Xeomin vs. Botox vs. Dysport

Botox & Dysport now have a new contender in the cosmetic space... Xeomin.

About Xeomin: (pronouced ZEE-oh-min) from Merz Pharma GmbH & Co KGaA

Download the Xeomin Report PDF

Botox, Dysport and Xeomin have a lot in common, but they also have some important differences. Unlike both Botox and Dysport, Xeomin does not need to be refrigerated before it's reconstituted (see below). This should be an advantage during distribution. What's more, Xeomin has no additives — just botulinum toxin type A. This may lessen a patient's likelihood of developing antibodies.

Supposedly, Xeomin is more like Botox than Dysport. It takes about one week for the full effects of Xeomin injections to be realized, and once this occurs the results last from three to six months. Dysport, Xeomin and Botox should not be used interchangeably.

Also, since Xeomin is approved only for cervical dystonia and blepharospasm in adults who have had previous treatments with onabotulinumtoxinA (Botox), any use for wrinkles and crows feet is going to be off label. This, along with the fact that Botox pretty much owns this space will probably mean that Xeomin will have a hard slog finding a huge audience. It may be worth trying thought to see if you just like it that much better. (Anyone who's already tried it, please leave a comment and let us know what you think.)

Storage

Unopened vials of XEOMIN® (incobotulinumtoxinA) can be stored at room temperature 20 to 25°C (68 to 77° F), in a refrigerator at 2 to 8°C (36 to 46°F), or a freezer at -20 to -10°C ( 4 to 14°F) for up to 36 months. Do not use after the expiration date on the vial. Reconstituted XEOMIN® (incobotulinumtoxinA) should be stored in a refrigerator at 2 to 8°C (36 to 46°F) and administered within 24 hours.

Indications & Usage

Cervical Dystonia: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with cervical dystonia to decrease the severity of abnormal head position and neck pain in both botulinum toxin-naïve and previously treated patients.

Blepharospasm: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with blepharospasm who were previously treated with onabotulinumtoxinA (Botox).

Complications

Like other botulinum products, Xeomin must carry a black box warning regarding a rare risk for spreading outside of the injection site. If this occurs, life-threatening swallowing and breathing problems may result. This has not been seen in people receiving neurotoxins for cosmetic reasons or to treat blepharospams. It has mainly occurred among children treated off-label for cerebral palsy-related muscle spasms.

Adverse Reactions

Cervical Dystonia: The most commonly observed adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN 120 Units and XEOMIN 240 Units, respectively, were: dysphagia (13%, 18%), neck pain (7%, 15%), muscle weakness (7%, 11%), and musculoskeletal pain (7%, 4%).

Blepharospasm: The most common adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN were eyelid ptosis (19%), dry mouth (16%), visual impairment (12%), diarrhea (8%), and headache (7%).

Drug Interactions

Concomitant treatment of XEOMIN and aminoglycoside antibiotics, spectinomycin, or other agents that interfere with neuromuscular transmission (e.g., tubocurarine-like agents), or muscle relaxants, should be observed closely because the effect of XEOMIN may be potentiated.

Pregnancy

Pregnancy Category C: There are no adequate and well-controlled studies in pregnant women. XEOMIN should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Cost

The costs are expected to be similar to Botox. I checked over on Medical Spa RX and they don't seem to be carrying it as of now so you won't be able get a deal on it the way you can with Rx's Botox Group Buy Program.

Have you got any intention of trying something besides Botox or Dysport? Does Xeomin have a chance in your clinic? Would you try it on a few patients to see if you like it?

Botox Training MD Special Offer

Botox Training MD has slashed their Botox training course membership for a limited time.

I'm not sure if this is just a temporary discount or a new pricing strategy but if you're in need of some botox or filler training this would be a great opportunity to snag all of this at a fantastic deal.

Check out what's included in this offer:

As A Botox Training MD Member You'll Have Access To Everything You Need To Know To Add High-Profit Botox & Dermal Filler Treatments To Your Practice:

• Hands-On Botox & Filler Training Videos: Learn how to perform all common Botox and dermal filler treatments with 11 detailed video overviews and demonstrations; Brow lifting, crows feet, gummy smile, smile lift, lower face treatments and more!
• Comprehensive Training & Resource Guides: Illustrated PDF treatment guides showing exactly how each treatment is performed and how it can be modified for the best results. Resource Guides show you where to find the best deals on products and services to grow your cosmetic practice, from legal services to marketing resources.
• Insider Secrets From Experts: 5 interviews with physician experts that are already raking in cash that give you insider info on exactly what works; marketing, consultations, up-selling, pricing and more! Our experts spill the beans on everything from perfecting your consultation, to training your staff, to exactly how to prevent unhappy patients. These interviews give you access to information you can't get ANYWHERE else and are easily worth the membership all by themselves.
• 5 Special Bonus Products: Q&A sessions, patient marketing tips, consent forms, before and after pictures for your use, and the special Ultimate Botox Guide, a 35 page patient marketing eBook to distribute to your existing or prospective clients to position yourself as the expert in your market!

