A very intelligent, entertaining, and most beautiful patient was in my office today. She can afford to see the most popular as well as expensive Beverly Hills cosmetic physicians, yet she chose my practice for her facial procedures. After her rhinoplasty months ago I asked, "What was it that made you choose me to operate on your nose?" She answered with one word, her friend’s name (who had rhinoplasty here a few months before), and then simply added, "Seeing is believing". She has subsequently trusted her face to me with fillers and Botox. She shared an experience from her workout at the gym this morning. In the class, the lights are dimmed for the hour of the workout, and most people look better in the wall to wall mirrors in the dimly lit room. The inevitable moment of truth comes at the end of class when the bright lights are turned back on. In one of those "ah-ha" moments she came up with another cosmetic insight, "You can look good with the lights on!" with emphasis on the “can”. With a non-invasive, safe and effective treatment that combines the precise and individually tailored use of Restylane, Juviderm, or Radiesse and Botox, the Liquid Facelift rejuvenates the face without the cost and downtime of surgery. Patients look rested, healthy, and great with or without the lights on. Seeing is believing.

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".

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.

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.

The newest facial filler has been approved in the United States, Evolence. With rumors that traditional bovine (cow hide) collagen will not be available soon, this new product will be used in those patients who are unable to tolerate hyaluronic acid fillers. It is a porcine (pig skin) derived collagen product (we will have to ask the Rabbi if it is Kosher to inject). It is said to last 6 months (we'll see), and unlike previous collagen products will not require allergy skin testing prior to use. It is owned by Johnson and Johnson, so expect to hear about it a lot real soon. I have included their press release below: Herzliya, Israel and Morris Plains, NJ (June 30, 2008) − The U.S. Food and Drug Administration ("FDA") today announced the approval of EVOLENCE® for the correction of moderate to deep facial wrinkles and folds, such as nasolabial folds. EVOLENCE® is a new advanced collagen-based structural dermal filler, and a first of its kind product. The introduction of EVOLENCE® marks the first dermal filler entry for the Aesthetics Group of OrthoNeutrogena. While new to the United States, EVOLENCE® has been available in other markets such as in Canada, Western and Eastern Europe, Israel, South Korea and Russia since 2004. "EVOLENCE® represents a new generation of facial fillers, an innovative structural agent providing beautiful, immediate results by replacing the collagen lost with long-lasting, naturally sourced collagen," said Annie Heremans, M.D., Ph.D., Vice President, responsible for the Company's research and development of the Medical and Aesthetic Dermatology franchises. "We are pleased to enter the U.S. aesthetic space with a differentiated dermal filler designed for optimal patient outcomes. Given our rich heritage in skin care and and commitment to science, we anticipate EVOLENCE® will be a welcome addition to current aesthetic treatment options." EVOLENCE® will be introduced throughout the second half of 2008, in coordination with physician training, to ensure optimal patient satisfaction and outcomes. EVOLENCE® represents a breakthrough in aesthetics. As one of nature's most fundamental and abundant building blocks, collagen comprises up to 80% of the dermis and it helps maintain skin strength, structure and support. Collagen naturally breaks down as a person ages, leading to the appearance of wrinkles, lines and folds. EVOLENCE®, and its proprietary GLYMATRIX™ Technology, uses naturally sourced collagen to replace the body's lost collagen, adding volume and structural support in depleted areas, for a more naturally youthful appearance. In addition, no pre-test is needed, and GLYMATRIX™ Technology delivers longer-lasting durability than previous collagen dermal fillers. Results are visible and immediate at the time of treatment, with minimal to no bruising or swelling, allowing physician and patient to gauge the amount of wrinkle correction with more precision. EVOLENCE® is recommended for the correction of moderate to deep facial wrinkles and folds, such as nasolabial folds, to be injected in the mid-to-deep dermis. "We now have a collagen filler that does not require a pre-test and delivers immediate, beautiful and natural-looking results that last with minimal to little downtime for the patient," said Z. Paul " said Z. Paul Lorenc, M.D., F.A.C.S., Assistant Professor of Surgery, New York University School of Medicine and Principal Investigator on the EVOLENCE® U.S. pivotal study. "EVOLENCE® consistent and predictable results for all patients with every treatment."

