December 12, 2011

Is there any difference between Microbotox and Microdroplet botulinum toxin treatment?

There is an enormous difference between these two similar sounding treatments. Microbotox is a mesotherapy technique used to place very dilute BOTOX solution intradermally. The goal is to use BOTOX to relax the smooth muscles responsible for dilating pores. Proponents of the method feel the treatment helps create a smoother looking skin. This service does not address the muscles that create facial expression and are responsible for facial wrinkles.

In contrast, Dr. Steinsapir developed Microdroplet TM botulinum toxin as an alternative method for addressing brow ptosis and forehead lines without freezing facial expression or creating the risk of a droopy eyelid. Microdroplet TM botulinum toxin concentrates treatment in the muscles that account for eyebrow depression. These muscles live right along the eyebrow. The key to the treatment is using very small doses of botulinum toxin just below the level of the skin where the muscles of facial expression insert. This effective traps the botulinum toxin so the treatment can’t diffuse into the upper eyelid. Because only the muscles that pull the eyebrows down are relaxed, the frontalis muscle of the forehead does not have to work as hard to lift the eyebrows. This means fewer forehead lines without paralyzing the frontalis muscle. That frozen look is associated with heavy forehead treatment. Microdroplet botulinum toxin creates a forehead lift without freezing the forehead. This means you have natural forehead movement.

Microdroplet TM botulinum toxin treatment is so unique that the United States Trademark and Patent Office recognized Dr. Steinsapir as the inventor of this method and issued a rare medical method patent for this treatment.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon. He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.
To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

October 23, 2011

I am having BOTOX treatment complications and my wedding is in two weeks. What do I do?

BOTOX® complications can range from minor problems like bruising, frozen forehead, or swelling, to more severe problems like eyelid ptosis, to the even more rare systemic effects including difficulty swallowing.  Typically, even these more severe problems will resolve themselves over a period of 4 to 6 weeks without intervention.  However, given a very short time frame, it is essential to see a treating physician immediately to determine the best course of action.

Fixing Minor Problems

BOTOX treatments are popular because they are noninvasive and effective in relaxing tense muscles and smoothing wrinkles.  BOTOX is a naturally-occurring purified protein that relaxes muscles but is eventually broken down and expelled from your body completely.  The effects usually last 4 to 6 months.

With botulinum toxin A products (BOTOX, Dysport, Xeomin), adverse issues are usually the result of an unbalanced treatment.  Forehead treatment can be associated with upper eyelid or eyebrow ptosis.  Unbalance forehead treatment can result in issues of asymmetry.  It is possible to improve your treatment results using the appropriate counter treatment along the eyebrow using Dr. Steinsapir’s Microdroplet method.

Eyelid Ptosis

If your BOTOX treatment has caused eyelid ptosis, Dr. Steinsapir recommends finding an oculoplastic surgeon to help you with this particular issue.  Oculoplastic surgeons are trained to assess and treat upper eyelid ptosis. A prescription for Iopidine (aproclonidine ophthalmic solution) can be helpful in this circumstance; this medication is a glaucoma drop that can elevate the eyelid a couple of millimeters. The drops can also be used to assess the severity of the ptosis and predict the likely time frame for the resolution.  Dr. Steinsapir recommends trying the drops twice a day for a week.  If successful in opening the eye, the ptosis will likely resolve in 4-6 weeks and the drops will help improve the eyelid ptosis until resolution takes place.

The likelihood of upper eyelid ptosis is extremely small in the hands of an experienced injector.  Less experienced injectors are more likely to perform a treatment that causes ptosis.  It’s important to carefully research a doctor or nurse’s credentials and their track record for successful injections.  The individual performing your treatment has a profound effect on the risk of side effects.  Upper eyelid ptosis has been reported in as many as 5% of cases. The incidence of upper eyelid ptosis in the hands of experienced injectors is much less.   Dr. Steinsapir has seen only three mild cases of ptosis in his last 3,500 treatments.

Other Options

What if your doctor tells you that there are no treatment options?  Rescheduling an event like a wedding can be impossible.  Consider having a heart to heart with your photographer.  Can they photograph you to minimize the appearance of a droppy eyelid or photoshop your images after the fact?  If so, consider going forward with your plans and let the photographers cure your eyelid position digitally.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for his expert care.

To learn more about Dr. Steinsapir’s specialized BOTOX treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

 

July 26, 2011

How does BOTOX and the new product Xeomin compare?

Xeomin® is a Botulinum Toxin A, made by Merz Pharmaceuticals that contains the same active ingredient found in BOTOX® and Dysport®.  Unlike BOTOX however, Xeomin does not need to be refrigerated before reconstitution.  Xeomin isn’t currently approved for cosmetic uses but it is comparable to to BOTOX and Dysport.

Uses for Xeomin

Xeomin is approved by the US FDA for the treatment of adults with cervical dystonia, severe neck spasms, or blepharospasm, advanced eyelid spasms.   It is not approved for the treatment of wrinkles and crows feet in the United States, but it is used throughout Europe and Canada for this purpose.

