Tuesday, September 14, 2010

New Botox Available in US in September 2010

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A new type of Botox called Xeomin (Merz Pharmaceuticals] will become available in the US in September 2010. The drug was approved by the FDA in August 2010 for treating certain neuromuscular conditions, such as blepharospasm (chronic blinking), cervical dystonia (tight neck muscles that distort the head's position). It is not yet approved for cosmetic purposes to treat dynamic wrinkles between the brows and on the forehead. Such use would be considered off label but Botox was used in such an off label fashion for years before it received FDA approval for cosmetic use.

That means we will now have 3 products available, Botox, Xeomin and Dysport to treat aging wrinkles of the face. More Dysport has to be injected to get the same results as Botox but since the per unit price is cheaper the end cost to achieve a given result is the same for Botox and Dysport. Xeomin is formulated differently in that it does not contain the complex proteins found in the other 2 formulations. It is too early to say if this is a positive or negative attribute. It could lead to migration of the Xeomin away from the injection site with more side effects or it could mean you will not form antibodies or develop resistance to the medication after many injections.

Since the price of Botox did not change after the introduction of Dysport is likely those prices will not change after the introduction of Xeomin. That may be due to Dysport's failure to steal market share from Botox but only time will tell.


Wednesday, September 8, 2010

Countries where plastic surgery is most popular

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The International Society of Aesthetic Plastic Surgery recently conducted a survey and came to the conclusion that the countries where plastic surgery is most popular or the largest number of per capita procedures performed are :
1. United States
2. China
3. Brazil
4. India
5. Mexico
6. Japan
7. South Korea
8. Germany
9. Turkey
10. Spain
11. Argentina
12. Russia
13. Italy
14. France
15. Canada
16. Taiwan
17. United Kingdom
18. Colombia
19. Greece
20. Thailand
21. Australia
22. Venezuela
23. Saudi Arabia
24. Netherlands
25. Portugal

Brazil and China have taken the place of Japan and South Korea in previous surveys. The emerging markets of the world have emerged.


Friday, August 27, 2010

Abdominoplasty - MuscleTightening + Diastasis Repair

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This is how much muscle tightening I was able to achieve from this week's abdominoplasty for a mommy makeover.

The placement of the vertical row of sutures is the repair of a diastasis and in doing this repair the abdominal muscles are tightened. In this case I placed an extra horizontal row of sutures at the belly button level to get even more muscle tightening.
Mommy Makeover Surgery - Abdominoplasty
Abdominoplasty - Tummy Tuck
Mommy Makeover Abdominoplasty - Tummy Tuck on Youtube

Aaron Stone MD - twitter
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Monday, August 9, 2010

Botox Manufacturing Kills Mice

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I just found out today that for every batch of botulinum toxin created, tests are performed on laboratory mice. The test employed is the LD 50, that is the dose of botox that kills 50% of the mice it is given to. After the toxin is administered by a needle stick to the belly impaired vision, paralysis and respiratory arrest follow. Those that die suffocate. The process takes three or four days. The surviving mice are then euthanized. It is estimated that worldwide at least 600,000 mice die in the production of botox each year. In the European Union alone, tens of thousands of animals are estimated to be used in this testing per year. As the use of botox increases so does this number. Europe has a ban on animal testing for cosmetics but botox is considered a medical treatment so the ban does not apply. There currently is no other assay available or in use to determine botox strength and doseage in each batch of botox that is manufactured.

July 26, 2011 addendum:
Allergan (the manufacturer of Botox) spent $65 million on more than a decade of research that led to a new animal-free test, testing the effect of Botox on cells in a lab dish. The Food and Drug Administration approved the test in June 2011. Allergan estimates it will be able to reduce its animal testing by 95 percent over the next three years as countries outside the United States approve the new procedure as a replacement for the old LD50 test.


Monday, July 5, 2010

Baby Ear Deformity - Deformed Baby Ear

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25% to 35% of babies born in the United States each year are born with an ear deformity. That is 1.5 million babies each year. There are 4 types of ear defects:
1-small or absent ears
2-folded ears also called lop ear where the top of the ear is folded downward or Stahl's ear when the top of the ear is pinched like a Star Trek Vulcan look
3-cup or constricted ear which looks like there is an invisible ring around the ear squeezing it
4-protruding ears that stick out from the sides of the head
Some studies have reported that 70% of ear deformities will either worsen or remain the same over time as the child ages.


