Dysport Units and Dilution Versus Botox Units and Dilution: 3 to 1 will get it done.

 

As neurotoxin science continues to advance and more drugs become available, patients will be offered more choices of treatments.  Currently Botox (Allergan) and Dysport (Medicis) are the only FDA approved neurotoxins (also called neuromodulators) to treat facial lines and wrinkles.  Numerous other similar drugs are currently in the pipeline for FDA approval, including products from China and Germany.  Patients outside the USA have more options and US patients will soon have some of these options.  More options are not necessarily better options as Botox and Dysport have long track records of safety and efficacy, but these new products will more than likely also offer safety and effectiveness and may also be more cost effective for patients.

All neurotoxins will be compared to Botox in terms of safety, efficacy, time of onset and duration of the effects.  As with any new product competitor on the market, positive and negative rumors will abound that can assist or detract from the new product.  Finally, all new products will settle in to their niche based solely on their effect and not conjecture.

Dysport has big shoes to fill in taking on Allergan’s previous monopoly of Botox.  Dysport has an excellent track record in Europe where it has been an option for a decade.  Like any new drug, doctors must figure out “the right way to use it”.  More than ever before, drug companies are strapped in getting the word out by Big Pharma regulations.  Although regulation is necessary, drug companies are literally hamstrung and sometimes voiceless.  Dysport would love to tell doctors the “best way” to use the new drug, but simply are not allowed, so it rests in rumor and conjecture as the means of determining “best practices”.

The biggest question of doctors new to Dysport is “how does the Dysport dosage relate to Botox dosage.  Being a consultant for both companies, I am asked this question frequently in my teaching travels around the US.  Initially, doctors were saying that “one Botox unit should equal 2.5 Dysport units”.  Although not an official comparison, this suggested that in order to have an equal effect, a patient that would normally have 20 units of Botox to treat their frown lines would require 50 units of Dysport to appreciate the same effect.  Comparison of units are not “apples to apples” official pharmicopia, but rather convenient conversions to anecdotally arrive at a standard between the two drugs.  Unfortunately, I believe that this first round of “units to units” comparison gave Dysport the short end of the stick.  Here is the reason.  When a new drug is introduced that competes with a standing giant, patients will try it (or not try it) based on numerous factors.  These selection factors include the advice of the treating doctor, cost factors, rumored advantages, the “newness” factor and the possibility that the new drug will simply work different or better.  Herein lies the catch.  If a patient has been getting successful Botox treatments with 20 units to their frown lines and wants to try the new Dysport and their doctor gives the rumored 2.5:1 ratio (50 units of Dysport), the patient is going to be a hard line test of which one works best.  In my experience, the 2.5 conversion is not enough Dysport to produce the effect of 20 Botox units.  If so, the patient will have a less profound or shorter acting effect and Dysport will be “dissed”.  My experience (and that of other surgeons) of using 3 Dysport units for 1 Botox unit seems to be a more accurate dosage in the quest for equipotent treatment between the two drugs.  If doctors are truly interested comparing these two drugs, they must use an equipotent dosage, which I believe to be 3 Dysport units for each Botox units or 60 units of Dysport for an area usually treated with 20 units of Botox.  Failure to use this ratio may give patients a false comparison of the effects and longevity of Dysport. 

Why is all of this important?  Personally, I feel that Allergan and Medicis are both great companies and I use fillers and neurotoxins from both of them.  From a doctor standpoint, you have to offer all contemporary options to your patients and from a consumer standpoint, every Coke needs a Pepsi.  What is important is that when comparing on new product to another, it is done in a fair way for the surgeon and patient to accurately evaluate.  Having said this, I believe the fair and balanced (hey, does that sound familiar?) way to this is to inject 3 Dysport units for where you would use 1 Botox unit.  Then the surgeon and patient can fairly evaluate the drugs.  It is unfair for the company and patients to compare with a lesser amount.  You will never find an official chart that says use 3:1 and Medicis is not allowed to even think that out loud, so it is up to the experience of scientifically minded clinicians to fairly sort this out for everyone else.  I am trying to do my part and I think it is 3:1 ad nauseum. To prepare Dysport for this dilution, 3 cc of preserved saline is added to the 300 unit Dysport vial.  Five one half cc syringes are drawn up and each will contain 60 units.

