Ask The Doctor! When Should I Start Having Botox?

Ask the doctor

Reader:

Hi Doctor Lalloo.

I was wondering if you could tell me Botox. Is it safe and when would be the ideal time to start having the procedure?

I don’t want that ‘frozen face’ look!

Dr Lalloo: 

Here’s how to do it right at 20, 30, and 40.

Firstly there are different rules for different decades.

Anti-wrinkle injections used to be a procedure reserved for Beverly Hills housewives, but now this treatment, hailed for its minimal invasiveness and drastic results, is very commonplace. And these days, 20- and 30-somethings are depending on the injections to treat and prevent lines and wrinkles.

Now that the procedure is less controversial, I’m starting to see young women view it as a preventative measure instead of a means to treat skin that’s already showing signs of aging.

If that’s the case, when should you get started, and what should you know before going under the needle?

For Starters, Here’s How Botulinum Toxin A Works

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Botulinum Toxin A is an FDA-approved drug made up of botulinum toxins that, when injected into the correct facial muscles, temporarily blocks local nerve impulses that trigger contractions. This softens wrinkles and prevents even more lines from forming. As the skin ages, it loses its elasticity and collagen breaks down, so constant muscle and skin contractions can create more permanent creases.

While you can technically get anti-wrinkle injections at any age under a doctor’s supervision, the FDA has only approved it for those ages 18 to 65.

How you face changes in your 20’s, 30’s, and 40s’  and what you should know about getting anti-wrinkle injections

In your 20s:

To prevent wrinkles, some doctors may recommend using Anti-Wrinkle Injections as early as your mid-to-late twenties to reduce facial muscle over-expression, a totally genetic thing.

Botox

Many women don’t have wrinkles in this decade, and wearing SPF daily can help keep skin line-free. If you’re considering using Anti-Wrinkle Injections in the future, think of your twenties as a training wheel period: It can actually help you train your facial muscles not to move as much to prevent future skin wrinkling.

Just remember, Anti-Wrinkle Injections will affect the way your facial muscles move in general. This means it might feel funny when you try to make a particular expression. Don’t want that frozen face? Your doctor can use a smaller amount of the botulinum toxin and also inject it more superficially, so it doesn’t go as deep into the skin I avoid the frozen effect, which happens when too much is used. Most women I see in their 20’s are more looking for a refreshing treatment to look less tired and perhaps lift the eyebrows into a more seductive shape.

In your 30s:

botox

This is the decade when you normally start noticing somefine lines developing between your brows and around your eye area. “Botulinum Toxin will soften and even erase many of the finer lines around this age, as long as you continue keeping up with this regimen every 4-6 months or so.

If you’re only getting the procedure to look wrinkle-free for a particular event- your wedding, let’s say—or simply as a feel-good booster every now and then, you can space it out to every six to nine months to save yourself the cost of an appointment.

In your 40s:

At this age, your skin is thinning more rapidly, meaning wrinkles are far more obvious. If you’ve not yet used Botox, your muscles have been contracting for a long time and you might have a few static wrinkles.

Lines are more likely to have become etched in your skin even when you’re not moving the muscles underneath—not just dynamic ones that form only when you move your facial muscles.MTIzMDQ5NjY0NTAxMTU1MzQw

There’s also some mid-face volume loss (aka sagging) at this age, which Anti-Wrinkle Injections can help with, but your skin may not be perfectly smooth afterwards because of the changes in its quality and resilience.

Again, you’ll want to keep up injections approximately every 4-6 months and perhaps consider fillers to replace the lost fat and help lift the middle of the face and hollowed front of the face under the eyes.

The bottom line:

You don’t need Anti-Wrinkle Injections. Wrinkles are a part of the natural aging process, after all. But if it’s something that interests you, discuss it with your doctor, I recommend only ever having them done in a doctors office, I find it amazing that people think nothing of going to a salon to have this done to ‘save money’, would you bring a new born for their vaccines to a salon? Of course you wouldn’t you’d be terrified of doing that, but for some unknown reason Irish women don’t see it this way. Talk to your Doctor, in their registered office so that you can come up with a treatment plan that won’t leave your face looking stiff as a board…

Remember you get what you pay for too.

Hope that helps!

