The ISAPS organization sent surveys to more than 30,000 plastic surgeons in 25 countries to determine the popularity of both surgical and non-surgical cosmetic procedures across the globe.  Survey results revealed that plastic surgeons worldwide performed more than 8.5 million plastic surgeries and more than 8.7 million non-surgical cosmetic procedures last year.

The most popular body contouring procedures performed by plastic surgeons included liposuction, breast augmentation and tummy tuck, whereas the most frequently performed facial plastic surgery procedures included rhinoplasty and eyelid surgery.  In 2009, liposuction, breast augmentation and blepharoplasty procedures were each performed more than 1 million times worldwide.

Among non-surgical cosmetic treatments, injectable fillers, such as Juvederm and Radiesse, and wrinkle-relaxing injectables, such as Botox and Dysport, were the most popular internationally, however laser treatments, including laser hair removal, skin resurfacing and vein treatment were also frequently performed.

U.S. patients favored the surgical and non-surgical procedures that ranked highest internationally, a fact that is statistically unsurprising given that U.S. plastic surgeons performed more procedures in 2009 than surgeons from any other country (more than 3 million procedures.)

Plastic surgeons from Brazil and China performed more than 2 million procedures each last year, ranking these countries second and third, respectively, for total number of procedures performed by plastic surgeons internationally.

There was a wide gap between the number of procedures performed by plastic surgeons in the top three countries and the other two countries that rounded out the top five, as plastic surgeons from fourth- and fifth-ranked India and Mexico did not perform even 1 million total cosmetic procedures in 2009.

Xeomin will likely compete with Botox and Dysport for a share of patients seeking to reduce forehead creases and frown lines, however it is currently FDA-approved only for therapeutic use in treating neuromuscular conditions, including cervical dystonia, blepharospasm and other forms of focal dystonia.

Like other botulinum type A injectables, Xeomin can temporarily treat painful muscular tension and spasticity, as well as dynamic wrinkles, or expression lines, that can cause deep furrows and creases to form over time.

Some physicians anticipate that Xeomin will be better than Dysport and Botox for treating neuromuscular conditions, as the lack of complexing proteins in the product should prevent antibody formation and ensure that treatments are effective.

Others speculate that Dysport and Botox will be better than Xeomin for cosmetic wrinkle treatment, as Xeomin’s tendency to spread or migrate away from the injection site may lead to negative outcomes, including a crooked smile or drooping eyebrows.

But the only scientifically-proven difference that sets Xeomin apart from its competitors at present is the fact that it will not require refrigeration prior to reconstitution.  This would make using Xeomin slightly more convenient for physicians but would do little to benefit consumers.

Xeomin will be distributed in 50- and 100-unit vials, and its unit measurements will be about equal to Botox units.  The price of Xeomin per-unit will probably be about the same as the cost of Botox, and although Xeomin’s launch may increase the competition amongst injectable wrinkle relaxers, it is unlikely it will cause a significant decrease in cosmetic treatment prices.

It is important to remember that the success of your treatment with wrinkle-relaxing injectables is less dependent on the formulation of the product than the skill of the physician administering your injections.  So, whether you choose Botox, Dysport or Xeomin to treat your 11’s and horizontal forehead lines, seek an experienced Eugene plastic surgeon to ensure you achieve the best possible results.

The introduction of new cosmetic injectables not only offers patients more choices in facial rejuvenation, but also more competitive pricing and better results produced by better technology.

New hyaluronic acid fillers

Many of the new injectable fillers headed for the U.S. are composed of hyaluronic acid gel, including:

• Belotero (Merz), a hyaluronic acid (HA) filler similar to Juvederm offered in three concentrations—soft, basic and intense
• Restylane Vital & SubQ (Medicis), thinner and thicker formulations in the Restylane family of injectable HA fillers
• Juvederm Voluma & Hydrate (Allergan), thinner and thicker formulations in the Juvederm family of injectable HA fillers

Belotero has already been filed with the FDA and is purported to provide an improved level of tissue integration that causes fewer incidences of lumps and bumps than other hyaluronic acid fillers.

Juvederm Voluma is used throughout Europe for adding large amounts of volume to the face, such as the chin and cheeks.  SubQ is also a large volume filler reportedly used for both facial contouring and body contouring, including buttock and breast augmentation.

Restylane Vital and Juvederm Hydrate are ideal for treating areas that have been historically difficult to correct with fillers, such as the back of the hands, décolleté and neck, and both purportedly offer wrinkle prevention by boosting skin hydration and elasticity.

