Patients turning to financing options less

Fox News and the Associated Press are reporting that in Arizona and nationwide, some patients are either exploring financing options or putting off cosmetic surgery altogether, while the rest are seeking "beauty on a budget."

From the article:

"Even in the downturned marketplace, patients are visiting our offices for procedures like Botox an average of 2.9 times a year compared to the national average of 1.3 times," said Gulbranson.

On the other hand, the society's survey found a steep drop in demand for major plastic surgeries including breast augmentation and nose reshaping.

Some lending agencies that provide loans for cosmetic surgery are also struggling.

"Some lenders have gone under, others are tightening credit, but still others are doing fine despite the market," said Kelly Schnarr, account manager for Surgery Loans..."

We probably do financing for about 10% of our patients. Most of our patients pay with credit card or check, and rarely cash. But many areas of the country are different, and we're going to hear from some other surgeons later in the day.

Thanks for reading,
Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists NY/NJ

Two more allegations of illegal cosmetic surgery

There's been yet another arrest in cosmetic surgery:

In Chicago: "Med Spa Patients Say Lasers Scarred, Burned Them"
A chain of med-spas is dealing with lawsuits alleging that inexperienced and unqualified practitioners treated them with lasers when they should not have.

From the article:

"Can your skin type tolerate laser treatments? If so, which laser? At what energy level? And for how long? Those are all decisions that need to be made by an experienced practitioner.

For others the treatments can bring great results, but Garden, the past president of the American Society for Laser Medicine and Surgery warns, "These machines can still cause damage. They can still injure the patient."

This is a bad trend that is getting worse and worse with the state of the economy. Expect some big stories in the media about this type of thing soon.

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser and Surgery Specialists, NY/NJ

Update: Latisse approved by the FDA

To update a previous blog item, the eye-lash booster Latisse has been approved by the FDA. Expect to see it being sold in cosmetic practices sometime in February.

To recap, Latisse was originally a glaucoma drug called Lumigan, which has been in use for the last seven years. Patients reported side effects of enhanced eyelashes, which led Allergan to explore cosmetic applications for the drug. This is similar to Botox's birth as a treatment for excessive blinking that happened to smooth nearby wrinkles.

Thanks for reading,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg
Sanctuary Medical Aesthetic Center
Skin and Laser Surgery Specialists of New York/New Jersey

Another arrest in cosmetic surgery...

Another arrest in plastic surgery today... from the article:


"A dermatologist was arrested Thursday after being indicted on charges that he injected patients at his West Hollywood clinic with fake Botox that could have caused a muscle-paralyzing condition.

Dr. David Cary Hansen, who works out of a Sunset Boulevard clinic called Skinsation, is accused of buying a dozen vials of a form of botulinum toxin type A, which was not approved by the U.S. Food and Drug Administration for use on people, the U.S. attorney's office said."

It's never a bad idea to ask to see the actual vial of Botox or filler before it gets injected. If a product is too cheap to be true, then it's probably fake. Only go to a reputable doctor, you really get what you pay for.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David Goldberg
Sanctuary Medical Aesthetic Center
Skin and Laser Surgery Specialists of NY/NJ

Adult acne linked to stress?

Acne has been around forever. Yet acne has always been thought to be a teenage problem, not one seen in adults. An increasing number of adults are coming in with disfiguring acne breakouts. Could it be the stress of our everyday society? A recent article in the British Journal of Dermatology found a direct connection between stress hormone elevation and acne breakouts.



Adults are clearly breaking out with more pimples; sometimes they can look worse than their adolescent children. Thankfully, there are many ways to deal with this problem. Some patients can be treated with a variety of antibiotics or other oral medications. However, all such medications have potential side effects.

An alternative is the laser approach that has developed extensively over the last 5 years. There are now lasers that decrease the bacteria that cause acne. Some of these light-based devices, known as light emitting diodes, are painless and can be used on all skin types. Other lasers work through a heat based effect and can shrink the oil glands that promote acne. Finally for very difficult acne patients, a topical medication known as amino-levulinic acid (ALA) can be activated by certain lasers to have a profound acne clearing effect. In fact, some investigators feel that this process, known as photodynamic therapy (PDT), may eventually lead to a cure for acne.

One of the greatest benefits of laser acne treatment is that some of these technologies not only help to clear acne, but also improve acne scarring. The scar improvement occurs because such lasers produce new collagen formation. This leads to acne scar improvement and smoother skin.

