Dr. Engler on Jerseylicious – 6 minute compilation

http://bodysculpture.com/media.html

Dr. Engler on Jerseylicious – Short Version

http://www.mystyle.com/mystyle/videos/v90786_jerseylicious-getting-bigger-boobs.html

How to Choose a Breast Implant

What’s Plastic About Plastic Surgery?

Actually, quite a bit.

But do you know why plastic surgery is called “plastic?” While most people think that it’s because plastic materials (like silicone) are used in plastic surgery, the term was in use long before implants made of plastic were developed. Plastic actually refers to the strict definition of the word: “capable of being molded or of receiving form.” Used in the sense of changing the position of skin and moving skin and tissue from one part of the body to another, this meaning of plastic came to be used for the materials we now call plastics, not the other way around. Plastic surgery itself is plastic: new developments, technologies, and techniques emerge on a regular basis. These are five of the most significant trends in plastic surgery.

1) More surgery through smaller incisions, which means less scarring.
Liposuction is the best example of this trend. Virtually unknown thirty years ago, liposuction is now the most commonly performed cosmetic surgery in the United States. Using incisions that typically measure half an inch or less, nearly every part of the body can be recontoured. While the most common areas are the stomach, hips, and thighs for women, and the chest, stomach, and love handles for men (and the chin/neck for both!), it is also used on many other areas. Dramatic changes can be effected with only minimal “evidence” being left behind. Another example is the “transconjunctival lower lid blepharoplasty,” which is the removal of fat bags under the eyes using small incisions placed inside the lower eyelid itself, leaving nothing visible on the skin. This procedure is often combined with laser resurfacing to tighten the skin. A third example is saline-filled breast implants. This implant is inserted empty and then filled once it’s in place. Compared with silicone implants, which come pre-filled, a similarly sized saline implant can be inserted through a smaller incision, thereby leaving a smaller scar.

2) Younger patients having smaller procedures, and dividing one big procedure into several smaller ones. Instead of waiting until there would be the most dramatic changes, patients are undergoing procedures at an earlier age (i.e., a Maintenance philosophy). Aside from there being “less to do” on younger patients, the recovery tends to be easier. Less time is therefore lost from work and one’s regular routine. Similarly, instead of combining several procedures into one big session, patients are more likely to have a long-range plan for what they want to do, and have things done as they “arise.” Typically, this might be eyelid surgery in one’s thirties or forties and a facelift in one’s forties or early fifties, with liposuction of the chin, Botox, and Collagen injections in between.

3) The diminished role of the doctor as teacher
It used to be that the doctor was the patient’s primary – if not only – source of medical information. While the doctor remains a key resource, the explosion of information available online has changed the way information is obtained. Patients routinely arrive at a consultation already knowing a lot about the procedure(s) they’re interested in. This is really to everyone’s advantage. Patients get a lot more out of a consultation when they already know the basics. That way, they can use the time they spend with the doctor to see how the generalities apply to them, to ask any specific questions they have, and, in another function of the Consultation, to better assess the doctor and his or her office staff. In brief, the ideal – for all involved – is the “educated consumer.”

4) Newer anesthetics that facilitate outpatient procedures
In the past few years a new group of intravenous anesthetic agents have changed the way anesthesia can be administered. While typically described as deep intravenous sedation, these powerful but short-acting preparations allow people to be sedated to an appropriately deep level for the procedure itself but then to wake up relatively quickly. As an added benefit, they are associated with fewer side effects (such as nausea). Traditional general anesthesia is still an excellent – and often the best – choice, but the new anesthetics have facilitated another trend: more outpatient and ambulatory procedures in a hospital, surgicenter, or in a doctor’s office. While there are advantages and disadvantages with all facilities in which plastic surgery is performed, the unmistakable trend is toward outpatient procedures. Smaller, outpatient facilities, including doctor’s offices, offer a level of privacy and personalized, attentive care that can be difficult for larger facilities, such as hospitals, to provide. The changes in health care in general and the way hospitals are staffed and reimbursed have also contributed to this phenomenon.

5) Increased Safety
Advances in surgical technique and instrumentation as well as in monitoring capabilities and anesthesia have combined to make plastic surgery safer than ever before. For example, liposuction is now performed by first infusing a wetting solution that contains lidocaine (a local anesthetic that decreases the amount of anesthesia required) and epinephrine (which constricts the blood vessels and decreases bleeding). This combination allows more fat to be removed more safely than could be done previously when little or no fluid was injected before the surgery. At the same time, new anesthesia equipment allows more precise and careful monitoring of the patient during and after the surgery. An example is the pulse oximeter which, through a clip placed on a finger, uses light spectometry to measure the oxygen concentration in the blood. This sensitive instrument allows the anesthesia, particularly the type that is used commonly in plastic surgery, to be delivered more safely.

