Dr. William H. Truswell: Aesthetic Laser & Cosmetic Surgery Center In Massachusetts

William H. Truswell MD, FACS, limits his practice to facial plastic surgery.

A Massachusetts plastic surgeon who's also running a medical spa? We got together to see what Dr. Truswell has learned in 30+ years in practice. 

Name: William H. Truswell MD, FACS
Location: Northampton, MA
Clinic: Truswell Aesthetic Laser & Cosmetic Surgery Center
Website: truswellplasticsurg.com

That's interesting: Dr. Truswellis the autor or co-author of several books including: Your Complete Guide To Nose Reshaping, Your Complete Guide To Facial Rejuvenation, Your Complete Guide To Facial Cosmetic Surgery, The Non-Surgical Facelift, and Surgical Facial Rejuenation.

A believer in returning something to the community, Dr. Truswell participates in Face to Face, the pro bono domestic violence program of the American Academy of Facial Plastic and Reconstructive Surgery. He has performed numerous reconstructive procedures for victims of domestic violence. These women are referred in from recovery programs, are completely separated from their batterers and are working to restore their self esteem. That recovery is helped by erasing the physical evidence of beatings such as scars, deformed noses and unset facial fractures.

Click to read more ...

Top 5 Medical Spa Treatments In 2011

The top nonsurgical treatments in 2011?

1. Botox: 5.7 million treatments (up 5% from 2010)
2. Filler Injections (Juvederm, Restylane, Perlane, etc) 1.9 million treatments (up 5% from 2010)
3. Laser Hair Removal: 1.1 million (up 15% from 2010)
4. Chemical Peels: 1.1 million (down 3% from 2010)
5. Microderm: 900,000 (up 9% from 2010)

Source: American Society of Plastic Surgeons

Can Nurse Practitioners Offer Botox?

By Carolyn Buppert, NP, JD

Can Nurse Practitioners offer Botox, Restylane, Juvederm and other cosmetic treatments on their own?

The answer to this question is going to be state-specific. Here are the steps to follow:

1. Read your state's Nurse Practice Act section on scope of practice for nurse practitioners to answer these questions: What acts require physician collaboration or supervision? How is collaboration or supervision defined? (Boards of Nursing in the United States: State-by-State Web Links)
2. Go to your state's Board of Medicine Websites and search for any policies on provision of botulinum toxin (Botox®). Note that botulinum toxin is a prescription medication, so a prescription or order for the medication must be written and someone must administer the drug. If your state has policies on botulinum toxin, note the requirements for prescription and administration. Some states consider administration of botulinum toxin a medical act, and some states consider it to be within the scope of a registered nurse. Prescribing is always a medical act.
   
   If you live in a state that requires no physician collaboration when nurse practitioners prescribe, then as long as the Board of Medicine has no requirements with respect to botulinum toxin, you are free to proceed with your practice idea. If your state requires physician collaboration in order for nurse practitioners to prescribe, then you'll need to line up a collaborator. In most states, the collaborator does not need be on site, but in some states, the collaborator must practice at the site with specified frequency. Follow the rules as they relate to any prescribing.

About: Carolyn Buppert, NP, JD is an attorney practicing in Bethesda, Maryland.

Submit a guest post and be heard.

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 ...

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.

Medical Spa MD: Filler Injection Tips (Restylane, Juverderm)

 Restylane, Juverderm and filler injections tips for physicians running medical spas and laser clinics.

The following is from a string of emails that were circulating among some of Medical Spa MDs Members. I've edited this somewhat to make it readable and get rid of all the extraneous copies. I'm also not displaying the identity or email addresses of the physicians in this thread.

Please leave your thoughts below as a comment.

Note: Some of the comments below might be out of order from the original thread. Emails' somewhat difficult to follow as a thread but you'll get the gist.

Filler Injection Discussion & Tips: Restylane | Juevederm | Evolence

1.  When I use the "push ahead" technique, I feel that I get better "plumping" per cc of filler.  I learned this from Kevin (thanks Kevin).

 

2.  When I use the "push ahead" technique, the filler fills a few millimeters in front of the needle tip.  You need to realize this to be able to put the material exactly where you want it.  Sometimes you have to "feel" the injection because you can't "see" the plumping.

