Allergan Q1 Profits: Botox, Dysport, Juvederm Ultra XC

Allergan's Q1 Earnings Call: Allergan's thoughts on it's Botox and Juvederm Ultra XC growth.

You might want to visit our Select Partner Medical Spa RX after reading this.

First quarter sales increased year-over-year 11.2% in dollars and 6.9% in local currencies, boosted by the strong pickup in the sales of medical devices, which grew 18.4% in dollars and 13.4% in local currencies. The growth in the Medical Aesthetics businesses was even stronger outside the U.S. in all regions and across a wide range of countries, with surprisingly strong performance in Europe.

Operating performance was strong, with non-GAAP earnings per share at $0.65, marking an increase of 18.2% versus the result for Q1 of 2009, and comfortably exceeding the Q1 expectations shared with you, the investment community, of $0.57 to $0.59.

Earnings growth was driven by strong gross margin expansion, especially in the Medical Device segment. Careful spending in the selling, general administrative area, whilst we increased investment in R&D by 11.1% on a non-GAAP.

Within SG&A, we however doubled our DTC expenditures versus Q1 of 2009, which of course was the low watermark for spending when the world economy was in crisis. Our plan is to continue to invest in 2010 across our brands and into the recovery of our markets.

During the quarter, we were pleased that we continued to strengthen our R&D pipeline, supplementing our internally development programs with acquisitions and licenses. In January, we acquired Serica, a company with proprietary technology for use in tissue regeneration especially applicable to breast reconstruction, as well as the license for Ser-120 in Phase III clinical development for nocturia. Strategically, we have made good progress in building up a portfolio of urology assets.

We also furthered our aspirations to be the leader in medical aesthetics also in Asia, by reacquiring the rights to BOTOX Cosmetic in Japan and China and expanded our footprint in fast-growing emerging markets by establishing direct operations for all of our businesses in Turkey, effective from the second quarter.

After the out-licensing transaction with Bristol-Myers for neuropathic pain, we've increased our degree of R&D focus on our core specialty areas.

Now I’d like to comment on our expectations for 2010. For the full year earnings outlook, we have brought up the bottom of the EPS range by $0.02 to $3.11 and have left the top end of the range at $3.15 which at the time of the last earnings call expressly excluded the costs of any healthcare reform bill in the United States. With the increase of the Medicaid rebate, extension to managed Medicaid and expansion of eligible hospitals in the so-called 340B program, we estimate that the cost of healthcare reform in 2010 will be approximately $12 million. This is now included in our outlook.

Turning to BOTOX

Sales growth has picked up relative to trends seen across 2009, with growth versus the first quarter of 2009 at 11.3% in dollars and at 6.6% in local currencies. Sales of $331 million were only modestly lower sequentially than Q4, which is always seasonally the highest quarter of the year. Most of this increase was due to the more economically sensitive aesthetic side of the business, as the benefits of the upper-limb spasticity FDA approval in March occurred too late in the quarter to contribute to our sales results.

Outside the U.S., we enjoyed very strong double-digit increases across a wide range of countries, with surprisingly strong growth in several of the main European markets. These global markets are precisely where we are successfully dealing with multiple competitors.

It would therefore seem that the market is recovering as we can measure our market share with only a short time lag. In Europe, on the aesthetic side, we’re holding share at just under 80%, as we deal with the incursions of both Merck’s, with their Zymine and Bocatua [ph] brands and Galderma with Azzalure.

On the therapeutic side, it seems that most of ZMM’s market share gains have been at the expense of Dysport. In the U.S., BOTOX sales growth is less buoyant, as there was no base of Dysport sales in the prior year, but it is clear that the market is growing again.

We estimate that in the aesthetic market, Dysport had somewhere between 13% and 14% share in the first quarter. We'll be curious to see the lasting impact of the Dysport Love It or Leave It promotion after it terminates at the end of May.

In the therapeutic market, Dysport’s share is so far negligible, given the long history and experience of BOTOX use. In Europe and the U.S., we have recently introduced a 200-unit vial, which is useful for injectors treating large muscle groups, as well as for differentiation from competition. Regarding global market share for the fourth quarter, the last quarter for which data is available, we estimate that BOTOX held 79% share in a market growing 13% year-over-year.

Regarding the clinical program for BOTOX for chronic migraine, the clinical trial results of our PREEMPT program were published in Cephalalgia, the journal of the International Headache Society. Regarding facial aesthetics, we've experienced an even stronger rebound in sales than observed with BOTOX. Dermal filler sales grew year-over-year, a very strong 42.4% in dollars, and 34.5% in local currencies, with great growth in all operating regions of the world, with Europe again surprising on the upside.

