Botox® Cosmetic, the rejuvenating and anti-wrinkle wonder, is celebrating its 10th year anniversary this month. Back in April of 2002, it was approved by the FDA (Federal Drug Administration) for the cosmetic treatment of frown lines between the brows. Its clinical usage, however, dates back to the 1980s when it was employed for the treatment of opthalmological (eye) problems. Over the ensuing years, Botox® has been found to be effective in the treatment of a multitude of medical issues such as chronic migraine headaches, excessive sweating (hyperhidrosis), and muscle spasm disorders such as of the neck, bladder, vocal cords, anus and even vagina.

There now may be yet another therapeutic benefit of Botox®: the treatment of depression. The potential beneficial relationship between the usage of Botox® and the improvement of clinical depression has been noted for years including by several small studies and anecdotal reports. A scientifically sound pilot study recently performed at the Hannover Medical School in Hannover, Germany with the results recently presented at the 20th European Congress of Psychiatry, provides far more substantive evidence to support this relationship. Importantly, it was not supported by any of the manufacturers of the botulinum toxin.

This study was conducted as a randomized, double-blind, placebo-controlled trial (jargon for the study being conducted using scientific principles that would minimize bias in the results) using injections of either onabotulinumtoxinA (Botox®) or placebo into the appropriate muscles between the brows that are associated with the frown lines (the procerus and corrugator muscles in the glabellar region of the forehead) in 30 female and male patients with chronic major depression. These individuals were already being treated with antidepressant medication. Assessment was quantified using a standardized depression rating scale.

What were the findings?

The study investigators discovered that just one Botox session resulted in not only the diminishing of the frown lines (as expected) but also in a strong and persisting improvement in the depression of these patients who had not responded adequately to previous treatments. At 6 weeks, the Botox® treated group experienced a 50% improvement in their scores compared to only 9% in the placebo group. Under the category of a full response, 60% of the Botox® patients experienced this versus only 13% in the placebo group. Even more amazing, 33% of the Botox® treated patients experienced complete remission.

A few theories have been advanced to explain this phenomenon including positive feedback from friends, family and others who might have told patients that they didn’t look so angry anymore (due to diminished or suppressed frowning and wrinkling). The person can also note this when he or she looks in the mirror and doesn’t always appear to be so angry or even old anymore.

There study provides additional evidence in support of the old adage that “if you look better, you will feel better”!

If you would like more information on Botox® or other anti-aging treatments such as Juvederm®, Restylane® or Radiesse® 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

Here at the Arizona Center for Aesthetic Plastic Surgery, I see a tremendous number of patients who are seeking improvements in the appearance of their face though the usage of dermal fillers such as Juvederm® and Restylane® rather than with surgery such as facelifts or even fat injections (lipofilling). Notable, there has been a quite significant increase in demand for these products over the last several years which can be, in large part, attributed to the recession and overall poor economy. Though these may not be the ideal or even first line solutions for signs of facial aging, they are at least far more affordable and do provide for facial rejuvenation. They are often combined with the usage of Botox®.

Who are these people seeking improvements though dermal fillers?

They are largely women and range in age from the twenties up to the seventies. Their frequent concerns include addressing wrinkles, creases, folds, lines, scars, areas of deficient volume and volume asymmetries. Most of these are expected consequences of the aging process. Of course, a very popular reason for their usage is to augment lips that are either congenitally small or smaller than desired or have atrophied over time age.

Dermal fillers can be injected to soften, make less conspicuous or even ablate creases, folds and lines essentially anywhere on the face. The most common areas that they are used for are around the mouth (nasolabial folds and marionette lines), the jowls and contour depressions below the eyelids. They can also serve to add volume to areas that are deficient in volume for a multitude of reasons. Common locations include the cheeks, cheek bone area and chin but can also include the brows and even jaw line and nose.