To find out more about Botox, Dysport and cosmetic facial surgery in Richmond, Virginia visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

The Diva Lift: Facelift for Full Figured Females

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In this day and age, it is a bit disgusting that some surgeons go out and makes a minor change to a procedure that has been around for a century and “invents” some new miracle procedure.  There are bunches of these types of docs out there.

I recently detailed some of my work that involved modifications of traditional facelifts in patients with high body mass index (BMI) in an article in Cosmetic Surgery Times.  The Body Mass Index is a formula that gives a number based on the height and weight of the patient.  Overweight patients (full figured) present many differences when compared to the average facelift patient.  This magazine goes out to cosmetic surgeons from multiple specialties and frequently details new or innovative approaches to cosmetic surgery.  The editor, Teresa McNulty, and I discussed a modified facelift that I was performing on full figured women with great results.  She was impressed with my surgical results and suggested the name of the article be the “Diva Lift”.  So there, that is how the name came about and not as a self anointed marketing ploy on my behalf.

What is the “Diva Lift”?

First of all, the word Diva, until the past decade when it became descriptive of any star female singer, was commonly used to describe full figured opera singers.  Facelift surgery is a very large part of my cosmetic facial surgery practice and one of my favorite procedures.  I enjoy facelift surgery because I think it is the most dramatic cosmetic surgery procedure that exists for several reasons.  First of all, you can hide mediocre surgery on boobs, bellies and buts, but you can’t hide facial surgery.  Secondly, as we age, big changes occur in our cheeks, face and neck that cannot be disguised with clothing.  Another important thing about facelift surgery is it is probably the most noticed surgery as patients look at their face daily more than any other body part and those we interact with see our face more than other parts of our body.  Facelift is the ultimate rejuvenation procedure.  Patients simply feel bad when their face ages and feel better when it is firm and tight.

 Facelift patients come in all size, shapes and genders and unlike some operations, no two are the same.  Also many surgeons perform different variations of facelift surgery.  Like anything else, there is a right way and wrong way to perform facelift surgery.  Many surgeons perform time tested “textbook facelift surgery” while others get lazy and adopt shortcuts that affect the results and longevity.  Worst is the current rage of “minimally invasive facelifts” that are merely marketing ploys of corporate franchises.  These lifts claim to be revolutionary or miraculous and lure patients with promises of maximum results with minimum downtime and cost.  Note to consumers!  You get what you pay for.  I don’t mean this only in terms of cost (because some of these miracle lifts cost more than my larger lifts) but in terms of recovery.  If a patient over 40 years desires comprehensive facial rejuvenation that will last over 10 years, then they need a longer recovery.  Two weeks of recovery is not too much to endure to reverse decades of aging and skin sagging.  To truly address the deep tissues of the front of the neck and cheeks, incisions must be made under the chin and in front of and behind the ears.  These incisions are well hidden and almost unnoticeable when performed by experienced surgeons.  These trendy “minimally invasive” facelifts only use a smaller incision in front of the ear and this severely limits the effect of the lift.  When you perform facelift surgery correctly and comprehensively, it requires tightening of the neck muscles under the chin (called the platysma muscle).  It also requires tightening of the deep layers of the cheeks (known as the SMAS which stands for superficial musculoaponeurotic system) with numerous sutures for a secure and lasting result.  Finally, the incision behind the ear (which is hidden in the hair) is absolutely imperative to truly address the excess skin of the chin, face and neck.  When a surgeon shortcuts any of these incisions or approaches, the patient gets short changed.  The result will simply be less dramatic and for sure will be less long lasting.  A three to five day recovery may sound like a great thing, but it is a short cut.  To address all the important structures, a recovery closer to two weeks is necessary.  Most facelifts with short recoveries will unfortunately also have short results and will begin to relapse within the first 2 years.

The “Diva Lift” (and I must admit that I hate to “name” a facelift is far from a short cut.  In fact, it is a more aggressive facelift because these overweight patients have more fat and skin and need more surgery to obtain a natural and long lasting result.

 

How is the “Diva Lift” different from conventional facelifts?

 

The main differences of the “Diva Lift” are modifications of traditional facelifts to address the excess fat and skin.  The first difference is that these procedures require a higher level of liposuction of the superficial and deep fat when compared to a normal weight patient.  Also, deep fat accumulations are addressed under the chin and the front of the neck.  By reducing or sculpting this deep neck fat, the surgeon can obtain a much more defined neck after the facelift compared to facelifts that don’t involve this deep fat. After the superficial and deep fat are reduced or removed, the neck muscles in the front of the neck (platysma) are tightened.  The “Diva Lift” also involves a higher level of “liposculpture” where instead of just removing the fat under the skin; it is sculpted to provide youthful contours of the jaw line, jowls and neck.  Full figure patients also have much more fat in their cheeks and neck and the “Diva Lift” specifically address this to a greater level than the conventional facelift.