So it is true that stress does cause acne flares. In our current stressful times, laser treatments can lessen the stress by clearing acne and making skin look healthier.

David J. Goldberg, MD
Sanctuary Medical Aesthetic Center
Boca Raton, FL
Skin Laser & Surgery Specialists of NY/NJ

Jason Pozner, MD
Sanctuary Medical Aesthetic Center
Boca Raton, FL.

Reloxin: Part Deux

I am one of the U.S. investigators performing FDA studies on Reloxin. The stuff works and is safe. The distributor of Reloxin (Medicis) is doing things the right way. We have been following Reloxin patients – and re-treating them – for 3 years. This wrinkle softening material will do exactly what it has done in Europe as Dysport. It will give both patients and their physicians another wonderful choice in the fight against wrinkles.

According to Colin Stewart at the OC Register's In Your Face blog, Medicis' application to the FDA is essentially the same as the one that was rejected just 11 months ago, but has cleared up issues regarding Medicis' "sponsorship and ownership of the filing."

Dr. David Goldberg

Sanctuary Medical Aesthetic Center

Skin and Laser Surgery Specialists of NY/NJ

Reloxin preferred over Botox in tests?

I just returned from a Pharmadura meeting in Dallas, which centered around the upcoming FDA approval for Botox competitor Reloxin. It's called Dysport in Europe and is to be distributed by Medicis in North America.

The advantages of Reloxin are its faster onset and "softer" look. Some proponents claim there is a longer lastings effect, but this is not certain at present. Anecdotal evidence from patients in the U.S. FDA trials who were Botox users are that these patients preferred Reloxin. Adverse incidents from the FDA trials are less then those experienced with the Botox trials, but his may be due to the fact that the physicians in the trials are more experienced injectors.

We await FDA approval and hope to have Reloxin for clinical use by first quarter 2009.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David Goldberg
Skin Laser & Surgery Specialists NY/NJ
Sanctuary Medical Aesthetic Center

SMAC on Youtube

We now have two Youtube videos up from appearances on Florida television.

The first is of our laser breast lift using an Accent skin tightening system.


The second is a segment with Dr. Goldberg using fillers to help correct droopy earlobes.


Thanks for reading,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Dr. David Goldberg
Sanctuary Medical Aesthetic Center
Skin Laser & Surgery Specialists NY/NJ

Another big acquisition in dermatology

After last week's Johnson & Johnson acquisition of Mentor Corporation, Rhonda Rundle of the WSJ is reporting that Valeant Pharmaceutical Sciences International is buying Dow Pharmaceutical Sciences Inc. for $285 in a move that will boost Valeant's presence in the skin-care market.

From Valeant's website:
"Valeant is working to build a significant dermatology portfolio through both acquisitions and internal growth. Valeant's dermatology sales force currently focuses on promoting Kinerase® and Efudex®/Efudix®, but also sells a number of other successful brands including Oxsoralen-Ultra®, Dermatix™, Glyquin®, Solaquin® and Eldoquin® in markets throughout the world."

They mostly sell creams for wrinkles, acne, and scar reduction. I expect to see a lot more of these acquisitions by companies looking to hedge their bets in this economy.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Allergan to release first medical eyelash-boosting makeup

It is amazing how much we have learned about the science of hair. Over two decades ago a medication used for high blood pressure (minoxidil) was shown to grow hair when applied to some men’s scalps. Later was shown that women with thinning scalps could also benefit from this magical potion. This had led to what is now marketed as today’s Rogaine®. The problem was that the medication in general is only useful when topically applied to the scalp.

For the last 20 years promoting hair re-growth has remained an enigma for body areas outside the scalp. Physicians frustrated with their inability to induce hair growth then switched gears and began to focus on laser hair. For the last 15 years we have developed all kinds of lasers and laser-like systems for the removal of unwanted hair. These included ruby, alexandrite, diode and Nd:YAG lasers as well as intense pulsed light sources. These in-office devices have become highly successful and have now led to the development of less powerful, but still somewhat successful home hair removal devices.

So folks can now easily have their hair removed, but how can they re-grow it? Of course there are always hair transplants. These surgical procedures are usually performed on the scalp, but have been successfully undertaken on other locations on the body as well. These kinds of surgical approaches care near impossible to perform for such tough areas as the eyelash region. Women, for years have done all kinds of things to plump up their eyelashes. But results can be very unnatural.

