Nithya - a collagen boosting injectable from horse tendons - the next big thing?

Nithya, an injectable derived from horse tendons, is being used in the UK in leiu of Botox for wrinkle reduction.

Nithya is a Hindi girls name meaning "always" or "eternally". It's bening touted as a year-long replacement for Botox with a different, and better, treatment mechanism.

There's an article from the UK discussing Nithya as Botox replacement. Link

Described as a 'truly unique form of pain-free anti-ageing treatment', Nithya, which is offered at Vida Aesthetics, is the first skin rejuvenation injectable made from equine-sourced protein available in the UK...

According to the clinic, results are long-lasting, and unlike wrinkle reduction treatments like Botox, which paralyse the muscles and dermal fillers, Nithya apparently works 'in harmony' with your natural tissue structure. The clinic say it lasts a year, whereas Botox lasts around four months.

Eddy Emilio, Director of Vida Aesthetics, who is pioneering the treatment, says the launch of Nithya is already proving popular with his clients.

'This exceptional collagen-boosting product is proven to be safe, has had no reported side effects, is hypoallergenic and gives excellent results. We truly believe this could rival the results of established but overused anti-ageing cosmetic treatments,' he said.

'This is the only commercially available Type I collagen intended for aesthetic use in the country, and we’re already getting rave reviews from cosmetic doctors thanks to its excellent results and numerous areas it can improve the appearance of. 

'The idea of using protein sourced from horses may seem quirky, but we’re certain this is the future of anti-ageing!'

Described as a 'truly unique form of pain-free anti-ageing treatment', Nithya, which is offered at Vida Aesthetics, is the first skin rejuvenation injectable made from equine-sourced protein available in the UK.

The £250 skin plumping treatment is apparently designed to holistically improve the production of new collagen, helping to ease fine lines around the eyes and improve facial volume in areas such as the cheeks.

Described as a 'truly unique form of pain-free anti-ageing treatment', Nithya, which is offered at Vida Aesthetics, is the first skin rejuvenation injectable made from equine-sourced protein available in the UK.

According to the clinic, results are long-lasting, and unlike wrinkle reduction treatments like Botox, which paralyse the muscles and dermal fillers, Nithya apparently works 'in harmony' with your natural tissue structure. The clinic say it lasts a year, whereas Botox lasts around four months.

Eddy Emilio, Director of Vida Aesthetics, who is pioneering the treatment, says the launch of Nithya is already proving popular with his clients.

'This exceptional collagen-boosting product is proven to be safe, has had no reported side effects, is hypoallergenic and gives excellent results. We truly believe this could rival the results of established but overused anti-ageing cosmetic treatments,' he said. 'This is the only commercially available Type I collagen intended for aesthetic use in the country, and we’re already getting rave reviews from cosmetic doctors thanks to its excellent results and numerous areas it can improve the appearance of. 

'The idea of using protein sourced from horses may seem quirky, but we’re certain this is the future of anti-ageing!'

The Vida Aesthitic clinic has some before and after photos posted here

From Vida Aesthetics site:

(Nithya) Is a Class III medical device. It is a heterologous Type I collagen powder which stimulates the production of new fibroblasts to create native Type III collagen, a process that is fundamental in cosmetic medicine and anti-aging treatments. In the form of a lyophilized collagen patch, this product has been used for almost 30 years and is still successfully used today to affect the healing of skin ulcers, open wounds, scars and bedsores.

Each package  consists of a glass bottle containing equine type I collagen in powder form, sterile and pyrogen-free.

Is safe, with no reported side effects, is hypoallergenic and gives excellent results. Used in combination with lidocaine, the surgery procedure is virtually painless and is the only commercially available Type I collagen intended for aesthetic surgery. The product bears the CE 0373 mark.

It produces the optimal conditions to restore connective tissue. It supplements dermal bio-revitalization and assists the regeneration of connective tissue in the dermis proving perfect conditions for the physiological neo-formation of collagen. Can be used for body and facial chrono- and photo-aging treatments.

Packaged for single use and must be placed in suspension immediately before use in WFI (Water For Injection) at a ratio of a vial of collagen to 5 ml of WFI. Once in suspension, the product should be used immediately and any remaining following the treatment should be discarded. Using the appropriate size needles from 32G x 2 mm up to 30G x 4 mm, the product is administered through intradermal infiltration by medical practitioners licensed to carry out such treatments. The technical skill of the practitioner is key to the success of the treatment so it is recommended that the practitioner receives specific training on the mesotherapic injection technique.

Vida Aesthetics is also offering Nithya injectable training: Link

Physician Burnout: Why it still matters

Medscape recently released its annual National Physician Burnout and Depression Report. It reveals that out of the 29 specialties, plastic surgeons and dermatologist rank the lowest in the bunch. While it is no cause for alarm, it is still important to take care of yourself as a physician as some studies find there is a connection to patient care and medical errors as well.

