Increased Botox Longevity With A Zinc Supplement

Botox & Zinc? Does Zinc make Botox last longer?

An American Academy of Cosmetic Surgery news brief has reported that a Houston oculoplastic surgeon, Dr. Charles Soparkar, has come up with a way to make Botox (and presumably all botulinum toxin neuromodulators) more effective and last longer. In a modified double blind, randomized, placebo-controlled, crossover pilot study and a subsequently completed formal study, the duration of effect was increased by 30% in over 90% of the patients studied. The study included both cosmetic and medical indications (blepharospasm, hemifacial spasm).

The theory goes like this: Botulinim toxin is very dependent upon zinc for effectiveness. Unfortunately, 50% of the US population is zinc deficient. Apparently, dietary zinc can be poorly absorbed due to binding elements found in many foods called phytates. Dr. Soparkar’s group posited that adding zinc to the diet of patients having a weak response or short duration of effect to botulinum toxin may be beneficial. Additionally, a phytate munching phytase enzyme was added to increase zinc bioavailability.

The result is a prescription medication called Zytaze. Each capsule contains 25mg of highly bioavailable zinc citrate and 1500 mg of Phytase. Patients take 2 caps daily for four days prior to AND on the day of injection. The drug is supplied in a 10 cap pack and cost $60 - $80. The result has been less frequent and decreased amounts of toxin needed and potential patient savings. (However, does the cost of the drug nullify these advantages?) This is great news for patients and a potential niche offering in the commoditized botulinum marketplace. Maybe not so great for practices depending on a high turnover of renewable products and services. 

Who else has experience with Zytaze?  

I Want To Be A Fibroblast!

What criteria is most important when choosing a treatment or technology to stimulate fibroblasts for skin rejuvenation?

Being a dermatologist focused on aesthetic treatment options for improving skin's condition  it's quality and overall appearance – I clinically and scientifically overlook tons of different approaches.

Basically, and I think we can agree on this, many treatments try to target the fibroblast. Its about the stimulation of this branched tissue cell who's function is to maintain the structural integrity of connective tissues by continously secreting precursors of the extracellular matrix such as ground substance, a variety of fibers notably the reticular and elastic ones and cytokines.

The goal in many skin rejuvenation treatments is to activate and stimulate the fibroblasts... and there are countless strategies to do this: You might choose chemical peels, energy based devices such as non-fractionated or fractionated resurfacing lasers, intense pulsed light (IPL), infrared light or radiofrequency. One might think of dermal filler substances such as hyaluronic acid or – better – calciumhydroxylapatite (there are even publications on a stimulating effect botulinum toxin type a...). Further one might consider microneedling, dermabrasion, etc..

Or think about "newer" technologies such as platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid). And last but not least cosmeceuticals (this list is not exhaustive!!).

Which strategy to choose? It's actually very difficult to find way through this jungle!

I would like to encourage and activate the discussion here and ask for your opinion: What are the most important criteria for you when you do your choice? Is it about mangeability, about downtime, about scientific proof, about safety, about treatment protocols (such as e.g. multiple treatments), about clinical experience of other physicians, about availability, about the learning curve, about the deligability, about the costs?

What's your decision maker here?

Submit Embezzlement & Employee Theft Stories From Your Medical Practice Or Clinic

Unfortunately, employee embezzlement and theft in cosmetic medical clinics is commonplace. We're going to help you with that.

We've posted about theft and embezzlement before. Read: Embezzlement & Employee Theft: It can, and probably will, happen to you.

We're building a new loss prevention report that will cover this area and provide you with just about every trick in the book including:

• How common embezzlement schemes are set up and how these criminals cover their tracks.
• How thieves steal Botox and injectables to supply their side business.
• Credit card and payment scams at the front desk.
• Treatment room cash payments.
• Inventory and product theft in the back room.
• Everything else...

To do this we're reaching out to you, our Members and readers, and asking for your help. If you have inside knowledge of a situation that involved embezzlement or theft, that you let us know by submitting your story and giving us all the gory details. (No identifiable information is required so you can tell the story anonymously if you wish.)

Click Here To Submit Your Story

http://MedicalSpaMD.com/Embezzle

We're compiling these submissions as well as drawing on our own experiences and contacting embezzlement and loss prevention experts to produce a comprehensive blueprint for protecting your clinic and your business that will give you insight into how these scams work, and how you can prevent them.