Dr Lalloo FRCS(Ed) MICGP

Doctor Lalloo 1

Please note that Dr Lalloo’s opinions are based on the information given to him. You should always consult your GP if you have concerns. This does not constitute a doctor patient relationship. MCRN No 019510

To submit a question to Dr Lalloo in the strictest confidence, please email info@sosueme.ie and include ‘Ask The Doctor’ in the subject line.

Doctor Lalloo 2

About Dr Lalloo:

Dr Lalloo is qualified from the Royal College of Surgeons in Dublin, and has a fellowship in surgery from the Royal College of Surgeons Edinburgh. He is a fully qualified GP with an interest in skin surgery and dermatology. His registered qualifications with the Irish Medical Council are MBBCh, FRCS Edinburgh, MICGP. Dr Lalloo is on the specialist register with the Irish Medical Council.

Dr. Lalloo is a recognised expert in medical aesthetics having established Cosmedics Clinic in 2002 when medical aesthetics was in its infancy in Ireland. He is a member of the British College of Aesthetic Medicine and on the committee of the Primary Care Surgical Association.

– See more at: http://sosueme.ie/lifestyle/ask-the-doctor-when-should-i-start-having-botox/#sthash.qMQxzthn.dpuf

The Star Newspaper, article written by Kellie Billings, Blogger, Freelance Writer & Professional Makeup Artist

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ASK THE DOCTOR – I have suffered with boils on my inner legs and under my armpit……

Question: I’m nearly 24 and since about the age of 12, I have suffered with boils on my inner legs and under my armpit, sometimes even on my bikini line.

I have gone to my doctor and they have given me antibiotics and creams but nothing seems to help. They leave purple scars too. Is there anything I can do to help or get rid of these?

It’s such a nightmare. They really do put my self-esteem down.

Thanks x

2

Dr Lalloo: 

Hi! My heart goes out to you. To me it very much sound like a condition called Hidradenitis Suppurotiva but I have not examined you.

This is a condition characterised by recurrent boils and abscess formation in the skin of arm pits / groin, under the breasts and pubic region (areas where we have what are called Apocrine Glands in our skin that is the sweaty areas), it is not however due to disease of the sweat glands as the name implies. Typically there are lots of scars from old cysts and sinuses or tracts between the lesions, which are pus filled. It is also known as Acne Inversa

Who gets it?

  • Hidradenitis usually starts at puberty, and is most active between the ages of 20 and 40 years, and in women, can resolve at menopause. It is 3 times more common in females than in males.
  • Other family members with hidradenitis suppurativa
  • Obesity and insulin resistance/metabolic syndrome
  • Cigarette smoking
  • Follicular occlusion disorders: acne conglobata, dissecting cellulitis, pilonidal sinus
  • Inflammatory bowel disease (Crohn disease)
  • Rare autoinflammatory syndromes associated with abnormalities of PSTPIP1 gene

hidradenitis

What causes it?

Hidradenitis suppurativa is an autoinflammatory disorder. Although the exact cause is not yet understood, contributing factors include:

  • Friction from clothing and body folds
  • Aberrant immune response to commensal bacteria
  • Follicular occlusion
  • Release of pro-inflammatory cytokines
  • Inflammation causing rupture of the follicular wall and destroying apocrine glands and ducts
  • Secondary bacterial infection

What is the treatment for hidradenitis suppurativa?

  • General measures
  •  Weight loss; follow low-glycaemic, low-dairy diet
  •  Smoking cessation: this can lead to improvement within a few months
  • Loose fitting clothing
  • Daily unfragranced antiperspirants
  • If prone to secondary infection, wash with antiseptics or take bleach baths
  • Apply hydrogen peroxide solution or medical grade honey to reduce mal-odor
  • Apply simple dressings to draining sinuses
  • Analgesics, such as paracetamol, for pain control.

Hidradenitis-suppurativa

Medical management of hidradenitis suppurativa

Medical management of hidradenitis suppurativa is difficult. Treatment is required long term. I usually start with antibiotics and a contraceptive pill and can go from there to injecting the pustules all the way to removing the diseased skin. There are multiple ways to treat this depending on the patient, but we have no cure at the moment unfortunately, other than complete excision of the diseased skin, which can be very challenging, even then it is not a guarantee.

I hope this information helps you and remember you are not on your own, I have seen hundreds of patient’s with this condition and many have gone on to live normal healthy lives.

As you can see, I have included some very mild pictures, I have lots more that are way, way more awful looking, but these are at the very mild end of the spectrum as I don’t want to shock or upset anybody either.