• FREE Botox Marketing Mini-Course: Just ask to be notified above (you don't have to by anything) and we'll send you a free mini-course on marketing your new cosmetic services! You'll find out how to set up your legal structure, where to outsource and where to do-it-yourself, and how to train your staff. It's completely free and without any obligation!

See the training course here: Botox Training MD

Texas Law & Botox Regulation

Eveidently, and this surprises me, if you're in Texas, anyone can inject Botox, Restylane, orJuvederm if they're 'delegated to' by a clincian.

Is this why the individuals and websites that were leading the do-it-yourself Botox injections hailed from Texas?

• DIY Botox Injections
• Botox Self Injectors & Entitlements
• Fake Botox Or Not, Discount Medspa Is Going To Jail

Hopefully, Texas will get it's act together and finally pass some sensible regulation around Botox and injectables. Undoubtedly there are individuals who have been injecting safely and will be affected by this but it's just not a good idea to have anyone able to inject.

via WFAA.com

Last year, actress Dana Delaney opened up publicly in Prevention magazine about getting a botched Botox job that caused one eye to droop. She said the wrinkle fighting toxin was improperly injected into a nerve.

Botox and other injectable treatments are controlled substances. Only someone with a medical license can order them. That has many surprised to hear there are no rules about who can inject them. In medical spas across Texas, just about anyone can wield the needle.

“As long as I’m the one purchasing it, right now I can delegate to whoever I want to,” said Dr. Lori Stetler, a Dallas dermatologist.

Stetler applauds efforts to make the lucrative anti-aging industry safer for patients.

Friday, the Texas Medical Board will consider changing who can be delegated to perform “cosmetic procedures” that use “prescription medications.” That includes Botox and a host of other wrinkle fillers, including Restylane and Perlane.

Among the considerations is limiting who can give injections to doctors, nurses or physician assistants. Training is also an issue. Currently, no experience is required.

“There’s no set or approved curriculum or licensure or anything for that,” said Stetler, who says patients can unknowingly find themselves in unqualified and inexperienced hands.

She hopes potential state-wide changes will improve the safety profile of all anti-aging clinics.

“I like the idea that they are looking into and hopefully will get rid of some of those people who are harming the public,” she said.

Friday will be the medical board’s first discussion. Action is unlikely. If the board eventually changes the regulations, anyone who breaks the rules could face punishment or potentially lose their medical license.

"Action is unlikely?" What is going on in Texas? Why would the Texas Medical Board be unlikely to take action and follow almost every other state on this issue? Who are the doctors arguing against this?

By this reasoning it should be possible for Texas physicians to run 'Do It Yourself Botox Course' and teach patients how to inject themselves...

Botox: Allergans (Still) Big Seller

Every successful cosmetic clinic that I know of is a big consumer of Botox by necessity. Medspas, derms, clinics and in many places dentists offer Botox and move a lot of it.

Here's a really good artitlce on how Allergan has positioned Botox to be a really stable source of income over the long term.

Via CNN Money

Alergans Survival Strategy: Botox Everlasting

Most big, mainstream pharma companies are desperately working to develop new expensive drugs and filing lawsuits to extend patents on old ones. But to dodge that deadline, Allergan is using another strategy; let’s call it the “stay small and make weird products” approach.

The company behind Botox, the “face-lift in a bottle,” is itself aging rather gracefully. Net sales increased by 13.3%, to roughly $1.3 billion, in the first quarter of 2011 compared with the same period last year, and the company has given analysts no reason to think it won’t put together a string of good quarters.

That’s because Allergan’s product portfolio is looking first class: “We believe Allergan has one of the most compelling growth profiles in specialty pharma,” a May report by Piper Jaffray analysts David Amsellem and Michael Dinerman said. But pharma companies need more than a good growth strategy, says Ken Cacciatore, an analyst with Cowen Group. They should also develop new products and have plans to keep the patent rights for the ones that they already have. “That’s really the holy grail of pharmaceuticals,” he says, “and Allergan has it.”

The holy grail

A huge part of Allergan’s patent-cliff immunity is its blockbuster Botox, which has helped the company evade the patent problems facing others in the industry in two ways: First, Allergan has continued to discover new applications for it. “Really, Botox is a Russian doll,” says Allergan CEO David Pyott, because Allergan keeps discovering new uses stacked inside the original treatment.