The recent FDA approval of Latisse, by Allergan (the makers of Botox®) may change that. Latisse is the first and only FDA-approved product to enhance eyelashes (making them darker, longer, and thicker). Ther discovery of this remarkable product occurred when physicians noted that another product already on then market for the treatment of glaucoma (Lumigan) was found to promote eyelash growth. Lumigan is applied as eye drops in the eye. Latisse, in contrast, is applied directly to the eyelashes with a special applicator. Today we can grow hair, tomorrow perhaps skin. Who knows what is next?

David J. Goldberg, MD

Sanctuary Medical Aesthetic Center

Skin Laser & Surgery Specialists of NY and NJ

Why does fractional laser skin resurfacing work?

Fractional resurfacing has been a buzzword for the last few years with the introduction of the Fraxel device. Things have progressed and new machines have been introduced that have made treatments more effective. Fractional resurfacing is a laser procedure that treats only a fraction (or portion) of the skin surface. The laser puts down a series of spots that treat typically from 5-30% of the skin surface area per treatment – leaving 70-95% of skin untreated. The theory is that the partial injury creates an environment under the skin that leads to collagen changes and therefore improved skin. The devices are broadly grouped into non-ablative and ablative lasers. Non-ablative fractional lasers create a column of dead skin that the body eradicates while ablative lasers create an ablation channel.

For the record, laser skin resurfacing was one of the big movers in the American Society of Plastic Surgeons' 2007 report (PDF), being performed 32% more times than in 2006. I expect this trend to continue in 2008, as the faster turnaround time and less scary perception of non invasive surgery seems to be en vogue right now.



Thanks for reading,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Home Laser Hair Removal

Kristine Johnson at WCBS in New York just reported on laser hair removal being available at home, in conjunction with this month's Allure magazine, which I was quoted in. This is old news down at SMAC in Boca Raton, where we've been carrying the Tria by Spectragenics since April.

Effective lasers for home use are a hit. It is no surprise that such machines are finally here. In fact, it is now almost 15 years since our research team and teams at Harvard Medical School were able to show that lasers could safely, effectively and permanently remove unwanted hair. First we were only able to treat dark hair on light skin. Then lasers became available to treat unwanted hair on dark skin. Now we are investigating approaches to treat white hair – something that has always been a challenge. The enormous acceptance of this method of hair removal led me to write an entire textbook on Laser Hair Removal - a book now in its 2^nd edition.

The success of physician in-office laser hair removal now has led to the development of small at home devices. Some such as Tria and Silk’n really do work --- with some caveats. Most such systems are only safe for lighter skinned individuals. In fact the company that makes Tria requires you to call in after you purchase the device so that they can activate it. If you tell them that you are dark skinned, they will not activate it.

Another disadvantage of the home devices is that they are really slow. It will take you forever if you want to use them on large areas such the legs or back. However, if you want to treat some straggler hairs or a few hairs on your toes, these home based machines are ideal. Finally, none of the home devices are as strong as those used in a doctor’s office – they will never work as well.

The success of laser hair removal in physician offices has also led to a darker side – inexpensive laser hair removal procedures performed in many spas, often by a high school graduate without any physician supervision. In-office and in-spa laser hair removal is performed with high powered devices. If not used properly, significant scarring can and, unfortunately, does occur. Find out who is treating you and whether there is physician supervision. Yes, you will pay more money – but it will also be safer.

David J. Goldberg, MD
Sanctuary Medical Aesthetic Center
Boca Raton, FL
Skin Laser & Surgery Specialists of NY/NJ
New York, NY

Jason Pozner, MD
Sanctuary Medical Aesthetic Center

The future of cosmetic applications for stem cells

From World Health News:

"
30-year-old mother-of-two Claudia Castillo needed a new left bronchus after her airways had been damaged by tuberculosis. Transplanting airways has always been very problematic and such transplants are usually unsuccessful. Therefore researchers at the University of Bristol in England embarked upon growing the woman a new airway.
...
Writing in The Lancet, the authors conclude: “The results show that we can produce a cellular, tissue-engineered airway with mechanical properties that allow normal functioning, and which is free from the risks of rejection. The findings suggest that autologous cells combined with appropriate biomaterials might provide successful treatment for patients with serious clinical disorders.”
"

There are far reaching implications for this in plastic surgery and cosmetic dermatology. The use of stem cells to grow body parts is something out of science fiction but is now a reality. Someday we may be able to grow breasts or other body parts that have been removed or never formed.