Merz, the company that developed Xeomin, reports that clinical studies for cosmetic applications are underway.  Doctors are able to use this product in what is referred to as “off-label” manner, meaning that your doctor can prescribe Xeomin at doses and for procedures other than those recommended by the FDA, however in these situations, you are using the product at your own risk.  It is possible to obtain treatment for cosmetic indications with Xeomin.  Just note that such uses have not been tested rigorously and may pose higher risk than being treated with drugs that are formally approved for treating cosmetic issues such as BOTOX® and Dysport®.  Based on studies so far and the use of Xeomin in Europe – where it is available for cosmetic purposes – doctors anticipate that Xeomin will work very much like BOTOX for cosmetic applications.

Botox versus Xeomin

There is no scientific evidence to suggest that Xeomin will be better than BOTOX, or less effective.  If you are treated with Xeomin, the dose your doctors uses may be the same or slightly different than the dose used for BOTOX.   These products are not bioequivalent and for this reason, treatment may vary.

Like any product introduced into the market as a competitor to existing brands, the use of Xeomin, once it is approved by the US FDA for cosmetic use, will be based largely on personal preference.  But as with any Botulinum Toxin A injection, it’s important to remember that only an experienced cosmetic surgeon should perform the procedure.  Just as BOTOX and Dysport cannot be administered by an esthetician, an unsupervised nurse, or anyone other than a licensed professional, Xeomin is no different.  Do not assume that because it is new and has different dosing and storage requirements than BOTOX, that it can be administered by anyone.

About Dr. Steinsapir

Dr. Steinsapir trained alongside the inventor of BOTOX and has performed thousands of BOTOX treatments in Los Angeles since 1988 and recently patented his Microdroplet BOTOX technique. He is a board certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in BOTOX, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment.  No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success.  Only you and your treating physician or surgeon can determine if a treatment is right for you.

January 4, 2010

What’s the Difference between Dysport and BOTOX?

Both Dysport® and BOTOX® are botulinum toxin A products that relax overactive muscles to improve facial aesthetics.  But just because these products share a category does not mean they are equivalent.  In fact, it’s important to note that they are not equivalent and the FDA does not consider them to be so.  To be considered a generic drug that is the bioequivalent of a name brand drug, the generic product and name brand must share a dose and therapeutic effect by 90%.  This means that doctors do not have to adjust dose or treatment when switching between the brand name drug and the generic version.  This is not the case with Dysport and BOTOX.

The relative strength of BOTOX to Dysport is thought to be about 2 to 4, so they cannot be used in similar doses.  Further, Dysport diffuses more widely than BOTOX, meaning that treating one section of the face with Dysport will have a wider effect than treating the same portion with BOTOX.  This is not necessarily better or worse – what it means is that BOTOX and Dysport have different applications.  We don’t have meaningful evidence that Dysport lasts longer than BOTOX.  However, Dysport seems to kick in faster and some people really like this difference. These two products share important similarities, but we must be cautious in differentiating them as well.

Is Dysport Better than BOTOX?

It’s too soon to tell because Dysport only just became available in the United States in mid-2009.  So far Dysport and BOTOX seem to be comparable products with important differences outlined above, and Dysport has not demonstrated any clear advantages.   We already know BOTOX to be an extremely beneficial product that is here to stay, and we also know that Medicis (the maker of Dysport, Restylane, and Perlane) has consistently created effective products.  This said, BOTOX is still the market leader and Dysport will need to prove itself and withstand the test of time.

Some people are holding their breath in hopes that BOTOX and Dysport prices will compete until prices drop considerably.  Although there is some competition, we advise you to go ahead and take a deep breath and not expect a drastic change.  Introducing a new drug or product to the market is a costly endeavor that requires extensive research, production, and testing.  Add to this the cost of an experienced doctor who specializes in these procedures, and we see that cosmetic procedures from the better providers are never going to be significantly less expensive.  The advanced and technical nature of the medical field means that good medicine will always come at a premium, if administered safely and as recommended.  Since Dysport and BOTOX are not bioequivalent products, the competition between these products is even less direct than some imagine.  If you have been waiting for the price of BOTOX to drop sharply, you may be disappointed.  BOTOX is still worth as much as it was before, and Medicis still needs to recover the cost of bringing Dysport to the market.  Additionally, it is rumored that the price of BOTOX is scheduled to go up in 2010.

Dysport is turning out to be a great product, just as we expected.  Doctors are now gaining experience with Dysport and perfecting its use. So…

Should I Be Treated with BOTOX Or Dysport?

Your treatment will depend on the results of your private consultation.  Choose a doctor with extensive experience in treating the face with botulinum toxin A products for the best results.  Very subtle differences in treatment make the difference between good and extraordinary results, and experience guides doctors in making treatment decisions.  While any new product has the disadvantage of a short track record, a doctor with a demonstrable high skill level will know how to best apply the new product and when it’s preferable to use the leading brand.

Dr. Steinsapir trained with the inventor of BOTOX and has performed thousands of BOTOX treatments for over two decades.  In this time he has helped BOTOX recipients achieve remarkable results and has pioneered the patent pending MicrodropletTM BOTOX treatment.  As a professional considered among the top BOTOX practitioners, he can help you get the best results from a traditional BOTOX treatment or the new Dysport treatment.  Contact us today for an individualized consultation to find out the most appropriate treatment for your unique concerns.