Besides the deep fat in the neck, the way that the deep tissues of the cheeks are managed is critical in larger patients.  In many patients, a common surgical technique called “plication” involves tightening the deep fat and tissues in the cheeks by folding them over.  In a thinner patient this technique may be desirable as it add some facial volume, whereas in the full figure patient the goal is to reduce some of the cheek volume.  With this in mind, the “Diva Lift” involves a more comprehensive method of treating the deep tissues in the cheeks called “SMASectomy”.  Instead of folding the tissue over on itself like plication surgery, some of the deep tissue is actually removed which not only tightens but slims the face, which is very important in this type of patient.  In the “Diva Lift”, much more time is spent dealing with fat excess than in the conventional facelift.  Also important in this type of lift is the tightening of the backside of the neck muscles (posterior platysma).  Many surgeons omit this step and again, it improves the result and longevity of the lift.  Why doesn’t every surgeon do all of this?  The answer is simple.  It takes time and expertise to competently perform these procedures and some surgeons don’t want to devote the time or do not have the surgical expertise.  The “Diva Lift” is not a facelift for beginning or inexperienced surgeons.

The last step of the “Diva Lift” that varies from conventional facelifts is the excess skin management and incision patterns.  Since the full figured patient has more skin than the average patient, incisions must be slightly larger (but still well hidden) and performed in a certain manner so there is no bunching of the tissue.  These incisions are specially designed as not to be noticeable or make big changes in the patient’s hairline, specifically the sideburn region and the hairline behind the ear.

So, the “Diva Lift” is not a smaller, but rather a larger type of facelift.  It embodies a little more aggressive treatment at each step of the facelift when compared to the average facelift.  It definitely requires more work on the part of the surgeon and perhaps a few more days of recovery for the patient, but the results are worth it.

Some surgeons may read this and say “this is nothing new and Dr. Niamtu is merely doing a larger facelift”.  In some ways they are correct, but it is not simply a larger facelift.  It is a combination of procedures that must be addressed in a specific way with careful attention to details as the full figured facelift patient requires a different type of surgery.  I am the first to admit that I have not invented or discovered anything new.  I have merely modified common facelift techniques to better serve the full figured patient and have obtained impressive results with this technique that have been natural appearing and long lasting.

There may be nothing new under the sun, but there are surely ways to innovate existing procedures to better benefit selected patient populations.

To find out more about facelift surgery by Dr. Niamtu in Richmond, Virginia visit www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Botox without Needles?

For over 100 years, doctors have been administering medications with needles.  I can’t think of any single factor that patients of all ages hate about seeing the doctor that is worse than the fear of needles.  Besides scaring patients, many health care workers are injured or infected from accidental needle sticks.  There is nothing fun about needles!

There are hundreds of scientists and researchers constantly working on alternate medication delivery systems to get medications in the body without using needles.  We have made good progress with numerous medications.  Patients with chronic pain are able to get pain medication from patches applied to the skin and numerous other medications can be administered in this manner.  I predict that in the future, we will even be able to provide general anesthesia without needles or tubes in ones throat.

A topical, non injectable form of Botox (botulinum toxin A) is impressing researchers and is in phase II clinical trials. Revance Therapeutics is a private company in Mountain View, California that has developed a gel that is mixed with the Botox or Dysport that allows large macromolecules to cross the skin and provide local and targeted treatment of the muscle that causes “crow’s feet” wrinkles.  The company calls this technology TransMTS (macromolecule transport technology) and this technology is based on a single, straight-chain peptide that allows the skin to accept the medication instead of preventing absorption.  To get a bit more technical, adding a peptide as a separate component to the neurotoxin allows the medication to cross the skin. The peptide is said to form an ionic bond with the toxin and the peptide also has a protein transduction domain (PTD) which allows the medication to penetrate the skin.  The protein carrier featuring (PTD) holds on to the cell membrane and allows larger molecules to pass.   Currently, there have been over 600 crow’s feet regions treated with this technology with impressive clinical results and without complications.  Studies are also in place to use this topical application to the under arms for control of sweating.