Current work is on fat stem cell transplants for breast reconstruction and facial augmentation, but someday many diseased organs may be repaired and even cosmetic applications will be found. The concept for cosmetic purposes goes back two decades when investigators first took human cells known as fibroblasts and were able to grow collagen from these cells.

It was thought that if such cells were taken from an individual, were then induced in culture to form collagen --- and that collagen was re-injected into that individual’s wrinkles – the results would be permanent. Unfortunately, they were not. Things clearly have changed. Now that a full bronchus has been formed, skin, breasts and hair may not be far behind.

Thanks for reading,

Dr. David Goldberg
Skin Laser & Surgery Specialists of New York & New Jersey
Sanctuary Medical Aesthetic Center

Visit to one of the first med-spas in Toronto

I spent some time over Thanksgiving visiting with Dr. Steve Mulholland, of SpaMedica in Toronto. I toured his facility, which was spectacular and will be even better after an upcoming renovation. SpaMedica was one of the first medi-spas out there and was an inspiration for SMAC in Boca Raton.

Canada has different rules when it comes to testing and approving new devices, so Steve has a bit of an advantage there when it comes to new technology. We're still testing the Ultrashape but he's been using it in his practice for some time, since it's already approved in Canada. He combines it with Velashape to get some more cellulite removal.

Pretty soon he'll be getting the Liposonix device from Medicis. It's similar to what Ultrashape does, but it's more thermal and supposedly has tighter skin contracture, albeit with more pain. I trust Steve's judgment so we'll see what he says about it. Maybe he should do a split body study on love handles, where each side is treated with a different machine.

He gave me the scoop on some other upcoming technologies that I'll be talking about later.

That is all,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Johnson & Johnson buys Mentor for $1.07 billion

Johnson & Johnson is no longer just your baby's favorite pharmaceutical company. After recent flirtations with the cosmetic market (Evolence), some people speculated that they might try to compete with the big boys of Allergan and Medicis. They're certainly going to do that now, after acquiring Mentor Corporation this morning.

Mentor makes popular breast implants, as well as the recently released Evolence (collagen filler) and Prevelle/Prevelle Silk (hyaluronic acid mixed with painkilling lidocaine).

The deal seems to be a big-business affirmation that the cosmetic market will remain strong.

Florida #1 in Cosmetic Surgery Arrests

Last week, the American Society of Plastic Surgeons put out a press release advising patients to avoid seeking deals on cosmetic surgery. The key is to have the procedure done right the first time as corrective procedures can get very expensive.

People have always looked to save money on cosmetic surgery, and we’ve heard and dealt with countless horror stories. We have seen many patients with terrible scarring and swelling from having illegal substances injected into their lips by unlicensed foreign practitioners in their garage. Needless to say they needed to have corrective work done just to look normal again.

Undoubtedly a most bizarre and sad example of a disastrous procedure performed by an unlicensed practitioner occurred in New York several years ago. An unlicensed practitioner advertised that he was a physician who performed a variety of cosmetic laser procedures. Eventually, he was reported to the authorities and was found guilty of practicing medicine without a license. Before he was sentenced for this crime, he fled to Costa Rica. While hiding in Costa Rica, the body of a missing patient who died while undergoing a procedure by this felon was found buried on a property he owned n New Jersey. He was ultimately extradited back to New York not only for practicing medicine without a license, but also for murder. This is an extreme example, but something that can happen when people choose to pay less to have a procedure performed by someone who is clearly not qualified to do the procedure.

Click here to see every publicized arrest for all things cosmetic in the last two years. In the last two years alone, there have been eight high-profile cases in Florida, the most in the country. We're not kidding in saying that we're pretty experienced in dealing with these cases. Every pinprick on the map has some details about each case; the date it happened, and what happened.

California was second with six arrests, Arizona third with three.

Have a great Thanksgiving.

Dr. David Goldberg
Skin Laser & Surgery Specialists of NY and NJ
Sanctuary Medial Aesthetic Center

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Ab Etching with Laser Lipo

Last week I had a great conference call with Dr. Marc Salzman from Louisville, Dr. Barry Citron from New Jersey, and Brian Heil from Pittsburgh about skin tightening with laser liposuction.

I presented on my laser ab etching technique, which you can see in the before and six months after photos above. The patient was 66 years old! This is really popular for people who exercise and eat right, but just can't get over the hump when it comes to having definition in their abs.

The six-pack is marked out and then we give local anesthesia. I use a very fine Sciton pro-lipo cannula to remove the excess fat, and then I do some touch up with a tiny regular lipo cannula. The surgery takes about 45 minutes, and then it really takes a few months to really see the final full results. I also use Dr. Goldberg's favorite RF skin tightening device, the Accent, for any touch-up that is needed later on.

-Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Foreskin derived beauty products are not new

There has been a hum about Valveta, a substance purported to be the newest anti-aging skin treatment (see below).

Although the concept of using foreskins for cosmetic purposes may seem quite radical, it is not really new. This approach is the basis for a very popular skincare cream known as Neocutis. Neocutis products, first developed for burn patients in Switzerland, contain a variety of growth factors -- all derived from a single group of human foreskin cells. We use Neocutis in our Boca Raton, NYC and New Jersey offices as part of our anti-aging skin care approach.

The basis of Neocutis cream’s healthy skin benefits derives from research I performed several years ago. This research, now published in the Journal of Cosmetic and Laser Therapy, showed that when women applied this cream to their face for 6 months, aging skin looked healthier and shinier. When biopsies were performed on the treated skin, new healthier collagen was noted to be induced by the foreskin derived growth factors in the cream.

Foreskin derived beauty products may seem radical, maybe even weird. But they are not new and they can make skin look good.

David J. Goldberg, MD
Skin Laser & Surgery Specialists of NY/NJ
Sanctuary Medical Aesthetic Center

Upcoming filler will use discarded baby foreskins

You'll be hearing a lot about this filler soon. From today's NY Daily News:

"Vavelta is a clear liquid derived from baby foreskins, donated by mothers whose babies have just been circumcised. The liquid is injected into adult skin damaged by acne or burns.

The results look promising so far, but it's a bit early to get too excited. Vavelta, developed by a British biomedical company called Intercytex, is at least four years away from being available in the U.S. If it does win FDA approval, chances are Vavelta would be used only in the treatment of burns and acne, at least initially, a company spokesperson says.

The treatment, which claims to be permanent, is different from skin fillers like Juvederm and Restylane because it contains tiny skin cells, called fibroblasts. The cells rejuvenate and revitalize damaged, aging skin from the inside by actually repopulating the lower skin layers with millions of healthy young skin cells."

The article goes on to add that one foreskin is enough to create thousands of treatments, as the skin cells can be grown into cultures and frozen. We will back soon with Dr. Goldberg's recent publishedstudy on growth factors in foreskin cells used by Neocutis that lead to healthier skin.

Full text of FDA filler document

You can review the PDF here. (via In Your Face).

Treating dark skin for acne with laser

Treating adult acne with lasers instead of risky pills is one of the hottest topics that plastic surgeons and dermatologists alike are focusing on. Dr. Goldberg just came from the ASDS meeting, where they talked about lasers and laser-like devices such as Isolaz that can help lead to radiant skin texture without taking antibiotics and/or Accutane.

One of the big roadblocks in all laser treatments has been the risks that darker skinned and Asian patients face, especially regarding hyperpigmentation. We posted on that here for laser hair removal.

I was just at the Sciton users group meeting in Los Angeles, where I was lecturing on advanced laser resurfacing and fractional laser resurfacing. An interesting topic related to this was presented was by Dr. Todd Besinger (who provided the above photo), a dermatologist from Hawaii. He presented some excellent data that shows that acne scarring can be treated very successfully in Asian patients with minimal post-inflammatory hyperpigmentation. For laser wonks out there, he had especially good results with the smaller spot size Sciton with each spot at 250 microns.

Experienced doctors out there have figured out how to treat all skin types with lasers. This is going to be a big story in 2009 as it becomes more widespread.

Dr. Jason Pozner
Sanctuary Plastic Surgery
Sanctuary Medical Aesthetic Center

FDA Report on Wrinkle Filler problems

This week the FDA said that it had received 930 reports of health problems from wrinkle fillers over the last 6 years. These problems included facial weakness , disfigurement and even rare, but potential life-threatening events such as severe allergic reactions. Other more common problems include minor swelling. The FDA does not identify which fillers are the culprits, whether they are FDA approved products and whether they were injected in the offices of qualified cosmetic dermatologists or plastic surgeons. Needless to say my patients are already asking me whether they should be getting wrinkle fillers or whether I, as a cosmetic dermatologist and an attorney, am comfortable giving fillers. The answer is a simple one. I am totally comfortable with doing this and my patients love the results.

