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.

Change Your Eye Color With A Laser?

Currently, if someone wants to change their eye color, they're limited to using colored contact lenses. However, Dr. Gregg Homer, a US physician, is currently testing a laser that will permanently change eye color from brown to blue. 

Topical Botulinum Toxin is Coming!

Botulinum toxin first came into clinical use in the early 1990s. Since then it has become very widely used, and is a billion dollar business. It acts by blocking the transmission of the signal from the nerve to the muscle, so the muscle is not stimulated and does not contract. Fortunately, the product is specific for the motor nerves and it does not affect the sensory nerves. Thus there is no localized loss of sensation or numbness associated with the use of botulinum toxin.

From the onset, the product has been injected into the target muscles. The toxin molecule is large, and it is difficult to get large molecules through the skin intact. Furthermore, in many areas the product must be placed precisely, so as not to affect muscles that would give an undesireable effect. Droopy upper lids or an assymetrical smile are examples of unwanted botulinum toxin effects.

Pan-Facial Filling: The End of the Facelift?

As our understanding of what causes facial aging advances, our approaches to this problem are advancing as well. Gravity as an explanation for the aging changes in the face has been discredited. Three factors are now recognized as important in facial aging: changes in the skin quality, mostly due to insults from the environment, but also due to biological changes that are not fully understood; repeated folding of the skin and loss of volume of the underlying tissues that support the skin. It is the last of these changes that I will discuss here.

For a while we have recognized that the loss of facial soft tissue: fat, muscle and connective tissue, have played an important part in facial aging. More recently it has become clear that loss of bone also plays a very important role. The openngs for the eyes are much larger in the skull of a 50 year old, than in the skull of a 20 year old. The jaw bone of a 20 year old is thicker and wider than the jaw bone of a 50 year old. These changes not only cause deflation of the face, but change the proportions. In the young individual the upper lip occupies 1/3 of the distance from the bottom of the nose to the tip of the chin. In the elderly it takes up 1/2.

Fat Injections: A Boon or a Bust?

The popularity of fat injections has risen and fallen, and appears to be on the rise again. The realization that many of the facial changes of aging are due to the loss of volume of both soft tissue and bone, has dramatically increased the use of fillers. Because the commercially available fillers are relatively expensive, fat grafting has been attractive as a relatively inexpensive source of a large volume of filler material, material that is native to the patient and should not cause allergic reactions.

Zeltiq: A Triple but not a Home Run

The Zeltiq Coolsculpting device has been the most succesful piece of equipment we have ever acquired. It works exactly as advertised. It is useful for belly fat, love handles and back fat. We have also used it on the buttocks and the male breast. These last two applications are off label, and the use on the buttocks was for volume reduction and not shaping.

Everyone sees results, which usually start to become apparent after one month, and can continue to improve for up to three months. Each treatment removes 20-25% of the fat in the roll of tissue thay is grabbed by the machine. Most people end up having two, or occasionally more treatments in the same area. Everyone sees results and we have had no unhappy patients.

Microlaserpeel + Broad Band Light: 1+1=3

Although patients commonly come in requesting a single procedure, very frequently they will get significantly better results if two or more procedures are combined. That is true of the MACS-lift (short scar facelift) combined with neck liposuction. It is also true of the microlaserpeel combined with the BBL (broad band light)

 

Fractional CO2 Resurfacing: Does The Emperor Have Any Clothes?

In an article published in the October 2010 issue of Lasers in Surgery and Medicine, the authors examined the results of fractional ablative CO2 resurfacing in 9 Chinese patients. The patients were being treated for skin rejuvenation and acne scars. Overall, the vast majority of the patients were pleased with their results, and there was mild to moderate improvement. However, there were significant problems with post treatment increase in skin color, and the authors raise the question of whether the results were enough to justify the treatment.

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.

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.