I hope you find your answer and the best of luck

– See more at: http://sosueme.ie/lifestyle/ask-the-doctor-2/#sthash.YgzAUWtm.dpuf

ASK THE DOCTOR – Acne is a scourge for many… my latest post.

Question: “For as long as I can remember, I have suffered with such bad skin. Lots of girls my age (29) complain about spots or blemishes which annoys me as I suffer with near enough boils on my face. They come up like lumps, feel like bruises and nothing I do gets rid of them. I cleanse, tone and moisture my face daily so my skin is extra clean so it’s not from dirty pores. 

My wedding is coming up, and I just don’t know what I can do anymore. No amount of make up covers them, and I don’t want to go into my thirties looking like a teenager with spots, or boils in fact. 

Right now, I have 5 on my face and 4 on my neck, and they’re not only unsightly, but sore too. I’ve also been on the pill for 10 years and wonder if this is contributing to it?”

2Dr Mukesh: 

I sympathise with you as this is a common enough problem found in men and women, it is unsightly and quite painful physically.

The simple truth is that there is no regime of skin care that you can do that will stop it. If I am correct without having actually examined your skin and taken a proper medical history it sounds very much like Acne Conglobate or Cystic Acne.

Acne Conglobata is a type of acne that leads to cysts under the skin which are painful and inflamed. It can affect the face and other parts of the body such as the neck and back or chest.

There is hope though, you need to go to your GP and ask to be referred to a Dermatologist as the treatment of choice is Roaccutane plus or minus long term antibiotics. Sometimes I will even inject the cysts with a special steroid that makes them shrivel up quickly and lessens the scarring left when the cysts burn out.

Sometimes changing your pill to one which has Cyproterone Acetate in it can help too, but as you said you’ve always had bad skin. I would just get on with getting to a doctor who specialises in skin now as your wedding is close and time is not on your side unfortunately.

The official advice is summarized below:

What is acne conglobata? Acne conglobata is an uncommon and unpleasant form of nodulocystic acne in which there are interconnecting abscesses and sinuses (channels under the skin). These result in unsightly hypertrophic (thick) and atrophic (thin) scars. There are groups of large macrocomedones and cysts that are filled with smelly pus.

Acne conglobata is occasionally associated with: Other disorders associated with follicular occlusion, particularly hidradenitis suppurativa, a condition in which similar boil-like lesions and scars occur in the armpits, groins and under the breasts.

Nodulocystic acne may very rarely be a manifestation of a genetic disorder, PAPA syndrome.

What is the treatment for nodulocystic acne? Treatment of nodulocystic acne can be challenging and may require a combination of medicines. Topical treatment is usually ineffective.

The recommended treatment for nodulocystic acne is isotretinoin (Roaccutane), which should be commenced early to prevent scarring. The treatment is required for at least five months, and further courses are sometimes necessary.

Patients with acne conglobata often need additional treatments, such as:

  • Oral antibiotics
  • Intralesional steroids
  • Systemic steroids
  • Hormonal therapy in women

To submit a question to Dr Mukesh in the strictest confidence, please email info@sosueme.ie and include ‘Ask The Doctor’ in the subject line.

3

About Dr Lalloo:

Dr Lalloo is qualified from the Royal College of Surgeons in Dublin, and has a fellowship in surgery from the Royal College of Surgeons Edinburgh. He is a fully qualified GP with an interest in skin surgery and dermatology. His registered qualifications with the Irish Medical Council are MBBCh, FRCS Edinburgh, MICGP. Dr Lalloo is on the specialist register with the Irish Medical Council.

Dr. Lalloo is a recognised expert in medical aesthetics having establishedCosmedics Clinic in 2002 when medical aesthetics was in its infancy in Ireland. He is a member of the British College of Aesthetic Medicine and on the committee of the Primary Care Surgical Association.