I have been giving wrinkle fillers for over 20 years. I have treated tens of thousands of patients with the FDA approved products. These include Restylane, Perlane, Juvederm, Radiesse, Preville Silk, Sculptra, Zyderm, Zyplast, Cosmoderm, Cosmoplast and Evolence. All are FDA approved in the US. Of course there are risks to any procedure. You must feel comfortable with whom you are seeing. The injector of the filler must be experienced and qualified. That being said, I have never ever seen anybody with a life threatening event. Of course swelling can occur and yes occasionally a patient needs a little hand holding.

I am not only comfortable giving my patients fillers injections, I am also comfortable giving them to my family members and even getting them myself. The issue is not whether reactions can occur. Of course they can. It must be remembered that millions and millions of wrinkle filler injections have been given with success. The incidence of complications is never zero for anything. The key is to be sure your physician is using a FDA approved filler and that he or she is experienced. I need some more filler in my smile lines and will certainly get more done to me.

David J. Goldberg, MD, JD
Skin Laser & Surgery Specialists of NY and NJ
Sanctuary Medical Aesthetic Center

Weighing in on Korean Cooking Oil Filler

Everyone is talking about Hang Mioku, the Korean woman who became addicted to cosmetic surgery to the point of injecting her face with cooking oil when no real doctor would see her.

It's not as far-fetched as it sounds, especially with today's economy. Every city in America has several arrests a year involving illegal practitioners, doing all kinds of back-alley liposuction, breast implants, fillers, and anything else you can think of. Patients looking to cut costs often end up risking their health, tens of thousands of dollars of corrective surgery, and if they're lucky, merely a disappointing result.

Always do your homework and go to a respectable board-certified doctor. If we say no, and we sometimes have to, then we really mean it. If we say yes, we have FDA-approved procedures and fillers that won't make you the 5 o clock news.

One of my patients spoke to ABCNews.com about her own plastic surgery nightmare, and was kind enough to mention the work I did in correcting it. You can find it here.

Dr. Jason Pozner
SMAC

Beyond mesotherapy for skin tightening

Body sculpturing with non-surgical approaches was one of the most exciting topics of the ASDS meeting. The development of minimally invasive skin tightening and fat removal technology has always been an equal source of fascination and frustration for the media (see traditional mesotherapy), but there are procedures coming up that could advance far past what is currently possible.

To me, the current king of skin tightening and cellulite reduction is the Accent. It's a deeply penetrating unipolar radiofrequency device. The main difference between unipolar and older bipolar RF devices is it doesn't need to use electrical current in the tissue; rather, it uses high-frequency electromagnetic radiation, which causes the water molecules of the skin to rapidly oscillate, thus producing heat, which dissipates deep into the surrounding tissue.

I authored a study in the Journal of Dermatologic Study on this that you can find here.

Newer research have focused on ultrasound (UltraShape, as Dr. Pozner told you about below), or cryolipolysis (Zeltiq) and injectable substances such as deoxychoate.

This is the latest that may allow patients to lessen fat and improve their body shapes without surgery, pending FDA approval. I am one of the investigators on this new material manufactured by Kythera. The stuff literally melts fat. It’s development follows some of the pioneering work on a scientific approach to mesotherapy by California dermatologist, Dr. Adam Rotunda.

A common problem in the past has been poor standardization of mesotherapy injections. This has led to a lot of bad results due to some inexperienced practitioners. Once again, patients should never skimp on qualifications when it comes to cosmetic medicine. Kythera may someday make mesotherapy a widespread option for skin tightening.

Dr. David Goldberg
Skin and Lasers
SMAC

Back from another conference

The annual American Society for Dermatologic Surgery (ASDS) meeting ended this past weekend in Orlando, Florida. The meeting was remarkable for its emphasis on non-surgical approaches to skin rejuvenation. I'll talk about the facial enhancement items first.

The liquid facelift approach to facial enhancement was emphasized in many of the sessions. A variety of new wrinkle fillers and facial volume enhancers can now be used in addition to Botox® to lift jowls, fill sunken cheeks and lower eyelids and lift brows – all without surgery. These fillers include Radiesse, Sculptra, which you know about already, and a new products called Novielle.

Dr. Pozner and I are on the Advisory Board for Coapt, the manufacturer of Novielle and among the first in the world to use this product. The material is a natural calcium gel unlike any other material currently used for non-surgical facial enhancement.

It is now increasingly easy to postpone a facelift for those who wish to avoid surgery. I'd like to point to the leaders in this field now, including Dr. Alistair Carruthers, Dr. Tina Alster and others.

