FDA Approves Botox Competitor Dysport / Reloxin!

BIG news in the plastic surgery field. The FDA approved the drug Dysport (otherwise known as Reloxin) today for the treatment of fine lines in the glabella (between the brows). This is the first bona-fide competitor to Botox, as it is also a Botulinum Toxin Type A.

I've mentioned Reloxin in this blog before, as well as on the Rachael Ray show a couple months ago. Plastic surgeons (and patients) hope that this can act as an economic bailout for the 4 million Americans who pay several hundreds of dollars for each Botox treatment. I think we would all welcome a price war between Allergan (makers of Botox) and Medicis (makers of Dysport).

How does Dysport compare to Botox? Other than the fact that they are both Botulinum Toxin Type A, it's difficult to tell. However, if Dysport is priced competitively with Botox and has similar efficacy, we may see a multi-billion dollar product reaching your plastic surgeons' offices in the next 30-60 days. Stay tuned!

Source: Globe Newswire

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Stars Admitting to Botox

A recent article in People Magazine has compiled a number of celebrities who have gone on record to having Botox injections. Most of them like what the treatments do, and there is an estimate that 75% of stars over the age of 35 receive Botox injections! Here is a list of the stars who get or have gotten Botox:
Brooke Shields
Vanessa Williams
Lisa Rinna
Lori Loughlin
Daisy Fuentes
Jenny McCarthy (yes to Botox, but no to vaccines?)
Jennie Garth
David Hasselhoff (ha!)
Simon Cowell
Linda Evangelista
Janice Dickinson (no surprise there)
Courteney Cox
Teri Hatcher

If the star's name is highlighted, you can click on it to visit one of my previous blog entries on their Botox.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Botox for Breast Augmentation?

Will its applications never end? Some doctors have found a new use for Botox: Breast Augmentation. According to nbc10.com, some plastic surgeons are injecting Botox into the muscles of the chest in an attempt to straighten a woman's posture and thereby enhance her bust line. Click here for the article.

I've never performed this procedure before, but I bet that the before-and-after photos are not very impressive. I would think that the doctor would need to use huge amounts of Botox to weaken the muscles of the chest, which are quite large. Time will tell on this one...

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Botox Safety Article in Allure Magazine

Allure magazine has a very well-written article on the recent controversy regarding Botox safety. The media has recently focused on a study from Italy showing botulinum toxin being found in parts of the brain fluid in mice who had it injected near their whiskers. Allure's Joan Kron (a very well-respected journalist) has written "Botox on the Brain," addressing the recent controversy. I always find her articles well-written, well-researched, and very objective. Click here for the article.

She has also written on fat melting injections in the past. Click here for my post on this topic.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Safety of Botox

A U.S. consumer group called Public Citizen has recently asked the FDA to reconsider the safety of Botox treatments. They pointed to some 16 deaths following Botox treatments, citing complications such as paralysis of the esophagus and aspiration pneumonia.
Botox is currently the most common medical cosmetic treatment today. According to the American Society of Plastic Surgeons, last year over 4.1 million Botox cosmetic treatments were performed. It is currently FDA approved for treatment of glabellar wrinkles, which are the frown lines between the eyebrows. Any other treatments are considered 'off-label.'
I believe Botox is a very safe treatment if performed in the right hands. Over the past few years we have performed probably 500+ Botox treatments in my practice without a single known significant complication. If it is injected cosmetically for the upper face (where it is most effective), I can't see how someone would get a complication like that mentioned above. The worst that can probably happen is drooping of an eyelid (very rare) or a bruise (somewhat common).
I surmise that the esophageal and lung complications may have resulted from Botox being injected for non-cosmetic reasons. It is currently being used for more indications than can be mentioned here, including TMJ, migraines, and various muscle spasm problems. It's possible that poorly performed treatment for a non-cosmetic indication could result in the bad complications cited by the Public Citizen.

For the article on the Public Citizen, click here.
For the reply by the American Society of Plastic Surgeons, click here.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Cosmetic Injectables... Which ones are the Best?