Did you get your hair done ?

kelly b
beforeafter
Sitting having coffee with some of the girls after our usual friday morning music class with our kids I announced I had to leave early. “Ooh, doing anything nice?”, they asked. “Nice?..Well if you think getting a load of needles inserted into your face to freeze it nice then yes, I’m doing something nice. Queue the puzzled looks. I was having botox done. Nice may not be the best word to use when having this procedure done but the results are nice, beautiful even.
“Why are you getting botox done, you don’t need it?”. This I’ve heard off pretty much everybody whom I’ve told I was getting botox. It dawned on me that maybe they just didn’t understand botox. Most of the girls couldn’t understand why I would want to get it done. I’m young(ish), mid thirties and not terribly aged yet, ‘yet’ being the operative word. So I set about explaining why I would want to get botox.
Firstly let me explain, botox is not a reversal procedure. It will not turn back the clock on already ingrained facial lines and wrinkles. It is a pause button. It delays the ageing process and so by doing it now I can prevent my face from becoming more wrinkled than it already is. While it does not plump out lines present at rest on the face it can help to smooth them out a bit.
A few puzzled faces still looked back at me in the cafe, some nodded in agreement some maintained I didn’t need it but each to their own and all that. So I left saying I’d be back to prove myself right next Friday with a fresher face.
I’ll admit this is not my first encounter with botox, I’d had it done last year and was pleased with my results. For some reason though this time I was a little bit more nervous. I think it was the fear of pain. I was so nervous the first time I got it done my whole body was tense which made the supposedly painless procedure quite painful. I can still hear the noise of my skin popping when the needle was inserted, I’m not sure that noise will never leave my memory.
This time however I was going to a different clinic and seeing a different Dr. A Dr. I’d wanted to see for a very long time now. I’d heard nothing but great things about Dr. Lalloo and I’d seen his ‘work’ on a few faces and knew that I was going to be in the best hands possible.
Battling the M50 traffic on a very wet and stormy Friday afternoon I arrived at the Primary Care Centre in Blanchardstown. Dr. Lalloo’s clinic, Cosmedics, was located on the second floor, so up I went, waiting a minute or two before Dr. Lalloo appeared. If I’m being honest I greeted him with a false bravado. I may have been smiling on the outside but honestly my heart was about to jump out  of my chest. Should I make my excuses, say I felt unwell? Maybe the girls were right, I really didn’t need botox, I could just head home…but my feet kept on following him.
He took me through to one of the therapy rooms and began asking the important ‘WH’ questions, “Why did I want botox?”, “Where did I want it?”, “Did I understand the process?”. He examined my face explaining where I might benefit from the toxin, he also pointed out where I might benefit from a filler. “Filler??!!!”. Oh god this is not something I signed up for. Surely I don’t need fillers? Do I?. Facing the mirror Dr. Lalloo showed me where there had been some hallowing under my eyes. I admit I had noticed this myself over the last year or so. I wasn’t sure though whether it was just from tiredness and kids or from gaining and losing weight over the course of my pregnancies. It wasn’t something that really bothered me, but now that it had been pointed out to me and I was getting the opportunity to do something about it maybe I should.
Again let me explain the filler Dr. Lalloo was suggesting was for under my eyes. The dark hallows that most of us get as we get older. I had done a little research on this before, I knew that it filled the area called your tear trough. It could plump up the skin reducing the hallowness and therefore reverse the signs of ageing by a couple of years.
After a further twenty minutes of explaining the the pro’s and of course the possible con’s of both procedures I decided to go for it. Despite my earlier hesitations I really wanted the botox, my laughter lines had really started to become more noticeable and the lines on my forehead were beginning to become a permanent fixture as were my 11 lines or Glabella, the frown lines between the brows. The filler I was a little more apprehensive about. Would it be painful? Would I end up looking like I had something done to my face. I really didn’t want to change my appearance, I’m happy enough with it, I just wanted to freshen myself up a bit. Dr. Lalloo assured me that I would look no different than I do now except maybe a few years younger. He told me that by filling the tear trough my cheekbones would be slightly raised, in turn lifting the naso-labial lines (those lines from your nose to the corners of your mouth) which would instantly give me the appearance of a more youthful face. I was sold. I also knew that any work that was going to be done on my face would in time fade so if I was unhappy with anything it wouldn’t be permanent. Probably not the best argument for getting it done but it made me more comfortable going ahead with it.