Juvederm & Juvederm Ultra XC

In the U.S., we've seen huge growth in the JUVÉDERM line since the launch of JUVÉDERM Ultra XC, this is the lidocaine-containing product, in early February. Although we have gained some market share, it would seem that the market is responding strongly to the reduction in treatment pain experienced with this lidocaine-containing product and already a substantial share of the mix is attributable to JUVÉDERM Ultra XC.

We have just initiated print advertising for JUVÉDERM XC and have a PR campaign with TV host Dayna Devon, as our spokesperson to further drive growth. In Europe, we launched new additions to the JUVÉDERM product line, JUVÉDERM Smile at the IMCAS Conference in Paris in January and JUVÉDERM Hydrate at the Anti-Aging Conference in Monaco in March. JUVÉDERM Smile was also approved in South Africa, JUVÉDERM XC in Korea and JUVÉDERM Ultra Plus in Taiwan.

Voluma was recently launched in Brazil and also approved in Taiwan.

Based on our analysis of the world market in Q4, which we estimate grew 12%, it is clear that global market growth has accelerated since then. Our analysis also points to JUVÉDERM market share gains in all regions of the world. Beyond superior product performance characteristics, Allergan also benefits from having full product line.

At the end of the first quarter, Allergan's cash and cash net of debt positions totaled approximately $2 billion and $471 million, respectively. Allergan continued to maintain exceptional cash flow generation capabilities in the first quarter, with operating cash flow after capital expenditures of approximately $161 million, an increase of approximately $56 million over the first quarter of 2009.

The Price Of Fake Botox

Are price increases in Botox motivating some physicians as well as non-physicians to sell fake Botox to their patients?

A Houston physician, Gayle Rothenberg was sentenced to 5 ½ months in Federal prison last Friday for injecting patients with a fake Botox product not approved by the Food and Drug Administration for human use. Apparently Dr. Rothenberg injected at least 170 patients with an unapproved botulism chemical. According to testimony, Rothenberg stopped using Botox after a price increase in January 2004 and began ordering the unapproved drug, which was half the price, despite knowing it was not for human use and labeled only for research purposes. In 2004, when fpur people became paralyzed from the counterfeit Botox, the FDA’s involvement has led to 31 arrests and 29 convictions of individuals selling the fake Botox. In addition to a jail sentence, Dr. Rothenberg must pay more than $98,000 in restitution to her patients and cannot reinstate her suspended Texas medical license.

The case of Dr.Rothenberg is no different than the case of Laurie D’Alleva, another fine citizen of my home state of Texas charged with selling counterfeit Botox. So far D’Alleva’s case has yet to be prosecuted as evidence is still being gathered. The common similarities between the two are that both individuals were motivated by greed to jeopardize patient safety ahead of financial gain.  Laurie’s case is especially intriguing to me based on public opinion. Here is someone who seems to be viewed by her customers as a “business woman” who was doing a “good service” for those individuals who felt that Botox cosmetic was too expensive because the “greedy” doctors were charging too much for the filler. While Laurie seems to be viewed by many as a caring individual, making Botulism more affordable to the masses, public commentary on Dr. Rothenberg is quite the opposite. Comments such as “5-1/2 months? Justice is not only blind, it's stupid. (and maybe corrupt) “ and “That sentence is not even one day of confinement for every defrauded patient!.” I feel the same way as the above two comments, but why is the public sentiment different with these two con-artists? Is it because one is a doctor and one is not?

Personally, I find it very frustrating that the price of Botox has doubled in since its introduction. I remember being excited when Dysport came out because I thought this product would be half the price and would drive the price of Botox down so more patients could afford the price. Sadly, this was not the case. As physicians have to pay more money for Botox, so do their patients. These increasing prices enable individuals such as Ms. D’alleva and Dr. Rothenberg to find counterfeit Botox they can buy at a cheaper price to make a greater profit, while sacrificing patient safety. Laurie d’Alleva’s “Botox” price was probably pennies on the dollar, whereas a physician’s cost for Botox is now at $600 per bottle. Hopefully another pharmaceutical company peddling botulism toxin will come along, get FDA approval and drive the price of Botox down to a more reasonable price for physicians to purchase for their patients. Until then, brace yourself for more Laurie d’Allevas and Dr. Rothenberg’s to come along. Thank heavens for the invention of ventilators!

