Is Botox & Restylane carrying your Medical Spa?

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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.

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Botox? Restylane? Juvederm? Lose the wrinkles & get a job.

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The unemployment rate for the month of June for the U.S. was hovering around 9.7% according to the U.S. Bureau of Labor and Statistics. Some of my own family members have found themselves out of work after being in management positions for years only to be replaced by younger, cheaper laborers. Skilled individuals are being turned down for new job opportunities, but for what reasons?

People I know who are out of work state that they are told they are "over qualified" for the open position, or their salary requirements are "too high" for the company to met during these struggling economic times. Okay. I understand that.

Recently, our medical spa was interviewed by a local newspaper who was writing an article about older unemployed people turning to cosmetic services in order to freshen their image to compete with younger job candidates. The article stated that job competition is fierce and while candidates are polishing up their resumes, they're seeking aesthetic services to polish up their bodies and faces. Other physicians interviewed for this article stated that people ranging from 40 years old and up, predominately women, are looking to have these procedures performed.

When we were approached about this article I was dumbfounded for I truly did not know of any of our clients who came in saying, "hey, can I get some Botox and filers to erase these lines on my face to compete for this sales job against this 25 year old right out of college? And, why your at it, can you get rid of these flappy arms and turkey neck I have?" And, believe it or not, we were approached for our comments on the same topic for a major magazine.

Our medical spa is close to Philadelphia and New York City and we are surrounded by thriving companies like Merck, Johnson & Johnson, Olympus, etc. so we're not in a rural area by any means, and I still wasn't aware that older job candidates were racing to have these procedures performed to increase their chances of landing a new job. I have seen an increase in new clients because of new technologies and products we have added which weren't available a few years ago.

I'm very interested in knowing if your practice has seen an increase of clients undergoing cosmetic procedures to compete for a job and, if so, what procedures are they seeking to have performed? Are they predominately male or female and what is their approximate age range? If this truly is a real "situation" perhaps we're missing a marketing opportunity to offer these individuals discounted bundled packages to assist them with their quest.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Dysport FDA Approval

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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

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Plastic Surgery & Beauty

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Plastic surgeons and even med spa physicians offering Restylane and Juvederm would be well intentioned to make sure that they understand the cannons of what beauty actually is. In many ways it's the elimination of asemmetry or extra 'noise' like wrinkles or pigment.

Via CNN: It's hard to pinpoint what distinguishes a gorgeous face from an average one, but some researchers are getting pretty close. Psychologist Lisa DeBruine, Ph.D., of the University of Aberdeen in Scotland says she's found that women's faces get more attractive to men when they are ovulating. "We're not entirely clear why there's this difference, but we think that the women might look healthier, have a bit of a healthier glow when they are ovulating."

Symmetry is another factor that determines a face's attractiveness. Kendra Schmid, an assistant professor of biostatistics at the University of Nebraska Medical Center, says there is a formula for the "perfect" face. She uses 29 different measurements to determine someone's appeal on a scale of 1 to 10.

To start, Schmid says the ratio of the length of the face to the width of the face should be 1.6, also known as the golden ratio."The face should also be divided into three equal pieces vertically," she says. "The forehead, then [the bottom of the forehead to] the nose and then from the nose to the chin."

Who's face is the most "perfect," according to Schmid's measurements? No big surprise here! "Brad Pitt's is the highest that I've ever used the [formula] on," she says. "He was a 9.3 [out of 10]."

Brad's partner, Angelina Jolie, didn't fare too badly either. "Angelina was a 7.67, and that's pretty high," Schmid says. "Most people rate about 4 to 6. ... The thing that is probably lowering her score is the thing that she's most famous for -- her full lips." Schmid says that ideally the width of a mouth should be twice the height of the lips.

Other celebrities Schmid tested were Halle Berry, who scored a 7.36, and Hugh Jackman, a 6.45. "There's never been anyone who was a perfect 10," Schmid says. "If you're out there, we're looking for you!"

Botox ~ Approved uses by country

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There's a lot of Botox used around the world from sweating to headaches to wrinkles.

Here's a graphic from a Botox story on CNN.

In the hunt to discover the next blockbuster medical use for Botox, doctors have injected it experimentally into muscles and glands all over the body, making it medicine’s answer to duct tape. According to recent medical journals, physicians have used it to treat chewing problems, swallowing problems, pelvic muscle spasms, drooling, hair loss, anal fissures and pain from missing limbs.

“We see it as a molecule that keeps on giving. As we understand it more, it gives us new ideas of how to use it,” says Dr. Mitchell F. Brin, a neurologist who is the chief scientific officer for Botox at Allergan, the drug’s maker.

No other therapeutic agent “has so many demonstrated uses,” he says.