 

3.  I mix 0.1 cc of lidocaine with epinephrine with my Juvederm.  This helps with bruising (epinephrine) and when the lidocaine goes away and the Juvederm attracts water, the two effects cancel each other and there is not as much enhancement after the injection due to the hydrophilic nature of the Juvederm.

 

4.  I use Juvederm Ultra under the eye and above the lip.  I use Juvederm UltraPlus everywhere else.

 

5.  I constantly complain to my Juvederm Rep about the 0.8 cc syringes.  I use lots of Radiesse because you get almost twice as much material for the same price.  Volume, volume, volume.  Please complain to your rep, maybe we can get them to change. 

 

6.  I hear the Evolence is very good.  We will be getting trained and start using it next month.

Thanks for the filler tips.Can you explain how you get the Lido with epi mixed into the Juvederm syringe? --PD

Fluid Dispensing Connector from Braun Medical Inc (you can get from PSS)

BD 1 ml Luer-Lok Syringe

 

This syringe allows you to get very precise amount of lidocaine (swish back and forth 20 times).

 

I use this syringe to put exaclty 1 cc of saline in my Botox Bottle. When I reconstitute the Botox (this gives it full strength per unit). The chances of intravascular injection might be lower with push ahead because the material will push the vessels out of the way as you advance --  Jeff

Hi Jeff,--I agree w/ #6.  I seem to get good augmentation, less redness, swelling and bruising with Evolence.  I use it for deeper fills in cheeks, NLF, etc.  Don't use it for lips or under eyes.  I do same with Lido w/ epi.  I tend to use Juvederm in lips.  Perlane / Restylane for other areas.  I agree w/ why Allergan uses 0.8 cc syringes. I've moved away from Radiesse.  I feel that the duration is not that much longer than a good correction with the HA's.  Besides, I believe a fair amount of the volume of Radiesse is a gel carrier, thus needing touch-ups at 2-3 months.  Perhaps that's why the went to the larger syringes? -- Don

The push ahead technique also moves small blood vessels out of the way, so you may notice less ecchymosis is overall pts. -- Greg

Jeff: --"Push ahead" has a higher risk of vessel cannulation & potential for vascular effects - skin necrosis in glabella, even potential for retro-grade flow to eye (causing visual loss).  I wouldn't recommend that technique for the periorbital area.

Restylane is recommended for the tear troughs;  it's less hydrophilic than juvederm - which means less post-treatment swelling.--Tom  --  [note from Jeff:  Tom is a plastic surgeon]

I would not use push ahead around the eye, I agree with Tom's comments. It works great for NLF. I was actually taught this by a PS -- Greg

Thanks Jeff for your kind comments. However I must make a few points in regards to fillers:

1) There are some areas that one has to still do the retrograde injection either b/c the purpose was to make a straight line (eyebrow lift and vermillion border and the bow-tie (the vertical lines connecting the base of nose and the upper lip border) AND when injecting the most inner 1/3 of the tear-trough to avoid risk of filler getting into the orbital space due to its close proximity to the orbital rim.

2) On the glabellar injection, it is best to first push and pull the needle thru the space underneath to break up the tissue before actually injecting the filler both in an anterograde and retrograde pattern

3) I ONLY use the 1/2 inch needles in all my injections

4) One can inject even Radiesse and/or Perlane via an 1/2 inch 30 gage needle. Why is this noteworthy to mention?? When I work on the lips and Marrionette's lines, I ususally first build the Vermillion border with Radiesse or Perlane (I get the best "lifting outcome" with heavier filler). I push the 1/2inch needle all the way forward then slowly and steadily inject while withdrawing (retrograde method). Then I re-evaluate how much of a correction I already get of the Marrionette' line and lifting up of the lip body. My next step is to inject into the most lateral lip section (about 1 cm distance) starting at the corner (using Perlane or Restylane or Juverderm). This time I inject slowly as I push forward (anterograde). Often I ended up correcting about 50% of the marrionette's line by going after the lip's border and most lateral body. Besides, the patient loveto see that they now could see their lip body all the way to the corner and more "smiley shape". The last step is the trickiest one, I use either Radiesse or Perlane on an 1/2 inch 27 gage needle. First placing my left thumb at the patient's lower half NLF's I retract the skin upward (about 2-3cm upward) then I approach my needle in an upward (vertical) position at about one centimeter lateral and one cm below the mouth corner of that same side. Then I aim diagonally toward the corner and start injecting anterograde just 1-2 mm below the imaginary horizontal line of the mouth corner (about 0.2 cc), then I withdraw the needle and reaim straight up and inject just below the horizonal line (0.2cc) then I do it one more time aiming diagonally outward (0.2cc). What was I attempting to do?? I was laying down a new flooring along the imaginary horizontal line. After the injection, release the left thumb. You will be surprised to see the retracted portion just rest right along this new floor, thus the Marrionette'line has been corrected. This is different from the common fanning technique of using the filler to "blow up" around the Marrionette's line. If you look carefully at those company's issued photos, the area around the Marrionette's line now appeared very swollen and puffed up. It is aesthetically unpleasant. It looked like the patient was beat up below the mouth. It reduced the profile of the chin.