Guest post by Wendy Hovorka, Valley Laser Surgical Solutions Vein Center,  McAllen, Texas

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Restylane Big Lips Overdose

If you're looking to see what a Restylane or Juvederm lip filler overdose looks like... well, then look no further.

This collection of lip augmentation overdoses is brought to you from Russia, where it looks like you can buy your Juvederm or Restylane wholesale and it's sold in 2-liter bottles.

Plastic surgery is booming thru Russia and it appears from these lip augmentation photos that the natural look isn't really in. There are enthusiasts in Russia tracking down Russian ladies with poor results on social networks and publishing them in special communities, sometimes making fun of them, but sometimes admiring their marvelous lips.

Click to read more ...

Dysport Reviews

Evidently Dysport is very friendly with some docs. Too friendly for the FDA when it comes to promoting Dysport before it's been approved.

From Pierce Mattie PR:

It appears it is not only bloggers that are feeling the heat from the government in regards to their relationships with the brands they write about, but cosmetic dermatologists as well. Recently the FDA made an example of Dr. Leslie Baumann by sending her a warning when she was sourced for several beauty magazine articles regarding her positive praise of Dysport, the newly approved Botox competitor created by Medicis prior to such approval. The warning appears to have more to do with disclosure than anything else, which, mark my words, will be the buzzword of 2010 due in part to both the FTC and FDA.

Dr. Baumann was given 10 days to "clean up her act;" I wonder how her publicists will handle that.

It is a publicist's job to land their client in A+ publications and in this fierce competitive world of Beauty PR, everyone wants to be first to be sourced for being in the know about the latest and greatest beauty treatment.

However, Dr. Baumann's publicists should've been more careful considering her relationship with Medicis as an "investigator" for Dysport. In all of the articles she was quoted in, not once did she disclose this relationship, but merely indicated her praise that the neurotoxin was more effective than Botox.

Medical Spa RX: Botox sales through November.

Here's a chart showing the number of wholesale Botox, Dysport, Restylane, Juvederm and Sculptra orders through MedicalSpaRX.com since the site was launched. You'll see immediately that the number of individual orders per month is growing dramatically.

The numbers above show just how good physicians are finding Medical Spa RX's service and pricing. Almost everyone who's placed a 'test order' of a single vial of Botox as I've suggested before has come back within the next 30 days and placed additional orders, adding to a growing number of physicians who are using RX for the majority of their filler and Botox. (308 orders in November and 87% growth over October.)

I've received some email questions about Medical Spa RX and how it works. Here's some info.

Medical Spa RX is a Select Partner of Medical Spa MD. The RX site an exclusive portal made available exclusively for Medical Spa MD Members to harness the collective buying power of a community of more than 4,000 physicians worldwide.

This exclusive arrangement means that Medical Spa RX has access to a large community of Medspa MD Physician Members, and those same physicians have collective buying power that they don't have by themselves. This large community means that RX can price 100mu of Botox at wholesale prices, much lower than they normally sell it for.

And we've been extremely diligent in makeing sure that Medical Spa MD Members are being taken care of. As far as I'm aware we've never had a single complaint about Medical Spa RXs service or products.

I should note here that Medical Spa RX and Medical Spa MD are completely different entities. Medical Spa RX is a Select Partner who offers exclusive services to our Members. (Any technology provider or service company who can provide meaningfull value to our Members is welcome to apply.)

For those physician or medical spa Members who have not yet ordered your Botox through Medical Spa RX and are in a position to do so, I'd highly recommend giving them a chance by placing a small test order of whatever you use most, Botox, Restylane, Juvederm of Dysport. You can see clearly from the chart above that physicians are obviously ordering more and more.

We're ecstatic that Medical Spa RX is doing so well for our Members and hope that other technology and service providers will make their offerings available to our community. We're actively seeking additional parthers to help. If you're a reputable company who would like to apply to become a Select Partner, please contact us using this form. (You'll need to provide significant benefits to our Members.)

Note: Any post mentioning Botox on Medspa MD is a spam magnet. Spam will be ruthlessly deleted and the spammer reported and blocked.

Single use Botox?

Is your medical spa using a new vial of Botox for every patient?
 

If your medical spa is using a new vial of Botox for every patient, yours will be the first medical spa or cosmetic practice of any kind that I've ever know to do so.