Cosmetic dermatology isn't all about fillers, however. Tomorrow, I'll talk about some of the new non-invasive body sculpturing techniques that were being shown off.

Dr. David Goldberg
Skin Laser & Surgery Specialists
Sanctuary Medical Aesthetic Center

More on the "Air Implants" from Allure...

Allure's "Scalpel News" last month mentioned the new "air" implant called the Implite. It's being developed by Dr. Ami Glicksman in Israel, who is a friend of mine and also the inventor of the Ultrashape, which we're privileged to be one of six sites conducting clinical trials in the U.S. Needless to say I'm very impressed with what he is doing.

Anyway, I caught up with Dr. Glicksman at the ASPS conference and he showed me his latest prototype of the Implite. At this stage, it is about 1/3 as heavy as traditional implants. It's not a balloon like you would think, but more of a shell/skeleton that happens to have some air inside of it. They've already tested it at depth and altitude and it's passed with flying colors.

Many complications from breast implants come from their unavoidable weight. Whether they're made from silicone or saline, implants will eventually sag. What goes up, must come down.

That's why it's important for patients to ask lots of questions and have realistic expectations about the result.

At this stage, I can't say much more about it, but they're looking to start clinical trials overseas in a few years, with FDA testing coming after that. They are also looking for additional financing of $1.5 to 2 million to really get going.

Look out for the Ulthera after FDA approval

One of the most exciting upcoming things I've seen in a long time was a Deep SEE presentation from Ulthera at the ASPS conference.

They have some major ultrasound patents that they are using to combine facial imaging and tightening into one package. First, they use the ultrasound handpiece to create a sonogram looking into the patient's skin and everything underneath. After reviewing that information, the same handpiece can be adjusted to send low levels of heat energy to a precise depth below the outer layers of the face.

The energy causes to tighten, and then grow new collagen over time. Pending FDA approval, this could be really good for the "SMAS" (i.e. the facial suspension system of the face that is targeted by traditional facelifts), the sub-skin muscular layer, and also the neck.

I'm always on top of the latest minimally invasive technology at SMAC so I will be following this one closely. The imaging technology here might herald even greater levels of precision and predictability of results in facial tightening.

Back from the ASPS conference...

I'm back to work after the annual meeting of the American Society of Plastic Surgeons in Chicago. The best part is always getting an insider's preview of the upcoming technology that no one else has seen yet.

On Monday, I was on a panel hosted by Dr. Daniel Dubin (Vice Chairman of Leerink Swann, founder of MEDACorp) about non-invasive body contouring technology.

The main focus was on non-surgical fat removal and centered around three devices that are awaiting FDA approval:

The first two are very interesting ultrasound devices. The UltraShape and Liposonix both use ultrasound waves to break up fat deposits, which the body then treats as regular fat and flushes them out via the liver. Liposonix was acquired by Medicis a few months ago, so along with Reloxin they'll have a lot of new products coming out next year.

The third is the Zeltiq. It uses a process called Cryolipolysis, which precisely cools fat to induce it to break down.

FYI: Our practice in Boca is actually one of six sites in the country that are conducting FDA tests for the UltraShape, while Dr. Goldberg is conducting Zeltiq tests at Skin and Lasers in New Jersey.

These are absolutely the newest non-invasive procedures and pending FDA approval, you'll be reading about them in every women's magazine and seeing them done on TV in a couple of years.

Dr. Jason Pozner,
Sanctuary Plastic Surgery

Pliaglis quietly pulled from market

It was launched with a lot of fanfare, but Galderma announced that they are discontinuing Pliaglis, which was a topical analgesic that would create a mask of lidocaine and tetracaine.

From Pliaglis.com...

"We took this action because of recurring inconsistent viscosity (thickness) of the product formulation. Our testing has found significant levels of variability in the viscosity parameter, resulting in a thicker cream which can make application of the product difficult."

After pulling the mask off, the application area would, in theory, be numb and ready to inject, thus eliminating the need for a separate injection of lidocaine.

It's a shame, it was highly effective, but varied in consistency due to compounding pharmacies.

Some injectors mix a little lidocaine with the Botox or filler, if requested by the patient.

