While we wait for the ASAPS statistics to come out....

The blog BellaSugar has posted on a new dark chocolate product called Bochox. Complete with an official looking medical wrapper, $5 Bochox promises to release endorphins that make you not care about wrinkles anymore.

The release of the American Society of Aesthetic Plastic Surgeons' annual statistics is imminent, so we will be on here the hour they are released with our impressions and explanation of what the numbers mean.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Sculptra Outcomes for Darker Skin Types?

Upon their approval of the heavy-duty filler Sculptra, the FDA mandated that additional clinical trials be performed upon darker-skinned patients for the treatment of HIV-related facial atrophy. The original trials heavily focused on white males.

The Global Medical News Network is out a writeup of the five year study, conducted by Dr. Douglas Mest of Blue Pacific Aesthetic Group in Manhattan Beach, CA.

The results are good, here at year one. A question was whether darker-skinned patients would create too much collagen, causing hypertrophic scars and keloids. But it turned out that "they do very well with this product," according to Dr. Mest, with new collagen forming more quickly than light-skinned patients without any unwanted side effects.


You can see the results in the picture above. SMAC offers Sculptra to restore volume after lipoatrophy, a.k.a facial fat loss.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

SMAC's Dr. Wagner on BBC's Whicker World

Alan Whicker is a very famous television host in Britain, hosting the BBC travel program Whicker's World from 1959 to 1990. In the days before mass travel, he'd go across the world, bringing the lives of the rich and famous into millions of English households.


Long before he joined SMAC in Boca Raton, Dr. Kurt Wagner and his wife Kathy were two of Whicker's interview subjects when he came to Beverly Hills in 1973. The interview was so popular in Britain that Whicker (now in his eighties) came to Boca Raton recently to film a new interview for his upcoming "where are they now" series. Dr. Wagner's new interview was mentioned in the UK newspapers the Daily Mail and Guardian, while Wagner's 1973 interview was included in Whicker's greatest hits DVD collection.

Looking at his widespread media exposure, Dr. Wagner was a trailblazer and diplomat who turned plastic surgery into a mainstream topic worldwide. In this and his several appearances on the Merv Griffin Show in the 60s and 70s, Dr. Wagner discussed topics in plastic surgery that seem tame and commonplace by today's standards, but at the time were revolutionary and novel. Was he the original Dr. 90210?

For example, even though it still pops up in the media as a new concept, TIME magazine broke the story of "men getting cosmetic surgery" in 1971, with quotes from Dr. Wagner.

Below is a three part series of Dr. Wagner's appearance on Whicker's World. The new interviews will come out sometime in March.






Check back tomorrow for video of Dr. Wagner on the Merv Griffin show.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Oscar Buzz: Dr. G out in the blogosphere

The American Society of Plastic Surgeons recently reported in a survey of their members that Hollywood-based cosmetic surgeons saw as much as a 25% jump in non-surgical procedures and touch ups leading up to the Oscars.



The press release was a call to action for the popular blogs Stylelist and Yahoo!Shine, who both interviewed me not only about what the stars do to prepare, but their entourage.

Thank you to Boydie Beener and Jennifer Romolini for their dilligent reporting.

Dr. G Tells Us How His Star Patients Prep for the Oscars [Stylelist]

Celebs' Pre-Oscar Beauty Prep: More Botox this year, in more ways than you want to know [Yahoo!Shine]

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

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Is it a trend? Another cosmetic surgery arrest.

I think we are entering trend territory here. Two women in Tampa are in critical condition after going to a cosmetologist in search of "J-Lo style bottoms." Silicone was injected, and it did not go well.



Here's a writeup in the Daily Mail about it:

"
Andrea Lee, 30, suffered total kidney failure after being 'poisoned' with what is believed to be industrial silicone.

Her friend Zakiya Teagle, 33, is also in a critical condition in a Florida hospital after her internal organs stopped functioning.

Police in Tampa, Florida, are now searching for the fake doctor who carried out the cosmetic procedures on both women.