Here's a story from the Las Vegas Review Journal that specifically points out Botox as a 'contributor' to an outbreak of hepatitis C. Of course, if you read the story you'll see that some nurses were observerd 'reusing needles' that contaminated vials of Botox. A very different cause indeed from just using the Botox on multiple patients.

And of course, there's the cost, which almost every medical spa meantioned in the story. (You'd have to get all of your Botox from Canada to afford that.)

Here's the story.

Single-use Botox vials used on more than one patient.

That practice at the Endoscopy Center of Southern Nevada, public health officials have repeatedly said, contributed to the hepatitis C outbreak in the Las Vegas Valley.

A phone call to inquire about the cost of a Botox party was greeted with this information: "It will be cheaper if all the partiers use the same vial."

One business that seems to be going well in Las Vegas is known for throwing Botox parties. That's an ongoing phenomenon across the country where friends get together and drink champagne while their wrinkles are needled away.

"We just couldn't handle it financially," said one medical assistant who asked to remain anonymous. "We would have gone out of business."

Medical assistants at two different spas said their owners only stopped multipatient use of single-use vials of Botox "until things quieted down" after the hepatitis outbreak was announced.

The Review-Journal had little trouble finding medical providers who said they and their companies knowingly broke state and federal regulations.

"You can't have doctors worrying about breaking the law or guidelines or whatever," Niamtu said.

A new company called Dysport is manufacturing a similar product, and the competition could force Allergan to provide smaller dosage vials to physicians who want them, he said.

Now a federal lawsuit filed in California by Las Vegas physician Ivan Goldsmith argues that sales representatives for Allergan Inc., maker of the popular anti-wrinkle drug Botox, promote multipatient use of its 50-unit or 100-unit single-use vials.

Goldsmith's lawsuit alleges that doctors can only make a profit using Botox if they reuse the single-use vials that the drug comes in.

But the complaint also raises issues that go beyond dollars and cents, ones that the community has been acutely aware of since the hepatitis C outbreak became public in February of last year.

The Botox business model "created an unacceptable and unreasonable risk of serious and debilitating injuries and illnesses, including HIV and Hepatitis B and C," states the lawsuit, filed Sept. 29 in U.S. District Court for the Central District of California.

Allergan spokeswoman Kellie Reagan said the product's (Botox) prescribing label has always been clear: single use only.

She wouldn't comment, however, on how Allergan's sales representatives promote the drug's use.

Goldsmith said in the lawsuit that Allergan misrepresented to him "the true and permissible use of the product."

Most patients need far less Botox than is provided by Allergan in either its 50-unit or 100-unit vials, the lawsuit said.

And, according to the suit, the medication can't be saved for later use on the same patient because, once a vial is opened, it must be thrown away within four hours of first use.

Physicians and medical spa providers of Botox contacted by the Review-Journal said Allergan's sales representatives have consistently said vials of Botox could be used for multiple patients.

"No matter what training seminar or continuing medical education course I went to, the Allergan people always said a vial was for multiuse," said Sandra Bledsoe, who operates Focus Medical Weight Loss & Spa. "Many patients only need 15 or 20 units at a time."

"Allergan seminars have demonstrated multiple patient use of the product for years," said Las Vegas plastic surgeon Dr. Julio Garcia, who said he has attended the company's seminars.

Garcia said doctors felt they could be safe if they used a new syringe and needle for each injection, which, even if against the rules, would result in sterile treatments.

The problem comes when mistakes happen, said Dr. Joseph Niamtu, a Richmond, Va.-based cosmetic facial surgeon long active with the American Academy of Cosmetic Surgeons and the Cosmetic Surgery Foundation.

"Someone inadvertently picks up a contaminated syringe and inoculates the entire vial," he said.

That may sound familiar.

Last year, health officials revealed that authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center's Shadow Lane clinic reusing syringes in a manner that contaminated single-use vials of medication.

Nine hepatitis cases were linked to the practice, and more than 50,000 people were urged to get tested for blood-borne diseases.

Medical officials say no cases of hepatitis C have been connected to Botox injections.

Still, Dr. Ihsan Azzam, state epidemiologist for the Nevada State Health Division, said concerns about blood-borne diseases in relation to the administration of Botox can't be dismissed.

He said discussions with some of the state's medical providers have made it clear to him that multipatient use of single-use Botox vials continues in Nevada.

The Review-Journal also contacted providers who say the practice is ongoing.

"I think we need to include use of Botox as a risk factor when we talk about hepatitis," Azzam said.

He noted that after he sent a bulletin to physicians and other medical providers about injection safety in the wake of the hepatitis C crisis in Las Vegas, some providers who administered Botox in their practices were not supportive.