The plastic nature of plastic surgery has made the procedures safer and more effective than ever before. Like the lasers themselves, we can expect that plastic surgery will continue to evolve “at the speed of light.”

Botox / Dysport Prices

Botox:

$10 per unit for 100 Units (ie, $1000); $11 per unit for 50 units (ie, $550).  And you can share either vial – 50 or 100 Units – with a friend!  (as long as you both come in at the same time or within a few hours of each other..you need to keep it fresh – see previous posts)

Dysport:

$5 per unit (minimum 150 units). $4 per unit if you have 300 units – and you can share that with up to 4 friends if you all come in at the same time.

(Prices are subject to change…unfortunately….

Interested?  Please give us a call at 212-308-7000

What are the Choices with Injectable Fillers?

At present, there are five main choices when you’re talking about fillers:

1)   Hyaluronic acid gels (Restylane, Perlane, Juvederm Ultra, Juvederm Ultra Plus

2)   Radiesse

3)   Fat (your own!)

4)   Sculptra

5)   Silicone

Before we go through each of these, let’s talk about what fillers are used for.

As you age, several things happen to your face (actually, they happen to the whole body, but we’re going to concentrate on the face for now).  First, there is a loss of volume.  The youthful face typically is comparatively round and full, particularly on the cheeks.  With time, increasing amounts of that volume is lost, causing hollowing.  The second phenomenon is sagging, or loss of elasticity.  This, too, occurs on many parts of the body but, with respect to the face, it results in increased jowling and sagging of the lower face and neck, and contributes to the hollowed appearance of the cheeks.

Often, the first place this appears are the smile lines, which are also called the nasolabial lines (the deep lines that go from the sides of your nose to the corners of your mouth), which become more pronounced when you smile.  The next most common area is just below that; lines that go from the corners of the mouth down to the chin and are called puppet or marionette lines.  The last of the more common areas is referred to as the pre-jowl sulcus; it’s the hollow that forms on each side of the face between the chin and that early jowl described above.  (If there’s a lot of jowling and/or significant excess skin of the lower face or neck then you’ll need some kind of a facelift to get a real improvement.  Fillers can do a lot, but they can’t do everything).

Once you’ve decided that you’re going to have a filler, there are many choices.  One issue is how long the filler will last.  You might think that a permanent filler is the best choice, but there are many potential problems with this.  First, since your face changes as you age, what looks best right now might not in a few years.  The amount – and location – of whatever fillers you get is something that you may want to be able to adjust as you age.  Secondly, some of the permanent fillers can be associated with some – permanent – problems, or complications, particularly if your body has a reaction to them.

The most commonly used fillers right now are the hyaluronic acid products, which include Restylane, Perlane, and Juvederm (of which there are two forms, Juvederm Ultra and Juvederm Ultra Plus).  Basically, Restylane and Juvederm Ultra are the shortest-lasting fillers, lasting about 4-8 months (depending on the amount you have injected).  Perlane and Juvederm Ultra Plus last longer (about 6-12 months).  I prefer to use them for first-time filler patients until we see what each person likes, and many people stay with these indefinitely.  They are proven, safe, and effective.  And those are good things.

The first two on the list – Hyaluronic acid and Radiesse – come in prepackaged syringes and can simply be used as needed.  No preparation is required, minimal anesthesia, no downtime.  You call up, come in, and have the injections.

In addition, in the event that too much is injected into one spot they can be reversed (there are a few, very rare complications that can not be reversed) by injecting a chemical that essentially dissolves the filler.  It’s called hyaluronidase and if you’re having this procedure done, it is reasonable to ask you doctor if hyaluronidase is available just in case there’s a problem.

Each is available in individually packaged syringes that contain about 1 cc.  Most people are treated with 1-2 syringes for maximum benefit.  Some people have two syringes injected at once; others have one syringe injected at the first visit, and then come back about a month later to have more done, depending on where it is needed most.

