In Season: Teenage Plastic Surgery

It's the summer, which is known as a popular transition period for teenagers to get plastic surgery. In turn, it's a popular time for the media to come out with their yearly stories on the trends in teenage plastic surgery.

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There was just a Today Show segment on the topic, and here's a pretty level-headed article from USA Today by Mary Brophus Marcus.

"According to the American Society for Aesthetic Plastic Surgery, 160,283 children 18 and under had cosmetic interventions in 2008. The figure was even higher in 2007, tallying 205,119, but industry experts say a slowing economy probably forced the numbers down in 2008. In 2000, the number was just 145,094.

Those under 18 who opt for such procedures are not only children with cleft palates or disfiguring birthmarks. Some children are having more controversial procedures, such as "Asian eye" surgery to widen the appearance of eyes in people of Asian descent. But for the most part, these are otherwise healthy kids looking to improve an awkward but functional feature, such as a large nose or small breasts, says Donn Chatham, a plastic surgeon in Louisville and president of the American Academy of Facial Plastic and Reconstructive Surgery."

You can find a complete report of 2008's trends in plastic surgery for patients aged 13-19 here, from the American Society of Plastic Surgeons.

We will soon have a guest blog from Dr. Frederick Lukash, a plastic surgeon in New York who has been at the forefront of teenage plastic surgery for the right reasons.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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

Catching up with Doctors star Peter Ajello

Peter Ajello is a formerly obese candidate for abdominoplasty and liposuction, who has lost well over 150 pounds based on a bet with a buddy.

The television show "The Doctors" actually had him on the show to share his story and to tell him that I will be donating the necessary surgery; with the caveat that he has to lose another 50 pounds.

Here is the video:

Are nipples the new black?

A post on the New York Magazine website seems to think so.
Nipples, as you can see with Victoria Beckham above, have become a fashionable accesory. New York Magazine speculates that there may be a big jump in cosmetic nipple surgery so women can keep up.

Unfortunately, the American Society for Aesthetic Plastic Surgery stopped keeping track of cosmetic nipple surgeries in 2005, so there's no way to know for sure, nationally. But we can tell you that nipple procedures are very common in cosmetic practices. We rebuild nipples that are lost to cancer, correct inverted nipples, increase projection with fillers like Radiesse, and we also do areola reductions often.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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

Botox a cure for baldness?

Colin Stewart at the OC Register's In Your Face blog wrote yesterday about a story in Britain's Daily Telegraph featuring Beverly Hills plastic surgeon Dr. Simon Ourian, who claims that he has been having success regrowing patients' hair with Botox.

"It’s not a claim that’s made by Botox-maker Allergan of Irvine. The announcement came from cosmetic surgeon Dr. Simon Ourian of Beverly Hills, who says injections in patients’ scalps have produced hair growth.

“It doesn’t make sense that Botox would cure baldness,” says Dr. Christopher Zachary, chairman of the UCI Department of Dermatology. “I have injected men numerous times high on the [forehead] and have never seen any hair growth.”

“It simply does not make sense, physiologically. I think he might have the same success if he injected lemonade,” says bariatric surgeon Dr. Brian B. Quebbemann of Newport Beach."

We're going to throw in our own two cents here: we wish.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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

Why we never touch a study without FDA approval

Last week, the U.S. Attorney's office announced that medical device maker Norian Corporation is being charged in connection to unlawful clinical trials. In a nutshell, they were conducting clinical trials for a device that was not FDA approved, for surgeries involving treating spinal compression in the elderly. The device was actually putting people at risk, and they still went ahead with the trials.

This is why many devices cannot be rushed to market; we must follow strict FDA guidelines. We are conducting many clinical trials with FDA-regulated botulinum injections (Botox alternatives), fillers, and laser studies, such as with Invasix, Scar Revlite, and more. This is something we are mindful of at Sanctuary Plastic Surgery, SMAC, and Skin Laser Surgery Specialists.

Despite being widely available throughout the world, it took Dysport a long time to release in the U.S. due to FDA guidelines that simply have to be followed. A paperwork snafu pushed it back from the first half of 2008 to just becoming available now.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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

In Depth: Cancer drugs used cosmetically

Dr. Dana Sachs from the University of Michigan has confirmed what cosmetic dermatologists have known for years –topical use of cancer-fighting fluorouracil not only removes pre-skin cancers, but can dramatically improve the cosmetic appearance of sun-damaged skin.

