our office staff will be happy to make arrangements for you and recommend local hotels to meet your needs.

We have used Accent XL in my practice for the past year without any complications. When performed properly, the Accent XL cellulite treatment is very safe, and patient satisfaction rates have been very high. If too extensive of a treatment is performed at one time, some patients may complain of short lasting nausea due to the break down of too many fat cells. Our nurse who performs the treatment has been treating patients for over two years without any problems. As with all aesthetic treatments, the results and complication rates are dependent on the physician or nurse performing the treatment,as well as the technologythe technology. Therefore choose your practice most carefully, particularly in today's market place where everyone from podiatrists to attorneys are running med-spas with a "supervising physician".