Second, Botox is also a special pharmaceutical because of the way it’s made. “It’s going to be very difficult for anyone to get a truly substitutable product through the FDA,” says Cacciatore.

That’s because Botox is something called a biologic, which means it isn’t man-made. Instead, Botox is created by making a solution that contains trace concentrations of the deadly botulinum toxin. Botox works in both the medical and cosmetic arenas by temporarily paralyzing targeted muscles. For example, Botox injections into the eye muscles can help patients suffering from a condition called strabismus, in which their eyes are misaligned. In a more vain vein, cosmetic Botox reduces the appearance of wrinkles in the forehead by numbing facial muscles so that they can’t contract to form creases.

Allergan and doctors have found muscle paralysis can be useful in other places: Allergan plans on getting Botox approved to treat patients with neurogenic detrusor overactivity, or overactive bladders, this year. Last year Botox was approved to treat chronic migraines, which is one of Allergan’s most promising markets, according to Ben Andrew, an analyst from William Blair & Co. Botox has the potential to be the first treatment of its kind in that space, he says, because it’s preventive: “Every other FDA-approved product is used in response.”

Botox’s success as a treatment for chronic migraines could surprise the market, according to Gary Nachman, a senior analyst in specialty pharmaceuticals with Susquehanna Financial Group: “You’re looking at a potentially huge blockbuster that people are really not giving them full credit for.”

Product diversity

Allergan is unique, says Lavin, because it has positioned itself well in three distinct sectors: ophthalmology, obesity, and cosmetics, all of which target the aging, sedentary population of U.S. consumers. “I think of aging and obesity as two areas I’d like to invest in,” he says.

Allergan can develop in seemingly strange sectors because of its relatively small size. It has a market cap of about $25 billion, compared with, say, J&J (JNJ, Fortune 500) and Novartis (NVS), which have market caps of $183 billion and $145 billion, respectively. “A company like Allergan still has a small enough base revenue that incremental hundreds of millions matter,” says Cacciatore. “Large pharma companies have consolidated themselves into a box where they need incremental billions.”

Allergan’s growth strategy allows it to invest in niche markets heavily enough to be a persistent threat to much larger companies. It’s a phenomenon that CEO David Pyott enjoys: “I remember years ago when I was relatively new at this job, and people said, ‘Do you really think you can compete against Pfizer in ophthalmology?’ We’d just smile and say, ‘We love taking market share from those guys.’ ”

Method to the madness

Allergan’s portfolio looks bizarre at first glance, but there is a pattern to much of its drug development.

Take Latisse, for example. Allergan researchers noticed that patients using its glaucoma treatment Lumigan were also growing longer lashes. The company then conjured up a medical condition, hypotrichosis, or inadequate eyelashes, to pair with its newly made drug. Allergan essentially created the market for Latisse, which was approved by the FDA in 2008. The company expects to make over $500 million from Latisse — again, a drug it had already invented and released as Lumigan.

Latisse is just one example of how Allergan aims to keep improving its own technology to discover new drugs, renew patents for existing ones, and find new uses for both. Pyott says he has overseen the growth of the company’s research and development budget from $80 million when he joined 10 years ago to $800 million this year. That’s about 16% of total sales that Allergan plows back into R&D.

Dysport hasn't really made a huge difference and for most medspas or clinics it's certainly still playing second-fiddle. )I'd be interested if anyone has information they could add as a comment as to exactly where Dysport sits as a percentage of market share right now.)

Managing Patient Expectations Part 2 - Botox Training MD

Read Managing Patient Expectations Part 1

Managing patient expectations is a learned skill but one that you have to master in order to run a competitive and profitable cosmetic practice.

Be aware of is patients who are complaining about previous providers. It's a potential indicator that this client might be a difficult client to deal with.

Clearly if someone is continually bashing another doctor (provided that the didn't do something that caused obvious harm) and they're angry with that doctors and his staff, that's going to put me on guard.

Now, there are situations where a patient's anger is appropriate.

I have a patient right now, that for years, went to another provider, and when she came to me and told me that she's switching providers, I did become a little alarmed right out of the bat. But once I got to know her my misgivings were removed. She had been going to this other physician for years and years and years, and she was upset with him because of the treatment she received for the previous several injections... but she attributed it to the front desk since the clinic had became very busy and impersonal. So I think you have to look at each patient individually. She was legitimate with her complaint and we have a great relationship but there are others.. If a patient is very, very angry, and constantly bashing a former provider and complaining about results you need to be aware, because you could be the next one on their hit list.