Topical fluorouracil can lead to great cosmetic improvement. Identical results can be seen when a process known as photodynamic therapy (PDT) is used to treat pre-cancerous changes of the skin. In this process a topical medication called levulinic acid is applied to the skin and is followed by laser/light source treatment of the skin. Both topical fluorouracil and PDT are FDA approved to treat pre-cancerous skin changes. Both cosmetically improve sun damaged skin. But which technique is better? The answer should be known soon.

We are currently comparing these 2 great cosmetic approaches. In a 60 subject study, we are treating 20 subjects with the Carac brand of topical fluorouracil, 20 subjects with PDT and 20 subjects with a combination of topical fluorouracil followed by PDT. Our study goes beyond that of Dr. Sachs in that not only will clinical improvement be evaluated, but biopsy documentation of changes will be looked at as well.

Is one cosmetic approach better than the other? Maybe yes, maybe no! Time will tell. What can be said with certainty is that neither approach will, as suggested by the Daily Telegraph, replace Botox® or Dysport. Botox® and Dysport are used to improve muscle induced stress lines. Topical fluorouracil and PDT are used to treat sun damaged aging skin. These approaches are best when used together.

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

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

Another DIY Disaster: Silicone Injections for lip augmentation

From WCCO in Minnesota:

"A year and a half ago, another doctor had given her silicone injections. That treatment went well but it wasn't cheap. It was $2700 for a series of three treatment.

So she turned to the Internet and found a site advertising silicone for $10.

The site clearly says the product is to be used externally as a personal lubricant. She thought because it was 100 percent silicone she could inject it. She bought the syringes at a local pharmacy.

"Initially I thought I did a good job," she said.


However, within a day her lips and cheek were disfigured.

"Its very frightening, its very embarrassing having to be in public," she said. "

In South Florida, we see many patients that were injected in garages, spas and laundry rooms by unlicensed practitioners. Many times, patients do not know what was injected, and whether it was temporary or permanent. Most don't have problems, but but when complications arise they are difficult, if not possible to completely correct.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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

Could a chemotherapy drug be used cosmetically?

FoxNews reported today on an Archives of Dermatology article on a small study conducted by Dr. Dana Sachs at the University of Michigan.

"The study involved volunteers between the ages of 56 and 85 who applied cream made from the drug to their skin twice a day for two weeks.

After the two weeks were up, dermatologists reviewed before and after pictures of the patients and found the cream had reduced both fine and course wrinkles, as well as age spots.

Fluorouracil is already used as a prescription skin treatment for actinic keratosis, which is a precancerous skin lesion that is caused by frequent and intense exposure to the sun."

We are in the middle of our own study of this topic and will post some more information soon.

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

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

Palomar: Over the Counter clearance for a consumer laser wrinkle-removal device

24-7 Wall Street.com broke some cosmetic medicine news last week:

"Palomar Medical Technologies Inc. (NASDAQ: PMTI) is seeing shares surge to new heights not seen in 18-months. The company is the first to receive FDA approval for over-the-counter clearance for a new, patented home use laser device that for the treatment of periorbital wrinkles (for eyes, like crows feet). The beauty of this, no pun intended, is that it is part of a Johnson & Johnson (NYSE: JNJ) partnership and that may lead to much greater use. This one will not exactly kill the entire Botox market for Allergan, Inc. (NYSE: AGN), but even for one such possible replacement the idea of a home-use laser has to be a bit more enticing than getting stuck with a needle full of Botulinum toxins."


Palomar's entry into the home use cosmetic device market simply expands the 5 year growth of such technologies. Palomar's home unit for skin rejuvenation joins other home use devices such as Tanda and Zeno for acne and the Tria and Silk'n for hair removal. What is clear is that home devices will expand the continued interest in non-surgical skin health. At the same time, it must be emphasized that such low powered technologies will never be as effective as those that are used in a physician's office.

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

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

Viewer Mail: Is Revitalash comparable to Latisse anymore?

On a recent blog post regarding Latisse, we received the following comment:

" I understand that Doctors sell Latisse to make money. What I don't understand is why anyone would pay $120.00 (my OB/GYN sells it) for this product when there are OTC products that do the exact same thing (in the same timeframe) for less money. I use Revitalash (it was developed by an eye doctor) and got longer (even curlier) lashes in 9 weeks. I was hesitant to try any of these products, but am so glad I did. Lashes make such a difference to the face. I get lot of comments, mostly people want to know what mascara I use. Needless to say, Revitalash is good option to the pricey and risky Latisse."