Sharhonda Lindsay, 32, has gone on the run after the two women were rushed to hospital with critical injuries caused by her injections."

There has been a significant uptick in these in the last few months. It's never worth it unless you can go to a board-certified doc.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Hawaii Dermatology Seminar Wrap-Up

I have just returned from the 33rd Hawaii Dermatology Seminar with exciting thoughts on the future of non-invasive cosmetic aesthetic treatments. What became clear at this meeting is that the current economic difficulties have not stopped investigators and industry from exploring further non-invasive methods that will lead to more beautiful skin.

Hot topics included discussions about the use of stem cells to promote healthier skin, new fractional skin tightening methods, cryolipolysis of fat, and the next generation of Botox® like substances.

Fractional skin tightening by Primaeva is an attempt to improve upon the non-surgical approaches already seen with such technologies such as Thermage’s (now called Solta) ThermaLift and Cutera’s Titan technology. With this technique small electrolysis sized needles deliver scientifically controlled heat to tighten jowls.

Cryolipolysis by Zeltiq involves the precise delivery of cold to unwanted fat areas such as love handles. Initial work was done on animals, but data was recently presented at the American Society for Dermatologic Surgery meeting, showing that dramatic results can be seen in humans.

Here's a before picture:

Patients sit and read the newspaper while their fat is frozen away! Our NJ office is one of the FDA sites where we are treating love handles. This far patients have only been treated one time with this method of fat reduction.. Yet to be seen are whether multiple treatments lead to better results and how this method compares to other more-invasive methods of fat removal.

Here is the same patient four months afterward:

At the Hawaii Dermatology Seminar there was also ample discussion about Reloxin from Medicis.. This yet to be approved product is probably going to be the first US competitor for Botox® . Also discussed were other potential Botox® competitors such as PurTox from Mentor and Xeomin from Merz.

The future of cosmetic dermatology is great!

David Goldberg, M.D.
Sanctuary Medical Aesthetic Center
Skin Laser Surgery Specialists of NY/NJ

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

Predictions for 2009 ASAPS Stats

The annual statistical report from the American Society for Aesthetic Plastic Surgery is due to drop soon. Click here to see last year's report.



As you can see, they poll over 12,000 plastic surgeons, dermatologists, and otolarynologists across the country to estimate trends in cosmetic surgery from year to year. It can be broken down by age and/or gender, and places each year into a historical perspective.

It's a no-nonsense way of gauging what the real trends are, rather than taking one or two plastic surgeons' words for it.

Anyway, here are my predictions for this year:

Thanks to Allergan's well-publicized financial reports, I will say minimally invasive procedures will be down about 5%, facelifts are down 30%, eyelids down 20%, liposuction down 15%, and breast augmentation down 5%.

When the report drops we'll be back with more. An ASAPS representative estimated that it will be out by the end of the month.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Yet another sad tale of unqualified cosmetic surgery

The latest cosmetic surgery nightmare is making the rounds: this time, a pair of women in Tampa seeking "J-Lo" type enhancements are in critical condition.



From the article:

"Andrea Lee, 30, suffered total kidney failure after receiving the injections at a private home in the community of Town ‘N Country. Her friend Zakiya Teagle, 33, is also in a critical condition.

The Hillsborough County sheriff’s office is now looking for the woman who they say administered the shots illegally.

Sharhonda Lindsay of Tampa is wanted for practicing medicine without a license. A warrant for her arrest was issued Monday, according to the Web site.

"It almost is bootleg cosmetology here," said sheriff's office spokesman JD Callaway. "These two victims knew of this woman, at least one of them did. They knew that she was known to have given injections to other women to enhance the buttocks area.”

This is something that we have been tracking for a while, and it seems to be happening more and more. Simply put: going for bargains with unlicensed people does not pay off in the long run: if you're lucky, it'll only hurt your wallet with the revision work you'll need, and it could threaten your life.