I think it's important to take as much time as you can so that you're comfortable and the client's comfortable. To simply make a decision that you're not going to treat that patient and you are now wasting your time, sitting in that room with the patient is the bad approach because then the patient's gonna be angry.

As far as I know, I've never sent anybody out of the office angry because I declined the treatment.

I really make the decision very rapidly as to whether I'm going to treat them or not. I think with time you develop that. I know within the first minute or so if I'm going to treat or won't, but I spend the same amount of time sometimes for both of them - the person I'm going to treat versus the person I'm not going to treat -  because to make that person angry is not what I want to do for a number of obvious reasons.

Often, I can convert them into doing something else that's realistic or telling their friends that's I'm genuine person.  I listen to exactly what they want and I try to understand what they want to have done. Sometimes it's a very small,small correction they're asking for and I don't think I can alleviate it... a very tiny line that I can barely see. So I listen to them, I give them a mirror, I have them point it to me. I try to totally understand what they are pointing up. And most of the time, I can see what it is they want me to correct.

However, if I don't think I can correct it and I think that it's unrealistic, I don't tell them: "That's unrealistic", I explain to them the limitations of the product and the scientific discussion. This product is made for this procedure, not unfortunately for what you want to have done and what you want to have done, I'm unable to correct this in the way that you're asking for.

Some patien'ts don't accept that and will respond with..  "But you're a plastic surgeon or you're an aesthetic physician, this is what you do." So then you have to educate them more with, "Unfortunately we don't have all the tools available". (The 'no magic wand' defense.)

So, even if you've decided that you're not going to treat a specific patient, I think it's really important to spend time with them, see what they want you to do and have them leave happy.

Botox vs Dysport: A Comparison

By plastic surgeon, Marc Sheiner MD

What's the difference between Botox and Dysport?

The following discussion will explore Dysport and Botox Cosmetic in the United States, stressing the differences and the similarities between them. The discussion will begin with the similarities between Dysport and Botox.

Both of these roducts, Botox and Dysport, are neurotoxins. Specifically, they're type A Botulinum toxins that are Citicholine release inhibitors. Both therefore block the Citicholine release and prevent the communication between the nerve and the muscle, temporarily immobilizing muscles that produce wrinkles. Both are similarly FDA approved for the temporary improvement in the appearance of moderate to severe glabellar lines associated with Procerus and Corrugator muscle activity, i.e. the frown lines. Both are supplied in vials, and the fine powder requiring reconstitution with saline and both are injected in the facial muscles with a 30 gauge needle. In addition, both are also used off label to treat crow's feet and forehead lines or the lip line, essentially anywhere a rhytid or a wrinkle is present.

It has been reported that Dysport has a quicker onset, that is, people notice the effect of Dysport in 1-2 days as opposed to 4-7 days with Botox. Also, it is commonly reported that Dysport diffuses over a wider area than does Botox. This make some importance when treating areas around the eyes and that you can use a smaller amount of Dysport and alleviate potential complication such as ptosis (sagging or drooping of the eyelid). There are also some reports that people state that Dysport is less painful although this is not proven in any scientific literature. In addition, there are reports that Dysport may actually last a bit longer than Botox. Typically, Botox remains effective for 3-4 months and some reports say that Dysport may act a bit longer, 4-5 months.

Now for the differences among the 2 products. (Some of the differences are scientifically proven while others are anecdotal references.)

To begin with, Botox is supplied by the manufacturer Allergan in 150 unit vials. Typically the 100 unit vial is supplied for $525. Dysport is supplied by Medicis in 300 and 500 unit vials. The 300 unit vial typically goes for $475. So if the Botox and the Dysport vials are divided by units, one can see that 1 unit of Botox costs $5.25 with 1 unit of Dysport costs $1.50. However, the difference does not equate to a cheaper product if you will because you actually require more Dysport to obtain the same results with Botox. And we will discuss that in a moment.

The Botox is used in a fashion exactly the same as Dysport. However 1 unit of Botox does not equal 1 unit of Dysport. Typically, anywhere from 2.5-3 or even 4:1 ratios of Dysport to Botox is effective. So, that is to say that you may require 2.5 or 4 units of Dysport to obtain the same result as you would with 1 unit of Botox. For example, the glabella is typically treated with 5 injections of Botox, 4 units in each site and that's a total of 20 units. With Dysport, you actually use 10 units in 5 sites for a total of 50 units. Another difference is the reconstitution.

Reconstitution simply means the product needs to be dissolved in normal saline. There are many ways to do this. I typically apply 2.5 cc's of normal saline to a 100 unit vial of Botox, which will give you 4 units of Botox per 0.1 ml of fluid.

With Dysport, you place 1.5 cc's of normal saline into the 300 unit vial and that would equate to 10 units of Dysport per 0.05 mL or cc's of fluid.