The other prepackaged filler is Radiesse, which is a little different.  Radiesse consists of calcium hydroxylapataite (CaHA) particles which are suspended in a hyaluronic acid gel.  Those particles stimulate the growth of collagen, which is one of the building blocks of your own tissues.  As a result, Radiesse lasts longer than the straight hyaluronic acid gels. Depending on how much is injected, the correction can last up to 18 months and, in some cases, even longer.  Radiesse is available in two sizes:  0.8 cc (just a little less than the hyaluronic acid gels) and 1.5 cc syringes.  Maximum correction, as with the hyaluronic acid gels, often requires more than one syringe.

The good thing about Radiesse is that it lasts longer.  But one issue to consider is that, unlike the hyaluronic acid gels, you cannot completely reverse the effects if there’s any sort of a problem with them.  Hyaluronidase may work on the gel portion of Radiesse but it will not do so on the CaHA.  Problems are rare but, if they do occur, there is a certain peace of mind knowing that hyaluronidase is an option.

After these two fillers, the issue becomes a little more involved and, as a result, I’ll save discussions of Sculptra, Injectable Fat, and Silicone for another post.   There will also be another post that addresses the risks of fillers.

In summary, fillers are used to replace volume that has been lost as you age.  They are excellent, temporary “fixes” that contribute to an enhanced look.  To look your absolute best, you’ll probably need a little of everything:  fillers to replace lost volume, Botox or Dysport to soften frown lines between and on the sides of your eyes and on your forehead, good sunscreens and skin care all over and, for the most dramatic and longest-lasting results – surgery.

Interested?  Please call us at 212-308-7000, and come in for a consultation.

Tummy Tucks, Mini-Tummy Tucks, and Liposuction – How Do You Choose the Right Procedure(s)?

These procedures are discussed in greater detail in
Dr. Engler’s book, BodySculpture – Plastic Surgery of the Body for Men and Women.

As always, it all starts with the Anatomy and, in this case, we’re going to focus on the abdomen (the tummy) and the Love-Handles (also called the Hips, although that can also refer to the Outer Thighs).

You have to start by assessing the upper and lower parts of the abdomen separately: look at the areas above the belly button, and below the belly button, and then try to see whether you have relatively more extra skin there, or more extra fat (or both!). In general, liposuction is effective when you have extra fat but the skin tone is relatively good; a tummy tuck (or other skin tightening procedure or method) is necessary when you have a relative excess of skin, or poor quality skin (i.e., poor elasticity). This is common after pregnancy, with age, and with weight gains and losses – so the more of all of these you’ve had, the more likely that you’ll need a tummy tuck rather than just a liposuction alone.

So now let’s talk about each of these procedures:

1) A Tummy Tuck, (officially called an abdominoplasty), removes excess skin and fat from the stomach (abdomen). A horizontal (transverse) incision is made near the lower portion of the abdomen, usually just above the pubic hair. The incision (and the resulting scar) extends across the front of the lower abdomen, nearly from one hip bone to the other. In most cases, it is either gently curved or W-shaped, with rounded points. Once the incision is made, the skin is separated from the muscles underneath (the “abs”). Starting from that point, the skin is lifted up as far as the ribs (an incision is made around the belly button, which is left in place…it is reshaped later). The abdominal skin is then stretched and pulled down (like a window shade), the excess is removed, and the skin is sewn back together. An incision is made in the skin and the belly button is brought through and sewn into place so that the patient keeps her own belly button. In most cases, all of the skin between the belly button and the lower incision can be removed, and sometimes even more. The pubic mound can also be lifted and tightened, as indicated (another one of the wonderful things that can happen with…time!). The muscles of the abdomen (or more precisely the connective tissue covering them) are usually tightened as part of this procedure.

Despite the scar this procedures leaves, there are many cases in which it is the best option; sometimes it’s the only one. Many different variations of this procedure, in terms of precise location and pattern of the incisions, as well as additional minor procedures and maneuvers that can be performed to tighten the connective tissues further, are in use. The basics of the operation, however, are the removal of excess skin and, if indicated, the tightening of the abdominal muscles. Liposuction of the hips and thighs can often be performed at the same time as a tummy tuck; liposuction of the remaining areas of the stomach (e.g., the upper stomach) is often deferred to another time (several months later) for safety concerns since the healing of the entire tummy tuck may be affected adversel. This is particularly true for smokers, patients with certain medical conditions and extensive procedures, but can apply to anyone.