But some health advocates worry that doctors are widely adopting novel uses for Botox before federal guidance and rigorous clinical studies have established safe and effective dosages for the new treatments.

“It’s trial and error with a nerve poison,” says Dr. Sidney M. Wolfe, the director of the health research group at Public Citizen, a consumer advocacy group. Last year, the group petitioned the Food and Drug Administration to require a warning label for injectable toxins.

Reloxin vs Botox

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Reuters has this press release from French drug maker Ipsen about it's Botox killer, Reloxin:

French drug maker Ipsen's (IPN.PA) anti-wrinkle treatment Reloxin, a possible rival to Allergan's (AGN.N) Botox, reduced forehead wrinkles and had few side effects in a U.S. study published on Monday.

Ipsen said in January the U.S. Food and Drug Administration had extended to April 13 its review of the company's injectable botulinum toxin product for possible approval.

A study involving 1,052 people, published in the Archives of Facial Plastic Surgery, showed that Reloxin improved the appearance of moderate to severe forehead lines.

Within a week, 93 percent to 95 percent of the people in the study responded to the treatment, consisting of five injections at a time, the researchers said. One treatment typically worked for almost three months.

The patients received up to five sets of five injections over the 13 months of the study.

Only one person dropped out of the study due to side effects related to the drug, the researchers said.

Ipsen in 2006 granted Scottsdale, Arizona-based Medicis Pharmaceutical Corp (MRX.N) rights to develop, distribute and commercialize Reloxin in the United States, Canada and Japan for aesthetic use and Medicis funded the study.

The company declined to comment on the findings, citing the ongoing FDA review. The drug is approved for fighting wrinkles in 23 countries, but not the lucrative U.S. market.

"It had a good safety profile and was effective, but we did not do a head-to-head comparison (with Botox). That's the next step, of course, something that probably will be done in the future," said Dr. Ronald Moy of the California Health & Longevity Institute, one of the researchers.

"It will be a good alternative for consumers and may be less expensive," Moy added in a telephone interview.

The drug is made from a toxin made by the bacterium Clostridium botulinum, which also causes botulism food poisoning.

Botox, Fillers & The Right to Inject

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A few months ago, I was attending a function in NJ where some physicians were in attendance. Through the course of discussion, some of us became involved in a discussion about NJ State law which prohibits nurses from injecting Botox or dermal fillers. While many of us sat there with our jaws dropped in disbelief of what we were witnessing, a plastic surgeon went into a soliloquy about why nurses shouldn’t be injectors.

There he stood on his soap box declaring his supremacy over all that was injectable as highly experienced nurses began interjecting some factoids about how nurses are specialized in IV therapies, take more time to attend training courses, and overall exhibit better patient care. It went on and on with no outcome other than shattered egos.

The truth is, many States permit nurses and PAs to inject Botox and dermal fillers as well. While many physicians may hold true to their stance that a skilled board certified dermatologist or plastic surgeon should be doing the injections, what truly matters is the skill, experience and knowledge of the injector. My point is, there are as many physicians out there who should not be doing injectables as there are nurses.

While Botox has had as many horror stories as, say, laser hair removal or lipodissolve, the truth is (if you care to do some research) that the majority of the issues with Botox were due to the fact that they were administered by either non-licensed or untrained personnel such as estheticians. In regards to nurse injectors, many of the State laws declare they can perform the injections under the direct supervision of a physician who has performed the initial examination of the patient and has written orders for it.

The initials after a person’s name should not be the deciding factor when clients choose a practitioner to inject their Botox or fillers. What is important is excellent knowledge of facial muscle anatomy, training, certification, education in the latest techniques, and hands-on experience.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Botox training for physicians: SEO Garbage

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SEO (search engine optimization) is becomming increasingly important for your clinic or medspa.

If you happen to search for Medical Spas on Google you'll be thrilled to know that Medical Spa MD ranks #1. Why? Because there are thousands of comments and nearly a thousand posts that are all original content and create for those searching for informaton that's found on this site.

Of course there are the scammers and hackers who play the system.

Search for Botox Training for Physicians and you'll see a hose of adword-cram sites that exist only to get you to click on a paid listing link and charge the company for the click. These pages are build in the hundreds and stuffed with backlinks and garbage content that's copied and pasted. It's not original, it's not worth anything, and it exists only to trick consumers into clicking on ads since they typically have no other navigation or content for anyone to click on.

Here's an example con job page that ranks high in Google for 'Botox Training for Physicians'. You'll notice that there's no links other adwords. This site is so bad they're actually named Link 1, Link 2, Link 3 at the bottom and evey other link is named; Is anything better than Botox, Physician Botox training and other such keyword stuffing. So this site is actually sitting on top of the content that you would actually be looking for if you were looking for Botox training. The best content on the page is actually 'in' the ppc ads but there's no relevance, just paid listings.