Those are some of the similarities and differences. I would now like to discuss some of the questions that typically are asked by clients when they are deciding whether to use the Botox or Dysport.

One common thing that I hear often is one of the products is better than the other. I explain to them that basically both are the exact same product aside from some molecular differences. And I explain that some report subtle differences regarding quicker onset, but in my experience both products produce the same results and last essentially the same amount of time.

Another question I often hear is one of the products associate with more complications than the other product. And I tell them no, that both of the products are associated with the exact same side effects profile. You can obtain bruising, swelling, redness, ptosis from both of the products. However, Dysport is a relatively new product in the United States and Botox has been used for a greater length of time so the exact safety profile of Dysport has not been illustrated to date.

Another question I sometimes hear is why should I choose Botox over Dysport? If I'm asked that question, I don't make the decision for the person. I will occasionally help them along by explaining to them that I personally use on family members and what product most clients use. I tell them that they both predicatively improve wrinkles and in my office they're both the same price. You'll read a lot of information that Dysport is cheaper.  And of course if you do the math, 7:01 in the beginning you'll see cheaper per unit but you need to use more units. Still, when you do it that way, Dysport does come out to be more affordable. However, I offer them both at the same price after discussion, explaining to them that both of them have the same side effect profile and produce the same results.

And if you present them with that information and then say one is more expensive than the other, most people obviously choose the cheaper one so I just keep it in the office as an added product you know, cause some people  do actually prefer one product over the other, that's why I keep it in my office.

So, in conclusion, although there are subtle molecular differences between Botox and Dysport, both are injected exactly the same way, both have the exact same indications, that is the treatment of facial wrinkles or rhytids and both require reconstitution with normal saline. In addition, both have the similar side effect profiles and both, in my practice are similar in price. Although as mentioned, some practitioners will offer Dysport at a decreased cost. Also, some clinicians do report a quicker onset and a longer duration of action of Dysport but presently, this does not appear to be clinically significant.

In my opinion, again, I offer a choice because some people prefer it and other people actually like to try new products. My vote goes to Botox cause of it's long safety record and the fact that it's on the market for such a long time and I have predictable results with the product. However, I do think it's an added product for all aesthetic practices.

About: Marc Scheiner MD is the primary instructor for the online botox training course for clinicians at BotoxTrainingMD.com and is the owner of O'leigh Aesthetic Surgery Center in Elkton, Maryland.

Managing Patient Expectations Part 1 - Botox Training MD

Managing patient expectations are crucial to the success of any aesthetic practice.

If you are not 100 % on board with understanding and dealing with patient expectations, I believe it's going to be difficult to be successful with any aesthetic practice.

The way that I manage patient expectations starts from the initial correspondence with my clinic. My front desk staff typically will notify me if anything out of the ordinary is discussed on the phone at a new patient's consultation request. So, if for instance, they have a request that's perhaps out of the ordinary or they're perhaps not comfortable with the way the conversation went, they'll let me know so I'll have right off the bat, I'll have a little understanding that maybe it'll take a little bit more time with describing what can be done or perhaps the mode where I am not going to perform a procedure.

It's just as important and more difficult sometimes to actually refuse to perform a procedure than it is to do a procedure, have an unsatisfactory outcome, and recover from that. So I want to make that kind of clear again that if somebody presents to you that you do not feel comfortable treating, it may be more difficult to refuse that treatment than it is to actually deal with somebody who develops a complication or unsatisfactory result. However, interestingly enough, if you take the time to explain to a person why you don't feel you can't perform what they want, it can actually turn into a positive experience in the form of her/him recommending other patients to you. Or maybe that person selecting a different treatment that you offer. So, again, we start off right out of the bat, by making sure that our front desk is well aware that I need to be informed of anything out of the ordinary when a patient calls or comes in for the first time, not matter what it is.

There are two things I'm looking for. Out of the ordinary being number one, and number two would be behavior that is really not acceptable social behavior, like anger or overly demanding behavior. I like to know that too because if somebody is angry or demanding with the front desk in an unacceptable manner, then that is a clue that perhaps their behavior will be the same after I treat them.

If you're in this field long enough, you're going to hear some strange requests.

We get calls not too infrequently, once or twice a year from clients that are in the process of changing from a male to a female or a female to a male and they would like to have some, not only surgical procedures but some nonsurgical procedures like Botox or Dysport and a filler like Restylane or Juvederm. Typically, they are often required to have psychiatric evaluation before they undergo the actual transgender operation. So I've had a few instances where I had to contact their psychiatrist or actually put them in contact with a psychiatrist before treating them. So that's a little out of the ordinary.