2) A Mini or Modified Tummy Tuck is a variant of this procedure that removes and tightens skin only below the umbilicus (belly button). It is usually combined with a liposuction of the entire stomach and, if indicated, the hips and thighs. The scar may look the same as the scar that you get with the tummy tuck, but it’s a much less involved procedure, and with many fewer risks. For that reason, I try to do this procedure whenever it’s an option. It does not tighten the skin above the belly button – but if that’s basically okay, and the main problem is the skin below the belly button, then this can be an excellent option. Safer, less discomfort, faster recovery.

An existing scar, such as from a C-section, is usually removed with either of these procedures. These scars are the result of an understandably hurried procedure (the C-section!) so it’s not surprising if the scar turns out to be less-than-perfect. Fortunately, there are lots of choices on how to “fix” them. Whether you choose to have the scar revision alone (i.e., just try to make the scar look better) or combine it with more liposuction and/or a skin tightening procedure is, of course, up to you. As always, you need to know what’s good and bad about each of the options, and then you’ll figure out what’s best for you.

3) Liposuction alone (i.e., no skin tightening). Liposuction is a GREAT procedure, but you have to know what it will and what it won’t do. It will remove excess fat; it will not “remove” excess skin. You do get some skin tightening as part of the healing process but not enough to make up for what would be accomplished with a skin removal technique such as either of the two procedures discussed above. If you have some excess fat but the skin tone is reasonably good, then lipo is the perfect choice. It is associated with many fewer and smaller incisions than a tummy tuck is, and has a much less complicated healing process. As long as it’s the right procedure!

Liposuction of the Love Handles (hips, “muffin tops”) can usually be done at the same time you’re having either of the skin removal procedures (a tummy tuck, or a modified tummy tuck) BUT you can typically have much more lipo, and of more areas, with the modified procedure than with the more formal, full tummy tuck. This has to do with concerns for safety, and the blood flow to the remaining tissue. In general, increased and aggressive amounts of lipo can impair the body’s ability to heal in the case of the full tummy tuck. In that case, additional lipo may be deferred to a second procedure, some months after the first.

Breast Lifts and Reductions

These procedures are discussed in greater detail in “BodySculpture – Plastic Surgery of the Body for Men and Women.”

A Breast Lift or Breast Reduction is a procedure in which the breasts are lifted and, to a varying degree, tissue is removed from the breast.

Many different symptoms are associated with enlarged breasts. They include neck, shoulder, and back pain, rashes, painful bra strap grooving, fatigue, and the inability to exercise or to sleep on one’s back (breathing is difficult in this position due to the weight of the breasts). Some people are skeptical that enlarged breasts can be associated with symptoms such as these, but there is no question that that is often the case. A tremendous amount of relief is achieved by these patients as a result of the breast reduction, aside from the improvement in the overall appearance, balance, ability to wear standard-sized clothes, etc.

The surgical techniques used for these two procedures are essentially identical. The amount of tissue removed determines whether it is called a Lift or a Reduction. When primarily skin, with or without a small amount of breast tissue, is removed, the procedure is called a Breast Lift, or Mastopexy (literally “securing of the breast”). When more breast tissue is removed, it is called a Breast Reduction. Even in this case at least some skin is always removed and in both procedures the nipple position is normally raised. In general, a reduction of less than about 300 grams (10 ounces) is considered a Breast Lift; a reduction of more than 500 grams (17 ounces) is routinely considered a Breast Reduction. The range in between (300-500 grams) is somewhat debatable but, depending on the patient’s BMI (Body Mass Index), may still constitute a Reduction.

Many different types of breast reduction procedures have been described and are in use. Various scar patterns are produced as a result of these procedures; the most common of these are the “lollipop”- shaped scar and the “anchor” – shaped scar. Different surgeons may have preferences for specific procedures, and certain anatomical factors can influence the decision-making process. For small lifts, particularly done at the same time as the insertion of breast implants, it may be possible to use an incision only across the top of, or completely around, the areola.

Depending on the amount of tissue being removed (in proportion to the patient’s BMI) a breast reduction may be partially or totally covered or reimbursable by the patient’s health insurance policy. There are no guarantees as to what is and what is not a “covered’ procedure; instead, each situation is unique, and those decisions depend largely on the specifics of the patient’s insurance policy.

This procedure can be performed in a hospital on an out patient basis, or in an office operating facility. Larger procedures in general, and certainly including larger breast reductions, are usually performed in a hospital.

