Plastic Surgery Seattle Blog

Cosmetic medicine is a “buyer beware” industry full of unqualified, unscrupulous practitioners promising cosmetic enhancement for a fraction of the usual cost.

All too often, cosmetic procedures offered at too-good-to-be-true prices prove to be at least twice as expensive as treatment performed by a qualified specialist in aesthetic medicine because of the poor aesthetic results they produce, which require additional revision surgery.

As highlighted in recent news featured by CBS Atlanta and the Orange County Register, sometimes discount cosmetic treatment can even cost far more than money.

See a board certified specialist for plastic surgery

Take for instance Kenyatta Brown, an Atlanta-area mother of four who nearly bled to death during a routine breast augmentation procedure performed by an ophthalmologist, or eye doctor, hoping to make a few quick bucks in the lucrative, cash-upfront business of cosmetic surgery by offering deep discounts.

Brown will likely spend thousands more on revision breast surgery than breast augmentation performed by a board certified plastic surgeon would have cost in the first place.

Brown’s story also illustrates the reality that medical authorities, such as state licensing boards, do not monitor or restrict medical practice based on specialty training or experience, so any licensed physician is legally allowed to practice plastic surgery or any other medical specialty regardless of his or her training or experience level.

Always seek cosmetic treatment at a licensed medical facility

Mayra Lissette Contreras, 22, of Pacoima, Calif. was duped into seeking treatment at an unlicensed back-alley cosmetics clinic run out of the San Fernando Valley home of sisters Guadalupe Viveros, 53, and Alejandra Viveros, 50.

After receiving silicone injections for buttocks enlargement, Contreras became ill and eventually died of respiratory problems.  The Viveros sisters are wanted by police but have fled to Mexico to avoid being prosecuted for Contreras’s death.

The cautionary stories of Kenyatta Brown and Mayra Contreras underscore the importance of researching your practitioner prior to undergoing cosmetic treatment and seeking an experienced Seattle plastic surgeon operating out of a licensed Seattle medical facility for breast augmentation, body sculpting or any other procedure.

Swiss-based medical device developer, manufacturer and distributor Anteis S.A. launched an automated injection pen in 2010 called the Anteis Injection System.

The Anteis Injection System purportedly allows physicians to achieve more precise and consistent results with gel-based dermal filler injections because it is physically easier to use than standard syringes and electronically controls and regulates the volume of the filler and injection speed as it is introduced into the dermis.

The injection pen device is now being used in Europe with some apparent success.

Patients who have injectable filler treatments with the Anteis Injection System, as compared to conventional injection methods, report:

• Less pain during treatment
• Fewer and less severe side effects, such as post-injection bruising, swelling and redness
• Decreased social downtime

In addition to superior aesthetic outcomes, physicians using the Injection System are also reporting reduced muscle fatigue associated with administering manual injections with dermal filler.  The device is also purported to offer physicians improved handling, greater freedom of movement and increased opportunity to focus on ideal product placement rather than injection technique.

According to Anteis, the Injection System is effective for all types of cosmetic injectable treatments, including wrinkle treatments, facial volume restoration and augmentation and treatment of skin depressions, such as cellulite.

The Anteis Injection System was also awarded the 2010 red dot design award in the product design category, as well as the 2009 Gusi Peace Prize for its contribution to improving people’s well being through the application of innovative technology.

Although the Anteis Injection System is a promising innovation in cosmetic dermatology, it has not been appropriately tested or approved by the FDA and is not yet available in the U.S.  Additionally, the injection device was designed to work with Anteis-brand injectable fillers made of hyaluronic acid gel and has not reportedly been tested with fillers made of other substances, such as Radiesse, nor with wrinkle-relaxing products, such as Botox.

If you’re considering treatment with injectable fillers in Seattle, seek an experienced injector with superior injection technique who can ensure your experience with cosmetic injectables is painless, positive and precise.

Last March, researchers with the American Society for Aesthetic Plastic Surgery (ASAPS) sent surveys to 687 patients who had received Botox and/or wrinkle filler treatment. 

The full results are available here via MS word doc; some of the noteworthy findings are as follows:

 - Most patients described themselves as healthy individuals; 95 percent 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.

 - Among survey respondents, the average patient was “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 chose Botox to treat glabellar lines – the vertical lines, or ‘angry 11s’ 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.

Botox injection can effectively smooth out facial wrinkles, but is that all we should use it for? Doctors once thought that off-label use of the drug – which was originally developed for treating muscles spasms – would be limited. If you do a little research however, you’ll find that physicians are continually finding new and more interesting uses for Botox.

