Anti-Wrinkle Injections: The Facts

Anti-wrinkle injections are currently the most common medical cosmetic treatment.  There have been  17 million injections that have been safely administered for cosmetic purposes alone since 2002.  It is currently approved for treatment of glabella wrinkles, which are the frown lines between the eyebrows.  Any other treatments are considered “off-label” (a common and legal practice in which a drug is used for a purpose other than the officially approved one).

Here  are  some  other  interesting  facts  you  should  be  aware  of:

  • Clostridium Botulinum (the bacteria that causes food poisoning) was first identified at the University of Gent, Belgium, in  1895.
  • Anti-wrinkle injections consist of Botulinum toxin type A, which was isolated in the purified form by Dr. Herman Sommer at the University of California in the  1920s.
  • Botulinum toxin type A stops the release of certain chemicals at the junction between a nerve and a  muscle, so the message for the muscle to  ”work” is blocked and therefore relaxes.  Its anti-wrinkle properties were discovered in the 1980s  by  Dr.  Jean  Carruthers  (an ophthalmologist) and her husband  Arthur  (a  dermatologist) when patients being treated for crossed eyes and facial spasms told their doctors that their lines and wrinkles had vanished since starting the injections.
  • Anti-wrinkle injections are approved in more than 75 countries for 20 different neurological indications and approved for cosmetic use in more than 40  countries.
  • In the  20-year history of using the drug for cosmetic treatments, there is no anecdotal evidence of any long-term problems because any muscle weakness from the injections is reversible because Botulinum toxin type A ’s action is temporary.
  • Botulinum toxin type A has been used in other conditions such as migraines, excessive sweating,  incontinence, hemorrhoids and has even been used on patients with gallstones.
  • The cosmetic formula on uses a much lower dose of the toxin than the one used to treat major muscle spasms.
  • Anti-wrinkle injections are not a panacea for every facial wrinkle.  Those caused by other mechanisms such as hereditary,  smoking, sun exposure, and the effects of gravity,  do not respond adequately.  Nor are anti-wrinkle injections particularly effective for wrinkles around the mouth.  Other treatments (such as Retin-A, chemical peels, collagen or fat injections, laser therapy, or facelifts) may help for people who wish to minimize these types of wrinkles.

A  U.S. consumer advocacy group called Public Citizen has recently asked the Food and Drug  Administration  (FDA) to reconsider the safety of anti-wrinkle treatments.  However, my main issue with them is that they have grouped together adverse events from both the medical and cosmetic uses of the drug.  They pointed to  180 cases of serious complications like pneumonia and difficulty breathing or swallowing, which included 16  deaths  (collected from  9 full years of data).  Earlier in 2005,  The Centers for Disease Control and Prevention reviewed  1,437  adverse reports:  406 after medical use of the toxin  (217 of them were serious effects)  and  1,031 after cosmetic use  (36 of them serious).  The proportion of serious reports was  33-fold higher for patients treated for medical problems than for those receiving cosmetic treatments and the worst disasters have occurred when unqualified practitioners administered the drug.  The FDA has also confirmed that there has never been a reported death where a causal link to the cosmetic use of anti-wrinkle injection was established.

Don’t forget that many cancer medications are derived from substances that in other contexts would be considered dangerous.  And many other drugs that are licensed for a  particular condition are used  “off label” to treat other problems.  Remember, all drugs have unwanted side-effects, so that with more people using anti-wrinkle injections, the list of unwanted effects may be growing.

Earlier this year,  the Food and Drug  Administration  (FDA) which reviews the continuing safety of anti-wrinkle injections, notified the public about reports of their serious side-effects.  Most of these,  however, resulted from medical, not cosmetic uses of the toxin.  Medical treatments typically require much larger doses, and many of the patients have other health problems that increase their risk.  For e.g. to treat the furrows between the brows,  a typical dose consists of 20-35  i.u.’s  (intramuscular units) compared to over  200 for neuromuscular disorders.  The reactions included respiratory failure (which sometimes was fatal) in a range of doses and use, many of them “off-label” e.g. limb spasticity associated with cerebral palsy in children.