For more information, and before-and-after photos, please visit the Breast Lifts and Reductions page of my website, http://www.bodysculpture.com

Skin Care

The largest organ of your body is – your skin! In view of that, much less attention and care are given to it than one might think. There are many ways to influence and optimize the appearance of your skin. The following is a general outline.

There are three general principles to Skin Care: 1) Maintenance of the desirable qualities you currently have, 2) Repair of any damage (caused by the sun, environmental factors, etc.), and 3) Prevention of future damage. Fortunately, currently available skin regimens can address one or more of these principles concurrently.

Optimizing the appearance of your skin starts early – when you are born. Sun exposure is the best-known negative factor: early use of sunscreen and limiting sun exposure is arguably the single most important thing that can be done…although for anyone reading this now it’s probably a little late to get the maximum effect! But it is never too late to start. Ongoing sun protection includes the avoidance of peak sun strength and UV radiation (generally about 11 am – 3 pm), and active use of a good sunscreen (ideally spf of at least 50, applied early, often, and in sufficient quantities). Beyond that, environmental influences such as smoking, exposure to strong wind, alcohol and many other factors can contribute to the suboptimal appearance of the skin.

What then – aside from the Sun Protection guidelines noted above – can be done for your skin? [Injectable treatments such as Botox/Dysport and Fillers are discussed separately.]

The simplest regimen is the daily application of a series of preparations that exfoliate the skin and produce, in effect, a very light peel. This results in skin that is softer and smoother. The treatments can also be used to improve a number of different skin conditions, including fine wrinkling, sun damage, blotchy pigmentation and dark patches, superficial acne scarring, and age spots.

The first approach is with topical skin care products; i.e., products that are applied directly onto the skin. There are many different types and lines of products and treatments available; they accomplish both the optimization of the existing appearance of the skin and the repair of existing sun damage. The bases for these treatments are any of a number of light acids such as Retin-A or alpha-hydroxy acids (e.g., glycolic acid and lactic acid). The preparations are applied to the face every night for several weeks, until improvement is achieved, and about twice a week thereafter. Other areas of the body, such as the hands, arms and shoulders, can also be treated. Dry, flaky skin can be expected during the first phase of treatment; this is, in fact, the “light peel”. A moisturizer should be used and, as with other forms of exfoliations and peels, a sunblock.

At present, our skin care is based around the Revaleskin line of products that include coffee-berry. Coffee-berry is the most effective antioxidant currently available. Antioxidants have
anti-inflammatory properties that decrease irritation. These reverse some of the signs of aging (such as fine lines and wrinkles, blotchy pigmentation, dry skin, and increased blood vessels) AND they help prevent additional damage.

Revalé and Retinoids work synergistically. For maximum effect, the antioxidants should be combined with retinoids, although either set of products can be used alone. Retinoids (Renova, TretinX, Retin-A) – produce smoother skin, flatten lines, lighten dark spots, promote collagen and elastin formation and protect against skin cancer. However, they also increase sensitivity to the sun. Therefore, you MUST use sunblock.

Conditions involving deeper layers of the skin, such as wrinkling (particularly around the upper lip, mouth and eyes), and acne scarring, often are treated most effectively with resurfacing procedures, such as laser and other light source therapies, chemical peels or dermabrasion, since the exfoliation described above is not adequate. All three modalities diminish wrinkling and produce a more youthful appearance by removing superficial layers of the skin.

Resurfacing, whether through laser, chemical peels or dermabrasion can be light, medium or deep. The use of different techniques and chemicals is responsible for this variation in depth. Deep resurfacing procedures produce more dramatic improvement than light ones, but also have a longer recovery time, and have increased risks. For this reason, a series of light to moderate procedures is often recommended in place of a single deep one. The skin is generally extra sensitive to sunlight after resurfacing, and a sunblock must be used daily. Not all skin types are equally good candidates for these procedures. In general, lighter-colored skin is considered better since darker skin may have an increased risk of pigmentary (color) changes and scarring with these procedures.

The best-known resurfacing devices are carbon dioxide and erbium lasers. Fractionated procedures, in which the energy of the lasers is administered to only a portion of the treatment area at one time, have gained popularity. Still, the depth and coverage of the treated area remain the keys to the effectiveness of any resurfacing procedure. The also are the main factors in determining the downtime and risks of the procedures. Many different “lighter” treatments are available.