And the other out of the ordinary are extremes of age. Teenagers calling for Restylane to augment their lips or Botox and knowing how to deal with that. And that would simply be... they have to be over 18. I mean you have to understand the..or appreciate the indications for Botox and it's right on the label.

Read: Managing Patient Expecations Part 2

About: Marc S Scheiner MD is a plastic surgeon who teaches Botox and filler injection technques to physicians and clinicians through Botox Training MD and his 14 credit CME two-day hand's on seminars.

Botox For 8 Year Old Girl?

Botox Mom is shooting up her 8 year old.

You'll have to watch an advertisement, but Anderson Cooper's take on Botox Mom illegally shooting up her 8 year old daughter is worth watching.

Of course Botox Mom isn't the only one finding and using Botox themselves as we've discussed before in these posts:

• Fake Or Not, Discount Medspa Is Going To Jail
• Botox Self-Injectors & Entitlements
• Do It Yourself Botox: Are These People For Real?

The 'Botox' vial shown in the clip clearly doesn't have a hologram and I can't believe it's real. I'm guessing that it's some fake from China.

It shouldn't be too hard to find out where she, and these other 'pageant moms' are getting this.

The American Society of Aesthetic Medical Professionals

We're happy to announce a new partner for Medical Spa MD, the American Society of Aesthetic Medical Professionals.

The American Society of Aesthetic Medical Professionals was founded by plastic surgeon Dr. Marc Scheiner and runs a number of Botox and filler injection training seminars, generally in the North East. Their training courses are attended by physicians, dentists, nurses, physician assistants, and nurse practitioners who are interested in adding Botox and fillers to their practice. You can find their main site here and view their upcoming course dates and registration page.

Their training training courses take place over 2 days. The first day of training is dedicated to Botulinum Toxin injections and the second day to dermal fillers. You may choose to attend one or both days of the course.

Here's some info about the course from the ASAMP site:

The courses assume you have no experience in aesthetic medicine and are designed to educate you in the evaluation and treatment of facial ageing using Botulinum Toxin and dermal fillers. You will be trained to inject Botulinum Toxin and dermal fillers with an experienced plastic surgeon. Participants in the certification courses will inject actual undiluted Botulinum Toxin and Dermal Fillers. You will find that many training programs use diluted Botulinum Toxin or normal saline. We will maximize your learning experience by replicating an actual client encounter using the correct product and live models. This is a hands-on course and you will be required to inject the products using a model that you bring.

After participating in many different training seminars it has become apparent that the most effective way to teach cosmetic injections is to have the participants provide their own models. Previous experience teaching injection methods using volunteer models has been unsatisfactory as often the models only want 1 or 2 areas treated. This leaves the participant without hands-on training in all areas. Furthermore, it is beneficial to the injector to actually see the results of his/her treatments in the weeks following the treatments. With a volunteer model, the participant will likely never see them again. Finding a model to inject Botulinum Toxin and dermal fillers requires you to simply bring a spouse, friend, brother, sister, mother, employee, or any other willing participant.

At the completion of your Botulinum Toxin and Dermal Filler training you will have the tools, as well as the confidence, to begin injecting Botulinum Toxin and Dermal Fillers on the day you return to your practice. In addition, as mentioned above, your course fee includes 12 months of complimentary telephone and/or e-mail support. If at the conclusion of your training, you feel that you are not able to begin injecting Botulinum Toxin or Dermal Fillers, you can repeat the course at no cost**. As you can see, our goal is to not only give you the absolute highest level of training but to provide you with on-going support as you begin to grow your aesthetic practice

There's always been a tremendous interest in training courses on Medspa MD. We hope that the inclusion of ASAMP and Botox Training MD will bring a valued asset to the commuity.

Botox Self Injectors & Entitlements

Women are still injecting themselves with fake Botox?

The stupidity of some people continues to astound me. Here's a comment that I received from 'Regina'.

I could rail on this for quite some time but I think that Regina does an excellent job of displaying her ignorance and self-entitlement for cosmetic treatments that she evidently can't afford.... Amazing.

I can no longer afford Botox. I paid $670 for three areas and now I broke the bank,  I have to pay it back with very high interest (23%) .
Do the doctors care about my financial problems?  NO!  In fact, I have never seen a more careless crowd of ignorant  doctors,  when they sell me Botox. Why?  Because they are profiting from Botox and then they date younger women with my money, while I cry myself to sleep without a dollar in my pocket. .
I injected myself with Hyaluronic Acid from Brazil and I am looking just fine and people are impressed with my independence and courage.

