Botox® and the other lesser know botulinum neurotoxin type A agents, Dysport® and Xeomin®, can effectively treat dynamic facial wrinkles such as of the crow’s feet, forehead and the glabella (the so-called “1”s and “11”s). They do so rather predictably and without surgery though these treatments are not meant as a replacement for rejuvenating procedures like face lifts, forehead lifts and blepharoplasties (cosmetic eyelid surgery). The most significant negative associated with the treatment by Botox® and the other products is that they have to be injected through the skin in order to exert their effects. Even though the needles used can be extremely tiny, they are still needle sticks.

Wouldn’t it be nice if there were some way that these neurotoxins can be delivered to the underlying muscles without the need for injections?

Like applying them topically.

Of course! There would be no discomfort whatsoever when administered this way.

To this end, there are several investigational studies some of which have been completed, that have evaluated/are evaluating a topically applied botulinum neurotoxin type A specifically to the crow’s feet area. Preliminary results have been quite promising including one study which showed therapeutic effects that were similar to those obtained with the injectable versions, lasted nearly 4 months and were not associated with any serious adverse treatment issues.

There are a few ongoing studies on this topically administered botulinum neurotoxin type A formulation and more will need to be performed before there will be definitive answers and information that can support its safety and efficacy. It may be several years or longer before this neurotoxin could be approved by the FDA (Federal Drug Administration) and brought to market.

Let’s hope that it will be sooner rather than later.

If you are interested in getting Botox® treatments, information on any plastic surgery procedure or would like to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

If you have been hoping for a reliable yet less expensive alternative to Botox® for the treatment of your frown lines, you are in luck. In August, the United States Food and Drug Administration (FDA) approved the usage of Xeomin® (incobotulinumtoxinA) for a variety of issues including frown lines. Among the information that it examined in order to approve this new product were comparative studies from Europe that evaluated Xeomin® versus Botox®. Manufactured by the pharmaceutical company Merz, it has been used elsewhere in the world since 2005 in over 84,000 people and presently is available in 20 countries.

What is Xeomin®?

Xeomin® is another botulinum toxin A, in the same category as Botox® and Dysport®, which acts by temporarily paralyzing the underlying muscles in order to treat wrinkles. These three products have the same basic toxin particle but their formulations are different. Because Xeomin® doesn’t have a surrounding protein particle as the other two products have, it may have the theoretical advantage of lowering the risk of developing antibodies to the product which can reduce effectiveness. (In reality, this does not really seem to be much of an issue with either Botox® or Dysport®.)  It appears that its effects and characteristics are similar to those of Botox®.

Presently, Xeomin® is being released in very limited quantities until its planned widespread release sometime in 2012. We are honored to have been selected by Merz as one of only a limited number of physicians in the Scottsdale and Phoenix metropolitan area able to offer you this new product. In order to make Xeomin® an attractive alternative to the iconic Botox®, we are offering very attractive discounts that can add up to around 20% or $100 less than Botox® (if you use an average of 50 units).

If you would like more information on Xeomin® or Botox® or would like to schedule a consultation and treatment of your wrinkles with either product, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In several previous posts including most recently Buyer Beware When It Comes to Selecting A Doctor to Perform Your Plastic Surgery, I have emphatically stressed the importance of seeking a well qualified board certified plastic surgeon for your plastic surgery needs. This is true not only for cosmetic surgery procedures such as breast augmentation, tummy tucks and facelifts but also for non-surgical ones like Botox® and Dysport® injections and dermal fillers such as Juvederm®, Restylane® and Radiesse® to enhance facial volume and address deep creases and wrinkles. (Note: There are many well trained and skilled dermatologists who also offer these injectables.)

It may seem rather obvious to you as to why you would want to have your cosmetic surgery performed by someone who is well trained and board certified in plastic surgery. Unfortunately, I have seen countless, otherwise intelligent patients over the years who knowingly sought care from poorly “trained” health care providers that often unscrupulously portrayed themselves as either plastic surgeons or an “equivalent” and ended up with either substandard  or even disastrous outcomes.