Unlike Juvederm Hydrate, Restylane Vital offers a specialized automatic injection pen that regulates product injection volume and speed for more precise results.

Other innovative facial fillers

Novabel is the first injectable filler composed of spherical, flexible structures called Geleons, which are formed from marine brown algae extract.  This patented Geleon technology reportedly makes Novabel injections virtually pain-free and also improves skin elasticity.

In addition, the composition of Novabel is said to make injection easier and reduce swelling, making it ideal for adding volume to facial areas with thin skin, such as the eyelids and tear troughs.

In addition to Novabel, another new non-HA filler is working its way to the U.S.  Derma Veil, a pure collagen stimulator made of polylactic and polyglycolic acids (PLGA) will compete with Sculptra for a portion of the facial volume restoration market if approved.

Better than Botox? Naked botulinum type A injectables

In addition to injectable fillers, new botulinum type A neurotoxins Xeomin and PurTox are also poised to enter the U.S. marketplace.

Unlike Botox and Dysport, the active protein structures of PurTox and Xeomin products are not complexed to other, inactive proteins, leaving the active proteins “naked.”

As a result, it is theorized that these wrinkle relaxers may work faster, last longer and decrease the possibility of allergic reaction and development of blocking antibodies in patients.

PurTox has completed clinical trials and may be close to FDA approval.

Be a fan of Juvederm on Facebook if you want useful information from Dayna Devon about Juvederm and “switching up” your aesthetic routine to look better.

Juvederm is a smooth injectable gel composed of hyaluronic acid, a natural component of the skin that gets depleted over time.  With different formulations of Juvederm, your physician can correct a variety of imperfections.  The most popular treatment is for the nasolabial folds, the lines that run from your nose to the corners of your mouth.  Alternative treatments include Restylane, which is also made of hyaluronic acid, and Radiesse.

To increase lip projection and fullness, the procedure uses a specific neck muscle and its adjacent tissues as an implant. Twenty-five participants in the study saw an average increase of 0.9 – 0.99 mm of lip projection, and results were long lasting.

In recent years, several different methods have been utilized in lip augmentation procedures.  Fat grafting, collagen injections and surgisil implants have all been used, but the current gold standard is hyaluronic acid.  Wrinkle fillers like Restylane and Juvederm are often injected to add volume and enhance the shape of the upper lip, lower lip and Cupid’s bow, while also addressing wrinkles around the mouth.

Read an abstract of the study in Archives of Facial Plastic Surgery

Dr. Bruce Genter, a plastic surgeon in Pennsylvania, voiced his skepticism in this ABC news segment, pointing to the lack of scientific evidence supporting acupuncture as an effective wrinkle treatment.  Yet, some are saying it works for them; are they seeing real change or is wishful thinking clouding their perception?

Julia Engstrom, who says she has used Botox and laser treatments in the past, believes facial acupuncture has improved the texture of her skin and reduced the appearance of wrinkles. Nearing the end of 10 treatments, she says her improvements have come through improved sleep and relaxation. “I’ve noticed that my skin is a lot smoother, [there’s] a lot less red pigment in there and the wrinkling seems to be a lot less,” Engstrom said. “I [also] have a lot less darkening under my eyes and I’ve been getting a lot of compliments.”

Acupuncture, a process during which tiny needles are placed strategically into the body, is said to bring improved health and well-being. In an article for Prevention magazine, licensed acupuncturist and Traditional Chinese Medicine practitioner Phyllis Olson asserts that acupuncture can indeed lessen the appearance of wrinkles. She attributes this to a core premise of acupuncture – that health is reliant upon the healthy flow of chi (energy) in the body, which can be disrupted for a myriad of reasons. Acupuncture treatments are believed to break up energy blockages that prevent optimal blood flow to certain places in the body, improving circulation.

Beata Maslanka, Philadelphia acupuncturist and author of the “Art of Wellness” acknowledges that acupuncture doesn’t yield visible results that compare to Botox or other facial fillers, but claims that beauty actually comes from within; when internal imbalances are healed, people will look better overall.

Olson agrees, noting that the treatments foster relaxation of facial muscles, thereby reducing wrinkles. “Aside from the light, momentary stings, acupuncture is really quite relaxing,” she adds.

The results Engstrom points to are hard to discern from the video, but one can wonder about the salutary effects of relaxation and optimism, not to mention the natural human tendency to see (and believe) what we want to see.

