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.