I should note here that if you try to do this a couple of things happen:

  • You loose all credibility. It's really easy to spot when sites are doing this.
  • Google could very well catch you and penalize you by dropping your ranking. If you're using some type of SEO service that does this you're equally vulnerable.

I'll be writing more about SEO and how the web can be used correctly to disseminate the content you want to send and put it in front of the potential patients who are looking for you.

Comparison of what's in a Dermal Filler: Radiesse, Restylane, Perlane, Juvederm Ultra, & Sculptra

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What's in Restylane or Perlane? Here's a synopsis.

Radiesse

1.3 cc syringe, active ingredient is 30% "powdered synthetic bone"
Very good for nasolabial folds, cheekbones, jaw lines. Not good for lips. Lasts about 3-6 months after the 1st treatment, about 12-18 months after the second treatment. Considered "semi permanent" because the collagen that it stimulates will last for years after the product has dissolved. Cannot be dissolved with any chemicals such as Hyaluronidase. Can also be used on the backs of the hands.

Restylane

1.0 cc syringe, made out of cross linked Hyaluronic acid.
Lasts about 6 months. Tends to absorb a little water, which causes some temporary swelling. Good for nasolabial folds, lips, mild to moderate wrinkles. It can be dissolved with Hyaluronidase. Lasts from 3-12 months; 6 months is about average.

Perlane

1.0 cc syringe, similar to Restylane
The "particle size" in the Perlane is larger, which makes the Perlane thicker. It tends to be used for deeper wrinkles and contouring. It is very good for deep nasolabial folds, straightening the jaw line. It can be dissolved with Hyaluronidase. Lasts 3-12 months; 6-9 months is about average.

Juvederm Ultra ( Juvederm 24 HV outside the US)

0.8 cc syringe, similar to Restylane
Injects very smoothly and tends to flow nicely under the skin. Very good for lip enhancement. Absorbs a little less water than Restylane so there is a little less swelling, which may be important in the lips. Even though the syringe is smaller, there is a higher concentration of Hyaluronic acid in the material which gives it about the same amount of Hyaluronic Acid as Restylane. It can be dissolved with Hyaluronidase. Lasts 3-12 months; average is about 9 months, less in the lips.

Juvederm Ultra Plus (aka Juvederm 30 HV in other countries)

0.8 cc syringe, similar to Juvederm Ultra, but 20% thicker
Very good for deep nasolabial folds. Softer than Radiesse, less likely to leave a palpable lump in the skin.

Sculptra

One vial can produce 6-10 cc of material.
Comes as a powder, must be mixed with water and local anesthetic at least 2 hours prior to use, preferably mixed 24 hours prior to use. The initial effect only lasts for a few days. The fluid is absorbed, but the powder is left behind. The powder causes the skin to get thicker. 3-6 treatments, space 1-2 months apart, are needed. Vigorous massaging is needed 5 times per day for a few weeks after the material is injected (this is done by the patient at home). Very good for replacing lost volume in the cheeks.

Illegal Botox auctions on Ebay?

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Online auction site eBay has agreed to remove illegal Botox adverts in the UK after 240 unlawful listings were found over five days, a consumer watchdog said.

Via: Telegraph article; UK

16 companies and individuals were found to be advertising the prescription-only medicine to the public, with many unaware they were breaking the law.

Ebay had agreed to remove the promotions following a complaint by Which? and under the guidance of the Medicines and Healthcare products Regulatory Agency (MHRA), Which? said.

Adverts offered discount vouchers for Botox treatments and encouraged trade with "introduce-a-friend" offers.

A seller from Texas offers auction shoppers 100 units of Allergan's Botox Cosmetic. The seller markets this Botox by explaining that self-injecting Botox is easy and a money saver.

When having this treatment at the Spa, I started to think that it wasn't that hard to do after watching the girl at the MedSpa do mine, and started talking with her about options of doing it at home. She was able to obtain quantities of the products they use at the Spa for me to use at home and share with my friends (mostly other Moms). I am just a real person who wants to share my amazing find and perhaps make a little money in the process.

Cheap Restylane & Botox: Are you buying it from Canada?

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restylane_botox_syringeI've received a number of inquiries about buying Restylane, Botox, Juvederm, and other injectables from Canada, Ireland or even Bulgaria.

Here's are two threads from the Physician to Physician discussion area:

There does seem to be a great deal of pricing disparity. Canadian, English and Turkish suppliers and pharmacies who are selling Restylane and Botox are certainly undercutting the pricing that doctors are charged in the US.

