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

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

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