If you have any thoughts on this topic or what we should include, please leave them in the comments below.

Top 10 Countries For Cosmetic Procedures

According to the International Society of Aesthetic Plastic Surgery, here are the top 10 countries ranked by number of cosmetic procedures.

Some interesting facts according to the report:

• Japan moved from #6 in 2009 to #4 in 2011.
• France moved from #14 to #9 in the same period.
• The US dominates with just under 18% of procedures worldwide.
• Asia performs the most treatments by continent with 28.8% of plastic surgeons and 31.7% of total procedures. North America is second with 24.3% of the worlds plastic surgeons and 24.6% of the total procedures.

Is Technology Changing The Doctor-Patient Relationship (for the Worse)?

The first point of contact for a patient to ask post-surgical questions should be the surgeon who performed said surgery. The trend seems to be in exactly the opposite direction.

I've noticed a concerning trend. I participate in websites like RealSelf.com that connect plastic surgery patients and cosmetic surgeons. These sites are allowing patients to have near immediate access to expert plastic surgeons from across the nation and plastic surgeons to interact with potential patients.

In the past few months an increasing number of patients in the early post-operative period (some with dressings still in place!) have posed questions to “online surgeons” seemingly before seeking follow-up with the plastic surgeon who just performed the procedure. It is concerning that a patient would seek advice from a surgeon they do not have a doctor-patient relationship with and who is unfamiliar with the specifics of the surgery that they've recently undergone. Patients have even gone so far as to inquire about where to seek second opinions and whether revision surgery will be necessary all within the first post-operative week.

The early post-operative timing of this phenomenon is most concerning. This is the period in which we need to reassure our patients that bruising and swelling will resolve, dressings and sutures will be removed and that they truly will look great once they’ve healed. This period can cause patients significant distress and many require a lot of hand holding at this point.

We’re obviously failing some of our patients if they're reaching out online during this period instead of calling our offices and dropping in to be evaluated. I agree that second opinions are highly valuable and would not hesitate to arrange such for a concerned patient. However, a patient-initiated second opinion from an unfamiliar, online surgeon who has an incomplete picture of the patient's history is problematic at any time point let alone while the compression dressing is still in place!

What could possibly be responsible for this trend? As cosmetic surgeons are we so difficult to reach that our patients need to seek online advice from others? As we become more amenable to interacting with potential patients online are we failing to care for those who have already made a trip to our operating room? Is it simply easier for our patients to log onto a website rather than call the doctor's office? What can we do to direct those online inquires back to our own practices rather than into the digital ether?

As a Facial Plastic Surgery practice, my entire team is in the business of building relationships. If a patient has a professional, responsible and ethical plastic surgeon, the first point of contact to ask post-surgical questions should be the surgeon who performed said surgery. This trend seems about as far astray of that goal as one could imagine.

Has anybody else noticed this trend online? Have you experienced this with one of your own patients? What you have done to prevent this from happening in your practice? Please contribute your thoughts.

Fairwarning: The LipoTron 3000 FDA UnApproved $85k Massager

According to a new story on Fairwarning.org, RevecoMED claims that their LipoTron device is really being marketed and sold as an $85,000 massager.

I just got off the phone with Myron Levin or Fairwarning.org who contacted me about Advanced Aesthetic Concepts attempts to have comments and reviews about the Lipotron 3000 and their business removed from Medical Spa MD claiming that some negative comments were costing them sales. It was an intersting discussion and Myron filled me in on some of the background that went into the story which has some interesting twists including anonymous calls to the FDA and secretive meetings with criminal investigators.

Read the entire article here: Fat-Melting Device a Weighty Matter for FDA on Fairwarning.org

From the Fairwarning.org article: 

According to interviews and records, Reveco first sought a green light from the FDA in 2007. It chose the FDA’s market clearance procedure, which is less demanding than the formal approval process.

To get a new device cleared this way, the manufacturer must show it is similar in safety and effectiveness to products that are already on the market.

However, Reveco’s bid failed. The company’s initial application “wasn’t in-depth enough,” Rosen said, and the FDA repeatedly sought additional data. Finally, according to Rosen, “We said, ‘You know what, it’s not worth it.”

According to interviews and a document reviewed by FairWarning, the FDA then told Reveco that the device could not be marketed.