No mention has been made of how long the treatment takes or how long it lasts and there will certainly be variables that effect results in given patients.  In any event this new technology is very exciting and representative of what the future holds for painless application of medicines.  This would be a very welcome addition in the cosmetic facial surgery arena.

To find out more about Dr. Niamtu and cosmetic facial surgery in Richmond, Virginia visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

www.lovethatface.com

The Liquid Facelift: there’s a sucker born every minute!

 

P.T. Barnum, the great circus promoter is frequently quoted as saying “there is a sucker born every minute”.  I am sure he would be quite amused by the new amazing miraculous “Liquid Facelift”!

In this day and age, the best way to promote one’s agenda is to “invent” a really sexy sounding facelift.  First you need an unusual name so the media can key in on it and it will make patients think it is new.  Next, you need to make it sound like it is some new “miracle” that has displaced previous technology.  Finally, you need to make it sound really desirable.  The best way to do this is to tell people that it is non surgical and has little or no recovery.  If someone can put these three things together and find someone in the media to promote it, they will frequently get their 15 minutes of fame.  In the best case scenario the entire hype concept will really take off and the “miracle procedure” will fill the appointment book of the promoting doctor and he or she will frequently franchise their technique to teach other doctors this gift to humanity.  It all goes great guns……………..until…………..well until the other doctors, the public and the media find out four things.

1.  It is really not a new technique, only a hyped repackaged version of procedures that have been around for decades.
2. It is very expensive; it has more recovery that promoted.
3. It is really not a facelift and the results in the average patient are disappointing
4. It doesn’t work.

When all of these factors fall into place, and they always do, many patients are left disappointed and with skinny wallets in the wake of disappointment. 

We have seen this many, many times!  Do names like the Contour Thread Lift, Thermage, The Life Style Lift sound familiar?  I am not sure which is sadder, the fact that so many doctors try to make something out of nothing for personal gain or publicity or the fact that the poor public is so gullible and easily parted from their hard earned cash.  To me, this is much like the weight loss or diet industry.  It is a well established fact based on science and physiology that if you restrict caloric input and exercise you will lose weight.  That simple, no magic!  Yet as I was typing this blog, a commercial came across about the Cookie Diet.   All you have to do is eat these yummy cookies and the weight will fall off!  Please! This should be illegal, but I am sure thousands of gullible people will try the cookie diet and that it will soon fade into obscurity that the thousand diets before.  Will the public ever learn?  If it sounds too good to be true, is it true?

Back to the liquid facelift.  What this procedure really is, is filler injection.  Yep, filler injection, Restylane, Juvederm, the same stuff that thousands of docs do every day.  The liquid facelift is nothing more than a mega filler injection session.  Instead of just filler in the lips or smile lines, it goes in the midface, the jowls, and other place.  Nothing new as most of us that inject filler inject it in these areas when requested.  So, please consider several things.

1. The liquid facelift is not a facelift.
2. The liquid facelift is filler injection.
3. Fillers laser up to a year in the best scenario.
4. Fillers are extremely expensive and a liquid facelift can use up $5-8,000 of filler in 20 minutes.
5. Most people that need a facelift have excess skin and loose muscle.  The liquid facelift does not tighten the skin or muscle; it just fills up hollow spaces.  This is fine, but is it worth it for a year of looking better.
6. A facelift can last 10-20 years, and yes, it required surgery and 2 weeks of recovery.  So what, if you want a real facelift with real facelift results, have a real facelift.
7. All the filler in the world won’t tighten up turkey gobbler skin on the under the chin and under the neck.

 

Is there anything good about the liquid facelift?  Sure, fillers are great and even though I do almost 100 facelifts a year, I am one of the busiest filler injectors in my state.  Fillers are great, but they are not a facelift and should never be used in conjunction with the word “facelift”.

If P.T. Barnum were still alive and if he was a doctor, I bet he would be a big proponent of the liquid facelift.

To find out more about Dr. Niamtu or cosmetic facial surgery in Richmond, Virginia, visit www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Laser Treatment of Burn Scars on the Today Show: Miracle or Not?

On May 28^th the Today Show ran a very interesting segment about a very touching story of very pretty triplets that were badly burned in infancy and were treated with a new laser treatment to improve their burn scars.  The laser was the Lumenis Encore laser and the Deep FX laser, also made by Lumenis.