So,  my  advice  to  patients  and  clients  seeking  anti-wrinkle  injections  would  be:

  • Choose your doctor or nurse injector carefully.  They should be both experienced and competent and make you feel safe and at ease.
  • Injectables should be performed in an approved medical office or medical spa.
  • Ques on the authenticity of the injectable.  Ask to be shown the brand packaging.
  • Pay close attention to the potential complications which should be thoroughly discussed during the informed consent process.

Thanks for reading!

Dr. Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

Should Nurse Injectors Perform Cosmetic Procedures?

Nurse injectors.001

I’m constantly asked by patents whether nurse injectors are truly qualified to perform cosmetic injections. For me, the most important factor for any nurse injector is their relationship with an appropriately trained, supervising doctor, and how closely the nurse and doctor work together. That doctor can either be a plastic surgeon, dermatologist, facial plastic surgeon, or ophthalmic plastic surgeon who has prescribed the injectable treatment appropriate for the patient. Remember–50 % of complications resulting from cosmetic injections are reported to result from unqualified providers, and that –33 % result from injections administered in a non-medical setting, such as a hair salon or private home.

Patients always have the option to request the doctor perform cosmetic injections, but not infrequently, specifically ask for experienced nurse injectors. In the later case, there are a few guidelines which I think are important for nurse injectors to adhere to:

  1. Nurse injectors are under the supervision of a qualified doctor who has prescribed the injectable treatment appropriate for you.
  2. Nurse injectors should demonstrate appropriate medical education and training specific to the delivery of cosmetic injections.
  3. Perform injections in a medical setting supervised by the prescribing doctor. Patients should not accept treatment from nurses or any other doctor in private homes, hair salons, hotels, bars or any other non-medical setting.
  4. Nurse injectors should follow all of the appropriate steps in performing cosmetic injections, and that all patients are given informed consent documents that clearly define the risks and benefits of the procedure.
  5. You have the option to request the doctor perform your injections.
  6. Nurse injectors should also have recent continuing medical education (CME) to be abreast of the latest injectable techniques, and should inject patients just like you on a regular basis (several patients weekly).
  7. Your doctor should also have recent continuing medical education (CME) to be abreast of the latest injectable techniques, and should inject patents just like you on a regular basis (several patients weekly). No matter what, regardless of who delivers the injection, if I as the doctor prescribe the treatment, inevitably the patient outcome is my responsibility. Therefore, it’s incumbent on me to have well trained and expert nurse injectors, someone that I can trust to inject my family members and friends. And that is exactly what I do.

The Physicians Coalition for Injectable Safety in the US state that before you undergo any injectable treatment, ask your doctor these key questions. A qualified doctor will not hesitate to provide you direct answers:

Doctor

1. What is your board certification?

2. How were you trained to do injectable treatments?

3. Do you regularly provide injectable treatments?

4. How many people have you treated with a condition similar to mine?

5. Will you personally inject me? If not, what are the qualifications of the person who will?

Brand

1. Exactly what brand of injectable do you recommend for me?

2. Is it FDA-approved (in Australia that should be TGA-approved) specifically for cosmetic purposes?

3. May I see the packaging to verify the brand name?

Safety

1. Are there any precautions I should take before my injectable treatment?

2. Will anaesthetic be necessary? Is it available?

3. What can I expect to experience after my treatment?

4. What are the potential risks of treatment?

5. How long will my results last?

Question: Do you think that there is much of a difference between a doctor or a nurse performing cosmetic injectables? You can leave a comment below.

#001: How CoolSculpting reduces fat stubborn bulges forever [Podcast]

Have you heard of Coolsculpting? It’s a non-invasive cosmetic surgery procedure that’s sweeping the world at the moment. Trademarked by Zeltiq Aesthetics, Inc. it actually refers to the medical device that’s used to destroy fat cells. The process is pretty simple. It principally relies on controlled local cooling to reduce fat deposits within that specified target area. The fat cell reduction is caused by what’s called apoptosis or ‘cell death’ of the subcutaneous fat tissues. This process is based on studies that showed that when exposed to low temperatures subcutaneous fat tissues suffer damage. It has also shown that while the fat cells get crystallised, shatter and die, the overlaying skin, nerves and vessels do not. Accordingly the procedure was developed that cooled the targeted areas via thermal conduction.

