The following is a guide to the most popular injectables, ordered based on their relevance.

Click on links below for related blog posts about each topic and FDA approval summaries.

Botox Cosmetic maintained its position in 2009 as the top cosmetic treatment. Botox is so popular it’s basically become a fixture in the American vocabulary. Senators even tried to enact a Botax! Composed of a bacteria called botulinum type a, Botox creates a temporary paralysis of facial muscles to reduce wrinkles.

What it treats: glabellar lines, frown lines, forehead furrows, crow’s feet, cervical dystonia, blepharospasm, strabismus, hyperhidrosis, headaches, etc.

Read:

• New Botox Uses Still on the Horizon
• Allergan Disputes Botox Marketing Restrictions
• Free Botox for the Unemployed?

Dysport received FDA clearance last year, becoming the second cosmetic treatment with botulinum type A. Expect to hear more about this product as people choose between Dysport and Botox in the coming year.

What it treats: glabellar lines, forehead furrows, crow’s feet.

Read:

• Dysport soon to arrive
• New Botox competitor receives FDA clearance

The advanced porcine collagen dermal filler Evolence was discontinued in 2009. If you were happy with Evolence treatment in the past, you could wait and see if another company resurrects the drug, or you could ask us about other options.

What it treat[ed]: Smile lines, moderate to deep facial wrinkles and folds

Read:

• Orthoneutrogena puts the brakes on Evolence
• FDA Overview of Evolence

Juvederm, the hyaluronic acid wrinkle filler has only increased in popularity since receiving FDA approval in June 2006.  Last year, Allergan Inc. ramped up marketing of Juvederm with TV advertising and special rebate offers.

What it treats: nasolabial folds, marionette lines, facial lipoatrophy

Alternatives: Restylane

Read:

• Lip augmentation with dermal fillers
• Media buzz about liquid facelifts
• FDA overview for Juvederm

Bioform Medical announced worldwide shipment of over one million Radiesse syringes since 2002. Composed of a calcium hydroxylapatite gel, Radiesse has been ideal for deeper injections.

What it treats: tear trough deformities, moderate to severe facial wrinkles/folds

Read:

• Dermal fillers vs. Eyelid Surgery
• Radiesse ships one-millionth syringe
• FDA Overview for Radiesse

Until last year, Sculptra had only been approved for treating persons with HIV-related facial lipoatrophy (loss of fat). The FDA granted clearance for cosmetic applications and Sculptra was then rebranded as “Sculptra Aesthetic.” Many physicians jumped on the Sculptra bandwagon and started offering the drug.

What it treats: deep smile lines, contour deficiencies, folds, wrinkles

Read:

• Sculptra receives FDA clearance for cosmetic use
• Today Show features Sculptra Aesthetic
• FDA Overview for Sculptra Aesthetic

While Botox is typically used – and FDA approved – for treating wrinkles on the face and forehead, a wide range of other applications have been successfully performed.  Doctors have used Botox to treat hyperhidrosis, migraine headaches, muscle spasms, and many other problems.

According to current U.S. law, physicians are allowed to administer medicine for whatever use they deem appropriate.  They aren’t however, allowed to advertise or market medicine for any application under the sun.

The marketing restrictions placed on off-label Botox have evidently hindered Allergan’s ability to distribute safety information related to such uses.  The current lawsuit is intended to increase the physician’s ability to access safety information such as possible risks, benefits, dosing, patient selection, etc. and is in no way intended to boost Botox sales.

Read more about Botox Cosmetic.

There’s no harm in revisiting the topic if we can help clear up some confusion about the application of dermal fillers and how those procedures compare to surgery.

While the liquid facelift is basically soft tissue augmentation with Botox and injectable fillers, people say the goal is to achieve results that are similar to surgery. Yet the results are said to be “typically more subtle than surgery.”  As Dr. Hess pointed out, “a facelift tightens the deeper tissues of the face including the neck muscles and removes excess skin – things that a “liquid facelift” will never achieve.

Despite the subtle inconsistencies or perhaps, the misuse of terms, the topic is getting lots of media attention: Harper’s Bazaar is the latest to pick it up and interview some of the physicians that say they’re doing it.  The Best Beauty section of their September ’09 issue includes before and after pictures and a discussion of professional techniques for administering injectables.  The magazine’s website also has a decent article with some facts and figures about soft tissue augmentation with wrinkle fillers.