If it does have a wrinkle-relaxing effect, how long could this last? NYC dermatologic surgeon Barney Kenet, MD tells Prevention: “If acupuncture relaxes the muscles, it might reduce wrinkling temporarily. As for the increased blood flow, at most it will probably give you a temporary rosy complexion–something you don’t want if you have an inflammatory condition such as acne or rosacea,” he warns. “Otherwise, cosmetic acupuncture is relatively harmless.”

Maybe so, but then you may want to consider the cost. The average price of an acupuncture treatment for facial wrinkling could be as much as $60 to $100 per session, with 10 sessions recommended by Olson, followed by monthly maintenance procedures.

In contrast, the average Botox treatment in the US costs $472 and a single treatment will last 3-6 months. This makes acupuncture wrinkle treatments both an unproven and costly proposition.

Dr. Genter, whose patients are proof that Botox and other facial fillers visibly reduce the effects of aging on the face, says: ”If it increases your well-being that’s great, I just don’t know that it can make your face look younger.”

BOTOX injections may be the single most popular non-surgical procedure to reduce or eliminate facial lines, wrinkles and grooves.

Wrinkles emerge gradually

Crow’s feet, lines and even deep grooves appear on our faces over the years, the result of our natural expressiveness, lifestyle habits, and the tendency to move our facial muscles in habitual ways. For instance, you may squint a lot (when you’re concentrating, when you’re worried, when the sun is bright, or when you are trying to focus your vision.) As the years go by, this repetitive motion begins to carve lines in your face and can eventually result in a permanent expression of worry or intense concentration.

We frequently notice these facial lines and wrinkles on friends and strangers alike. At times, we also find ourselves looking at someone and wondering, “Why is she so angry?” or “Why is he so uptight and stressed?” We’re talking about that vertical line that runs down the center of the forehead: one of the most obvious facial flaws, in otherwise attractive men and women.

Why use BOTOX?

BOTOX injections are a quick and cost-effective way to improve your looks. Performed by a highly experienced hand, the results are truly gratifying, softening the appearance of common lines and wrinkles:

• Crow’s feet (around the eyes)
• Glabellar lines and forehead lines (both vertical and horizontal lines and creases)
• Smile lines (on each side of your mouth)

For days after BOTOX is administered, you will look in the mirror and continue to see increased improvement in your face as the treatment reaches its full effect. BOTOX requires only local anesthesia, if any at all. The procedure effectively blocks signals relayed between certain nerves and muscles, causing a temporary paralysis in specific facial muscles.

After Botox treatment, you’ll still be able to smile, frown, and make normal facial expressions. BOTOX generally lasts 4-6 months before it needs to be replenished. Over time, many of our patients notice that their facial wrinkles continue to diminish even when they have BOTOX treatments less often. It almost seems to “train” the muscles to be more relaxed, resulting in a more serene, pleasing image as time goes by.

A word of caution

Maybe you have heard about “BOTOX parties,” where the treatment is administered to a group of women in someone’s home. We strongly recommend that you avoid this route. You only have one face. Don’t place it in the hands of someone whose knowledge of facial anatomy may be insufficient. Just because someone can inject BOTOX doesn’t mean he or she can do it properly or with an eye trained to give the best aesthetic result. A trained plastic surgeon will administer the treatment with your very own unique face taken into consideration.

If you are between age 18 and 65, are not pregnant, nursing or living with a muscular disorder, you’re probably a good candidate. Talk to us about BOTOX and start the New Year on a brighter, more attractive note.

20/20 is asking people online “Have you tried do-it yourself plastic surgery?” The news organization claims that products like Restylane, Juvederm, and Botox are being “self-injected.”

RealSelf.com has also been blogging about this recent phenomenon.

We sincerely hope that no one, in Oregon or elsewhere, has attempted this kind of thing.  Injectable treatments might seem easy and quite comfortable in our office, but attempting to perform them yourself is just plain unwise.  To avoid significant risks, you need to know the proper injection technique (to say the least).

You’ll be in much better hands if you see a qualified cosmetic or plastic surgeon for your treatments.

A document containing a full summary of the findings is available here; a few of the noteworthy results are as follows:

 - Most respondents described themselves as healthy individuals; 95 percent said they exercised 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, with Juvederm being most popular.

 - Among the respondents, the typical 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 wrinkle treatments with others, and 70 percent said they received support from the people they told.

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

The April 30th announcement coincided with a 3 percent drop in Allergan’s (maker of Botox) shares, and a 14 percent increase of Medicis’ shares. Analysts and industry professionals expect Dysport to carry a slightly lower price tag 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 Oregon, see our homepage.