Wrinkle Treatments & Injectables-Lip Enhancement

Your skin will appear smoother and fuller and have an overall more youthful appearance with

wrinkle injections.

Lip Enhancement
Similar to dermal filler procedures, lip enhancement works by injecting hyaluronic acid into the area underneath the skin. This creates increased volume, making the lips appear fuller and more luscious. As well as increased volume, a lip enhancement procedure can add foundation to the skin and smooth out creases, leading to a more youthful appearance. Whatever your desired outcome, Clinic Aesthetic’s lip enhancing methods are effective and safe, using substances naturally found in the body to enhance your lips and give you a sexier, more youthful pout.

Botulinum toxin ...

Botulinum toxin is produced by a specific type of bacteria. In higher amounts, it can be poisonous. However, only small, weaker doses of botulinum toxin are used to reduce facial wrinkles.

When botulinum toxin is injected, it blocks certain nerve signals that make muscles contract. The muscles relax, reducing unwanted wrinkles. This effect lasts about 3–6 months. After that, the muscles move again and wrinkles come back.

Crows’ feet before botulinum toxin injection

When you have botulinum toxin injected, your doctor may first rub an anesthetic cream on the area to numb it. Then he or she will inject the medicine into specific facial muscles. This only takes a few minutes, and can be done right in the doctor’s office. You will be able to continue your daily activities right afterwards.

About 3 days after the injection, you should notice some muscles starting to relax. After 1 week, you likely will see fewer facial wrinkles and lines. This effect wears off in about 3–6 months.

how-does-botulinum-toxin-botox-work

PRP: Interesting Studies Investigating Platelet Rich Plasma, LLLT - Low Level Laser and Combined Effects

by: BENJAMIN GARRETT

Improving Patient Outcomes and Increasing Practice Revenue: Pain Management, Sports Performance and Surgical Recovery

A recent search on PubMed turned up some very interesting studies regarding PRP - Platelet Rich Plasma and LLLT - Low Level Laser Therapy.  While there are thousands of scientific studies on both PRP and LLLT used individually, it is  finally good to see some studies on the combined effects.  

Lasers Med Sci. 2016 Jan;31(1):19-26.   Analysis of experimental tendinitis in rats treated with laser and platelet-rich plasma therapies by Raman spectroscopy and histometry.

Lasers Med Sci. 2015 May;30(4):1305-13. doi: 10.1007/s10103-015-1733-6. Epub 2015 Mar 11.   Evaluation of low-level laser therapy, platelet-rich plasma, and their combination on the healing of Achilles tendon in rabbits.

Lasers Med Sci. 2013 Nov;28(6):1489-94. doi: 10.1007/s10103-012-1241-x. Epub 2013 Jan 10.   Low-level laser therapy combined with platelet-rich plasma on the healing calcaneal tendon: a histological study in a rat model.

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Neuromuscular Toxins

The first option, which is most appropriate for active lines or age associated wrinkles that are just starting to appear, is to temporarily weaken or paralyze the muscle that is causing the wrinkle. Botulinum Toxin type A is a family of neurotoxins that block nerve signals that cause muscles to contract.

The toxin works directly where it is placed, and thus can be artistically used to alter facial expressions. Botox Cosmetic® is widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. Other manufactures are producing variant toxins that will likely be approved for use in the near future, including Reloxin and PurTox. These toxins will be differentiated by their time to onset, duration of effect (the clinical effects of Botox Cosmetic® are typically 3 to 4 months), and the distance of effect from the injection site.

 Risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups. Specific risks should be discussed with your injector when considering treatment.

Xeomin Muscle Relaxing Injections

http://www.jcasonline.com/viewimage.asp?img=JCutanAesthetSurg_2012_5_2_121_99451_u5.jpg

Figure 1: Safe injection locations for neurotoxins. Injections ("x") 2.5 cm above the bony orbit (horizontal line), 1 cm lateral to and above the orbital rim (small dots) should avoid unwanted diffusion and paralysis

Dr Ben Chan

Dr Ben Chan 

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Medical Director, Cosmetic Institute of Australia, Principal, Skintech Group of Cl

What Does the Recent Texas Botox Arrest Mean to You? - American Med Spa Association

What Does the Recent Texas Botox Arrest Mean to You? - American Med Spa Association

By Alex R. Thiersch, CEO  of the American Med Spa Association (AmSpa)

As many have seen in the news recently, a Texas LVN named Michelle Bogle from Savvy Chic Medical Spa was arrested under the claim that she was practicing medicine without a license.; specifically, she was offering Botox injections. Although all of the facts about the case are not known, AmSpa wanted to take this time to review the rules in relation to delegating cosmetic medical procedures in Texas. The state of Texas is fairly liberal in who it allows to physically perform Botox and other injectable procedures. Anyone with proper training may inject Botox and other cosmetic injectable as long as it is under the protocols, supervision, and delegation of a physician. The Texas Medical Board has adopted Rule §193.17 (available here) to provide guidance to physicians who delegate these nonsurgical cosmetic procedures. The rule applies to nonsurgical cosmetic procedures, including injecting or using a prescription medical device performed by someone who is not otherwise licensed to perform the procedure and not a physician, PA, or NP.  The rule includes 13 points that physicians must adhere to in properly supervising and delegating such a procedure to anyone other than a physician assistant or a nurse practitioner. These include the following.