Bureaucratic tasks are the most cited reason for burnout. The second reason for burnout is working too many hours, and the third top reason is lack of respect from peers or colleagues or employees. Burnout is still an important cause for concern due to the effects that take a toll on physicians. Depression also affects their interaction with staff. 

In this regard prior to releasing Medscape’s annual results, a study was published that examined if doctors also sought cosmetic surgery when they were burned out (Milothridis et al, 2017). Liposuction was a preferred surgical procedure as exercise was less practiced by the physicians that took part in the study.

Findings:

• Doctors were more interested in undergoing elective cosmetic procedures because exercise, while an option, seems like a long term process in losing weight
• Burnout may trigger low self-esteem and distorted body perception.
• Women in their study were more interested in undergoing cosmetic procedures.

In the study, the sample size was small, but it shows that there are tendencies to look into cosmetic surgery when physicians are burned out and consider procedures that would result in something instant.

Who is the most burned out?

Women are the most burned out physicians based on the survey. Based on a JAMA article, sexual harassment is also another factor for burn out. Depression also contributes to physician burnout. Even if that is the case, the Medscape survey reveals that physicians’ depression does not affect their interaction with their patients.
 
How to deal with burnout and depression?

Apparently, based on the survey plastic surgeons are willing to seek help for depression or burnout.

Burnout and depression, while crippling at times, can be managed. Based on the survey, exercise, talking with loved ones, and sleep are ways to cope and manage their stresses. Self-care is a necessity for all physicians.

Software applications can also help curb burnout. There’s no exact one application in managing the burnout, but meditation applications and breathing exercise applications or any other lifestyle applications can help ease one’s mind.

Burnout is a common phenomenon across different industries. Learn to acknowledge it and manage and balance work and life activities.

References:

https://www.ncbi.nlm.nih.gov/pubmed/28779405
https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235?src=ban_burnout2018_desk_mscpmrk_hp

Facial Injections: Does the size of the needle matter?

For Botox injections, is there any benefit with using smaller needles?

The current standard seems to be 30-gauge needles for Botox, buta recent study shows that 33-gauge needles caused less pain.

(Investigations related to clinical needle derived pain also demonstrate that needle size is not the only factor affecting patient comfort level. In addition, the mechanics of needle insertion has been found to significantly affect pain. Both the force and the mechanical workload (i.e., area under the force-displacement curve) of hypodermic needle insertion have been found to positively correlate with the frequency of pain. Thus, needle tip sharpness and other factors, such as lubrication, which can reduce the force of insertion and mechanical workload, and pre-treatment with a topical anesthetic are important parameters that can be optimized to reduce pain from needle insertions.)

From the study:

The highest level of pain was in the malar region, and the lowest level was in the glabella. Although all pain scores were lower for the 33-G microneedle, the difference was significant only for the forehead. Because most minimally invasive procedures require multiple injections during the same sitting, the overall procedure was evaluated as well. Assessment of the multiple-injection process demonstrated a significant difference in pain level, favoring the 33-G needle. Although the difference in bruising was not statistically significant between the two needles, the degree of bruising was lower with the 33-G needle.

Conclusions: For procedures that involve multiple injections to the face (such as mesotherapy and injection of botulinum toxin A), thinner needles result in less pain, making the overall experience more comfortable for the patient and the physician.

There are a few other studies that show similar results and there are some contradictory findings from a study in 2010.

References:

1. The Effect of Microneedle Thickness on Pain During Minimally Invasive Facial Procedures: A Clinical Study. . Aesthetic Surgery Journal. 1 July 2014 Billur Sezgin MD, Bora Ozel MD, Hakan Bulam MD, Kirdar Guney MD, Serhan Tuncer MD, Seyhan Cenetoglu MD

2. Effect of Needle Size on Pain Perception in Patients Treated With Botulinum Toxin Type A Injections: A Randomized Clinical Trial. JAMA Dermatol. 2015 Nov;151(11):1194-9

3. Dermatol Surg. 2010;36(1):109-12. Needle preference in patients receiving cosmetic botulinum toxin type A. Price KM1, Williams ZY, Woodward JA.

4. Egekvist H, Bjerring P, Arendt-Nielsen L. Pain and mechanical injury of human skin following needle insertions. Eur J Pain. 1999 Mar;3(1):41-49.

5. Egekvist H, Bjerring P, Arendt-Nielsen L. Regional variations in pain to controlled mechanical skin traumas from automatic needle insertions and relations to ultrasonography. Skin Res Technol. 1999;247-54.