In his directive, which echoes the position of the Centers for Disease Control and Prevention, he wrote: "Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use."

He said a number of providers called him to say that they wouldn't follow the regulations because they knew how to safely administer Botox to multiple patients from a single-dose vial.

"I was very surprised," Azzam said Thursday, adding he hopes state inspectors will catch those who refuse to abide by medical regulations. "Some seemed to be daring me to come after them."

If caught, physicians' licenses would be at risk.

Azzam said Botox providers told him it would not be possible to make a profit if the injection practices he supported were followed.

"I followed the rules," Goldsmith said last week. "And it killed me financially."

Goldsmith is asking the court that his lawsuit be certified as a class action, arguing that more than 100 doctors who invested in the product are affected nationwide, with their economic losses exceeding more than $5 million.

In his lawsuit, Goldsmith said a 100-unit vial of Botox could cost him $1,000, but a patient treatment might only be $500. Because it is a single-use drug, the rest would then have to be thrown away.

"You were losing money that way, not making it," Goldsmith said. "The patient didn't want to eat the cost."

Goldsmith has had a run-in with the Nevada State Board of Medical Examiners, which last year subpoenaed some of his patient records.

The board said it had received information that Goldsmith illegally dispensed compounded medications, dispensed medications without having a pharmacist on site, allowed clerks to dispense medications, and used human growth hormone on patients without meeting Food and Drug Administration criteria.

Goldsmith has denied the allegations and, more than a year after the board's subpoena, no action has been taken.

Garcia said he is following the rules regarding Botox injections, but knows that many in the medical community aren't doing so.

Last year he wrote a letter to the state medical board saying patient safety could be compromised because spa personnel continue to inject Botox "with the doctor not present."

That issue has been in the news lately, the result of recent attempts by the medical board to keep medical assistants from injecting Botox. That effort failed.

"The possibilities of infection, given what is going on when it comes to injecting Botox by whomever, are terrifying," Garcia said.

"We're not talking about 40,000 or 50,000 people. We're talking about hundreds of thousands of injections" in Southern Nevada.

Tracy Jones, a Las Vegas saleswoman, said while she has been a frequent user of Botox, she generally doesn't know if she is the only one receiving Botox from a vial.

"It's not something people ask," she said.

Most medical providers are well aware that Botox, like any injectable medication, can be contaminated when drawn up into a syringe.

To prevent contamination in his Botox injections, Niamtu, the Virginia facial surgeon, said he and his staff every day will draw up five sterile 20-unit syringes of Botox from a 100-unit vial.

Though he said that may not be in accordance with CDC guidelines that say single-use vials cannot be used for more than one patient, Niamtu said he must walk a tightrope between the "practical and the optimal."

He said "something will have to be done," if medical officials in other states become as aggressive in enforcing regulations as he believes they are in Nevada.

"Doctors can't throw away that much medication, and patients aren't going to pay for the extra," Niamtu said. "Allergan will have to step up to the plate and make different quantities of the drug. It may cost them a little more."

Medical Spa RX: Canada Botox hits a new milestone.

Medical Spa RX has had it's first physician who has reordered Botox 5 times. In fact, there are a number of them. Woot!

Oddly enough, I consider 5 reoders of Botox significantly significanly more impressive than only 4. (I don't know why. Perhaps because Medical Spa RX has only been offering Botox for the last 4 months so 5 orders would be more than monthly.)

Medical Spa RX has been shipping orders for something on the order of 4 months now so 5 orders is telling me that we've got a number of physicians who switched to Medical Spa RX very shortly after we launched it and have been using it exclusively. (My clincs usually orded Botox or Restyland monthly so that's where my logic lies.)

We've been extremely diligent in makeing sure that Medical Spa MD Members are being taken care of by Medical Spa RX and as far as I'm aware we've never yet had a single complaint about the service or product.

I should note here that Medical Spa RX and Medical Spa MD are completely different. Medical Spa RX is Select Partner who offers exclusive services to our Members. (Any technology provider or service company who can provide meaningfull value to our Members is welcome to apply.)

For those physician or medical spa Members who have not yet ordered your Botox through Medical Spa RX and are in a position to do so, I'd highly recommend giving them a chance by placing a small test order of whatever you use most, Botox, Restylane, Juvederm of Dysport.

Also, if you haven't heard about the group buy option, there's nothing like it to harness buying power.