There are so many cosmetic injectables on the market today, it's difficult for a consumer to determine exactly what they want or need. Here are my opinions on the most popular cosmetic injectable treatments:

1. Botox: By far the best. Nothing works like it. Botox causes paralysis of certain facial muscles which cause wrinkles in the forehead, frown lines between the brows, and crow's feet wrinkles. It lasts 3-4 months on average and is the best "bang-for-the-buck," in my opinion. Plus, Botox injections are nearly painless if topical skin anesthetics are used.
2. Restylane: This is the most popular injectable "filler" today. This means the product is injected into wrinkles or the lips to fill them in by adding volume. I use this very regularly. It's best for filling in the nasolabial folds (the deep wrinkle from the side of the nose to corner of the mouth) and plumping up the lips. It is somewhat painful to have injected and can cause a bit of bruising in some. I often use local anesthetic injections for it. Restylane lasts around 6 months. Jessica Simpson has admitted to using Restylane.
3. Collagen (Cosmoplast, Cosmoderm, Zyplast, Zyderm): This used to be the most popular filler before Restylane came along. Collagen doesn't last as long (2-4 months on average) but is cheaper than Restylane and less painful to have injected. This is what Barbara Hershey had before she filmed "Beaches."
4. Hylaform / Hylaform Plus / Captique / Juvederm: These are all "Restylane substitutes." The first three were touted as comparable to Restylane but their longevity was disappointing (I saw 3 months for Hylaform and 4-6 months for Hylaform Plus). The newest one is Juvederm, and supposedly the results can last 6 months like Restylane. It is reportedly more comfortable to have injected as well. The jury is still out on this one.
5. Radiesse: This is another injectable filler. The benefit of Radiesse is that it lasts much longer than Restylane (over a year). However, I caution anyone who is considering having it injected into the lips. I have seen many cases where it has caused visible bumps which needed to be poked with a needle and the Radiesse squeezed out. It may be a good treatment for people who need long-term, deeper injections. Some people now inject it into noses to change the contour.
6. Artefill: This is a recently FDA-approved permanent injectable substance. Be careful with any permanent substance, as it can cause bad reactions even several years after it is injected. Physicians used to inject silicone into people's faces, with some disastrous results.
7. Fat: In my opinion, this is by far the best 'permanent' injectable treatment. I often perform facial fat grafting on my patients. I take fat from their tummy or thighs, purify it, then reinject it into the cheeks, under the eyes, and into the lips. It is real surgery, however, but can last for years.
Like with any medical cosmetic treatment, make sure you consult with a reputable physician before having it done. There are a lot of practitioners who are trying to do these injectable treatments with little or no experience or training. If you are not sure who to see, a board-certified plastic surgeon is usually a good choice.
If anyone has any experience with other injectables like Sculptra, I'd be interested to see what you have to say!

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

The most common celebrity plastic surgeries

What is the most common plastic surgery for celebrities? The following comments are my opinion only, deduced after working as a Hollywood plastic surgeon for a time and becoming a pop culture and celebrity plastic surgery "expert." By far the most common cosmetic procedure is Botox. Botox has gotten so widespread in Hollywood nowadays that I notice when people do not have Botox more than when people do. This was most evident when I watched Tea Leoni act all flustered in that Adam Sandler clunker, "Spanglish." She had so many forehead wrinkles and crow's feet in that movie that I found it almost distracting to watch her. That many forehead wrinkles are rarely seen in beautiful Hollywood actresses today, so I applaud her for going au natural.
As far as surgery goes, the top three in my opinion are liposuction, breast augmentation, and rhinoplasty. All three of these occur much more often in celebrities than in the normal population. Breast augmentations are often obvious (hello Mariah Carey!), whereas liposuction can be difficult to determine (I've had people tell me that J. Lo has had it done numerous times), and rhinoplasties are either good (Halle Berry?) or bad (Jennifer Grey?). There are many more celebrities who've had these surgeries done than most people may realize. (I even believe that the great Julia Roberts has had her nose done!) At some point, the normal population may catch up with Hollywood celebrities in the amount of plastic surgery performed, but by then the celebrities may have gone onto bigger and more drastic ways to keep themselves young and relevant. Maybe they will have started cloning themselves by then. Just what we need, another Carrottop!
Have a great Easter! My son Daniel (3 months old) is getting baptized on Easter Sunday, so we are very excited...