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.

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.

Topical Botulinum Toxin?

Revance Therapeutics, a start up company, has been working to develop a topical form of botulinum toxin. This would be an advantage for people who are adverse to needles. Botulinum toxin is a relatively large molecule, and conventional wisdom would suggest that it would be difficult or impossible to get such a large molecule through intact skin. The molecule would have to be in good enough shape to be functional.

Apparently Revance has overcome this obstacle and it is working on getting approval for its product for at least 2 different applications. The first of these is for the treatment of the wrinkles by the corner of the eyes, the "crow's feet". If the product is going to work at all, this should be a prime location. The skin in this area is thin, and the placement of the toxin does not have to be very exact. The product will be applied in the physician's office and the patient will have to wait while it is occluded for 20 minutes. How it will compare in price to the injectable toxin is unknown.

Resurfacing, the Big Gun

Skin resurfacing has been around for a long time. The earliest procedures were performed over 100 years ago, using a variety of acids. Eventually the procedures became somewhat standardized, with the phenol peel becoming recognized as the most effective of the peels. It has fallen from favor because, in the long term, it reliably produced significant loss of pigment (hypopigmentation). The weaker peels, some of which such as the glycolic and trichloroacetic peels, produced less problems but also were less effective and somewhat erratic in their outcomes.

Fraxel re:pair (CO2)

This past weekend I went to a Fraxel re:pair seminar at Reliant Technologies. The re:pair is a CO2 laser that uses Reliant's patented scanning technology to lay down a precise pattern of laser  pulses on the skin. There us no doubt, in my view, that Fraxel has the most sophisticated technology in the field. The scanner is fast and precise, and the relatively high power of the laser allows deeper penetration than competing lasers.

Fraxel Re:pair (CO2)

It was with some trepidation today that I signed the contract to purchase the new Fraxel Re:pair laser. The laser is quite expensive, but it appears likely to revolutionize the treatment of aging, wrinkled and scarred skin.

Smoking and Aging

In the December 2007 Archives of Dermatology there is an article published about a pair of identical twins. Although you cannot access the article without purchasing the access, photos of the two women are on the cover of the journal, and a clickable box on the link will enlarge the cover and the photos.

Pre-emptive Botox

This week I had one of my established patients come in for her first Botox treatment (Botox information) . She pointed between her eyebrows and said "I want to get rid of these". There was nothing visible. When I mentioned that, she frowned and, pointing to the wrinkle line that was now visible, said "I can see it starting to develop."

Lip Lines: A new approach

Lines on the upper lip tend to drive people, especially women, crazy. Lipstick tends to creep up and accentuate these lines. These lines are caused by folding of the skin by the orbicularis oris, the muscle that encircles the mouth. They're commonly thought of as smoker's lines, but for most people these days, they're really talk and expression lines. If you stand in front of a mirror and pucker your lips, you'll notice that each line occurs at the bottom of a fold. Unfortunately , not talking and not having any facial expression doesn't seem a reasonable approach to eliminating lip lines. That's why the use of Botox doesn't play a big role around the lips.