Update on 10-11-2009 by Medical Spa MD

Just a heads up. Many of these posts attract a huge number of spam comments. As such, posts are monitored daily. Any specific and identified comments are welcome but all spam comments or anonymous flaming comments are removed and IP addresses identified and/or blocked.

Medica Spa RX: Thank you for your Botox, Juvederm, Dysport & Restylane orders!

We would like to thank Medical Spa MD and all of its members for helping to make Medical Spa RX such a success. To date we have filled over a thousand member orders and have received nothing but great feedback on our pricing and service.

We ship all of our orders overnight when it has a temperature controlled product in it. The remainder are shipped 3 day service. Of course if you wish to take advantage of the huge savings available by becoming part of a group buy, it may take longer than 3 days to receive your order, but the savings are incomparable.

We hope that if you have not purchased from us yet, that you try us out. We do not have order minimums on any product. If you wish to order just 1 vial of Botox, Restylane, Perlane, Juvederm, or Dysport / Reloxin as a test... your order will be shipped immediately.

If you do order from Medical Spa RX, please keep in mind that we only sell to licensed medical professionals with prescriptive authority. We do not sell to individuals with a prescription, as we are licensed pharmaceutical wholesalers and not a pharmacy for individuals.

Thank you again to Medical Spa MD and its members for making this venture such a  success.

Regards,

Michael

The Medical Spa RX Team

Medical Spa RX: Botox, Juvederm, Restylane from Canada... or money in your pocket?

Our newest physician resource and premier provider, Medical Spa RX, is now open and taking orders from licesnsed physicians anywhere in the world for the most commonly used injecatbles including; Botox, Juvederm Ultra 2, Juvederm Ultra 3, Juvederm Ultra 4, Restylane Touch, Restylane Vital , Sculptra, Dysport (Reloxin), and Radiesse.

Medical Spa RX is the first of the resource portals and services that we're  making available to our Members. There are many more in the works that include other medspa products, advertising and marketing partnerships, SEO, and IPL and laser companies. We hope to have the support of our physician and medspa community as we look to harness the buying power and influence of the thousands of doctors who know and trust Medial Spa RX as the one place on the web where physicians can be part of a community and get absolutely unvarnished opinions from other doctors.

Since Medical Spa RX is the first of these partners to go live, it begs a number of questions around when, how and why to use Medical Spa Rx instead of your regular Botox, Juvederm and Restylane providers or pharmacies.

First, let me tell you that Medical Spa RX is a new pharmacy store front exclusively for Medical Spa MD Members from a major Canadian pharmacy that has been in business for many years and currently ships to physicians all over the world. 

Medical Spa RX as a complely seperate and unique entity from this pharmacies regular portals. Why? The prices on Medical Spa RX are much lower than their regular sites and are offered exclusivley through Medical Spa MD to our Members. (If you're not already a Member of Medical Spa MD you can join here for free.) You can't find better service or products anywhere. We've been buying Botox, Restylane and Juvederm for years. Beleive me, we know.

Since Medical Spa RX is a pharmacy in Canada, it rases a number of questions around how easy it is to order across borders, if it's the same Botox and Juvederm sold elsewhere, if it's illegal, and where it's from.

Some of the best reasons to use Medical Spa RX are already being addressed by well know physicians in our community.

...For myself, I'm happy to see this site offering to exercise a little muscle and pricing power by aggregating all of the individual docs and clinics on the site. I'd like to see even more of it. ~ Charles MD

...As with most scope of practice issues, it's really malpractice that might be the deciding factor. If this were something that was not FDA approved in the US it could be much dicier... the mesotherapy problems in Brazil spring to mind, or heart valves made in wherever. I'd place the risk that buying Botox from Canada would come back to bite you at about the same level as accidentally stabbing the patient in the eye with the needle (never heard of it). ~ JRB MD

TF brings up a good point, but we're all been using Botox off label for the last fifteen years of course. (Seems somewhat ridiculous to be using any drug off label and then nit-pick as to what order the words are in on the label as though that matters.) And, of course, it appears that this pharmacy ships world wide.

The most obvious question is: Is it the same Botox, Juvederm or Restylane that I get from my reps. Since Canada is pretty close on the medical front I'm sure that it is. (Bill, my Canadian MD friend will appreciate that.) I would be very reticent to order from South America or Asia. From Canada? Not so much.