Tuesday, June 22, 2010

#Hidradenitis of the Armpits - Boils Under the Armpits

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Inflammation of the armpit glands or #Hidradenitis, was first described by Velpeau in 1839. In 1854, Verneuitt suggested that this condition might arise from the sweat glands of the skin and described the clinical condition which is now recognized as hidradenitis suppuritiva. Since then, hidradenitis surgeons have recommended many forms of treatment for this entity: lotions, vaccines, fever therapy, toxoids, steroids, ultraviolet light, X-rays, antibiotics, and surgery. The disease does not occur before puberty because the apocrine sweat glands do not function at that age. Patients see this as boils under the armpits that swell, drain foul smelling material and then swell again as the cycle starts over again.



Monday, April 26, 2010

Nasojugal crease, tear trough deformity, nasojugal groove, bags under eyes, under eye hollowness

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In the young individual the transition between lower eyelid and cheek is imperceptible. The dividing line between these areas in older individuals is the nasojugal crease also called the nasojugal groove (term first used in 1961) or tear trough (term first used in 1969). It is an early sign of aging around the eyes, lending a fatigued and aged appearance to the face. As part of the aging process ligaments that fix facial skin to the underlying facial bones thin and lengthen or stretch, facial bones recede back and facial fat shrinks. This results in the drooping of facial skin and appearance of laugh lines, jowls, nasojugal creases, eyelid bags etc.. The skin within the nasojugal groove or crease becomes thinner and/or darker in color than the slightly lower nose or cheek skin. It can also seem deeper or be more visible if there is protrusion of fat into the lower eyelid. The aging process starts near the nose as the tear trough and progresses outwardly towards the same side ear becoming what is called the palpebromalar groove.
Tear Trough and Palpebromalar Groove Boundaries

Tear Trough and Palpebromalar Groove Boundaries


Examples of Tear Trough in Younger Patients Without Protruding Eyelid Fat

Examples of Tear Troughs in Younger Patients Without Protruding Eyelid Fat



Sunday, April 25, 2010

Gynecomastia

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Gynecomastia means enlargement of the male breast. The definition has nothing to do with what causes the enlargement or what tissue it is composed of. It is most common around puberty & can involve one or both sides of the chest. Most commonly the enlargement is centralized in the breast but occasionally it is not. It is present to some degree in about a third of male population. It appears either early in adolescence or later in the adult years of life and can be very disruptive in the life of a teenager or adult. Working out in the gym, going to the beach and changing in the locker room can become unpleasant ordeals.



Monday, March 29, 2010

Asian Rhinoplasty - AfroAmerican Rhinoplasty

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caucasian asian and black types of nosesThere are 3 main types of noses - Caucasian, Asian or Oriental and African. The Asian nose has characteristics between those of the Caucasian and African. Today one increasingly finds mixed features between these groups as well so some individuals can have a Caucasian tip with an African bridge or vice versa. The most visible difference is the more vertical nostril alignment with a longer strip of skin between the nostrils in the Caucasian nose vs. the Asian or African nose. The Asian and African nasal bridges are flatter and broader than the Caucasian. In some cases the bridge may be so flat that it appears scooped out or ski sloped. The nasal tip skin is usually thicker with a more rounded tip in the Asian and African noses. The thinner nasal tip skin in the Caucasian nose makes the tip cartilages and their shapes more visible on external viewing.

differences between types of noses
As you can see in the above diagram these differences are due to differences in the skin but mostly due to differences in the underlying bone and cartilage. In Asian and African noses:



Tuesday, March 9, 2010

Even a dog can benefit from a facelift

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As you can see even a dog can benefit from a facelift. This Shar pei required a facelift because the extra folds of skin were damaging the dog's eyes.

This Los Angeles billboard was actually an ad for a Comedy Central television show not a Veterinarian or a Plastic Surgeon


Aaron Stone MD - twitter
blogarama - the blog directory Listed in LS Blogs the Blog Directory and Blog Search Engine blog search directory


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