6. Schneider LW, Peck LS, Melvin JW. Penetration characteristics of hypodermic needles in skin and muscle tissue. Phase I (Appendices B-E). Final report. Highway Safety Research Institute, Ann Arbor, MI; 1978

7. Dermatol Surg. 2005 Dec;31(12):1655-9. Single-center, double-blind, randomized study to evaluate the efficacy of 4% lidocaine cream versus vehicle cream during botulinum toxin type A treatments. Carruthers A1, Carruthers J.

Originally published on LinkedIn by Michael Greenspan. Link

Persuasion & Your Medical Spa

Persuading your medical spa clients to take action.

Think about the last 10 decisions you have made.  How did you come to your decisions?  You probably made a mental note of the pros and cons, factored in your intuition along with some sound logic and came up with an intelligent decision.  You probably understand that most people aren’t as strong and smart as you and therefore are easy targets to sway.  But, that never happens to you.  You are just too smart.

You just made your first mistake.  You experienced something called the “fundamental attribution error”.  This is the belief that other people’s behavior is solely based on their personality, rather than external factors.  For example, “Mary is late because she doesn’t care if others have to wait for her” verses “Mary is late because she must have had car trouble”.

These types of biases are very common and play a big role in the way decisions are made.  So of course web designers are using this information to influence the behavior of users.  Some designers intuitively know what techniques to use to achieve this, but they many not be able to tell you exactly “why” it works.  However, there are some very skilled “persuasion architects” that understand the psychological behavior and intentionally design with this in mind.

There are 7 main components in the persuasion architect’s toolbox:  Authority, Commitment, Scarcity, Salience, Reciprocation, Framing and Social Proof.

#1 Authority: 

This principle is about influencing behavior via credibility. This is why you will see a lot of name-dropping, used to give the reader confidence that this information is valuable and credible.

Readers are more likely to believe information if it is written by an “expert” in the field.  In turn, they are more likely to act (buy) as a result of this information.

Persuasion architects exploit this principle by listing rave reviews and testimonials on their site. E-commerce sites show highly visible icons assuring the user that the site is secure.  Forums are another way to use authority.  People have the opportunity to rate their peers and users might rely on those ratings as if they were from an expert.

#2 Commitment:

This principle is about taking a stand on an issue that is consistent with our own beliefs.  When you take a stand on something that is visible to other people, you usually feel a drive to maintain that point of view to appear credible and consistent.

Designers use this principle by asking for a small, but visible, commitment from you. If they can get you to behave in a certain way, you’ll soon start believing it. An example of this is Facebook.  If a group page can get you to “like” their page and it appears on your newsfeed, you are basically recommending this to all your friends.  If you choose to “like” the Brady Bunch fan page, you have “publicly committed” to being a Brady Bunch fan.

#3 Scarcity:

This principle takes me back to the gas shortages of the 70’s.  The newspapers run the headline “Gas shortage in the US” and there are immediately lines around every block of people wanting to fill up their tanks. 

People are more likely to want something if they think it is in short supply or more valuable than it actually is. For example, psychologists have reported that if you give people a cookie from a jar, they rate the cookie as more delicious if it comes from a jar with only 3 cookies list verses a jar with 10 cookies.

Persuasion architects exploit this by showing scarcity of a product.  This could include airline tickets at a discounted price or a popular toy for Christmas showing just a few items left in stock.  They understand that perceived scarcity will generate demand.

Another example of this might be a Grand Opening sale.  How many times have you seen that sign stay up for months and months, hoping that new customers will take advantage of the “special” price?

#4 Salience:

People are more likely to pay attention to details in your user interface that are unique such as a colored “continue shopping” button.  For example, there are certain times during a purchase when consumers are more likely to investigate a special offer. Being able to understand this gives you an opportunity to sell more products or services by offering them at just the right time in the buying cycle.

#5 Reciprocation:

Do you like to return favors?  Most people do and it’s this psychology that is the basis for this principle.  If someone helps you paint your house or babysit your kids, you feel obligated to help them at a future date.

Persuasion architects know that if they offer you a small gift – a free newsletter or a sample chapter from a book – you are very likely to do something for them in return like buying the entire book or additional products.  At first they may not ask you to buy something.  They may start by asking you to comment on their blog or link to a website.  They know that it usually take several contacts with a user to make them an actual “customer”. 

#6 Framing:

Savvy web designers know that we like making choices.  It makes up feel in control of our destiny.  So, if we are given a choice of 3 tiers of products, you can be assured that there is one of them that they are pointing you towards whether you realize it or not.  Another example of framing is the car dealer who shows you the most expensive car on the lot knowing you can’t afford it.  Then the next cars he shows you seem like a real bargain in comparison!

#7 Social Proof:

Have you ever gone to lunch with a group of friends?  Have you ever watched as everyone orders and then base your decision on their choices? 