Having been on the site for going on 4 years now and having purchased an IPL and laser through the classified listings, I've come to rely on the opinions of the other long time members. Certainly I see the price as being the biggest attractor but I'm also attracted to the idea that this community now has leverage; buying leverage, reputation leverage and whatever other leverages exist. I'm well aware from my visiting technology reps that they're well aware of Medical Spa MD and what the community says about them.

I would guess that those physicians who have not been a part of this site for as long might do otherwise and think of Medical Spa MD as just another occasional resource. It is not, at least for me. For the first time as a single clinic I feel that I'm on a level playing field with the big boys. (Not to be gender specific.) Since Medical Spa RX is offering these kinds of prices exclusively to our community, I'm more than inclined to support them and hope to have other businesses recognize the power of this community in the future. It can only benefit us all.

I would like to buy retail Botox from my Botox rep for these prices... but that's not going to happen. Saving $3000-$5000 a month on Botox and Restylane is money in my pocket that I can use. ~Dermgal

Dermgal's absolutely right that saving $1500 or more a week in Botox and Restylane quickly adds up.

As for the Botox, Restylane and Juvederm, it's the same product sold through every reputable pharmacy. The cost is much lower because it's priced for countries other than the U.S. The copy on the outside of the box probably does not have the same wording as the product sold in the U.S.

While Medical Spa RX can ship anywhere in the world, there are some qualifications. Countries outside of North America aren't afforded the same guaranteed delivery since it's impossible to gurantee that worldwide.

Is it FDA approved? Certainly the drug itself is since Botox, Juvederm, Restylane and the rest are, but since the packaging might not be it's up to individual physicians to make that call. If you're not comfortable ordering product from another country, that's completely understandable. Don't. But if you're a doctor who is paying more for Botox and Restylane than you need to be, take a look at Medical Spa RX's prices. Better yet, contact Medical Spa RX and talk to them about their quality, service and gurantees. We're very comfortable that you'll never need to use another pharmacy.

(Surface Medical Spas and other clincs I know personally order almost all their injectables for every one of their clinics from outside of the US according to their medical director and have never had any problem.)

For our part at Medical Spa MD, we're not looking to promote anything other than a service to our Members and save them money as part of our growing network of physicians. We're actively seeking other pharmacies to partner with (including those in the U.S.) and when we find one that can provide the service levels, competitive pricing, and benefits to our Members that Medical Spa RX does, we'll be happy to provide that service as well.(If you're not already a Member of Medical Spa MD you can join here for free.)

So, if you're in a position where you need to save as much money as possible while still receiving the very best customer service and product, I'd urge you to join other members of Medical Spa MD in supporting this newest initiative and make a test order and see for yourself. Certainly the only way that Medical Spa RX can offer such deeplly discounted products is through the aggregated buying power of all of our members.

Take a moment to contact Medical Spa RX and see for yourself how much money you can be saving.

Medical Spa RX: Wholesale Botox & Injectables

Our newest physician resource and premier provider, Medical Spa RX, is now open and taking orders from licesnsed physicians for the most commonly used injecatbles including; Botox, Juvederm Ultra 2, Juvederm Ultra 3, Juvederm Ultra 4, Restylane Touch, Restylane Vital , Sculptra, Dysport (Reloxin), and Radiesse.

This new portal is the first of the resource portals and services that Medical Spa MD is making available to our members. There are more in the works.

Medical Spa RX is a major Canadian pharmacy that has been in business for many years and has created Medical Spa RX as a complely seperate and unique entity from their regular portals. Why? The prices on Medical Spa RX are much lower than their regular sites and are offered exclusivley through Medical Spa MD. You can't find better service or products anywhere. We've been buying Botox for years. We know.

Of course, as a new offering, there are questions. We hope to be as transparent as possible. Medical Spa RX will contribute to the forum discussions as well as posting regulary and replying to inquirys as here:

Medical Spa RX replies from this thread: Wholesale Botox, Restylane, and Juvederm

Thank you for your questions.

As a new partner of Medical Spa MD you can be assured that Medical Spa RX will strive to maintain the highest standards of both quality assurance and customer service. We greatly value our association with Medical Spa MD an it's world-wide physician community.

We are a licensed pharmacy in Canada that has been in business and serving the North American market for many years. Its only through our affiliation with Medical Spa MD and it's large community of physicians and order flow that allow us to sell far below our regular pricing. We hope to be part of Medical Spa MD's community for a very long time and our outstanding customer service, delivery guarantees and the lowest prices anywhere attest to that fact. (In fact, we built an entirely new portal to support Medical Spa MD's physician community instead of using our regular sites because we can't provide prices this low to our regular clientele.)