I have received many phone calls from excited patients who have burn scars or have relatives with burn scars, requesting the “new miracle laser that cures burn scars on the face and body”.  I want to say that I have the very laser that was featured and I am a huge fan of Lumenis lasers.  I also want to say that I am a bit disappointed that the general public may have come away from this feature with the idea that a huge breakthrough in burn treatment has been discovered.  I truly hope that it will advance the treatment of burn scars because that would truly be a huge advancement for humanity and the people that suffer from burn scars.  As a father of two severely disabled young sons, I personally know a parents heartache of seeing a disfigured child.

One problem of the media taking hold of a “new” treatment is that it is frequently presented as a huge worldwide breakthrough in medical advancements.  Sometimes it may be, but most frequently, these stories sensationalize these treatments and put the cart before the horse.  The problem is that viewers get the idea that this is world changing technology.  If a treatment is available that could truly and radically improve burn scars, it would be Noble Prize worthy, not just Today Show worthy.  We have seen the Today Show (and Oprah and other shows) present such “huge surgical advances” as the Thread Lift, The Fraxel laser, the Liquid Facelift and many other procedures that sounded sensational, but proved to be almost useless, let alone a breakthrough.  The key phrase with so many of these treatments is that “the results exceed the expectations”.

Dr. Jill Weibel is a friend of mine and she is one of the nicest and most compassionate doctors I have met and a leader in laser technology.  I believe this type of laser treatment for burns is in the really early stages of usage and that much more long term follow up must be done.  A study by a university burn center with long term follow up would be news worthy.  Single treatments with admittedly minor improvement (the video I saw showed one of the triplets stating that she thinks that she and her boyfriend can see a little improvement is not testimony for a medical breakthrough.  I say this realizing that she has only had a single treatment and perhaps more improvement will be observable with additional treatments.  I hope this is the case because Lumenis is a credible company that would love to be part of such a break through.  I do think, however, that the “miracle” hype on this story is premature and has been presented in too much of a sensational way.  The only bad thing about this is that it can lead the tens of thousands of burn patients to think that something has arrived to change their life.  I wish it were true, but I personally don’t think it is.  I really want it to be true.

Too often the media sensationalizes medical treatments and the public gets misled.  I am not expecting this treatment to be as sensational as presented and it is my fear that like the numerous patients that have contacted me that thousands of others around the country may be given false hope.  My phone rand many times after this story ran and I too have used the Deep FX technology on scars.  The thought of improvement with the new is exciting but it is too early to brand it as a “miracle”.  As academic surgeons like Dr. Weibel and others continue to blaze new trails with this type of fractional laser, the cosmetic treatment of burn scars may become a reality.

To find out more about cosmetic facial surgery visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virgina

Dysport: the new “Botox”

If Allergan’s Botox is Goliath, then Medicis and their new neurotoxin is David.  No one can argue that Botox has enjoyed a monopoly in the United States for past 15 years.  After all, Botox was a true paradigm shift in cosmetic surgery.  Never before, without surgery, could a patient have wrinkles disappear.  The introduction of Botox was something so different and so easy that it truly heralded in a new era known as minimally invasive surgery.  What began as a “pretty poison” has grown into “cosmetic maintenance” and now women and men get regular Botox injections with the same regularity that they get their hair colored or teeth cleaned.  Botox has not only continued to be safe and effective, but has gone on to treat many conditions from headaches to hemorrhoids.

Botox has gone largely unchallenged and Allergan has become a corporate giant due to its sales.  Second to Viagra it is the largest selling drug.  A brief challenge came in the “at the turn of the last century” with Myoblock, a similar product but chemically different.  Unfortunately for Myoblock, it did not live up to the effectiveness of Botox, and its popularity was short lived.  It is still used for the few patients that have a resistance to Botox, but is a small player.

Dysport is chemically very similar to Botox and has been used in the United Kingdom for 15 years.  It varies from Botox in its biochemistry and protein structure but basically does the exact same thing.  This drug has recently received FDA acceptance and will be sold in the United States under the same name.  Dysport will make a big bang with the media upon it final FDA acceptance and rumors will fly.  The Dysport FDA trials showed that Dysport took effect somewhat faster than Botox and basically lasted the same amount of time, about three months.  Why challenge the king of neurotoxins (more politically correctly called neuromodulators) with a drug that basically does the same thing.  I call it Coke versus Pepsi marketing.  Consumers and surgeons desire choices in everything from clothes, to cars to, carpet and want choices.  There is also some bragging rights from being the “new kid on the block” (just ask Red Bull).  Cosmetic consumers and media are fascinated by “new” technology and if it is new then it must be better.  Frequently this does not pan out, but a well marketed and effective competitor can certainly gain market share.  When all the US automakers were getting bailed out by the Federal government, Toyota (who was a newcomer to this country) remained strong.