LipoTron sales continued, however. Rosen wouldn’t disclose how many of the devices have been sold, but the number is believed to be in the low hundreds.

In 2011, Reveco took another tack with the FDA. It classified the LipoTron as a massager used for relief of minor pain. That would make it, in FDA parlance, a Class 1 device — a category that includes such simple, low-risk items as elastic bandages and examination gloves.

The advantage for Reveco is that massagers can be sold without a green light from the FDA. They automatically are exempt from FDA review and can be put on the market once a notice is filed.

Yet doctors and med spas have been promoting the device on the Internet not for massages but for removing fat.

Rosen said that was not Reveco’s responsibility, stating that the company can’t dictate what doctors do or “police everything out on the Internet.”

Asked who would pay $85,000 for a massager, Rosen replied: “Anybody that wants to buy it.”

Wow. It would take some really big cajones to claim that you're selling an $80k+ device named LipoTron to cosmetic clinics from a company named RevecoMED but you're only marketing it as "a massager for minor pain" and that it's the doctors who are running around uncontrolled promoting it for fat-melting. I'm actually somewhat impressed. I guess the real lesson is that if you can't get your device approved by the FDA as a medical device the first time, reclassify it as a band-aid and declare yourself in full compliance. That seems simple enough. 

Of course it also seems fairly clear from the article that if you have one of these devices and you're promoting it as FDA approved or as a treatment for anything other than a 'massager' you might not be in lock-step with the FDA, a fact that might be exacerbated by the fact that this story has been picked up by major media outlets like MSN.com.

I'm curious; Does anyone have one of these Lipotron devices that they're using as a massager for minor pain? You might want to see if it works on yourself because I'm guessing you have a headache about now.

Update on 2012-07-19 14:46 by Medical Spa MD

More bad news for LipoTron, RevecoMED (the manufacturer of LipoTron), and probably for it's resellers... as well as all the physicians and clinics who are offering LipoTron treatments.

Public Citizen, a consumer watchdog organization with 300k members, has contacted the FDA urging, among other things, that all LipoTron devices should be seized immediately.

Here is what Public Citizen is asking for; from their letter to the FDA:

Immediately seize all LipoTron devices that have been manufactured by RevecoMED and either (a) are being held in inventory by the manufacturer in the U.S. or (b) have been sold and distributed to user facilities in the U.S.

(2) Immediately order RevecoMED and any distributors of the LipoTron device to cease and desist all activities involving the distribution, sale, and promotion of the LipoTron device.

(3) Expeditiously complete its criminal investigation of the distribution, sale, and promotion of the LipoTron device and take appropriate legal action against those individuals, companies, and user facilities that are found by the agency to have engaged in any illegal marketing or promotion of this device

This can not be good news for any of the medical spas and clinics who already have this device.

Read the entire letter to the FDA

View attachments regarding the letter

View the Public Citizen press release

Stem Cells & The Vampire Facelift

If you attend medical conferences, or read the trade journals, you’ve no doubt heard about stem cells and their incredible potential in the healthcare industry. These cells have the ability to repair or replace damaged cells, reduce inflammation, and possibly even have a role in disease prevention and cure.

Lately, these cells have been the target of much interest in the cosmetic field. Platelet-rich plasma (PRP) is the portion of the blood that remains after centrifugation has separated out the red cells. This fraction is unusually rich in growth factors and stem cells, that have the ability to repair damaged skin, and act as a long-lasting filler to volumize the face. The PRP is activated using calcium, and then is immediately injected into the donor’s face.

At Canyon Lake MedSpa, we have been using the patented “Vampire Facelift” technique (Regen Labs) in conjunction with standard HA or CHA fillers. We inject the filler using standard technique and then layer the PRP on top. Although still very new to this technique, we believe we are seeing the early effects including improved skin tone and color. Research has documented significant prolongation of filler effect, but we have not been doing this procedure long enough to attest to that yet.

Since we are only minimally manipulating the blood (centrifuging and decanting off the PRP) in a completely closed system, and re-injecting it into the same patient, there is virtually no risk.

In our next article we will discuss, in greater detail, tips on collecting and injecting PRP, how to educate patients and the outcome of our patients’ results.

There has been tremendous interest in the very-well marketed “Vampire Face Lift” and we have experienced an increase in our Med Spa new-patient visits as a result of this interest.