5) For those of you that use fillers on the highly vascularized and shallow areas such as the temporal, crow's feet, undereye area lateral to the submalar area and along the lateral border of the cheek prominence (especially in those older skinny Caucasian ladies with much excessive very thin skin) I now emulate the same technique used in the hand. I would pinch to levitate the skin itself above the bony structure, then I bolus Restylane into the empty space. Then I massage it down. This elimates the risks of injecting into the vessels and nodules.

Interesting discussion.  So Kevin, how do you account for the difference in that anterograde injection you need less filler than in retrograde injections, assuming all else being equal?

Second, I am understanding one group claims anterograde injection carries a higher risk of vessel cannulation and possible intravascular injection, while another group claims that anterograde injection "pushes away" blood vessels, thus decreasing the risk. Not sure how anterograde increases risk of intravascular injection any more than retrograde.  If you push the needle ahead, transfixing a vessel, then begin injection, you can still conceivably deposit some material intravascularly, can you not?  Am I missing something here?

I also found an interesting idea of sub q bolus technique in areas of thin skin, ie crowsfeet, etc.  Anyone else try this method? ~ Don

Tom:

I do agree with you about those risks with anterograde injection. The key is always the skills in doing it, be it retrograde or anterograde. One always has to be very carefully doing anything around the eyes. However, the anterograde techinique has been advocated some of the best known experts such as Arnold Klein, MD and Kent Remington, MD. I also believed that the filler amount used was critical. It takes much more amount to get the same result with the often taught retrograde technique compared with the anterograde one. For example, I almost never required more than one full syringe in correcting bilateral NLF's vs what was typically used ( 2 syringes) by most others. I attached the before and after of a case wherein I used Readiesse to correct her NLF's and Marrionette's lines with anterograde technique. The after photo was taken right after. You can still see some of needle marks. I used one full 1.3 cc syringe, 1/2inch 30g for the Vermillion border and 1/2inch for NLF's and Marrionette's line. Notice also there was no "puffy/swollen look" medial to the Marrionette's line often seen with retrograde and fanning technique used by most others. ~ Kevin

All interesting comments.  The only place, I use “push ahead” is in the cheeks when doing them via the intra-oral route. (Apparently Radiesse is no longer teaching this method because may practitioners couldn’t get the hang of it but it works for me.)  I might try it in the “safe” areas such as NL folds.  We use only Radiesse and Juvederm and  I find that neither filler lasts as long as advertised in “first-timers”.  I’ve also had disappointing longevity in my older patients (>65) with both types fillers despite using numerous syringes.  I’m sure this has to do with their inability to generate collagen around the filler once the carrier gel is gone.  Does anyone know the age range of patients done in the filler studies? ~ SD

I came across this old thread way down in my inbox and read it again.  I’m not sure who wrote #4 below.  It sounds interesting but I’m having a hard time visualizing it.  Do you steadily move the needle forward  toward the lip edge as you are injecting or do you hold it in place while the area fills?  I’d love to see a drawing on where you start.  ~ SD

SD: I wrote those threads. The techniques that I described were similar to what you could see watching the video instruction on www.thederm.org by Kent Remington and his colleagues (lower face injection portion) THe only thing new from my thread was when fixing the Marrionette's line, his doctor (Nowell Solish) injection upward and anterograde from the lower part toward the lip corner only one time vs what I now do is I do the same thing but with a fanning pattern where (with the skin lifted about 1-2cm upward with the other thumb) I laid down "three such "anchoring points" along an imaginary horizontal floor starting from the lip corner going laterally for about 3-5cm long. Here I used something firmer such as Radiesse or Perlane. Having done this, you would release the thumb letting the skin go back down. Often you will see the Marrionetter's line is much improved because "part of that Marrionette's line" now is positioned along the horizontal flooring that you just created. ~ Kevin

PS: It is hard for me to send over some graphic illustration but I will attempt to do this in the future

Do it yourself Botox? ABC News wants to talk to you.