Pinch_Female_Muffin_Top

Since it gets rid of the fat there will be those who will be lead to believe that this would be great for weight loss. There will be those who will compare it to liposuction and what it can do. Unfortunately, this is not a weight loss procedure nor does it have the same fat removal capacity as that of liposuction. What does it all mean? This means that if you’re overweight or obese this is not the procedure for you. Simply put, CoolSculpting is a non-invasive cosmetic surgery procedure for people who are relatively fit but have certain fat deposits that they want to get rid of. It’s to simply get rid of the fat that can’t be removed no matter how hard one exercises or diets. They are usually found in the waist and are more known by the colloquial term ‘love handles’, or in the abdomen, hips, thighs, back rolls and “man boobs”.  The procedure simply targets these hard to remove fat deposits and kills them.

Play

Depending on the amount of fat in the targeted areas a treatment can last anywhere between one to three hours. The process is pretty simple in that the targeted areas are cooled by the CoolSculpting machine applicator that is placed directly over it. After the cooling process everything is done and you’re free to go. People can feel some pain during the initial part of the procedure. After that there’s nothing but cooling numbness as the process begins to take its effect. Other than the machine being attached to the body the patient is able to do things during the whole procedure.

Because CoolSculpting is a non-invasive cosmetic surgery procedure once the treatment is done the patient is able to get back to their daily routine, albeit with some discomfort. While there have been no known major side-effects, one does get some soreness, redness and even bruising in the areas that have been treated. The area could also be tender to the touch with a feeling of tingly itchiness and numbness. The numbness is due to the cooling effect and can last for some time after.

The number of treatments that you may have will vary depending on how much fat needs to be removed in the targeted area(s). This will all be up to your doctor. Even though CoolSculpting is a non-invasive procedure, it is best you do this after consulting with your doctor or an approved CoolSculpting practitioner. For more information please email us on info@drtim.com.au or call us on 13000DRTIM.

 

 

Facial Rejuvenation: The Five (5) S’s that causes facial skin damage

Often, I’m asked by my Facial Rejuvenation patients about how long their face lift may last. I’m reminded of the French surgeon Dr Vladimir Mitz, a pioneer in anatomy regarding facelift surgery, who told me once he had a crystal ball on his desk to answer such a question! At the time, I hadn’t appreciated how profound this idea was. It makes a lot of sense to me now. Why?

There are several factors to take into account when thinking about treating patients for facial rejuvenation. I call these “the 5 S’s” and they affect your skin and thus the face.  These are:

  1. Stress
  2. Sun
  3. Smoking
  4. Sleepless nights
  5. Sugars

Let’s just take stress’s terrible toll on the skin:

  1. Wrinkles: tensing and tightening facial muscles squeezes and pinches the overlying skin, creating wrinkles and lines.
  2. Acne: hormone receptors connected to the oil glands are triggered by stress hormones, so once they’re stimulated, the gland increases oil production, causing pimples and breakouts.
  3. Hair loss: normally, hair follicles are small and resting, or active and growing, but stress shocks the system, throwing the cycle into chaos and causing follicles to sleep longer rather than produce new hair. Once they wake up, the old hair falls out
  4. Grinding teeth: jaw tension will create lines and wrinkles as skin is pinched and collagen is broken down.
  5. Increased free radicals: stress causes blood vessels to clamp down, causing a shunting of blood away from the skin as blood focuses on internal organs.

Lack of blood leaves skin vulnerable to assault from the sun, cigarette smoke and other outside pollutants that create free radicals. As an example of what stress is capable of, we have all seen people who have lost their loved ones and 6-12 months down the track they’ve seemed to have aged 5-10 years; their skin is more wrinkled, dry and sallow looking. Imagine if you throw in the other factors like sun exposure and smoking and you can see how they can affect the longevity of a face lift. That’s why it’s like looking into a crystal ball. I say to patients that a face lift usually lasts 7-10 years if you are lucky and maintain it with regular microdermabrasion, skin peels and laser skin tightening.