Once all the consent forms were read and signed it was show time. ‘Before’ pictures were taken so I could compare the results once he was finished. I lay back in the chair where Dr. Lalloo began firstly with the botox. I shouldn’t really be calling it botox. Botox is a brand name like hoover is to vacuum. Instead Dr. Lalloo used a toxin called Dysport. Kinda like the Dyson vacuum of toxins. Enough with the vacuum metaphors, the toxin he was using like everything that he uses is the best out there, FDA approved and most importantly totally safe (well as safe as a toxin can be).
He started on my forehead, explaining exactly why he was inserting the toxin where he was and the reasoning behind it. It all made perfect sense to me then and I really was listening but for the life of me now I can’t remember exactly what he said and so don’t want to bore anyone with the finite details. Let’s just say he really knows what he is doing. I felt little or no pain. This was my biggest worry about getting it done, and here I was feeling relaxed and excited now to be getting it done. I think what helped though was his manner. Every time he inserted one of the needles he said “Good for you”. And I thought, ‘yeah, good for me, thanks Doc, I’m coping with this really well.’
Forehead done and onto the filler. He had said that this may be a little uncomfortable. He used the word sting actually. But again a “Good for you” from him and it was done. I couldn’t believe it. That was it? Honestly, no pain, not really, just a little pinch. I couldn’t wait to look in the mirror. The big reveal!! Oh, I look like me. Just a slightly better me, younger maybe, definitely. A pre kids me I think. Happy days.
After photos were taken, we went to his office to take a look at the pictures so I could compare the results. We both looked at the before and after pics and both struggled to pin point the exact reason why the girl on the right looked better than the girl on the left. The changes were so sublet yet striking. My eyes looked less tired, my smile brighter and cheekbones just a little fuller but I really couldn’t point to a specific change in my face. I just looked great, well for me that is.
The real test would be if my husband could tell the difference. Dr. Lalloo did explain that while the fillers are instant the botox/toxin can take up to two weeks to really settle in with results lasting up to five to six months. Usually first time botoxer’s can see the results last up to four months but would need a top up after that. As it was my second time getting it the results should last slightly longer.
I left the clinic feeling grateful. Grateful for the opportunity to have this treatment done, grateful to Dr. Lalloo for putting me at ease while still being reassuringly professional and grateful that all went well.
I couldn’t wait to get home and show off my face. Would anyone notice? I was hoping that they did, as in they thought I looked well, not as in, omg do you get your face done? A week on and thankfully its been the latter. Everyone has commented on how fresh I look, asking whether I’d had my hair done or changed my makeup. While some knew I’d had this done others didn’t and it was their comments that I was really interested in.
Would I recommend it? A big yes. I had drinks with a girlfriend the other night who didn’t know I’d had it done who said I was looking well. I excitedly told her what I’d had done, I think I may have sowed a little botox seed in her head.
While I would definitely recommend having this procedure done to anyone who has thought about it but just hasn’t made up their mind, I think it’s important to point out that you should really do your homework. Make sure you research the different types of toxins out there. Only go to a registered doctor. The toxin used is powerful and should only be administered by a trained professional. Know that not every doctor is going to yield the same result. Look for someone who has a strong aesthetic history, who understands the intricate dimensions of the face and the effects of beauty on the face. Ask people who’ve had it done are they happy with their results. And run a mile when you see salons offering too good to be true knock down prices on botox. It’s just that, too good to be true. Quality should be at the forefront of your mind when having any chemical inserted into your body.
I had the Dysport toxin inserted into three areas of my face. My forehead, my 11 lines and my laughter lines ,the cost of this was €425.00 with the cheek filler costing €350. Not cheap I know but Dr. Lalloo did not charge me extra for his time and so offered me the toxin and filler at a reduced rate of €650.00. This price I know is defiantly not the cheapest on the market but as I said before spend your money wisely. I knew I was in the best of hands with Dr. Lalloo, I’d done my homework and was more than happy to have him carry out the procedures knowing that the quality of the product he used was the best on the market. His knowledge and precision can also not be measured monetarily.
I am now happy with the face that looks back at me in the mirror. Don’t get me wrong I wasn’t unhappy before just a little weary of the forever tired face staring back. I’m glad I did something about it and hopefully this helps anyone who may be thinking of getting it done themselves.