Have you tried do-it yourself plastic surgery or home Botox injections?

In tough economic times, many try to cut costs, including in their beauty regimen. Despite the risks, some people have decided to skip the doctor -- and obtain and self-administer cosmetic treatments.

If you have self-injected products like Botox, Restylane, Juvederm, silicone, and other substances, 20/20 would like to hear your story.

Please fill out the form below, including information about your experience, and a producer may be in contact with you.

You can tell ABC all about it here.

Medical Assistant's can not inject Botox!

I've seen and head about medical estheticians, medical assistants and even front desk staff administering Botox injections.

It's not legal, as this story on the prosicution of a medical assistant clearly shows.

Betty Guerra’s monthslong nightmare is over.

The 45-year-old former medical assistant learned today from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed, she said.

“I always believed things would work out the right way,” she said tearfully. “I cannot be punished for something I didn’t do.”

Guerra’s July arrest sparked controversy over what medical assistants can and cannot do. Specifically, there was confusion over whether they are able to give shots.

Guerra was accused of unlawfully administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada.

The state attorney general’s office did not specifically say charges against Guerra would be dropped but indicated it won’t be pursuing the case.

“The complaint against Betty Guerra submitted to the Attorney General’s Office by the Board of Medical Examiners has been contradicted by the subsequent actions by the Board,” Attorney General Catherine Cortez Masto said in a statement. “Therefore, it is fair for us to conclude that it would be difficult to prosecute this case beyond a reasonable doubt.”

Guerra’s attorney, Jason Weiner, said this evening that the attorney general’s office had sent him a copy of an unfiled motion dismissing the case earlier in the day. He would not be able to provide the Review-Journal with a copy of that motion until Wednesday, he said.

After Guerra’s arrest, physicians became concerned about what duties their medical assistants could perform.

Former medical board director Louis Ling said that upon reading a 30-year-old law, he concluded that the assistants could not give shots. With flu season coming on, he then attempted to draft emergency regulations that would allow them to give flu shots, but not Botox or other cosmetic injections.

However, that effort was shot down when a judge recently ruled that the board, in considering the regulations, had violated the open meeting law.

The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.

Ling resigned on Friday.

Guerra, a mother of three who was a physician in her native Peru, said she has been under incredible stress since her arrest and lost her job because of the publicity surrounding her case.

“It was a nightmare. I could not even sleep or eat all this time, wondering what was going to happen.”

Still, she said she harbors no anger.

“Now, I start all over. But it’s just another experience in my life.”

Via Review Journal story.

Bootox: Botox & Restyland injections in your feet?

I came across this article from Australia on Botox and Restylane being injected in womens feet.

IT'S the subject of whispered conversations over cocktails deep within Flemington's Birdcage. The secret weapon a flock of fashionistas rely upon to teeter upon 10cm stilettos all day long at the races.

Botox and filler injections for the feet are the latest crazes in cosmetic surgery to make their way to Flemington - and the solution, according those with cash to splash, to the old racing conundrum of how to wear those towering pumps and not end up carrying them home after the final race has been run.

For about $1500, some doctors, such as Bondi-based cosmetic surgeon Michael Zacharia, will inject hyaluronic acid (Restylane) into the balls of the feet.

The fluid, commonly injected into joints to treat osteoarthritis, numbs the parts of the foot that become strained by wearing sky-high heels.

And judging by the height of the footwear that was racing out the door of Melbourne boutique Miss Louise yesterday, 10cm heels will indeed be spotted around the Birdcage today.

Dr Zacharia, who has been doing the procedure for just over a year, said the foot filling provided "internal padding for the feel at that point of pressure underneath the balls of the feet. Instead of using those silicon pads inside your shoes, this is an internal way of doing it."

The procedure, however, is a lot more expensive than purchasing a pair of silicon inner-soles. At $750 per foot, the fillers will last for about six months.