Things that you can do for facial rejuvenation to improve the health of your skin is to:

  1. Use regular sunscreen to protect your skin from free radicals from the outside world.
  2. Use antioxidants either applied topically or consumed orally such as vitamins A, C, E, lycopene, CoQ10, idebenone, green tea and grape seed extract.
  3. Take Vitamin B to stimulate hair growth.
  4. Relax. Calming your central nervous system and mind to give stress hormones a chance to switch off is a good thing. Try meditation, some quiet time or exercise.
  5. Anti-wrinkle injections. These injections not only make you feel better when you look your best, but medically they help muscles relax. There is a biofeedback between muscles and the brain, so if muscles aren’t tense, the brain interprets the quietness as calm and lets its guard down.

Question:  What do you do for facial rejuvenation to prevent facial aging? You can leave a comment below.

Laser Hair Removal Mythconceptions

There is no such thing as a single “best” laser for hair removal on all patients.  The best laser for laser hair removal for each person really depends on his or her skin colour. Thus, multiple lasers exist for hair removal. Different laser types, which emit distinct wavelengths of light, are better for treating different skin types. There are a number of manufacturers that make these laser types:

  • Alexandrite lasers. These emit laser light at 755 nm. These lasers work best on lighter skin. In my opinion,  it has been the most impressive laser for hair removal for light to olive skin types.
  • Diode Lasers.  These emit light at a wavelength of 810  nm.  Lighter skin types do well with this type of laser, as do some darker skin types.
  • Nd: YAG lasers.  These emit a 1064 nm wavelength.  This laser is best for darker skin types, as the higher wavelength reaches deeper into the skin.  This helps to avoid superficial skin melanin,  which pigments our skin.
  • IPL or  Intense  Pulsed  Light. It has been used for hair removal.  Lasers emit light at one wavelength (like laser pointers in PowerPoint presentations).  IPL machines produce a range of wavelengths  (like the cone of light from a torch one sees in cartoons) and are not lasers.  So,  there  is  no  such  thing  as  an  “IPL  laser”  or  “IPL laser  hair  removal”-  it’s  a  marketing  ploy  for  businesses  that  have  IPL  machines  and  not  hair  removal  lasers (the  only  exception  to  the  rule  are  the  few  machines  out  there  that  have  both  lasers  and  IPL  machines  in them).  Several studies have shown that  IPL is not as effective as dedicated hair removal lasers, and carry a higher risk of burns, blisters, and changes in pigment.

In my experience,  the Alexandrite laser is the most effective laser for removing hair on the lighter skin, whereas the Nd: YAG is the safest and best laser for more darkly pigmented skin.  Remember,  every laser  has  a  “target.”  For hair removal lasers, the goal is to selectively target the pigment (in other words colour) which in this case is called melanin found in hair follicles.  Melanin is the reason why we have black or brown hair or shades in between.  The hair follicles are living cells which make hair below the surface of the skin.  When the melanin is selectively heated, this destroys the hair follicle cells.  The lighter the hair, the less melanin the hair follicles will have in them.  As a result, hair that is blonde, white or grey does not improve with laser hair removal.  In my practice,  I have actually seen some patients notice a decrease in lighter hairs,  but it ’s the exception and not the rule.

Melanin is also present in skin and is the cause for dark skin and suntans.  It is the same target that the hair removal laser is trying to reach in hair follicles.  Hair removal lasers may target the melanin in the skin as well as in the hair follicles which sometimes results in burns,  blisters, and change in skin pigmentation.  As a result,  lower settings and longer laser pulse times must be used for darker skin to avoid damage.  As a consequence, more overall treatment sessions will usually be necessary.

Remember, laser hair removal is a medical procedure and you should always consult with a doctor who has extensive experience in lasers and laser hair removal.  This will maximize your chances of a great result.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au