Now, I will go ahead and order Botox from China and inject myself. I hope Allergan goes broke and China will win over this greedy world of US doctors. Hopefully, China is going to swamp the market with Botox, inject-able fillers, clothe and  what no all ---and the banks have been bailed  with my money  for nothing,  fatcat bankers putting aside very high amounts of money only to fall very  very low.  Love is all  God's money and that  I have left and I love Botox from China.

- Regina  kiwibird@bellsouth.net

Regina here doesn't mention it but I'm wondering if she feels that insurance companies should pay for her Botox treatments?

She's certainly a trusting soul since Botox from China is actually not 'Botox' at all. I can't imagine what the though process is for someone who will squirt who-knows-what into their own face.

Allergan Shifting Headache Sales Reps to Botox

Allergan sales forces previously working on GlaxoSmithKline headache drugs Imitrex and Amerge as part of a co-promotion will be reassigned to Botox, in support of the drug's new headache indication.

The move,  confirmed by a company spokesperson,  gives Allergan a jump start with headache specialists, since the GSK co-promotion deal was “a very good way for Allergan to learn the headache market,” Allergan CEO David Pyott told the Journal. Crystal Muilenburg, a spokesperson for Allergan, says that sales forces will initially target neurologists, pain, and headache specialists, to train them on Botox's “injection protocol and dosing regimen.” Muilenburg declined to estimate the number of reps that will support the headache indication, which received an FDA green light on October 15. GSK drugs Imitrex and Amerge have lost patent protection.

A key challenge that we started addressing immediately upon FDA approval is reimbursement,” said Muilenburg. “As with many new drugs, reimbursement is not widely established for Botox in this new therapeutic category.”

Physicians or patients looking for information on reimbursement can visit a dedicated website, call 1-800-44-BOTOX (option 4), or locate a Botox reimbursement business manager for “on-site education, training, and support,” according to the website. Physicians can also sign up to receive forthcoming treatment records and case studies on the headache indication, as they become available.

Allergan paid $600 million to settle Justice Department charges of off-label marketing in September, and pled guilty to marketing Botox off-label for conditions including headache. As part of the settlement, Allergan was forced to drop a First Amendment lawsuit challenging FDA policy on the exchange of “truthful scientific and medical information,” a spokesperson reported at the time. The pending approval in September of Botox for an ailment that previously existed as an off-label use sparked rumors about a relationship between Allergan's lawsuit and FDA's approval of the headache indication, rumors which Muilenburg quelled: “The FDA granted approval of Botox for the treatment of chronic migraine patients based on two phase III pivotal trials, and on its own merit,” she said. “The two actions are completely separate matters.”

Botox's headache indication, specifically, is for the prophylaxis of headaches in adult patients with chronic migraines. GCI Health has been awarded the PR account for the indication. Muilenburg declined to reveal other agency partners for the headache indication launch.

Botox Of The Upper Face Tutorial

Botox Tutorial: Injecting crows feet, forehead and the upper face

This advanced Botox tutorial covers a number of Botox treatments around the forehead and around the eyes including injecting the Frontalis, Obicularis Oculi, Corrugator, Procerus muscles.

Botox Of The Lower Face Tutorial

Botox Tutorial: Injecting the lower face

This advanced Botox tutorial covers a number of Botox treatments around the lower face including injecting the DAO, Mentalis and DLI.

Injecting Botox As A 'Medical Esthetician'

It seems that there are medical spas that are having non-medical staff performing medical treatments... In this case, Botox injections.

Here's a comment that someone posted on the comment thread from the post: Medical Assistants Can Not Inject Botox.

As a medical aesthetician I have injected under a physician's supervision for nearly eight years. That is the concept of a med spa? Medical Aesthetic procedures delivered under a physician's supervision. I have more often seen patients injured by laser treatments. In fact, in a decade of working in spas that offered Botox, I've never seen serious side effect. I've seen one temporarily droopy brow, once, injected by a "diamond" injector physician.
AestheticInjector

@Aesthetic Injector
You may have been doing this. Your supervising physician may know that you're doing this... but this is not legal in the US (or Canada or Euroope as far as I know).

First: There is no such licensee as a 'Medical Aesthetician'. If you're an esthetician working in a medical spa, you're an esthetician working in a medical spa. You have no expanded scope of practice or licensure about what medical treatments you can perform. Your esthetican license allows you to perform certain treatments... none of which allow you to break the dermis. You have no licensure that allows you  to perform injections. In this case there is no difference between an esthetician and the front desk staff (or anyone off the street).

Second; you equate what you're doing directly with a physician. In this you're correct. You are indeed performing medicine.

However, your supervising physician can not extend his or her license to allow you to perform Botox injections. It does not matter if the physician knows about it. It does not matter if the physician trained you to do it. It does not matter if the physician tells you to do it. The fact that it's relatively easy and that you've been doing it (even successfully) is irrelevent. Your physician can not 'expand' the treatments that you're licensed to perform. Injecting Botox is not one of them. There is no legal difference between what you're doing inside of this 'medical spa' and what you would be doing if you were injecting Botox in a motel room somewhere, other than the physician that's allowing you to do this is on the chopping block too.

Third; If you have any issue at all, you are not going to be covered by any malpractice carrier. You (and your supervising physician) are performing entirely without any net or recourse. Your supervising physician is probably in deeper water since his or her medical license is also at risk.

You mention that you've seen 'diamond' injectors who's Botox treatments have resulted in drooping around the eye. This is a known potential complication with Botox. So, if a diamond level physician who's squirting Botox day and night can have a complication, what are the odd that you could run into any sort of complication?

If you ever perform a treatment with a negative outcome that results in any investigation, you'll be found to be performing medicine without a license, without malpractice coverage, and without a chance of any good outcome.

So, what's going to happen?

Truthfully, I don't know, but here's a probable outcome based on experience.

Something is going to go wrong; you're going to have a complication, a patient is going to be unhappy, a staff member is going to be fired but has a grudge... something will happen. It always does at some point. It may even be unrelated.

Someone is going to point out that this clinic is operating outside of both legal and ethical guidelines, and then it's going to get ugly. If it involves a patient or civil suit it's going to be even uglier. These things have a way of cascading out of control.

If you disagree, I'd truly love to hear your arguments.

Anyone else want to weigh in on this?

Botox vs Dysport: Which one is more effective?

Botox vs Dysport? Well, Dysport as another few arrows in the marketing quiver with a new study that says that Dysport is more effective than Botox in treating glabellar lines.

Here's a release from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) that claims thta Dysport is actually more effetive than Botox.

The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) today announced positive clinical results demonstrating a significant efficacy advantage with Dysport™ (abobotulinumtoxinA) over Botox^® Cosmetic (onabotulinumtoxinA) for the treatment of Crow's feet. The data were presented Friday, September 24 at a scientific session at the AAFPRS 2010 Annual Fall Meeting, taking place September 23-26 in Boston.

Downloadable photos, fact sheets and other supporting materials available here: http://www.multimedianewscenter.com/aafprs/dysport-data-shows-superiority-versus-botox-cosmetic

The 90-subject study, titled "Internally Controlled Double-Blind Comparison of Onabotulinum and Abobotulinum Toxin Type A (Nettar, Kartik D., M.D., et. al)," met its primary endpoint (p=0.01) of greater efficacy of action with Dysport™ as defined by investigator assessment of maximum contraction at Day 30 post injection compared to Day 0. Additionally, a secondary endpoint -- subject assessment at maximum contraction at Day 30 compared to Day 0 -- also demonstrated statistical significance with Dysport™ (p=0.027).

"Botox has long been considered the gold standard of injectables, so this data showing Dysport's stronger efficacy is compelling," said Corey S. Maas, M.D., F.A.C.S., AAFPRS Group Vice President for Public and Regulatory Affairs. "Since injectables are the non-surgical cosmetic procedure rising fastest in popularity, it is important to continue honing new applications for existing treatments. Dysport's potential here is exciting as Crow's feet are a common concern for many men and women."

The study concluded that Dysport™ offers a quantifiable and demonstrable advantage in wrinkle effacement (shortening) and hyperfunctional frown lines compared to Botox^® Cosmetic in the treatment of Crow's feet. Study investigators recommend further studies in additional facial regions to confirm the data.

Both Botox^® Cosmetic and Dysport™ are FDA approved for treatment of moderate-to-severe glabellar lines (vertical lines between the eyebrows); neither product is presently indicated for treatment of Crow's feet. The study was funded by an educational grant from Medicis Aesthetics.

Additional Study Information: The randomized, double-blind, internally-controlled (split face) study was conducted at the Maas Clinic in California. Ninety subjects (75 females, 15 males) with moderate-to-severe lateral orbital rhytids (Crow's feet) were enrolled in the study. Participants received equivalent doses of both treatments: 10 units of Botox^® Cosmetic on one side of the face and 30 units of Dysport™ on the other side. Investigator and subject gradings of Crow's feet at relaxation and maximal contraction were obtained using the published validated dynamic and static Merz Crow's feet grading scale before injection (Day 0) and then two, four, six, and 30 days post injection. All patients were photographed in standard five-view series at rest and at maximal contraction in a dedicated photo lane recorded by Mirror software. Additional secondary endpoints not met in the study include investigator assessment at rest at Day 30 (p=0.41) and subject assessment at rest at Day 30 (p=0.28).