Both Revitalash and Jan Marini’s Age Intervention Eyelash Conditioner used to contain bimatoprost, the active ingredient in Latisse. Thus, it is true that older formulations of these 2 products would be expected to produce results somewhat like those seen with the Allergan product.

However, neither of those 2 products underwent the rigors of an FDA safety and efficacy trial as was done with Latisse. Thus, one could never guarantee the same results for those 2 products as can be expected from Latisse. Having said that, after Allergan’s lawsuit to prevent other companies from using their product, neither Revitalash nor Age Intervention now contain the active Allergan ingredient that leads to luxurious eyelashes.

There are undoubtedly still some older versions of these products available. However former users of these products cannot expect the newly formulated Revitalash and Jan Marini’s Age Intervention to produce the same results as Allergan’s Latisse.

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

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

5th Multispecialty Cosmetic Surgery Meeting in Vegas: Primaeva, Miratone info

Dr. Pozner and I both lectured at the 5th Multispecialty Cosmetic Surgery meeting in Las Vegas this past weekend. This unique meeting is attended by some of the best plastic surgeons and cosmetic dermatologists in the country.

One of the highlighted techniques was the Primaeva non-surgical RF (radiofrequency) skin tightening approach.

Our NJ office was one of the study sites for this technique over the last year. The procedure, performed with topical anesthesia, applies deep skin tightening heat through many tiny skin embedded needles. Sensors embedded in the system provide real-time feedback of skin temperature and tissue resistance within the treatment zone, overcoming the variability of patient response due to differences in tissue characteristics.

The goal is to produce more non-invasive skin tightening than is seen with the Thermage approach, with the realization that greater skin tightening will always occur with more invasive surgery.

The data presented at the Multispecialty meeting was also presented by me at the recent American Society for Lasers in Surgery and Medicine meeting. The machine, known as Miratone, represents the latest approach to non-surgical skin tightening.

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

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

The Aesthetic Show: Add the Soniceye to upcoming hot list

While in Vegas last weekend I also attended and lectured at The Aesthetic Show, run by Michael Moretti, publisher and editor of the Aesthetic Guide - this is a huge show that included many specialties. I lectured on fractional resurfacing, specifically on Sciton's erbium profractional and the many studies we have performed at SMAC with this device, and on non-surgical fat removal with Ultrashape, Liposonix and Zeltiq.

There were many excellent presentations, including NJ's Dr. Barry Dibernardo and Brazilian plastic surgeon Alberto Goldman on laser liposuction. Diane Duncan gave and excellent update on the Invasix's RFAL - Bodytite machine that i have been working on as well. More to follow from this meeting over the next few days with a guest blog.


The best part of this meeting was the new toys from industry. The coolest thing I found was a device called Soniceye, distributed by Sound Surgical Technologies (who sell the VASER system). This device is a hand held ultrasound transducer developed for the Department of Defense to be used in the battlefield, to help with intravenous access of wounded soldiers. There is a heads up display, and you can see me testing the device in the photo above. Might be great someday for liposuction or vein treatment. More to come!!!!

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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

Interview with Global Medical News Network: Rundown of upcoming filler products

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

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

Newsweek on Oprah: Pot calling the kettle black when it comes to bioidentical hormones?

A recent article in Newsweek by Weston Kosova and Pat Wingert titled "Why Health Advice on 'Oprah' Could Make You Sick" listed a number of beefs that some have with Oprah's approach to medical coverage. They led off with a slam on Oprah's bioidentical hormone episodes featuring Suzanne Somers. Unfortunately, the writers of the article made some logical leaps of their own. Our bioidentical hormone expert in Boca Raton, Dr. Mitchell Matez, took umbrage and wrote the following response:

"The Newsweek article is a complete and total "Oprah Bashing". Either Newsweek or the authors clearly have an axe to grind with Oprah that goes way beyond her opinions on hormones.

Just about everything they offer here with respect to Bioidentical Hormone therapy can be easily disputed beginning with the concept that there ISN'T a raging debate over hormones today. This debate has been raged prominently and publicly for more than a decade. Also the concept that "Menopause" has been shown not to be a "hormone deficiency" problem is ludicrous and defies science. Menopause means "cessation of menstruation" and this CLEARLY occurs as a result of diminishing Estrogen levels as we age.

"Unless a woman has significant discomfort from hot flashes -and most women don't - there is little reason to prescribe them". Another ridiculous statement - this one from a Reproductive Endocrinologist. I guess in her world after your reproductive years sleep, energy, libido, strength, sex, night sweats, headaches, cognitive decline, and weight gain are either normal or natural. Clearly to her they are irrelevant. ALL of my female patients would take exception to this!