Dr. David Goldberg
SMAC

A few thoughts on laser hair removal & dark skin

Colin Stewart of In Your Face out in California had a great post the other day about laser hair removal for darker-skinned patients. From the article:

"Devices that have been FDA-approved for removing hair from darker-skinned people, Dierickx said, include:

• LightSheer diode laser from Coherent
• SLP diode laser from Palomar
• CoolGlide Nd-YAG laser from Cutera (photo below)
• A new generation of Lyra Nd-YAG lasers from Laserscope
• GentleYAG Nd-YAG laser from Candela
• Filtered Flashlamp IPL from ESC

Hair removal treatments can produce burns, scarring, or pigment changes in patients with darker skin, said dermatologist Dr. Teresa Soriano, associate clinical professor of dermatology and co-director of the Dermatologic Surgery and Laser Center at UCLA.

“However, the advent of longer wavelength devices with longer pulse durations has made laser-assisted hair removal safe and effective in persons with darker skin,” she told the Dermatology Times."

Laser hair removal for darker skinned patients (including people with dark tans, which is quite common in Boca) is challenging, but combining the right tools with experienced hands leads to satisfied patients.

We use a 1064nm Nd:YAG laser that is very safe, thanks to its longer wavelength. Most of our darker skinned patients have hair that grows curly and can get ingrown and infected very easily, which makes this procedure very necessary.

If you have darker skin and are interested in this, make sure you ask about a longer wavelength laser! Dr. Goldberg, who literally wrote the only textbook on laser hair removal, recently had a patient who is a professional model. Unfortunately, she had bad scars from a previous doctor's laser work, which can happen if you don't go to an expert. Once Dr. Goldberg switched the model to the right laser, she had great results.

Dr. Jason Pozner
Sanctuary Plastic Surgery

Good News and Bad News From New ASPS Study

From the study:

" -- 59% of respondents say the economy has had an impact on their
plans for cosmetic plastic surgery. That's up 9% from six
months ago.
-- 48% of the survey participants are less likely to schedule a
consultation appointment now compared to 30% six months ago.
-- 27% of the survey participants indicated they were considering
less expensive options, compared with 20% six months ago."

As for surgeons:
"
-- 62% report a decrease
-- Region most affected - Northeast and Southeast
-- Region least affected - Midwest
"
Cosmetic surgery by its very nature is a luxury, and this is not a shock to anyone. Dr. Pozner at Sanctuary Plastic Surgery still is very busy with correctional and revision surgery, which is a big priority for many patients. However, the silver lining here is for cosmetic dermatologists:

-- 73% (almost 3 out of 4) report an increased or stable demand for
procedures like Botox(R), chemical peels, and hyaluronic fillers.

This is why we're still booming: these procedures are less expensive, less invasive, less stressful, and people don't have to miss work to have them.

With these factors, lipstick might get replaced by Botox as the recession-proof cosmetic. According to the Wall Street Journal, lipstick sales are down 6% compared to 2007, while lip gloss is down 14%. At the same time, studies like this suggest that Botox use may very well increase.

Thank you,

Dr. David Goldberg
SMAC
Skin Laser & Surgery Specialists

Tom Jones hides scars with his goatee

The site Contact Music had an item yesterday about how Tom Jones is openly discussing his cosmetic surgery.

"The Sex Bomb singer admits he has had several anti-ageing procedures, including work to his nose, eyes, and chin.
And he confesses the surgery left him with a scar - which he covers up with facial hair.
He says, "I had the fat removed from under my chin. That's why I wear the goatee because it covers the scar."

The majority of facial plastic surgery leaves behind hidden scars, but if it's a special case like Jones', it can usually be addressed with laser treatments.

But scarring aside, some of my male patients grow facial hair after surgery to take people's eyes away from their changes. People are more likely to just comment on the new goatee or mustache than nitpick a slight change in their nose.

Dr. Kurt Wagner, who works with me at Sanctuary Plastic Surgery, said that mustaches in particular have almost a 100% success rate in running distraction.

Speaking of men getting cosmetic surgery, here is an article that Dr. Goldberg contributed to for the Miami Herald.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

First Post!

I'm Dr. Jason Pozner, a board-certified plastic surgeon and co-owner of Sanctuary Medical Aesthetic Center in Boca Raton, with Dr. David Goldberg, a nationally esteemed cosmetic dermatologist, and owner of Skin Laser and Surgery Specialists of New York City, and Hackensack and Hillsborough, New Jersey.

If you want to know more about us, please visit our practices' websites at SMAC Boca and Skin Laser & Surgery Specialists.

We're going to use this blog to weigh in on the latest cosmetic surgery topics, point out emerging trends, and raise the level of discourse when it comes to evaluating the latest technology and techniques.

Thank you for visiting! I look forward to hearing from everyone in the comments.

Dr. Jason Pozner,
SMAC Boca