Always go to a board-certified doctor.

Dr. Jason Pozner

Sanctuary Medical Aesthetic Center

Dr. David J. Goldberg

Sanctuary Medical Aesthetic Center

Skin Laser Surgery Specialists of NY/NJ

Kicking off the Hawaii Dermatology Seminar

Aloha from the 33rd annual Hawaii Dermatology Seminar in Maui, Hawaii.

I have the honor of co-directing this yearly meeting with Christopher Zachary MD from Irvine, CA and Joseph Fowler, Jr., MD from Louisville, KY. This is one of the largest dermatology meetings in the United States.

Although the meeting covers aspects of both medical and cosmetic dermatology, some of the most well known speakers in cosmetic dermatology are here. These include Mark Rubin MD from Los Angeles, CA; Suzanne Kilmer, MD from Sacramento, CA; and Bruce Katz, MD from New York City.

The cosmetic topics include the latest in non-invasive approaches to body contouring, cellulite treatments, anti-aging approaches, laser resurfacing, new wrinkle fillers and Botox® like substances. New companies such as Zeltiq, UltraShape, Liposonix, Primaeva and Coapt will all be discussed. Stay tuned. More details to follow as the week progresses.

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

Jason Pozner, MD
Sanctuary Medical Aesthetic Center

The Latest Botox Competitor: REX

We are members of the alpha group for Relaxed Expressions, or REX for short. The device uses radiofrequency energy to first find the nerves to the glabella (the muscles that cause frowning), and then makes small burns in said nerves to paralyze them for 12-18 mon
ths: hence the relaxed expressions.

This procedure has also gone by the names of GFX and NoTox. According to a board-reviewed article on About.com, this procedure is said to create a more natural look than Botox, and also will be effective for those who have developed a resistance to Botox.

The REX technology has already been FDA approved for use with cardiac patients for over a decade... cosmetic applications were explored starting two years ago.

Thanks for reading,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Botox can prevent baldness?

According to recent tests conducted by Dr. Simon Ouiran from Epione, Botox can delay and prevent baldness.

From the article (courtesey of Grinza):

"Ouiran discovered the hair loss prevention properties of Botox while he was treating his mother from debilitating headaches—a side effect of chemotherapy. The doctor followed the advice of Allergan, the world’s leading Botox manufacturer, by using Botox as a way to alleviate migraines through scalp injections.

After injecting the cosmetic drug to his mother’s scalp, not only were her headaches gone, her hair also began re-growing.

“Of course, I was happily surprised by the result,” said Dr. Ourian. “So I decided to share this discovery with several of my regular patients. Because hair loss is a significant source of insecurity for many people, both men and women, there was no shortage of volunteers with thinning hair. The results for many were astonishing, and for some, a single session yielded dramatic results.”


We should wait for any peer-review results but this is another interesting off-label use for Botox. As you can tell from our pictures, we are anxiously awaiting trials of Botox to treat hair loss.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Guyuron study: behavior & genetics affect appearance of aging

Dr. Bahman Guyuron in Cleveland just released a great study in the ASPS' Plastic & Reconstructive Journal, exploring the nature vs. nuture of having great skin as one ages.

Some people are just born with great skin, and that's nothing new. But Dr. Guyuron's study compared 186 sets of twins, and using digital images and a comprehensive review of what they had done differently over their lives, was able to pinpoint exactly how much aging risk factors like stress, smoking, diet, and sun exposure can affect the emergences of damage and wrinkles.

From a WebMD article:
"Identical twins, unless they behave exactly the same, will exhibit their different lifetime experiences on their faces," he says. "If the biological clock is designed to make you age in a certain way, you can alter that by eliminating some of the external factors that make you age faster."

Also, aging reduces hormones, and "if they are replaced judicially under medical advice, that will delay aging," Guyuron says. "Estrogen has a significant effect on the elasticity of the skin." To look younger, overweight people shouldn't try to lose a lot of weight quickly, he says.