WEEK 1 – ASK THE DOCTOR

Please note that Dr Lalloo’s opinions are based on the information given to him. You should always consult your GP if you have concerns. This does not constitute a doctor patient relationship. MCRN No 019510

To submit a question to Dr Mukesh in the strictest confidence, please email info@sosueme.ie and include ‘Ask The Doctor’ in the subject line.

About Dr Lalloo:

dr lalloo

Dr Lalloo is qualified from the Royal College of Surgeons in Dublin, and has a fellowship in surgery from the Royal College of Surgeons Edinburgh. He is a fully qualified GP with an interest in skin surgery and dermatology. His registered qualifications with the Irish Medical Council are MBBCh, FRCS Edinburgh, MICGP. Dr Lalloo is on the specialist register with the Irish Medical Council.

Dr. Lalloo is a recognised expert in medical aesthetics having established Cosmedics Clinic in 2002 when medical aesthetics was in its infancy in Ireland. He is a member of the British College of Aesthetic Medicine and on the committee of the Primary Care Surgical Association.

Read more at So Sue Me

NEW! ASK THE DOCTOR

From next week onwards we will be starting a new Q&A series called, ‘Ask The Doctor in association with Suzanne Jackson, one of Ireland’s leading fashion & beauty bloggers.Whatever your question relates to, whether it be anxiety, sun damage, treatments, etc. you can email it in confidence to info@sosueme.ie making sure to include ‘Ask The Doctor’ in the subject line, and each week, Dr Mukesh will select one to answer on SoSueMe.
Your name will not be featured on the blog so please don’t worry about anonymity.

so 2

Lifestyle and Youthful Looks

D.A. Gunn; J.L. Dick; D. van Heemst; C.E.M. Griffiths; C.C. Tomlin; P.G. Murray; T.W. Griffiths; S. Ogden; A.E. Mayes; R.G.J. Westendorp; P.E. Slagboom; A.J.M. de Craen

The British Journal of Dermatology. 2015;172(5):1338-1345.

Abstract and Introduction

Abstract

Background Lifestyle has been proven to have a dramatic effect on the risk of age-related diseases. The association of lifestyle and facial ageing has been less well studied.

Objectives To identify lifestyle factors that associate with perceived facial age in white north European men and women.

Methods Lifestyle, facial wrinkling and perceived facial age were studied in two cross-sectional studies consisting of 318 Dutch men and 329 women aged 45–75 years who were part of the Leiden Longevity Study, and 162 English women aged 45–75 years who were nonsmokers.

Results In Dutch men, smoking, having skin that went red in the sun, being outside in the sun most of the summer, sunbed use, wearing false teeth and not flossing teeth were all significantly associated (P < 0·05) with a total 9·3-year higher perceived facial age in a multivariate model adjusting for chronological age. In Dutch women, smoking, sunbathing, sunbed use, few remaining teeth and a low body mass index (BMI) were associated with a total 10·9-year higher perceived facial age. In English women, cleaning teeth only once a day, wearing false teeth, irregular skin moisturization and having skin that went red in the sun were associated with a total 9·1-year higher perceived facial age. Smoking and sunbed use were associated more strongly with wrinkling in women than in men. BMI, sun exposure and skincare were associated predominantly with perceived facial age via wrinkling, whereas oral care was associated via other facial features.

Conclusions Although associative in nature, these results support the notion that lifestyle factors can have long-term beneficial effects on youthful looks.

Radiesse Filler now FDA Approved for use in Hand Rejuvination

Dr Lalloo has been using Radiesse in the hands for over ten years now, at last the FDA have caught up!

Cost, €450 – 800 for both hands. No down time as such.

The US Food and Drug Administration (FDA) has approved the injectable dermal filler Radiesse (Merz North America, Inc) for hand augmentation to correct volume loss in the dorsum of the hands, the company announced June 4.

Earlier this year, as reported by Medscape Medical News, the FDA’s General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee voted 9 to 4 that the benefits of Radiesse outweigh its risks. A majority of panelists also voted that it is safe and effective.

“Radiesse provides an immediate volumizing effect and can help to reduce the prominence of tendons and veins in the hands, delivering smooth, natural-looking results that can last up to 1 year,” the company said.

Radiesse is an opaque dermal filler composed of synthetic calcium hydroxylapatite microspheres suspended in a water-based gel carrier. It was first approved in the United States in 2001, and has since had subsequent approvals, including for correction of nasolabial folds in 2006. It has been used off-label for hand augmentation — and is approved in 52 countries for that indication.

Data to support FDA approval for hand augmentation came from a multicenter, randomized controlled study of 114 patients. Most were white women with an average age of 53 years. Eighty-five patients were randomly assigned to immediate treatment, and 29 to delayed treatment and were considered controls. The control group crossed over to treatment at 12 weeks.