Dr Zacharia said three or four people this week had told him they wanted the foot fillers for the Spring Racing Carnival, but he warned those considering the treatment that the sensation immediately following the injections could be uncomfortable.

"I've been told that for about 10 minutes afterwards it feels like you are walking with marbles in your feet, or it's like there is something in your shoe," he said.

The other procedure women are turning to is "bootox" - having Botox injected into the balls, arches and soles of the feet to paralyse the sweat glands, which Dr Zacharia said would also set you back about $1500.

Australasian College of Podiatric Surgeons president Mark Gilheany said while women might think the procedures were magic solutions to stiletto-fatigue, foot fillers could be masking symptoms of more serious problems.

He warned that for people experiencing a significant amount of pain standing in heels it could be a sign of partially dislocated bones or torn ligaments.

"If you require something of that (surgical) nature then you could have an underlying problem," he said.

"It's not something that is routinely done and I haven't seen any clinical trials to say whether the injection of a biological cushion into the foot is effective.

"If there was anything that really worked I'm sure I would know about it. It seems like a waste of time when you can stick a cushion in your shoes and take some paracetamol."

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.

Is Botox & Restylane carrying your Medical Spa?

More studies on Medical Spas, Botox & Restylane seem to be pointing to the steady climb of filler injections, even when other cosmetic medical treatments might be less steady.

Are Botox, Restylane and Juvederm appointments steady for you?

From the  article:

During times of economic uncertainty, economists have noted that American women load up on affordable luxuries as a substitute for more expensive items such as clothes and jewellery.

Dubbed the “Lipstick Indicator”, it was charted first during the Great Depression, when industrial production in the US was cut in half, but sales of lipstick climbed 25 per cent. In more recent periods of belt-tightening, including the Second World War and the 1973 oil embargo, general spending declined, but cosmetics sales held strong. Most recently, lipstick sales jumped 11 per cent in the months after the September 11 attacks on New York and the Pentagon.

But this time around, that is not happening. In 2008 annual lipstick sales actually dropped five per cent, according to Inside Cosmeceuticals, which tracks cosmetics purchases in the US and UK.

Now, it seems, Americans – both men and women – are splurging on a more modern luxury: cosmetic injections like Botox, Restylane, Juvederm and Sculptra.

The American Society of Plastic Surgeons reports that surgical cosmetic procedures like nose jobs and tummy tucks dropped off nine per cent from 2007 to 2008. However minimally invasive procedures such as Botox, which eases wrinkles, and Restylane, which puffs up sagging skin, are up more than five per cent.

“Botox and filler have carried us through this recession,” said Dr Herbert Parris, at the Ageless Remedies Clinic in Denver, which does laser treatments, facials and microderm abrasions.

He credits the rise in part to the fact that Botox patients have a 97 per cent satisfaction rate, on average, with Restylane and other fillers causing satisfaction about 60 per cent to 70 per cent of the time.

“It’s a quick hitter,” he said. “An easy pick me up.”

Clients at Ageless Remedies have sharply cut back their spending on other treatments such as facials, chemical peels and microderm treatments, according to clinic director Donna Reichert. But women – and increasingly men – keep walking through the door for injections.

“I think in part it is the instant gratification,” said Ms Reichert, noting that one often needs three months of treatment to see results from laser or chemical peels.

“With injections, they see the results right there right now. It is not as pricey as a facelift, which can cost as much as $12,000 [Dh44,000]. They can come in and spend $300 and see results.”

In America’s youth- and beauty-obsessed culture, some analysts believe there may be a larger factor at play.

“There have been a number of studies showing that there is both a ‘beauty premium’ and an ‘ugliness penalty’, in the labour market,” said Dr Nancy Etcoff, a Harvard Medical School psychologist and author of Survival of the Prettiest.

“Better looking women and men earn more than average looking people and unattractive people earn significantly less.”

At a time when joblessness is rising and, and companies are laying off workers, Dr Etcoff and others believe some may be rationalising expenditures on cosmetic dermatology to stay competitive in the job market and reduce visible signs of stress, like forehead wrinkles.

“Some may be downsizing from surgery to cosmetic dermatology. Others may be considering both and end up deciding that they can get a comparable benefit from dermatology with a lot lower cost,” said Dr Etcoff.

Click to read more ...

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