Even with injectable agents, training, experience as well as ethics matter. There are individuals in virtually every area of the health care industry offering Botox®, Juvederm®, Restylane® and other dermal fillers such as anesthesiologists, obstetricians and gynecologists, internists, family practitioners, nurses, dentists, naturopaths and other “para-professionals”. A weekend course is not enough to provide one with the aesthetic foundation, nuances, skills, experiences, etc. that would be a requisite for safe and appropriate outcomes.

The following patient who I saw exemplifies this problem. (She was very happy to share this experience with others so that they might be able to avoid the situation that she has found herself in.) She was unhappy with some grooves below her lower eyelids (called naso-jugal grooves) that were making her look old. There was no excess skin or fat bags. While living in California, an experienced plastic surgeon skillfully treated them with Restylane® resulting in an excellent outcome.

After moving here, a friend recommended that she use her person who wasn’t a doctor of any kind or even a nurse – but did offer injectable treatments. This provider not only injected the absolutely wrong material but also did it unskillfully and in the wrong location – and precipitated significant bleeding.

Eyelid bags and swelling created by inappropriate and unskilled injection of dermal filler into lower eyelids

Left lower eyelid bag resulting from dermal filler injection

Rights lower eyelid bag resulting from dermal filler injection

A trifecta of incompetence!

This unfortunate patient now has extremely prominent injectable created bags and distortions where there were none before. Making matters worse is that this is not a correctable situation. Hopefully with time, the injected material will dissipate and there will be no permanent long term deformities.

So, the next time that you are considering cosmetic plastic surgery, Botox® for your wrinkles or even treatment of the creases and grooves of your face with dermal fillers, think “Plastic Surgeon”.

If you would like information on any cosmetic plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Despite the tough economic times we are experiencing now, people still want to look good. In fact, with such a severely contracted labor market, a more youthful appearance may actually help you compete for a job more effectively. Besides, you just want to look better.

Are there actually ways that you can improve your looks without emptying your financial reserves?

The answer may be yes. For example, though a facelift, CO2 laser facial skin resurfacing or even eyelid surgery may dramatically rejuvenate your appearance, the price could be too costly for you right now. Though not a substitute, Botox® and facial dermal fillers such as Juvederm® and Restylane® may provide significant enough improvements to make you look and feel better and may even help you better compete for a job. Furthermore, these can be selected at a fraction of the price of more extensive facial rejuvenation. Interestingly, this is exactly the approach that many people have selected during the recession these last few years.

We do offer you a variety of choices in addition to Botox® to help you look better. These include the dermal fillers (skin plumping agents) Juvederm®, Restylane®, Radiesse® and Perlane®. Each one may possess distinct advantages for you depending on multiple factors including the areas that you are considering improving. These dermal fillers can be used to give you more youthful appearing lips, soften the creases around your mouth, fill in depressions at the jowls and various creases or scars on your face, create more prominent cheekbones, and even provide more fullness for sunken in cheeks. Depending on your goals, areas of concerns and financial situation, I can help tailor a strategy that can assist you in obtaining that desirable look which will also fit your budget.

If you are considering Botox® or facial dermal fillers such as Juvederm® and Radiesse®, you would like information on any plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In an article posted on June 21st, I discussed the risks that people take by seeking cosmetic surgery south of the border (Don’t Seek Plastic Surgery South Of The Border). Attempting to save money, too many patients expose themselves to substandard and poorly regulated medical care that results in disappointingly inferior outcomes for the “fortunate”, permanent and irreversible severe scarring and deformities for many or even death for the very unlucky. Expenses for corrective surgery, which doesn’t fully resolve the deformities, can far exceed what the aesthetic procedure would have cost to be performed by a board certified plastic surgeon in the United States.