1. A physician is responsible for being properly and appropriately trained in the specific procedure, and keep records documenting their training.  
2. Before the procedure is performed, the physician or a PA or NP acting under their delegation must perform an initial examination. This examination must include: taking a history, performing a physical exam, making a diagnosis, recommending treatment, developing a treatment plan, obtaining a patient’s informed consent, and providing emergency and follow-up care instructions. They must also maintain medical records, and have signed and dated written protocols and standing orders for the procedure
3. Following the above examination and diagnosis, the procedure can be delegated to another person as long as a PA, NP, or physician is on-site, or the delegating physician is available for emergency consultation and able to conduct an emergency appointment if necessary.
4. The physician, regardless of who they delegate to, maintains ultimate responsibility for patient safety. 
5. The physician is also responsible for documenting and maintaining the patient records. 
6. The facility must have a quality assurance program in place, including mechanisms to identify complications, adhere to protocols, monitor the quality of treatments, a review and improvement mechanism for protocols, and ongoing training.
7. Physicians can delegate procedures only at a facility where they have either approved of that facility’s written protocols for the procedure or they have developed their own protocols.
8. The physician must also make sure that the delegated person has appropriate training in several areas related to performing procedures (see the rule for details).
9. The physician must have in place a written office protocol for the delegated person to follow in performing the procedure.  his protocol must identify the delegating physician, criteria for the physician, PA, or NP to screen the patients, and description of appropriate follow-up care including for complications, injury, and emergencies.
10. The physician must make sure that the delegated person follows that written office protocol.
11. Patients must sign consent forms before receiving any treatment. The form must identify potential side effects, complications, and identity of who will perform the procedure.
12. The delegated person who performs the procedure must have a name tag which discloses their name and their credentials. 
13. The facility must have at least one person on-site who is trained in basic life support whenever a procedure is performed.

Each of these above points are necessary to be in compliance with the rule. However, this article is not meant to be an exhaustive compliance check rather to give more of an overview. So, if you are a physician planning on delegating such procedures to anyone other than a PA or NP, please carefully review the rule in total or consult with an attorney to ensure that you develop policies and procedures that are compliant with its requirements.   

The implications of this story are far-reaching. This is the second instance of an LVN being charged with the unauthorized practice of medicine in recent months as a result of an undercover sting operation (the other occurred in California). AmSpa encourages all of its members—particularly those in Texas—to ensure that they strictly comply with every step of the Texas delegation and supervision rules governing cosmetic procedures. Following each step specifically is critical, and practitioners must take care to pay very close attention to the specifics of the rule and follow it exactly. As now has been seen, failure to do so may result in criminal prosecution, not to mention action by the medical and/or nursing boards.

Tags:  Med Spa Law 

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The Difference Between Muscle-Relaxing Injections and Dermal Fillers

Enquiring minds want to know, “what is the difference between muscle-relaxing injections and dermal fillers?” Stop wrinkling your brow and wonder no more, you don’t want those lines to become permanent, do you, so you end up looking like Gordon Ramsay?

Dermal fillers are types of injectable cosmetics, intended to provide temporary solutions to minor facial skin problems and skin irregularities. Injected just under the skin by a qualified medical practitioner, dermal fillers can smooth out lines, creases and wrinkles by, well, filling them in or plumping them up. The most common dermal filler in use is a brand called Restylane. This has been around much longer than most of the other brands, and has a very good safety profile.
Muscle-relaxing injections (which are derived from Botulinum Toxin A, but don’t be worried as it’s perfectly safe in this form) are very effective as an anti wrinkle treatment, and is also introduced to the face via injection. Muscle-relaxing injections effectively relax your facial muscles (including, perhaps, the ones that are creating those creases in your forehead from wondering too much) and smoothes out your skin, eliminating deeper lines, creases and wrinkles.

Dermal fillers are more suitable for individuals wanting to get rid of lines and creases that are not too deep, or reduce the appearance of other facial skin imperfections, such as scars from acne spots. Dermal fillers are also very popular for non-surgically filling in dips and depressions on the nose bridge. Fillers also can be used for plumping up lips that are asymmetrical, or simply to give one more of a pout. There are many different types of dermal fillers on the market, each with its own particular benefits and/or shortcomings.
Muscle-relaxing injections are generally the choice of discerning men and women who are trying to eliminate facial lines and wrinkles that are more apparent than mere creases in the skin. Your cosmetic doctor will assess whether muscle-relaxing injections or dermal fillers are more suitable for you. The choice of which one to use is dependent on the positioning, severity and depth of your wrinkles.
As a general rule of thumb, the wrinkles around and between your eyes and on your forehead are usually treated with muscle-relaxing injections. Folds around your mouth and chin are usually treated by dermal fillers.'