The first step is a consultation, during which you can explain what you would like to accomplish, you will be examined, and then a treatment plan will be formulated. There are many different topical products, sunscreen and rejuvenating procedures available. These may include Skin Care, Botox/Dysport, Injectable Fillers, and/or Laser and Other Light Treatments. This field is rapidly changing and ever-evolving; there’s almost always something new. However, the core principles of Sun Protection, Maintenance, and Repair, remain the hallmarks of any Skin Care regimen.

Botox or Dysport?

What’s the difference between Botox and Dysport?

Well, depending on who you talk to, either a lot or very little.

Botox is, of course, better known. It’s been around for years and is actually one of the most consistently effective non-surgical treatments available. It targets those pesky frown lines and grooves on the forehead, between the eyes (the “11” lines), at the sides of the eyes, and nearly anywhere else on the face. It works by weakening the muscles that, when contracted, cause the lines in the first place. Weaken the muscles, you can’t frown as much, and the lines either disappear completely or, at least, are softened. Treatment typically lasts from about 6-9 months, depending on many factors.

Botox is actually botulinum toxin A (there’s a botulinum toxin B, but we’re not going to talk about that – yet). However, there are TWO versions of botulinum toxin A: onabotulinumtoxinA (which goes by the trade name of Botox, and is manufactured by Allergan) and abobotulinumtoxinaA (which goes by the trade name of Dysport, and is manufactured by Medicis).

So, Botox and Dysport are two versions of essentially the same thing. They are injectable treatments that relax muscles. Each comes in a vial that contains a freeze-dried powder that gets reconstituted (mixed with sterile saline) to form a liquid that can be injected.

Here’s where it starts to get tricky, because there are a lot of variables. When considering an injection, you need to know two things: how many units are being injected, and how old is the solution? Some people have been dissatisfied with the level of correction they’ve achieved, but there may be some simple explanations.

The first issue is how many units will be used. Botox is available in bottles of 50 or 100 units, so there’s a certain degree of flexibility. Most people need about 50 units (or, at least, they could benefit from that amount!) depending on how deep the lines are, how thick the muscles are (larger muscles require more botulinum) and how much correction is desired. Some people share a 50 unit vial if they just want a bit. In general, it takes about 20-40 units to get a nice correction between the eyes, 5-15 units at the sides of the eyes, and 10-40 for the forehead. One person can easily use 50 units; larger people or muscles, or a greater degree of correction, may require up to 100 units.

Dysport is packaged differently – it comes in a vial that contains 300 units. However, you generally need more units of Dysport to provide the same degree of correction as compared with Botox. Most people think it’s about 2 to 2.5 units of Dysport per unit of Botox. That means that 300 units of Dysport is ABOUT equal to 120–150 units of Botox.

But you can reconstitute the product (whether Botox of Dysport) with varying amounts of saline. Putting 4 cc’s into a 100 unit vial makes it 25 units per cc; putting 2 cc’s in makes it 50 units per cc. Putting 3 cc’s into a 300 unit vial of Dysport makes it 100 units per cc, which is then the equivalent of 40-50 units of Botox.

Confused? You don’t really need to be. What you need to know is how many UNITS you’re getting – not how many areas are being “treated” (what does “treatment” mean?), or how many “syringes” are being used (how strong is the solution?) or how many “injections” you’re getting. It’s all about the UNITS.

The next issue is how long the reconstituted product lasts after the saline has been added. Unless it’s being made up fresh for each patient, you have to know how old the product is when you actually get it. Botox, for example, says that any product not used should be discarded after 24 hours; the Dysport, packaging says that any product not used should be discarded 4 hours after reconstitution. Studies have actually shown that Botox can last a lot longer than that (up to several weeks) but it’s one of the factors to take into account if you’re considering these treatments.

For that reason, in my office we ONLY use product within the recommended time periods and, in general, make it up fresh for each patient or treatment.

One more issue is how similar the treatments are, assuming an equivalent number of units is used. There is a some disagreement over this. It has been reported that, when compared with Botox, Dysport works faster and spreads out (diffuses) more evenly. There are many possible factors involved in this, including how much saline is used to reconstitute the product (ie, how dilute it is) but this is a feature that has not yet been fully elucidated.

In summary, Botox and Dysport are excellent and equally effective treatments for facial lines, particularly between the eyes, at the sides of the eyes, and on the forehead. There are some differences, and some people prefer one versus the other, but both work well. If you’re interested in these treatments, ask your doctor the following two questions: (1) How many units am I getting, and (2) When was the product reconstituted?

Interested? Please give us a call at 212-308-7000.