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 treatments of Botox 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

In its latest issue, the publication Archives of Facial Plastic Surgery includes the results of a recent study on the wrinkle relaxing injectable, ‘Reloxin.’  During the study, Reloxin was evaluated on its long term safety for repeated use on moderate to severe forehead wrinkles or ‘glabeller lines.’

Reloxin would be the first real competitor for Botox in the U.S. cosmetic surgery market – a market which allowed Allergan Inc. to net $1.3 billion in revenue last year with Botox.  Medicis Pharmaceutical is expecting FDA clearance for Reloxin sometime this year.

A Los Angeles dermatologist commented to Bloomberg news about the study, saying “the side effects are the same as Botox” and “many of our patients liked it even better.”

Reloxin and Botox are similar in their composition; both contain a particular ‘botulinum toxin’ that has been proven to relax the muscles that cause wrinkles in the face.

Reloxin has actually been sold outside the U.S. under the name ‘Dysport’ for about 15 years, but Botox has still managed to claim over 80 percent of the worldwide market for the neurotoxin.  One market analyst speculates that “Reloxin may be priced 15 percent lower than Botox” which could allow it to claim a decent chunk of the market share.

Company spokespersons from Bioform Medical Inc announced last Thursday (Jan. 8th) that 1 million syringes of Radiesse dermal filler have been shipped worldwide since 2002.

Radiesse is BioForm’s staple product and most commonly prescribed to correct wrinkles, nasolabial folds and facial lipoatrophy.

BioForm is based in San Mateo, California, and has been incorporated since 1999.  Radiesse has been marketed for cosmetic and therapeutic use in Europe since 2002.  In 2006 the U.S. Food and Drug Administration expanded Radiesse’ approval to include  facial cosmetic use by physicians in the United States.

About 10,000 medical and cosmetic surgery practices have received the product, an achievement that surely defines Radiesse as one of the most popular dermal fillers on the world market.  The only comparable fillers that have achieved such widespread appeal are those composed of collagen or hyaluronic acid, both of which have been on the market longer.

Officials from the United States Food and Drug Administration met with a group of outside experts to review the various complications that have arisen from cosmetic dermal filler injections. Juvederm, Restylane, Radiesse and other new offerings are products that fall under this category.

The panel discussed the possibility of labeling changes and the seriousness of the reported complications related to injectable wrinkle-fillers that have occurred over the last six years.  Is this a reason to be concerned about dermal filler safety?  Yes and no.

It might sound alarming, but the complications and side effects associated with these products are still extremely rare.  Demand for fillers and wrinkle reducers like Botox has risen dramatically in the last decade, leading many inadequately trained persons to administer them in non-medical settings.  

The majority of industry professionals will attribute most of the reported complications to issues like these.  There are also well known problems that occur on a very infrequent basis, like minor swelling or allergic reactions, with the latter being a subject of greater FDA interest. 

According to a recent MSNBC news article, Allergan spokeswoman Caroline Van Hove said “no serious problems were seen in clinical trials of Juvederm, and the most common complaint since its approval was swelling in 0.4 percent of patients.”  Also, Food and Drug Administration officials noted that the “reports had several limitations such as failing to say when the problems started.”

Safety and proper training is of the utmost importance when considering any surgical or cosmetic procedure, so we recommend that all patients seek a knowledgeable plastic surgeon with the right qualifications.

For more information on the FDA panel discussion, the briefing is located here.

There are some things you can compromise on, but your plastic surgeon isn’t one of them. A dermatologist in California was recently reprimanded for injecting non-FDA approved Botulinum toxin into ten patients. The doctor and nearly a hundred colleagues tried to save money by buying the black market Botox without realizing it wasn’t approved for use in patients.

These findings highlight how important it is to find a reputable, board-certified plastic surgeon. If you live in the Seatte area and are interested in Botox or other cosmetic procedures, Dr. Gottlieb is a well-respected surgeon with extensive experience.

In the past, people who wanted to rid their faces of unsightly wrinkles had to commit to cosmetic surgery. But with the advent of Botox by Allergan, they have the option of banishing signs of aging with just a few injections. And people are flocking to this less costly and less invasive option in droves. According to the American Society for Aesthetic Plastic Surgery, surgeons performed 99,196 facelifts in the United States in 1997 while Botox injections lagged behind at 65,157. But last year, facelift surgeries had increased slightly to 138,153 while Botox injections skyrocketed to nearly 2.8 million.

Like many plastic surgeons, Dr. Jourdan Gottlieb does a lot of Botox injections for those in the Seattle area who want to reduce their facial wrinkles.