I have been fortunate to use Previle Silk hyaluronic acid filler with lidocaine on a few of my patients. It is the first FDA approved hyaluronic acid filler available in the United States. It is manufactured by Mentor Corp. in lovely Santa Barbara, CA. The word "silk" aptly describes the product as it flows and fills very smoothly. It is too early for me to judge how long it will last. It is stated that it should last for 90 days. I like using the product for it's anesthetic effect, and then follow it with the longer acting fillers at the same sitting. This "new kid on the block" will rapidly become a popular hyaluronic acid filler. Patients have been very pleased with the comfort of injection, and I appreciate not having to use dental blocks to fill the lips.

The FDA has approved a new hyaluronic acid facial filler Prevelle Silk. Hyaluronic acid (HA) is the filler material in Restylane, Perlane, and Juviderm. Preville Silk is the first hyaluronic acid product to contain lidocaine, a local anesthetic. In a controlled study, patients reported significantly less pain during injection with Preville Silk as compared to the other HA products that do not contain lidocaine. The new product is manufactured by Mentor Corp. of Santa Barbara, CA. It is still to be seen how long the product will last compared to the other currently available facial soft tissue fillers. I will keep you posted, if you have any questions contact me.

This is a recent post on the PSP eReport: AAFPRS: Botox Is Safe for Cosmetic Procedures In response to the recent news of the FDA's safety review of botulinum toxins in the United States, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) wants to clarify something: the FDA's inquiry relates primarily to high-dose medical uses of botulinum toxin Type A and not its aesthetic uses. Botulinum toxin Type A is indicated and used to treat a variety of often serious medical conditions, in which the drug does not have FDA approval. On the other hand, the FDA has for 6 years approved the drug's use the aesthetic treatment of wrinkles between the brows and involves very different doses. the organization stated this week. On February 8, the FDA announced it was reviewing certain serious adverse events following the use of botulinum toxins, particularly for the management of juvenile cerebral palsy. The AAFPRS further clarified that the adverse side effects under investigation by the FDA occurred in children with cerebral palsy where the therapeutic benefit of using botulinum toxin Type A was achieved in doses that were 15 to 20 times the dose used for aesthetic purposes.

Often times our hands give away our age. Like our faces, the back of our hands lose volume as we age. Great effort is made to rejuvenate the face, but patients will state that their hands "look so old that they give my age away". There is a new break through treatment that restores a younger appearance to hands. The injectable filler Radiesse is being used (off label) to replace lost volume in the hands. The procedure takes about 15 minutes to perform in the office. Patients are very satisfied with the results that last up to one and a half years. For patients who desire a more permanent treatment, the old standard of fat transfer to the hands is available.

The recent stir about the safety of Botox has nothing to do with the cosmetic use of the anti-wrinkle miracle drug. It is still as safe as ever to have a few of your wrinkles erased by Botox. We have used Botox over the past 30 years without any of these recent adverse effect reports. The FDA is reviewing botulinium-based drugs used to treat cerebral palsy and other ills. There have been reported cases of breathing and swallowing problems in pediatric cerebral palsy patients, and even a reported death in a CP child who subsequently died of pneumonia. These patients are receiving botox in doses that are many, many times larger than the small dose that is used for cosmetic treatments. Botox is used in these unfortunate CP patients to relieve muscle spasms in their legs, arms, and necks. Even the physicians who use botox to help CP patients are saying that the overdoses are likely from injectors who don't know how much to use and are using the wrong dosing of the drug. This news is a reminder that Botox is a potent drug and that injecting it is a medical procedure that should be performed by a board certified physician in a medical setting, not in a salon,spa, hotel room, or friend's house.

The recent stir about the safety of Botox has nothing to do with the cosmetic use of the anti-wrinkle miracle drug. It is still as safe as ever to have a few of your wrinkles erased by Botox. We have used Botox over the past 30 years without any of these recent adverse effect reports. The FDA is reviewing botulinium-based drugs used to treat cerebral palsy and other ills. There have been reported cases of breathing and swallowing problems in pediatric cerebral palsy patients, and even a reported death in a CP child who subsequently died of pneumonia. These patients are receiving botox in doses that are many, many times larger than the small dose that is used for cosmetic treatments. Botox is used in these unfortunate CP patients to relieve muscle spasms in their legs, arms, and necks. Even the physicians who use botox to help CP patients are saying that the overdoses are likely from injectors who don't know how much to use and are using the wrong dosing of the drug. This news is a reminder that Botox is a potent drug and that injecting it is a medical procedure that should be performed by a board certified physician in a medical setting, not in a salon,spa, hotel room, or friend's house.