Sculptra: An Old Filler Resurrected

 Sculptra is a unique filler that was first approved in the US in 2004, for treating facial lipoatrophy (fat loss) in AIDS patients. It consists of a suspension of particles of poly-L-lactic acid, a material that has long been used in the skin as an ingredient in absorbable sutures. Although it was legally used for cosmetic purposes immediately after its initial approval, it received official FDA approval for this indication in July 2009.

Zerona: Do You Believe in Magic?

Zerona is a FDA approved device using "low-level" laser light to "contour" the body. Before getting further into this discussion, to avoid interactions with the company's  lawyers, I should make two things clear. First, what I am writing represents my own personal opinion about this device, based on what I've learned in discussions with representatives of the company as well as information on their web site and information presented by speakers at medical meetings. Also, I own a competing device, the Zeltiq, which actually does much of what Zerona purports to do.

There is a long history of medical quackery claiming fat reduction without dieting or discomfort. Zerona, in my opinion, is the latest example of this. Zerona plays on the public's fascination with lasers as well as the almost universal desire to be thinner. While getting treated with the Zerona you lie on a table while 4 low-level lasers rotate above your body. There is no discomfort because, I believe, nothing is happening, though the company, Erchonia", would dispute that.

People Who Don't Get The Message

Today I received an email asking if we have a specific brand of CO2 laser. People who ask this kind of question have absolutely no idea what they're doing, and are at great risk of getting into trouble. In this Wild West world of cosmetic surgery, people get the idea that there is a magic machine or a magic procedure that will take care of their problems. That's absolute nonsense. Let's say there were such a magic machine, but it was operated by a moron who was also a crook, and had no previous experience with the machine. Would this be a good choice?

Hand Rejuvenation: An Underappreciated Treatment

"All the perfumes of Arabia will not sweeten this little hand." William Shakespeare, MacBeth

Fortunately, since Shakespearean times, we have become much better at improving the appearance of hands, although perhaps not much better at washing away their sins.

If you look at the hands of children, the skin is smooth and of uniform color. No bones or veins are visible. With time the hand skin becomes sun damaged and irregular discolorations and rough spots appear. As in other areas, the deeper tissues are lost, and bones and veins become more visible. Many people put up with this because they are not aware that treatments are available. We had a patient in this week who is very attractive with clear facial skin. She regularly gets Dysport and filler. Her hands look like the hands of an 80 yer old. When I mentioned her hands, she said that she feels like she should wear gloves all the time. We discussed other options.

Zeltiq: Cool Device or Flash in the Pan?

Zeltiq is a device currently available in the US, with an indication for skin cooling. However, the real purpose of this device is to reduce body fat through cooling. The company says that the device is in the late stages of FDA approval. When the FDA approves a device, it does not vouch for the effectiveness of the device, only its safety.

At a recent meeting I had the opportunity to view the machine and talk to the company representatives. The working end of the machine is a rectangular device about the size of a hand forming the letter "C". It is long enough to enclose about 1/2 of an abdominal roll of fat. The Zeltiq only treats the skin that can be inserted into the machine. Thus it cannot be used on the thighs or buttocks. It is primarily for the folds on the lower abdomen and "love handles", although it has had some success with folds on the back. It has also been tried on other areas, such as the arms, but there is not a lot of information about its effectiveness in these other areas.

The "Wow" Effect

There are precious few procedures that we perform where, immediately after the procedure, we can hand the patient a mirror and their typical response is "wow". The injection of filler is the outstanding example of this phenomenon. The results are immediate and frequently very impressive. The final result, however, is more of an art, rather than a science. This is especially true now that filling has evolved from plumping up a specific groove to re-contouring the face, producing a more youthful facial structure. This is very operator dependent and it is unusual to see physicians who are not members of "core" cosmetic specialties (dermatology and plastic surgery) venture into this arena.

"I love you, Dr. Bock"

That is how I was greeted last week by a long time patient. She had undergone a number of noninvasive procedures in the past few years, but two weeks before I saw her I had, for the first time, injected filler in her cheeks. The aging of the mid-face has, with the development of better and linger fillers, become recognized as one of the primary events that makes a person look aged. The young face is full, with smooth, convex surfaces, while the aging face becomes concave, with the loss of deep tissue and other structures. This produces depressions such as the "tear trough", a groove that extends downward and sideways from the inner (medial) part of the eye. It was this area that was filled in my patient. She was smiling as she reported that even her teenage son, without knowing that anything had been done, told her that she looked good.

Laser Fat Destruction & Eyelid Burns

Although many cosmetic surgeons now recognize that lower eyelid bags are more commonly due to tissue loss rather than true fat protrusion, there are many who are still excising lower eyelid fat. Apparently a very small subset of these is attempting to remove this fat by making a small incision in the lateral lower lids, inserting a fiber from the "LaserTight" device and attempting to melt the fat and tighten the skin. This is a procedure that is new to me, and on the surface appears fraught with hazard. There are muscles near the fat that, if injured, could make it difficult for both eyes to move in a coordinated fashion. Furthermore, bleeding from eyelid surgery can rarely result in loss of vision, and this procedure is performed without direct visualization.

Latisse: Something Really New

It is rare that a product or procedure is introduced that opens up a new area of cosmetic enhancement, or redefines an old one. The introduction of collagen filler injections was one, as was the introduction of Botox. The use of lasers to resurface the skin and destroy blood vessels was also a paradigm changer. Now we have the introduction of Latisse, which reliably produces longer, thicker and darker eyelashes in the vast majority of people.

How to Get Your Money's Worth When Times are Tough

Now that the economy appears to be in recession, it is more important than ever to get your money's worth when spending for cosmetic procedures. While it is certainly an option not to have anything done, for many people that may not be the best choice. There are many studies that show that your appearance significantly affects how people react to you. This is always important, but it may be even more so now, when people are feeling stressed. If you appear more relaxed, others around you will likely feel more relaxed as well.