To cut to the chase, Dysport is exciting because it is new and is also taking on heavyweight Botox.  It is likely to become a popular competitor.  What remains to be seen, and could make the difference in the wrinkle wars, is how Dysport is priced in comparison with Botox.  If Medicis significantly undercuts Allergan, Dysport could potentially displace the king.  I doubt that this will happen as corporate America is not fond of less profit.  A similar scenario occurred with Restylane, the revolutionary lip and wrinkle filler from Medicis.  This was the first new filler that was FDA approved and made a meteoric rise to the top of facial injectables.  There was no significant competition for about 4 -5 years until Allergan obtained FDA approval for Juvederm.  In the pre release period, much speculation occurred as to whether Allergan would significantly undercut the pricing of Restylane.  Guess what?  They did not.  Their pricing was almost identical and Juvederm no doubt took a chunk out of the filler sales dominated by Allergan.  Competition is generally a good thing as it offers the public more choices and can sometimes drive down prices, but don’t look for this with aesthetic companies.  They figure if patients will spend $500 for X, then they will spend it for Y.  Time will tell.

To find out more about Botox, Dysport and other cosmetic facial surgery procedures, visit www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Hyaluronidase to Dissolve Unwanted Lip and Wrinkle Filler

 

 

If you are old enough to have filler injections you are probably old enough to remember the scene from the movie “The First Wives Club” where Goldie Hawn gets lip injections and ends up with wickedly gigantic lips.

No one can argue that injectable fillers have added immensely to minimally invasive cosmetic facial surgery, but sometimes you can get too much of a good thing!

The complications associated with injectable lip and wrinkle fillers are usually pretty benign with under treatment and over treatment being among the most common problems.  Frequently, overtreatment is associated with novice injectors or poor technique, but even the most experienced surgeons will occasionally have an overzealous result.  There is no doubt that a patient may be disappointed with an under treated area, but they will be livid with an asymmetric or over treated area.  Let’s face it, no patient wants to walk around with excess filler in the lip, smile line or under eye area.

There are numerous fillers available and each of them has various positive and negative aspects.  The most commonly injected fillers are the hyaluronic acid fillers which include Juvederm Ultra and Ultra Plus, Restylane, and Perlane being the most popular.  Hyaluronic acid is a naturally occurring sugar that is present in many human tissues, especially the skin.  These fillers have been shown to persist in the body for up to a year, which is a good thing if you have the correct amount in the right place.  One additional (and I feel a huge advantage) with the hyaluronic acid fillers is the fact that they can be dissolved or reversed with a very predictable, safe and simple treatment that happens almost overnight.

Sound too good to be true?  It’ a fact.  Hyaluronidase is an enzyme that will dissolve hyaluronic acid rapidly and safely.  This medication is marketed as Amphidase and is mixed with local anesthesia and injected into the area of excess filler.  Almost like magic and almost overnight, the excess filler will dissolve, leaving a happy patient and surgeon.  Hyaluronidase has been used by doctors for injections for years, most commonly to assist the spread of local anesthetic solutions.  It has an excellent safety record although it is good to perform an immediate skin test and wait 5-10 minutes before treatment.  A small bleb of the inner surface of the forearm can be injected to see if it causes any inflammation in the area.

Hyaluronidase is used to dissolve excess or unwanted filler by mixing it with local anesthesia and injecting into the area of excess filler.

I have personally injected one of my patients and a bunch of patients treated by other surgeons with Hyaluronidase with good results.  The excess filler (assuming it is a hyaluronic acid type) dissolves in one or two days and is impressive.  Occasionally it is necessary to re treat an area with additional Hyaluronidase if the first injection did not take care of the problem.  I have used it to dissolve bumps on the lip, lips that were too big and fat or tear trough areas (the groove under the eye and above the cheek) that were over treated with good results.

 

The above patient was over injected with a filler and was unhappy with the excessive result.  She is shown 48 hours after Dr. Niamtu injected hyaluronidase into the area of excess under the eye.

To find out more about injectable lip and wrinkle fillers or other cosmetic facial surgery procedures visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com