The effectiveness of Radiesse was measured by the Merz Hand Grading Scale (MHGS) — validated by the company in another study — and the Global Aesthetic Improvement Scale (GAIS), which the patients used to self-assess results.

According to the MHGS, 75% of Radiesse patients experienced at least a one-point improvement at 3 months compared with 3% of those in the control group. The mean change in the MHGS from baseline was 1.1 point for those given Radiesse compared with 0.1 in the control group.

In addition, 98% of treated patients reported improvement in the appearance of their hands at 3 months. Improved aesthetic outcomes as measured on the GAIS after initial and repeat treatments correlating with clinical improvement were demonstrated in this study, with all primary and secondary endpoints being met, the company said.

Most adverse events were injection site reactions such as swelling, redness, pain, and bruising, which were usually mild to moderate, short in duration (lasting about 1 week), and required no treatment. No severe device-related adverse events were reported that required treatment, according to the company.

Radiesse is contraindicated for patients with severe allergies manifested by a history of anaphylaxis, or history or presence of multiple severe allergies; patients with known hypersensitivity to any of the components; and patients with bleeding disorders.

Botox Injections May Affect Skin Structure

Botox Injections May Affect Skin Structure

NEW YORK (Reuters Health) – Injections of onabotulinum toxin A increase skin pliability and elastic recoil, new findings show.
“Apart from just seeing the paralysis in the muscles that are treated, we are also seeing changes in the skin that are indicative of possible changes in fibroblasts,” Dr. James Bonaparte of the University of Ottawa in Ontario, Canada, one of the new study’s authors, told Reuters Health.
The findings raise the possibility that botulinum toxin A has direct anti-aging effects on the skin, and also suggest that it may be useful for scar treatment, Dr. Bonaparte added in a telephone interview.
Previous investigations have shown that wrinkles fade after repeated botox injections, but the reason why is not clear, Dr. Bonaparte and Dr. David Ellis of the University of Toronto noted in their report, published online May 21 in JAMA Facial and Plastic Surgery.
In a 2014 study, Dr. Bonaparte and Dr. Ellis reported biomechanical changes in the skin after botox injections, but their study only followed patients for up to two months (http://bit.ly/1J1Om02). Critics had questioned whether these changes were due to inflammation from the injections.
In the current study, to address this issue, the researchers followed patients for four months. They enrolled 48 women with no previous botox injections and with mild wrinkles at the glabella and lateral orbit. Forty-three women completed the study. The researchers used a Cutometer MPA 580 skin elasticity meter (Courage & Khazaka Electronic, Cologne, German), which measures deformation and relaxation of the skin when suction is applied and removed.
All patients received injections to the glabella, supraorbit, and lateral orbit, and all showed increases in skin pliability and elastic recoil at all sites.
Study participants also had reductions in the ratio of the viscoelastic component of resistance to elastic resistance, indicating that the changes were not related to swelling and inflammation. All measurements had returned to baseline levels by four months.
It’s possible, Dr. Bonaparte said, that fibroblasts may have receptors that interact with botox, causing the cells to produce more collagen, elastin and other substances that tighten the skin. He pointed to a 2014 laboratory study that found onabotulinum toxin A blocked the expression of aging-related proteins in fibroblasts exposed to UV B radiation, while increasing collagen production (http://bit.ly/1FDrNuA).
If this hypothesis is true, he added, it may be possible to reduce wrinkles by injecting onabotulinum toxin A directly into the skin, rather than using it to paralyze facial muscles. And if the injections do produce these changes in fibroblasts, he added, they could prove useful for scar treatment.
In an editorial, Dr. Catherine Winslow of Indiana University School of Medicine in Bloomington notes that onabotulinum toxin A could also directly affect skin by preventing the release of free radicals that occurs with muscular contraction.
“Piecing together this research with continued studies on elasticity and collagen content of injected skin will further the ability of facial plastic surgeons to refine their strategy for long-term planning of antiaging strategies with patients and educate them as to the importance of nonsurgical therapies for maintenance, in addition to opening new fields of potential treatment options for difficult scars and skin conditions,” she concludes.
Dr. Ellis and Dr. Bonaparte have received funding from Allergan, which markets onabotulinum toxin A as Botox.
SOURCE: http://bit.ly/1FDupZw
JAMA Facial Plastic Surg 2015.