Muscle-relaxing injections and dermal fillers are used to treat different areas and issues. However, in terms of their longevity, both muscle-relaxing injections and dermal fillers are temporary resolutions to the problems of ageing, offering a three to six month respite from wrinkles, before needing to be repeated.
For a more in-depth look at the different types of anti-wrinkle treatments available in Dublin, Ireland today, including Radiesse, Restylane and Sculptra, –download your FREE report called ‘The Facts About Anti-Wrinkle Injections and What You Need to Know’  from http://nonsurgicalfacelift.ie/

Normal ageing = Loss of Hyaluronic Acid

Hyaluronic acid is an essential skin component. It acts like a sponge that retains water and keeps the skin moisturized, plumped and healthy. We lose 50 % of our hyaluronic acid between the age of 40 and 50(1). The skin becomes dry, thin and fragile. (1) L’observatoire des cosmétiques, Octobre 2010 In addition to normal ageing and loss of hyaluronic acid, our skin is exposed daily to various external factors that change its surface which results in the loss of brightness: - Sun exposure - Pollution - Junk food - Lack of sleep - Smoking

	•YOUNG, HEALTHY SKIN  - Smooth and hydrated skin surface - Perfect light reflection - No shaded areas • AGEING, DAMAGED SKIN - Shriveled and dehydrated skin - Altered light reflection - Numerous shaded areas

Premature ageing = Excess of oxidative stress (free radicals)

Your body has a stock of antioxidants capable of neutralizing the oxidants. This balance can be disturbed by an unhealthy lifestyle and several external factors. The excess of oxidative stress (free radicals) attacks the skin, decreasing its elasticity and tonicity. An injectable revitalizing treatment with the adequate ingredients is a must to restore SKIN’S HEALTHY balance and fight against all aspects of SKIN AGEING.

 http://www.teoxane.com/en/skin-glow-loss

https://www.cnbc.com/video/2018/10/30/alibaba-robotic-warehouse-for-singles-day.html

Botulinum Toxin Injections Between the Brows Produce Significant Patient Satisfaction Rates

Botulinum toxin type A injections are the most common cosmetic procedure performed in the United States. There were 4.3 million procedures performed in 2015 accounting for 42 percent of all cosmetic procedures in that year, based on the Cosmetic Surgery National Data Bank Statistics from the American Society for Aesthetic Plastic Surgery, (ASAPS). According to a 2016 study published in the Aesthetic Surgery Journal, the official publication of ASAPS, patient satisfaction with their overall facial appearance increased by 28 percent with injections to the so-called “11s” (the glabellar rhytids, which are the lines that appear between the brows as we age).

The satisfaction rate was determined based on participating patients’ completion of the FACE-Q survey, a newly developed and validated patient-reported outcome instrument that can be used for measuring a patient’s own perceptions of cosmetic facial procedures. The survey consists of 63 questions asking patients to evaluate their overall appearance, age appearance, and the appearance of cheeks, nasolabial folds, lower face and jawline, chin and neck.

Dr. Daniel C. Mills, president of ASAPS states, “The results of this study are not surprising and validate what we’ve suspected for quite some time. I see an ever-increasing influx of patients in my practice in Laguna Beach, California requesting botulinum toxin type A injections to the area between the brows and other areas on the face, like the crow’s feet and forehead as a preventative anti-aging or pre-aging measure from patients in their 20s up to their 70s. It’s a quick nonsurgical fix that packs a powerful punch. This new study reaffirms the efficacy of botulinum toxin type A and the satisfaction it brings to patients.”

The study’s authors examined 57 female patients who completed the FACE-Q survey. After the baseline survey, the patients received injections of one brand of botulinum toxin type A, (Botox, Dysport or Xeomin) in the region between the brows. Two weeks post-injection, the patients completed the FACE-Q survey again. The percentage changes in patient responses from the first to second surveys were assessed to determine how the injections affected patient satisfaction with their facial appearance.

Patients stated that they believe they look an average of 5.6 years younger post-injection with any of the botulinum toxin type A products. The average age of the 57 patients with pre- and post-neurotoxin FACE-Q responses was 49.6 years (range of 32-75 years old).

“This indicates that patients’ satisfaction with their overall facial appearance was statistically significantly greater after receiving the injections, and certainly accounts for the continued success of neurotoxin popularity to reduce the signs of aging,” states Dr. Ivona Percec, the study’s senior author.

To view the complete study, visit the Aesthetic Surgery Journal website, academic.oup.com/asj.

About ASAPS

The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of more than 2,600 plastic surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict code of ethics and must meet stringent membership requirements.

Courtesy of The American Society for Aesthetic Plastic Surgery