Wednesday, November 26, 2008

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

Thursday, November 20, 2008

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

Tuesday, November 18, 2008

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

Saturday, November 15, 2008

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

Friday, November 14, 2008

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 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

Wednesday, November 12, 2008

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

Tuesday, November 11, 2008

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

Monday, November 10, 2008

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.

Friday, November 7, 2008

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

Thursday, November 6, 2008

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.


"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