Medical Spa MD: Physician community of skin clinics, laser centers, plastic surgeons, dermatologists and aesthetic doctors practicing nonsurgical cosmetic medicine.
To determine its efficacy, the researchers depended on the Synkinesis Assessment Questionnaire (SAQ).
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What injection methods are most useful and reliable for neurotoxin injections: Botox & Dysport.I have been in clinical private practice going on 14 years now and enjoy a busy and healthy cosmetic surgery practice. Injectables, both fillers and neurotoxins, remain an integral part of my practice and I suppose that the loyalty my patients show by continuing to return to me as their injection provider is testament that my skills must be competitive with the many other local physicians who offer the same procedures. I definitely do not price cut to keep the volume or attract new patients, and I believe I price fairly taking into consideration both my training and experience with typical pricing in my area by "mainstream" cosmetic providers.
I continue to strive to offer the least painful experience for my patients and have tried multiple different methods to decrease the degree of injection discomfort for my patients. From topical anesthetics, icing, slow injection delivery, and currently vibration-distraction techniques, I have yet to find the WOW approach. I do use lidocaine-treated fillers and believe that these have advanced our patients' injection experience to an appreciable degree.
My intent for this entry is to stimulate a healthy community discussion on what methods the readers have found useful and reliable for neurotoxin injections (to keep this discussion focused I am not encouraging discourse on filler injections but perhaps this can be a future topic of discussion), in addition to disregarding any approach that they have found particularly not beneficial. We all want to make our injections as easy as possible for our patients, so I am hopeful that this topic can generate healthy dialogue!
With Botox, Dysport, and Xeomin available and being marketed directly to your patients by thier manufacturers, how many — and which ones — do you need?In the United States, we currently have three neuromodulator products (Botox - Allergan, Dysport - Medicis and Xeomin - Merz) approved by the FDA for treatment of the glabella complex.
These products are also frequently used “off-label” for treatment of the upper-, mid- and lower-face. Botox has over a ten year-track record of safe and effective use and is the best-selling neuromodulator worldwide. Dysport was similarly approved as a cosmetic treatment in 2009. Of note, a recent injunction against Merz unrelated to safety or efficacy has delayed the nationwide rollout of Xeomin.
Given that we have multiple agents to choose from, there are a number of issues to consider when choosing which neuromodulator(s) to offer to your patients. I’ll focus on Botox and Dysport as Xeomin is currently unavailable and has yet to receive its nationwide rollout pending the legal controversy.
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.
Botox & Dysport now have a new contender in the cosmetic space... Xeomin.About Xeomin: (pronouced ZEE-oh-min) from Merz Pharma GmbH & Co KGaA
Download the Xeomin Report PDF
Botox, Dysport and Xeomin have a lot in common, but they also have some important differences. Unlike both Botox and Dysport, Xeomin does not need to be refrigerated before it's reconstituted (see below). This should be an advantage during distribution. What's more, Xeomin has no additives — just botulinum toxin type A. This may lessen a patient's likelihood of developing antibodies.
Supposedly, Xeomin is more like Botox than Dysport. It takes about one week for the full effects of Xeomin injections to be realized, and once this occurs the results last from three to six months. Dysport, Xeomin and Botox should not be used interchangeably.
Also, since Xeomin is approved only for cervical dystonia and blepharospasm in adults who have had previous treatments with onabotulinumtoxinA (Botox), any use for wrinkles and crows feet is going to be off label. This, along with the fact that Botox pretty much owns this space will probably mean that Xeomin will have a hard slog finding a huge audience. It may be worth trying thought to see if you just like it that much better. (Anyone who's already tried it, please leave a comment and let us know what you think.)
Unopened vials of XEOMIN® (incobotulinumtoxinA) can be stored at room temperature 20 to 25°C (68 to 77° F), in a refrigerator at 2 to 8°C (36 to 46°F), or a freezer at -20 to -10°C ( 4 to 14°F) for up to 36 months. Do not use after the expiration date on the vial. Reconstituted XEOMIN® (incobotulinumtoxinA) should be stored in a refrigerator at 2 to 8°C (36 to 46°F) and administered within 24 hours.
Cervical Dystonia: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with cervical dystonia to decrease the severity of abnormal head position and neck pain in both botulinum toxin-naïve and previously treated patients.
Blepharospasm: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with blepharospasm who were previously treated with onabotulinumtoxinA (Botox).
Like other botulinum products, Xeomin must carry a black box warning regarding a rare risk for spreading outside of the injection site. If this occurs, life-threatening swallowing and breathing problems may result. This has not been seen in people receiving neurotoxins for cosmetic reasons or to treat blepharospams. It has mainly occurred among children treated off-label for cerebral palsy-related muscle spasms.
Cervical Dystonia: The most commonly observed adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN 120 Units and XEOMIN 240 Units, respectively, were: dysphagia (13%, 18%), neck pain (7%, 15%), muscle weakness (7%, 11%), and musculoskeletal pain (7%, 4%).
Blepharospasm: The most common adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN were eyelid ptosis (19%), dry mouth (16%), visual impairment (12%), diarrhea (8%), and headache (7%).
Concomitant treatment of XEOMIN and aminoglycoside antibiotics, spectinomycin, or other agents that interfere with neuromuscular transmission (e.g., tubocurarine-like agents), or muscle relaxants, should be observed closely because the effect of XEOMIN may be potentiated.
Pregnancy Category C: There are no adequate and well-controlled studies in pregnant women. XEOMIN should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
The costs are expected to be similar to Botox. I checked over on Medical Spa RX and they don't seem to be carrying it as of now so you won't be able get a deal on it the way you can with Rx's Botox Group Buy Program.
Have you got any intention of trying something besides Botox or Dysport? Does Xeomin have a chance in your clinic? Would you try it on a few patients to see if you like it?
Physicians, plastic surgeons, and dermatologists practicing nonsurgical cosmetic medicine in medical spas, laser clinics and aesthetic practices.
A community of dermatologists, plastic surgeons, laser clinics, & skin clinics world wide.
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