A variation on this theme involves cosmetic surgery being performed in this country by individuals who are unlicensed, may not even be formally trained or who may be enterprising illegal aliens individuals who exploit their own ethnic community in order to make money. At times, this can be a difficult deception to discern especially for those who are not well educated or at least versed in what to look for or inquire about. These practitioners often lie about their credentials, licensure and experience and may even operate out of a store-front or their home and under the radar.

Such was the case involving two sisters of Mexican descent who were running an illegal cosmetic filler practice in Sylmar, California. Their injection of liquid silicone into the buttocks of a perfectly healthy 22 year old Hispanic female in July lead to her needless death – a horrific but not rare tragedy that can be perpetrated by these illicit operations. The women who performed the injections fled to Mexico.

Deciding where to seek plastic surgery is very important and should be taken seriously – and not just for a breast augmentation, tummy tuck, rhinoplasty or even liposuction – but also for injectables such as Juvederm®, Radiesse® and Botox®. Your decision should be based primarily on qualifications and reputation and then secondarily on price. Though there is never any guarantee of outcome, make sure that the physician that you are considering is either board certified or board eligible by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons (ASPS) which has rigid ethical standards. (I am both board certified by the American Board of Plastic Surgery and am a member of the ASPS.)

If you have any questions regarding my qualification or certifications in plastic surgery or on any cosmetic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Botox® has been used clinically since the 1980’s when it was employed by ophthalmologists to treat muscle issues of the eye. Over time, clinical uses of it have expanded considerably. In 2002, the FDA (Federal Drug Administration) approved its use specifically for the temporary cosmetic treatment of moderate to severe frown lines between the eyebrows. Although it is at other sites for the same muscle relaxing effect, these uses are technically considered by the FDA to be off-label.

What are the most common areas in the face that Botox® is requested? These are the areas associated with the most common muscle hyper-animation with expression and include:

1.  frown lines situated between the eyebrows and on the bridge of the nose
2.  crow’s feet creases at the corners of the eyes
3.  creases of the forehead

Far less commonly treated facial areas include the lower eyelid, creases around the mouth and specific neck creases. These are also higher risk areas for significant side effects such as drooping of the lower eyelid or weakness of the muscles of the lip than can affect speech, appearance and ability to purse the lips so you should use considerable caution and prudence before proceeding.

Though the duration of effects do vary from person to person and are even dependent on the specific area, expect around three to four months on average. Some patients can have results that last 6 months or more but this is not very uncommon. In order to maintain the effects, Botox® treatments should be repeated on a regular basis, usually every three to four months.

For more information on Botox®, fillers such as Juvederm™ and Radiesse®, eyelid surgery or any other cosmetic surgery procedure or to schedule a complimentary consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In April, the FDA approved the usage of another cosmetic wrinkle remover, which like Botox Cosmetic®, is derived from botulinum toxin. To be marketed as Dysport™ by Medicis Pharmaceutical Corp., it will be a direct competitor to Botox Cosmetic® which is sold by Allergan Inc. It has been used with great success since 1991 in Europe where Botox Cosmetic® is also very popular.

Though derived from botulinum toxin, these two products are not identical and do have several differences which will be sorted out in the future with greater experience. Dysport™ has a more rapid onset of action, typically one to two days versus the three to five days seen with Botox Cosmetic®. It also has a greater spread for a more diffuse effect, requires fewer injection points and may last slightly longer than Botox Cosmetic®. However, it does have significantly more adverse side-effects. Botox Cosmetic®, though requiring more injection points, is far more precise, predictable and has a lower risk of adverse problems.

Dysport™ should be available for clinical use here within the next month or two. Pricing is not yet established but will likely undercut the cost of Botox Cosmetic® in order to acquire patients and market share. Its presence will be a win-win situation for patients, allowing for more than one treatment option as well as providing competition which may lead to more favorable pricing and incentives.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona