Botox? Restylane? Juvederm? Lose the wrinkles & get a job.

The unemployment rate for the month of June for the U.S. was hovering around 9.7% according to the U.S. Bureau of Labor and Statistics. Some of my own family members have found themselves out of work after being in management positions for years only to be replaced by younger, cheaper laborers. Skilled individuals are being turned down for new job opportunities, but for what reasons?

People I know who are out of work state that they are told they are "over qualified" for the open position, or their salary requirements are "too high" for the company to met during these struggling economic times. Okay. I understand that.

Recently, our medical spa was interviewed by a local newspaper who was writing an article about older unemployed people turning to cosmetic services in order to freshen their image to compete with younger job candidates. The article stated that job competition is fierce and while candidates are polishing up their resumes, they're seeking aesthetic services to polish up their bodies and faces. Other physicians interviewed for this article stated that people ranging from 40 years old and up, predominately women, are looking to have these procedures performed.

When we were approached about this article I was dumbfounded for I truly did not know of any of our clients who came in saying, "hey, can I get some Botox and filers to erase these lines on my face to compete for this sales job against this 25 year old right out of college? And, why your at it, can you get rid of these flappy arms and turkey neck I have?" And, believe it or not, we were approached for our comments on the same topic for a major magazine.

Our medical spa is close to Philadelphia and New York City and we are surrounded by thriving companies like Merck, Johnson & Johnson, Olympus, etc. so we're not in a rural area by any means, and I still wasn't aware that older job candidates were racing to have these procedures performed to increase their chances of landing a new job. I have seen an increase in new clients because of new technologies and products we have added which weren't available a few years ago.

I'm very interested in knowing if your practice has seen an increase of clients undergoing cosmetic procedures to compete for a job and, if so, what procedures are they seeking to have performed? Are they predominately male or female and what is their approximate age range? If this truly is a real "situation" perhaps we're missing a marketing opportunity to offer these individuals discounted bundled packages to assist them with their quest.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Comparison of what's in a Dermal Filler: Radiesse, Restylane, Perlane, Juvederm Ultra, & Sculptra

What's in Restylane or Perlane? Here's a synopsis.

Radiesse

1.3 cc syringe, active ingredient is 30% "powdered synthetic bone"
Very good for nasolabial folds, cheekbones, jaw lines. Not good for lips. Lasts about 3-6 months after the 1st treatment, about 12-18 months after the second treatment. Considered "semi permanent" because the collagen that it stimulates will last for years after the product has dissolved. Cannot be dissolved with any chemicals such as Hyaluronidase. Can also be used on the backs of the hands.

Restylane

1.0 cc syringe, made out of cross linked Hyaluronic acid.
Lasts about 6 months. Tends to absorb a little water, which causes some temporary swelling. Good for nasolabial folds, lips, mild to moderate wrinkles. It can be dissolved with Hyaluronidase. Lasts from 3-12 months; 6 months is about average.

Perlane

1.0 cc syringe, similar to Restylane
The "particle size" in the Perlane is larger, which makes the Perlane thicker. It tends to be used for deeper wrinkles and contouring. It is very good for deep nasolabial folds, straightening the jaw line. It can be dissolved with Hyaluronidase. Lasts 3-12 months; 6-9 months is about average.

Juvederm Ultra ( Juvederm 24 HV outside the US)

0.8 cc syringe, similar to Restylane
Injects very smoothly and tends to flow nicely under the skin. Very good for lip enhancement. Absorbs a little less water than Restylane so there is a little less swelling, which may be important in the lips. Even though the syringe is smaller, there is a higher concentration of Hyaluronic acid in the material which gives it about the same amount of Hyaluronic Acid as Restylane. It can be dissolved with Hyaluronidase. Lasts 3-12 months; average is about 9 months, less in the lips.

Juvederm Ultra Plus (aka Juvederm 30 HV in other countries)

0.8 cc syringe, similar to Juvederm Ultra, but 20% thicker
Very good for deep nasolabial folds. Softer than Radiesse, less likely to leave a palpable lump in the skin.

Sculptra

One vial can produce 6-10 cc of material.
Comes as a powder, must be mixed with water and local anesthetic at least 2 hours prior to use, preferably mixed 24 hours prior to use. The initial effect only lasts for a few days. The fluid is absorbed, but the powder is left behind. The powder causes the skin to get thicker. 3-6 treatments, space 1-2 months apart, are needed. Vigorous massaging is needed 5 times per day for a few weeks after the material is injected (this is done by the patient at home). Very good for replacing lost volume in the cheeks.

Physician Training Review: How to inject Juvederm Injectable Gel by Allergan

By CHMD: Just viewed "How to inject Juvederm Injectable Gel" by Allergan 2007.  This instructional video was terrible! 

The technique was poor and anyone who tried to inject after watching this video is sure to get bad results.  Allergen should be embarrassed to put this video out. 

 

This points up two big problems with the injectable industry.

 

First, the instruction from the big companies is terrible, it stinks.  There videos are horrible and their instructional seminars are usually very bad as well.  They only show you one way to do things and you have to know many techniques.  The instructors many times don't know HOW they get the results and cannot explain and demonstrate how.  They use 3-4 syringes when we are only able to use 1 or 2 in clinical practice.

 

This is my recommendation to Allergan, Medicis and the others.  Make a great set of instructional videos which demonstrate and instruct how to do injections well.  Make them easily available to everyone.  Work together and share costs if you want.

 

Second, the FDA does not let the big companies instruct us how to do injections unless it is FDA approved for that area.  Since only the Nasolabial folds are FDA approved, that is the only instruction we get.  Allergan and Medicis TELL us to inject it everywhere, but they don't and can't tell us how to do it and get the best results.

 

My recommendation.  FDA, your rules are hurting, not helping us.  "Unintended Consequences"! Open your eyes and take a look at what is going on and modify your rules.

 

My other recommendation.  Allergan and Medicis, open your eyes and see how many BAD injections are done which turn patients (and their friends and family)off to injectables. Teach us how to do these injections correctly.  Don't just hire a plastic surgeon who does good work (and can't teach), hire someone who can teach.

Black Market Botox....A Better Buy?

Botox: $50 for 100mu?

Thought that would grab your attention.  I've heard you can find Botox on the internet for that price.  I wouldn't recommend it.

Occasionally a patient will ask me to explain why those people in Florida "died from Botox."  They are referring to a story that was widely publicized in early 2005 about some people in Florida who were sent to the hospital after receiving phony Botox injections and becoming paralyzed.  There was another story around the same time of a woman in California who died from Botox injections done by a hair stylist.  Hair stylist?  Yes, you read that right.  The very important distinction is that they didn't actually ever have Botox injected into them.  They were duped and actually had raw-grade Botulinum toxin type A used on them. 

Right about now you might be thinking, well that would certainly never happen to me.  My vials all say Botox and have the purple, red, orange colors on the box.  Matter of fact, I'm guessing that the guy in Florida thought his product was safe since he used it on himself.  I actually know a physician who had ordered, but never used, this killer Botox that he ordered from the same source. He thought he'd found a better source to get the real thing at a cheaper price.

Botox is a trademarked name for a substance that is made by Allergan. Anything else is phony and potentially very dangerous and most certainly not worth the savings that might be had.  This bootleg industry has become so prolific that I wanted to be sure everyone knew what to look for and what to avoid.  Fake Botox is frequently made in China or Korea. Authentic Botox is made and distributed world wide by Allergan and has a hologram indicating it's credibility.

To view the hologram on a vial of Botox:

1) Examine the vial under a desk lamp or fluorescent light source

2) Rotate the vial back and forth between your fingers; look for horizontal lines of rainbow color on the label

3) Confirm that the name "ALLERGAN" appears within the rainbow lines.

I'm guessing that this black market industry will soon learn how to counterfeit the hologram as well.