Apparently, the liquid facelift isn’t exactly a “touch up” here and there, but a relatively extensive  series of injections.  According to the authors, you can expect to pay at least $3,000 – $5,000 for a full liquid facelift.  A Florida dermatologist by the name of Dr. Fredric Brandt explains, “I re-suspend the face with Botox, lifting up the brows, neck, jawline, and tip of the nose and then fill in and replace volume around the eyes and cheeks.”

The liquid facelift has also been featured on The Doctors (NBC), Rachel Ray Show, New Beauty Magazine, Dr. 90210, FOX News, Cosmetic Surgery Times, and more exposure is said to be in the works.

As a board certified plastic surgeon, Dr. Hess can recommend the right surgical and non-surgical treatments to rejuvenate the appearance of your face and eyes.  Such treatments may include the following:

•    Upper or lower eyelid lift
•    A brow/forehead lift
•    Injection with Botox cosmetic
•    Injection of a dermal filler to add volume to sunken eye troughs

In some cases, patients benefit from a combination of the above options.

Many choose to combine eyelid surgery with a brow lift.  Choosing to undergo surgery (or even a non-surgical procedure) is a significant decision, so try to gather as much information as possible.  View before and after photos of patients like you, or speak to former patients and ask them questions like these:

• How was the procedure beneficial for you?
• Were you comfortable with your surgeon?
• Would you do it again?
• Would you do anything differently?

The eyes are one of the first features on the face to which most of us respond. You deserve to have eyes that radiate, eyes that brighten your face and eyes that reflect how young and energetic you truly feel.

If you’re ready to discuss your options in facial and eye rejuvenation, contact the Virginia surgery office of Christopher Hess.

But when I saw this article about free Botox for the unemployed in Arlington I have to ask myself to what lengths will businesses go to attract customers.  I mean aren’t there any standards out there?  Why would anyone try to attract patients that clearly don’t have any disposable income to buy products that require disposable income?  Well maybe on the flip side it’s that youthful look that will get you a job!  No, I can’t go that far.  That would be like giving up all of my ethics.  But spas are businesses that look at the bottom line first and patient care later on.

Since the deregulation of medicine in 1979, non-plastic surgeons have been climbing on the cosmetic band wagon in droves.  For the most part it’s a ‘cash up front’ business, which is highly appealing for anyone who has to deal with the injustice of the insurance industries.  But this has brought about the philosophy that anyone who has an MD or DO after their name and spends a weekend at a seminar is a legitimate provider of prescribed cosmetic products and procedures.  AND, that they are even more qualified to allow non-physicians to inject these products without direct supervision.

In Virginia it is required that any non-physician who injects products such as Botox or dermal fillers must be directly supervised by a qualified physician.  This means that the physician must be, at least, in the office at the time of injection.  Anyone who has any ethics understand this to mean that the physician should evaluate the patient, determine the correct procedure and, in my opinion, physically observe the procedure being performed.  This is why I do all injections personally.  But somehow I don’t think that’s what’s being done in these Med Spas.

So as our economy deteriorates and businesses begin to scrape the bottom of the barrel for money to make payroll etc. (trust me I know!), are we really going to throw out our ethics all together and pray on the most unfortunate in our society?  Sure you’re unemployed but you look great!  Oh, by the way that Botox isn’t permanent so come back in a few months for another treatment from our “staff.”   Instead let’s use our resources to the best of our abilities to help find jobs for these people.

A complete summary of the results (in a Word document) is available here; some of the most noteworthy findings are as follows:

- Most described themselves as healthy individuals.  95 percent of respondents said they incorporated exercise into their lives, and 78 percent cited healthy eating habits.

- Nearly 70 percent of the respondents who had been treated with Botox also opted for dermal filler treatment.

- Within the group, the average patient is “a married, working mother between 41-55 years of age with a household income of under $100,000.”

- 66 percent of the respondents said they received Botox treatment 2-3 times per year.

- 72 percent of the respondents chose Botox to treat glabellar lines – the vertical lines that appear between your eyebrows.

- 63 percent of the respondents chose dermal fillers to treat facial wrinkles and folds, mostly the nasolabial folds or ‘smile lines’ that travel from the nose to each side of the mouth.

- 87 percent reported that they discussed their treatments with others, and 70 percent said they received support from the people they told.

Rather than rebranding the drug ‘Reloxin’ as planned, Medicis Pharmaceutical decided to retain its original European name, Dysport

Coinciding with the April 30th announcement was a 3 percent drop in Allergan’s (maker of Botox) shares, and a 14 percent increase in the shares of Medicis. Analysts and industry professionals expect Medicis to market the drug at a slightly lower price than Botox, and say it could capture as much as 30 percent of the current market.