Above is a photo of twins... guess which one is a smoker.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Botox sales holding steady despite bad economy

According to an article by Natasha Singer in Wednesday's New York Times, Allergan is reporting a slight drop in sales of Botox for the fourth quarter of 2008.

From the article:

"The company reported that sales of Botox — both for wrinkle-smoothing and for medical problems like eyelid spasms — fell about 3 percent, to about $329 million in the fourth quarter, compared with the corresponding quarter in 2007.

Meanwhile, Allergan’s sales of skin-plumping injections — called dermal fillers or facial fillers — fell 8.8 percent, to about $56 million in the quarter, compared with the year-earlier period.

The company’s sales of breast implants were about $71 million in the fourth quarter of last year, down 12 percent compared with the same period in 2007.

“You could forecast that with implants, but the bigger question was, ‘How have injectables been holding up?’ ” said Gary Nachman, an analyst with Leerink Swann, a health care investment bank. “Now, even the injectables have been impacted significantly.”

The sky is not falling. This is actually good news for Botox, as we would have expected a bigger drop. If anything, only a 3% drop in filler and a 9% drop in filler is pretty strong in this economy.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

Upcoming MemoryGel Implant ruptures only 1.1% of time

I spent the weekend as a member of the Mentor advisory panel in Santa Barbara. It is an exciting time for Mentor, as its acquisition by Johnson and Johnson was finally completed last week. They will have a new position as the powerhouse aesthetic company while their infrastructure allows them to maintain the customer relationships that are core to Mentor.

Also recently released was the six year data on their MemoryGel implant. The data is very significant, as there is an extremely low rupture rate of 1.1% in augmentation patients. The capsular contracture rate was 9.8% and re-operation rate was 19.4%, but it is a bit misleading as the re-operation rate includes size changes and minor scar revisions. The bottom line is that the MemoryGel implant is an extremely safe and useful device.



Capsular contracture remains a significant issue for all breast implants and Mentor is heavily involved in research to prevent and cure it. The photo above is of Dr. Jason Pozner (me), Josh Levine (CEO of Mentor) and Dr. Roger Wixtrom - the toxicologist and researcher involved in much of the capsular contracture research, which I collaborated on.

Thanks for reading,

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center

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

More Q&A With Dr. Matez

Oprah Winfrey's show on Thursday with guest Suzanne Somers brought up more questions about bioidentical hormone therapy. In Boca Raton, we had Dr. Mitchell Matez watching. As our resident specialist on alternative medicine, he offers a full range of bioidentical hormone therapies, and here are his answers to some of the questions left unanswered during the program.

Is there any drawback to taking FDA-approved bioidentical hormones? What is the difference between them and what a compounding pharmacy provides?
The term “bioidentical” is used to describe a substance or hormone that is of the exact same molecular structure as those already present in the human body. This is in direct contrast to most drug company products that are either animal (horse) derived or chemically altered to be intentionally different from human hormone so that it can be patented. The word “bioidentical” may be a “marketing” term, but the concept is clear.

One drawback to taking the FDA approved versions of these hormones is the route of administration. Any Estrogen, even bioidentical, can potentially cause clotting abnormalities when given orally due to the effects of liver metabolism. Compounded formulas can be given transdermally (through the skin) or via implantable (under the skin) pellets which will enter the bloodstream directly before the liver and drastically reduce or eliminate this problem. Ovarian hormones enter the bloodstream directly!

Another drawback is the “one size fits all” mentality used when producing the commercially available products. Most come in only one or two dosing options whereas compounded hormones can be dosed very specifically to each individual patient.

What are bioidentical hormones made from?
Compounded hormones are initially derived from yams or soy. The hormones in these which are close to human but not exact are then brought to the lab and converted into exact molecular duplicates of human hormone and this is how they are administered.

Is there research saying they're safe?

There is a great deal of literature (in particularly Europe) supporting the benefit and safety of hormone therapy. The FDA does not acknowledge them.