It brings up a number of questions for docs and problems for the companies. How can they exploit the market opportunity in the US which will generally accept higher prices while still selling into countries that won't?

(Always be aware that laws differ everywhere and you're responsible for making informed decisions.)  

Botox Deaths

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skull

Botox Deaths via CNN.com

Botox is best known for minimizing wrinkles by paralyzing facial muscles -- but botulinum toxin also is widely used for a variety of muscle-spasm conditions, such as cervical dystonia or severe neck spasms.

The FDA said the deaths it is investigating so far all involve children, mostly cerebral palsy patients being treated for spasticity in their legs. The FDA has never formally approved that use for the drugs, but some other countries have.

However, the FDA warned that it also is probing reports of illnesses in people of all ages who used the drugs for a variety of conditions, including at least one hospitalization of a woman given Botox for forehead wrinkles.

Alergan Stock takes a dive. 

Smoothmed New York: Botox on the go.

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Botox will now be available as a walk-in, no appointment necessary treatment in midtown Manhattan.

 

Smoothmed, a retail medicine concept started by two plastic surgeons, will be opening it's doors on East 59th Street. My guess? It'll do fairly well and may be the largest Botox account in the U.S.. Of course it could go the way of SkinKlinic.

19skin600.1.jpg 

 From the New York Times: The Little Botox Shop Around The Corner.

Smoothmed, scheduled to open next month, will offer only one procedure: Botox injections to smooth wrinkles around the forehead, eyes, lips or neck. Its owners said the idea is convenience, competitive pricing and standardized care.

“Botox-on-the-go is the way we like to think of it,” said Dr. Andrew I. Elkwood, an owner of Smoothmed. He and his business partner, Dr. Michael I. Rose, are plastic and reconstructive surgeons who practice in Manhattan and in Shrewsbury, N.J.

Botox Cosmetic, a diluted form of botulinum toxin, is used to temporarily paralyze the muscles underlying wrinkles. Dr. Rose said that making injections easily available would expand the market.

“It will appeal to people who took a few hours to shop at Bloomingdale’s, to secretaries on their lunch hours, to people who live and work in the neighborhood, and we will be getting visitors who think on a whim, ‘I wouldn’t normally do this at home, but we’re in New York, so let’s try it,’ ” Dr. Rose said.

Silicone Injections: Illegal 'pumping parties' can be life threatening.

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silicon.jpgVia Physorg

A study of individuals who underwent illegal silicone injections revealed a high fatality rate from pulmonary silicone embolism, or obstruction of the lungs. The study was presented today at the annual meeting of the Radiological Society of North America.

The U.S. Food and Drug Administration banned silicone injections in 1992, but people still seek them out because they are cheaper and easier to get than professional plastic surgery or hormone therapy and provide immediate results. In surgical clinics, transgender patients are often required to undergo psychological testing before receiving treatment.

Unfortunately, the illicit nature of the injections makes it hard to estimate how common they actually are. However, the increasing popularity of the "pumping party"—where a host will inject a number of people with silicone in the same sitting—indicates both the demand and the ready availability of the substance.

Lips and Silikon 1000...a good combination?

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Grandma...is that you?

A good friend of mine recently confessed to me that she had seen one of my competitors and gotten Silikon 1000 in her lips.  I usually treat her for Restylane that we use judiciously in her nasolabial folds and her lips.  We also use a little Botox around her eyes.  She is 31 years old and has a beautiful face.  Her lips are full, but she wants "luscious!"  Her assistant had had it done with Dr. T and "she looked amazing."  And when my friend went to his office, his entire staff of young women all had gorgeous bee-stung lips. 

Now, for a moment, just forget all the stories of granuloma risk and inflammation.  Let us pretend that Silikon 1000 in the lips is 100% safe.  I actually do have Silikon 1000 in my office.  But I've only used it in a handful is situations.  One woman had been "butchered" (her term, not mine) by a oral surgeon and felt it left 2 divots in her lower lip.  I carefully filled these in.  Another woman's right upper lip dropped lower than her left from lingering Bell's palsy.  I used it to even out her lips. 

I have two patients who want to look like Angelina Jolie. I can't seem to put enough Restylane into their lips. One of them is from Texas and she said to me, "Honey, bigger is ALWAYS better!"  But the vast majority of my patients who want lip augmentation want only a slightly fuller look.  And so what happens when Angelina is no longer the superstar?  What happens when thin, straight, bead-like lips are in style?  Or what happens when all these young, beautiful woman with these mammoth sized lips get old and are grandmothers?  Their faces will continue to age in the normal, dynamic manner.  But those Silikon lips will be permanent!  I keep getting the visual of a faded tattoo on the side of  a wrinkled, sagging breast.