Oprah's personal claim of successful treatment (and presumably that of tens of thousands of women) are treated here as propaganda and lies. WHY?? What possible motive could Oprah have for being anything less than honest and forthright about her own personal experience? I also find it interesting that after researching and writing FOUR books on the subject Suzanne Somers is so easily discredited by these people. In my opinion her books are generally well written and for the most part backed up by science, research, and clinical experience.

A final note to the authors... next time do a little research on your own. The importance of Iodine in thyroid health is crystal clear in any basic science text. Your thyroid gland produces Thyroxine (T4) which is INERT in the human body. In order for the hormone to be functional it
must be converted to TriIODOthyronine (T3) by adding 3 iodine molecules. The United States Congress mandated iodonizing our salt supply for precisely this reason. This doctor is WRONG. In many cases mild hypothyroidism can be cured with iodine. When used and monitored properly it is extremely safe."

Dr. Mitchell Matez, D.O.
Sanctuary Medical Aesthetic Center, Boca Raton

Artefill coming back

Suneva Medical is doing a soft re-launch of Artefill, which is a collagen-based dermal filler. Billed as "permanent" filler, it was discontinued in December when its original company, Artes Medical, filed for bankruptcy under Chapter 7.

We will see if anything changes with the pricing or marketing strategy of the formerly doomed product.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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

Injectable fillers no longer on the "down-low"

A recent study from the research arm over at ASAPS (American Society for Aesthetic Plastic Surgery) regarding injectable fillers concluded that 87% of patients "come out" about it and 70% receive support from those who they tell.

We see that at SMAC... people are very happy to speak about their injectables, but for other things it is kept quiet.

Also, Dr. G and I are speaking at the Multi-Specialty Foundation meeting at the Bellagio in Vegas, and I will follow that up by speaking at The Aesthetic Show at Caesar's Palace later this weekend. Hot topics from these meetings will be posted on Twitter (@jpoznermd) and blogged about next week.

Survey Reveals Injectable Procedures are Mainstream and Accepted Medical Aesthetic Treatment Options [Press Release]

A new twist on Latisse, and more from the Annual Cosmetic Dermatology Meeting

I have just returned from co-directing the Annual Cosmetic Dermatology-Santa Monica Meeting. The meeting, directed by me and Dr. Christopher Zachary, Chairperson of Dermatology at the University of California –Irvine, was highlighted by discussions about 1) Dysport – the new competitor to Botox; 2) new techniques for body contouring; 3) novel approaches for the use of wrinkle fillers; 4) the benefits of cosmetic camouflage; 5) nuances of Latisse, the new eyelash enhancer; and 6) a look at the aging process of the face.

Dysport, the newly FDA approved wrinkle relaxer, will be available to US physicians over the next month. Based on the European experience with this product, US physicians are expected to embrace the new Botox competitor. In Europe, Dysport has been very popular for both wrinkles and excess sweating. Of note, the amounts to be injected are different than Botox. Patients will need to be certain injections are undertaken by experts so as to receive the appropriate response while lessening the chance of complications.

Cryolipolysis by Zeltiq, Focused Ultrasound by UltraShape and Liposonix (Medicis) are all expected to have a major impact on non-invasive body contouring. Although the results do not appear as profound as those seen with surgery, the non-surgical nature of these techniques should make them highly popular. What is not at all clear is when the FDA will approve these methods.

Wrinkle fillers are commonly used for smile lines. However the meeting focused on the use of such fillers for creating 1) a more natural lip appearance and 2) gently lifting droopy eyebrows. However, with any technique some bruising is possible. Dr. Howard Steinman, an expert in cosmetic mineral based camouflage techniques, taught attendees how to hide injection induced bruising.

We also learned some of the nuances of Latisse, the newly FDA approved eyeliner enhancer. It seems that although life-long use is required to keep eyelashes thick, the daily applications initially required may not be required with time. Finally, Dr. Val Lampros, a California based plastic surgeon, gave a fascinating lecture on the 3 dimensional changes that occur in all of our faces over the course of our lives. By understanding this, techniques for cosmetic improvement will continue to improve.

The meeting was highly educational. Santa Monica was fun. I will be back there again in a year.

Dr. Jason Pozner
Sanctuary Medical Aesthetic Center, Boca Raton
Sanctuary Plastic Surgery, Boca Raton

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