Botox and Dysport both perform the same basic function – neuromuscular blocking to relax and prevent wrinkles. Dysport however, is said to be more diluted than Botox and thus, more cost effective for providers. The recent FDA approval of dysport also came with a unique warning label describing the risks associated with the botulinum toxin.

For more information on wrinkle treatments in Virginia, see our homepage.

Many doctors use Botox to treat headaches, and their basic procedures are hardly different than those of wrinkle treatment. It isn’t entirely clear how the Botulinum toxin provides relief; it may work to inhibit certain pain-transmitting nerves. But evidently, many people suffer from fewer headaches after being treated with Botox.

As reported in the Journal of the American Academy of Dermatology, researchers from Allergan Inc. conducted surveys about sweating, revealing that almost 3 percent of the U.S. population (7.8 million people) believe their sweating to be excessive. At the time of the survey (in 2004), less than half of the respondents had sought medical help for the problem. Botox blocks the localized release of a specific chemical that stimulates sweating, and so the FDA approved it for this use years ago.

Last March, the New York Times published a story on the off-label use of Botox to help those who have suffered a stroke and have trouble relaxing certain muscles. According to the experts, “only about 5 percent of the stroke patients who could benefit from its use ever get it.”

Patients with even more obscure conditions have found success using Botox. In Feb 2008, USA Today reported that radio personality Diane Rehm (of National Public Radio) had received routine off-label Botox treatments for a vocal disorder called spasmodic dysphonia.

Aside from these therapies, surgeons and dermatologists are finding even more cosmetic uses for Botox. Dr. Lawrence Reed recently told an ABC news affiliate that “we’re at the tip of the iceberg where Botox is going to be used.” Reed has apparently been pioneering some interesting new cosmetic applications.

For acne, Dr. Reed injects Botox just below the skin: “It decreases the muscle pump and blocks the production of oils, so we use it for acne,” he claims. Other patients of Dr. Reed found success using Botox to relax certain muscles and actually make their eyes appear larger, and to supplement laser skin resurfacing.

If you’re considering Botox for any off-label use, make sure you choose a qualified physician. Despite the optimism surrounding Botox as a ‘wonder drug’, there have been complications and side effects associated with off-label use and inexperienced providers.  If you’re interested in Botox treatment around Fairfax, Virginia, see our homepage or contact us.

This “liquid facelift” is referring to the injection of dermal fillers and Botox Cosmetic to achieve facial rejuvenation.  Don’t get me wrong; I’m a huge fan of both dermal fillers and Botox, but their uses are limited and specific.  These products provide excellent rejuvenation of the nasolabial folds, tear troughs, stubborn glabellar folds, marionette folds and the like.  Botox can reduce wrinkles aroung the eyes (crows feet), glabellar lines (between the eyes), forehead wrinkles, and (with a competent surgeon) wrinkles around the lips.

A facelift, on the other hand, tightens the deeper tissues of the face including the neck muscles and removes excess skin.  These are things that a “liquid facelift” will never achieve.  So the differences between a real facelift and a “liquid facelift” is like night and day.  A visit to your Board Certified Plastic Surgeon will help you determine what is best for you.  See our homepage here or call 703.752.6608 for a complementary consultation to determine your facial rejuvenation needs.

As we age skin loses its elasticity and thus its toughness.  This is usually first recognized around the eyes with the development of “crows feet.”  In our early 30′s and 40′s this is a great time for Botox to relax the obicularis muscle and smooth the “crows feet.”  But as we age not only do we have to worry about loss of elasticity we also have to be concerned about the effects of gravity.  Gravity causes eyebrow droop which contributes to excess upper eyelid skin, sagging of the lower lid and periorbital wrinkles.

In our youth, 30′s or 40′s, Botox injected around the lateral eyes will relax “crows feet” and elevate the lateral brow creating the “Botox lift.” However, with increasing age and brow droop Botox can become detrimental.  If the lateral forehead is injected with Botox, in the aging forehead, this can cause significant sagging of the brow, increased accentuation of the excess upper lid skin and even problems with eyesight.  This is a clear indication that a brow lift is in order and Botox should not be used.

If you’d like to discuss aging eyes please contact Hess Plastic Surgery or call us at 703.752.6608 for a complementary consultation with Dr. Christopher Hess, your Board Certified Plastic Surgeon.