Now, I'll attempt to answer some of the questions that have been asked:

1) Licensed Doctors around the world can purchase any of our products; Botox, Juvederm Ultra 2, Juvederm Ultra 3, Juvederm Ultra 4, Restylane Touch, Restylane Vital , Sculptra, Dysport (Reloxin), Radiesse and our other injectables , however we can not guarantee the same delivery time frame as we can to the U.S. In addition, delivery to the US and Canada is always guaranteed whereas worldwide delivery is only guaranteed subject to location.

2) the new Juvederms are different consistencies from the Juvederm available in the USA. Juvederm Ultra 4 is by far the most popular. However, there is a slight change in consistency due to the Lidocane that takes a little getting used to. (We suggest a small test order to compare the benefits.)

3) All of the Juvederm we carry are manufactured by Allergan in their own facilities. These are the same as the products in the USA that Allergan sells.

4) Latisse is also sourced it from within the USA which is reflected in the price.

5) The Botox we offer is indeed manufactured in the same FDA approved Allergan facility in Ireland as is the Botox that the Allergan rep in the USA is selling. The only difference between the Botox that is originally sent to the USA or another country are very slight changes in the packaging. The efficacy of the product can not be argued because it is the exact same product that the Allergan reps are selling.

As Medical Spa MD's partner we hope to exceed your expectations in all ways. Please give us a small test order and let us earn your trust.

Yours,
Medical Spa RX

As one of the most trusted resources for cosmetic physicians on the web, we're looking to provide the very best services and products at the very lowest prices by leveraging our huge community of physicians. We invite you to make a trial order and compare Medical Spa RX to whatever existing solution you're currenly buying from.

Dysport FDA Approval

The neurotoxin wars got a couple of new wrinkles this morning with the FDA’s approval of Medicis/Ipsen’s Dysport for treatment of glabellar lines, along with the edict that all botulinum toxin manufacturers add a box warning to their products.

This box, the Agency’s most strict safety communication, is the result of the Agency’s ongoing safety review of such products, particularly in instances in which they migrate beyond the injection site. The FDA also expressed concern about the interchangeable use of the available neurotoxins and is asking for a risk-to-benefit strategy from each firm as part of a broader communications plan.

Well, the competitive landscape was bound to sprout a few dandelions along the way.

In the meantime, mark your calendars: Medicis announced it would ship Dysport for aesthetic use in the next 30 to 60 days.

Read the Press Release Below

Click to read more ...

Black Market Botox....A Better Buy?

Botox: $50 for 100mu?

Thought that would grab your attention.  I've heard you can find Botox on the internet for that price.  I wouldn't recommend it.

Occasionally a patient will ask me to explain why those people in Florida "died from Botox."  They are referring to a story that was widely publicized in early 2005 about some people in Florida who were sent to the hospital after receiving phony Botox injections and becoming paralyzed.  There was another story around the same time of a woman in California who died from Botox injections done by a hair stylist.  Hair stylist?  Yes, you read that right.  The very important distinction is that they didn't actually ever have Botox injected into them.  They were duped and actually had raw-grade Botulinum toxin type A used on them. 

Right about now you might be thinking, well that would certainly never happen to me.  My vials all say Botox and have the purple, red, orange colors on the box.  Matter of fact, I'm guessing that the guy in Florida thought his product was safe since he used it on himself.  I actually know a physician who had ordered, but never used, this killer Botox that he ordered from the same source. He thought he'd found a better source to get the real thing at a cheaper price.

Botox is a trademarked name for a substance that is made by Allergan. Anything else is phony and potentially very dangerous and most certainly not worth the savings that might be had.  This bootleg industry has become so prolific that I wanted to be sure everyone knew what to look for and what to avoid.  Fake Botox is frequently made in China or Korea. Authentic Botox is made and distributed world wide by Allergan and has a hologram indicating it's credibility.

(Note: Authentic Botox is available to physicians world-wide through one of Medical Spa MD's select partners, Medical Spa RX. Medical Spa RX is a licensed Canadian pharmacy who deals exclusively with authentic Botox, Dysport, Restylane, Perlane, Scuptra and other injectables.)

To view the hologram on a vial of Botox:

1) Examine the vial under a desk lamp or fluorescent light source
2) Rotate the vial back and forth between your fingers; look for horizontal lines of rainbow color on the label
3) Confirm that the name "ALLERGAN" appears within the rainbow lines.

I'm guessing that this black market industry will soon learn how to counterfeit the hologram as well.