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Teaching Facial Plastic Surgery

Teaching Facial Plastic Surgery in Las Vegas

I just returned from Las Vegas where I was lecturing at the 7th annual Multispeciality Foundation course on Facial Plastic Surgery. The first reaction from friends is, “oh, Vegas must have been a lot of partying and fun.” This course is so comprehensive that I didn’t want to miss anything, so I was inside the lecture halls from 7 AM until after 6 PM every day for 4 days straight. At night were dinner demonstrations and meetings with the various laser, filler (Juvederm, Restylane, Radiesse, Sculptra, Belotero) and neurotoxin (Botox, Dysport) vendors to see what’s the latest and greatest.

I gave four talks at this meeting. Three were on rhinoplasty:

  1. spreader grafts for primary and revision rhinoplasty
  2. What causes nasal obstruction other than a deviated septum
  3. Treatment of the complications of rhinoplasty
  4. Wow cheeksTM How to make nasolabial folds look better than just treating the lines. 

I also moderated a half day session on eyelid rejuvenation, including lectures on blepharoplasty, browlifts, Botox and fillers for the eye area.

This meeting has an amazing cadre of lecturers, equal numbers from each of the “core” disciplines of cosmetic surgery: Plastic Surgery, Facial Plastic Surgery, Oculoplastic Surgery and Dermatologic Surgery. Attendees can really see how different specialists approach facial aging and the varying ways that internationally recognized experts from each discipline treat facial aging.

This meeting was a true testament to the organizing committee and founder Dr. Randy Waldman; a long time friend and facial plastic surgeon (in that order of importance) from Lexington, KY. He ran a similar but smaller meeting in Newport Beach, CA for 17 years before this and is a true meeting genius.

Steven J. Pearlman, MD, FACS

Dysport and Botox in New York; better, worse or the same?

Dysport has been around in Europe almost as long as Botox. Recently it was FDA approved for cosmetic use in the U.S. for glabellar lines. These are the “angry 11’s” or frown lines between the eyebrows. Intentionally, this is the same area that Botox Cosmetic is approved for. Any other cosmetic uses, such as horizontal brow lines, crows’ feet, eyebrow lifts, raise down-turned corners of the mouth, plus loads of other uses, are called “off label.” What this means is that treatments for anything other than frown lines, is up to the doctor to explain to patients that the use is off label, but given the doctor’s professional experience and knowledge they are using the drug in a non-approved yet acceptable way. Off label issues was recently addressed in the NY Times by Natasha Singer.

So, what are the differences? Botox is now formally called anabotulinum toxinA and Dysport is abobotulinum toxinA. I won’t bore you with the technical stuff; these are very similar molecules and most importantly both are Botulinum Toxin Type A. Other Botulinum toxins are currently being investigated, but none have been found to be as effective and have as low a side effect rate as Botulinum Toxin Type A. Clinically, the new kid on the block is always touted as being better. Every new filler company says their filler lasts longer and in the long run, most didn’t. I polled my neurotoxin “guru” at the recent AAFPRS meeting, plus attended the new technology session. Their take is that the effects of Dysport may come on earlier and may last longer than Botox. However, Dysport may also have more diffusion. What that means is that there is slightly more spread from the point of injection. This occurs with Botox as well, but for both I use a very low dilution so spread with either should be minimal.

Will I switch? I had my official training from the Medicis Company for Dysport yesterday. I treated four loyal, astute patients. I will follow them and see for myself how fast it worked and how long it lasts on them, also if they note any differences. What my guru said was that it’s like Restylane and Juvederm, we first had only Restylane and once Juvederm came on the market I found that each has specific advantages and learned which one to use for each individual patient and area of the face to get the best results.  I will keep you posted.

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