I do offer my patients several dermal filler options for the treatment of these issues. They include Juvederm® Ultra XC and Juvederm® Ultra Plus XC, Restylane®, Perlane® and Radiesse®. Which one or ones are recommended for a particular patient would depend on a variety of factors and would be discussed at the time of consultation (as would risks, expectations, etc.). For lip enlargement, the choices are either Juvederm® (Ultra or Ultra Plus XC) or Restylane®.

Though dermal fillers like Juvederm® and Restylane® are not intended as replacements for plastic surgery procedures of the face (though they can be used as adjuncts to these procedures), they offer cost effective solutions for facial rejuvenation and do so without the discomfort of surgery and with minimal if any down time. So now you can afford to look even better!

If you would like more information on the dermal fillers Juvederm®, Restylane® or Radiesse® or for any plastic surgery procedure that I perform, please call my office at 480-451-3000. You can also schedule your complimentary consultation with me at that time as well.

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

Though it may seem like it has been around forever given its widespread popularity and publicity including media exposure, BOTOX® Cosmetic (produced by Allergan, Inc.) is celebrating its 10th year anniversary of FDA approval for the treatment moderate to severe frown lines between the brows. In 2002, it was the first product to receive such an approval and it remains the standard by which all other competing products are measured. (The medical usage of BOTOX® goes all the way back to 1989 when it received FDA approval for its usage in the treatment of blepharospasm, an abnormal condition involving the eyelid.)

Ten years later, it remains the overwhelming market leader as well as the therapeutic standard for the treatment of facial wrinkles. I surely can strongly attest to this through my brief but disappointing experiences evaluating the competing wrinkle treatment alternatives, Dysport™  and Xeomin®.

As a celebration marking this 10 year milestone anniversary, the company producing BOTOX® Cosmetic has made available a limited time rebate on it which I can offer you and which can add up to a total of $200 in savings (if you undergo 3 treatments). In order to be eligible for this rebate, you must have your first treatment with Botox®Cosmetic before April 30, 2012. There is additional information on the limitations and restrictions to this offer at the product website.

For more information on Botox® Cosmetic treatments or on any other plastic surgery procedure that I perform or 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

In November, I presented a report on Xeomin®, a newly available wrinkle treating neuromodulator that had been recently approved by the FDA. Available in various countries worldwide since 2005, it was touted as an alternative (cheaper?) to BOTOX® and a competitor of Dysport®. All three products are based on the same botulinum toxin A molecule but their formulations are different. They act by temporarily paralyzing the underlying muscles in order to treat wrinkles.

In November 2011, I was selected as one of only a limited number of physicians in the Scottsdale and Phoenix metropolitan area to able to offer Xeomin® for the treatment of wrinkles before its more widespread introduction planned some time later this year. The information provided and data available indicated that its effects and duration were similar to those of Botox®.

What were my findings in the 3 months that I have been offering Xeomin® as another option in the treatment of wrinkles?

Initially, my patients were very ecstatic. The onset of effect and its ability to treat wrinkles compared quite favorably to that of BOTOX®. Many of them had previously been treated with BOTOX® and stated that they noted little or no difference except in the much more appealing price. Then…

Suddenly and unexpectedly at six to seven weeks, they noted a fairly rapid return of their muscle function and with it – wrinkling again. This was a uniform finding in all the patients that I had contacted.

Not good at all – even at a significantly lower cost!

In comparison, my experience and the general consensus for the duration of effect for BOTOX® is around three to four months. Therefore, I can’t justify continuing to offer Xeomin® even at a significantly lower price knowing that it lasts around only half as long as the iconic and efficacious BOTOX®. (Note: I don’t offer Dysport® any longer either as I found it to be very unpredictable in effect as well as duration.)

So, if you are interested in treating those undesirable frown lines, Crow’s feet or other hated dynamic facial lines and creases, you still have the choice of BOTOX®, BOTOX® or BOTOX®!

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

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

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

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

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

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

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