The other day I was riding my bike through the beautiful Carpentaria country side, and met a fellow rider with whom I began to chat.  We discussed bikes (of course), and then ventured into a discussion of plastic surgery in Santa Barbara.  She asked some excellent questions about facial anatomy and the changes that come along with the aging process.  She also had questions about specific areas, and in particular the vertical lines on the forehead which we call “glabellar frown lines�.   I explained that the quick and easy way to treat these were with Botox and this was done very commonly.  I was interested to hear her response, however, which was concern about Botox as a “poison� that would make you sick.
It is not infrequently that I have this type of conversation in both the professional plastic surgery as well as the casual setting, as classic teaching is that botulism toxin, which Botox is made from, is poisonous when ingested in large doses (as from bad food).   This substance is poisonous because it paralyzes many muscles in your body when ingested in large quantities.  When refined and used in minuscule amounts with specific placement, as we do with injections of Botox in my plastic surgery office, this toxin does not affect the entire body- only the individual muscle that it is applied to. By paralyzing the very small muscle that contracts just under the skin, the Botox injection prevents the contraction of that muscle and therefore prevents the wrinkle in the skin overlying that muscle from appearing.  In this application, Botox is therapeutic, and not poisonous at all.
Lots of research has gone into development and purification and safety of Botox.  I would not use it on my patients if I had reservations about it, and it ranks highly as one of the most satisfying patient therapies short of surgery.  We must remember that like so many of the medications and even vitamins that we take, the proper dosing of the therapy is key.  Too much vitamin A can kill someone if taken in overdose amounts. Similarly with Botox, the right dose, indication, and application by a certified professional are key to a safe, youthful appearance.

Last Friday I got to attend a course on the new soft tissue filler- Evolence.  This is a Johnson and Johnson product that consists of cross linked collagen, which is a natural protein that makes up much of the connective tissue of the body.  The advantages of this product seem to be many, but the primary thing that strikes me is that Evolence seems to last at least 6 months as opposed to the hyaluronic acid products like Restylane and Juviderm.  (more…)

In about 2 weeks I’m going to attend a course which will allow me to use a new soft tissue filler made by Johnson and Johnson- it is a cross-linked collagen product for moderate to deep wrinkles and folds and is supposed to last AT LEAST 6 months.  Only a plastic surgeon who has attended this seminar will be able to get and inject the Evolence product, so it is not something that will be easy to find in the run of the mill medical spa.  I don’t anticipate that this will replace the other plastic surgery injectables that I use such as Radiesse and Juviderm and Resylane, but I do think for certain situations, this new product should be pretty fantastic.  Give us a call or send us an email to schedule an appointment if you think this type of plastic surgery injectable soft tissue filler is something you might like to have.