A great example of Social Proof is shopping on Amazon.  When you buy a certain product, say a digital camera, Amazon will then post a note to you saying “other people who bought this camera bought this case and memory card”.  Well, if other people bought them, you certainly should as well!

Another example is default buttons.  When ordering a television online, a good persuasion architect will have the 3-year warranty add-on already checked.  The buyer thinks, “I guess everyone buys this so I should too”. 

So back to my original question: How do you come to your decisions?  Maybe now you can see that your decisions aren’t always under your control!  Smart web designers are 2 steps ahead of all of us.

Current Trend in Injectable Fillers

Many market reports reveal that injectable fillers will still develop and produce more in the years to come. Injectable fillers are considered as alternatives to surgery and produce temporary enhancements on the area where the procedure took place. Recent developments with Injectable and Fillers have happened for the past few months. Thus, it shows that patients prefer these non-surgical or minimally invasive cosmetic treatments.

According to news releases, a report by Technavio, the global facial injectable market will continue to dominate during its predicted forecast (2016-2022). In a similar market report by Future Market Insights, a 10-year forecast was created. Both reports disclose the brands that lead the market are Allergan and Galderma.

It seems men are more open to undertake such a procedure as well. In the report by the International Society of Aesthetic Plastic Surgery. In the US alone, there were around 622,133 procedures done for men only. It also goes for the American Society of Plastic Surgeons, which also reported that an increase for injectable fillers for men were seen in 2014. For that year, 525, 135 procedures were seen. This change could contribute to cosmetic medicine research and would see how non-cosmetic procedures proceed and develop for men in the future.

Juvederm has also had an FDA product cleared recently. Juvederm Volbella XC is the newest injectable in the Juvederm group, is a lip filler that adds volume. Many doctors are offering the new filler in their clinic months after its clearance. One of its benefits include prolonged satisfaction in lip fullness, with 62% feeling satisfied a year after the treatment. Some subjects showed side effects such as tenderness, bruising, and redness. Most of the side effects were not adverse (did not last after 30 days).

Know what patients (or competitors) are saying about your clinic.

The very best way to stay informed of any new post or comment about you or your clinic is to create a few Google Alerts. It takes just a few seconds and will email you a link whenever one of your alerts is triggered.

To create an alert:

1. Visit Google Alerts
2. In the "Create an alert about" box, enter the words you want to get email notifications for.
3. Click Show options to say how often you get alerts, what types of results you want to get, and more.
4. Click Create Alert.
5. Once your alert is set up, you'll start getting emails any time Google finds new search results for your keywords.

You'll want to set up alerts for you name (with any common spellings), your medical spa or clinic's name, and possibly even your competitors to instantly be notified when something you're interested in gets mentioned.

Want to make more money in your medspa? Work on your personality.

85% of your financial success is due to your personality and ability to communicate, negotiate, and lead. Shockingly, only 15% is due to your technical knowledge - Carnegie Instistute of Technology

The above seems about right. The money gets made in the consultation room, not the treatment room.

Drive New Patients With Social Media

Everyone is on mobile, if you are not online then you're missing out.  But if you are, kudos to you and keep up the good digital work. As time passes, you may need to step up your game. Thus, improve your chances of patient visits by upgrading your current digital marketing strategies in the practice. 

Social media is omnipresent, that anyone who has access to the internet can have a social media account ready. Businesses use the opportunity to go on social networking sites, to gather more consumers and study their competition. Even if competition is evident, you can make social media a companion in your business. One of the many things social media introduced is the ability to go Live. This feature allows you to do as it suggests. Twitter, Facebook, and Instagram has rolled out this new detail, and users (whether for personal or business purposes) have taken advantage of this feature. Going Live means you can present yourself or your practice to patients. Give them a glimpse of what your typical day is, which could make you look transparent.

Aside from investing on social media, blogging is also a great way to reach out to patients. It may be a tedious task as you may need to fill up one post with around 200 words at the minimum. Here's the thing, blogging gives you a voice. Many consumers are able to find new products through blogs. If you write about your work or your interests, people are bound to find you. Keywords will be your friend here, but use it with caution. Market your services with blogging, share your thoughts about any issue, and put your name out there.

If you are looking into reaching out with your customers, you and your practice staff can set-up an online community via groups, in lieu of an email marketing campaign that may cost you. Some examples of online communities are: Google+, Facebook groups, LinkedIn groups. Encourage them to join the online community, whether it is in Facebook or LinkedIn. Of course, there should be boundaries set, and have patients engage with you and reach you for any concern. You could promote services and should avoid any spamming.

This year, you should remember these tips and keep them if they work for you. If your practice isn't on social networking sites, you could be losing revenue and patients, so sign up real soon and be part of the competitive market.

Strengthening Your Medical Spas Local SEO Strategy

Many say, it’s always best to start small, which is true, because going big could cost you. It is crucial to keep up with the trends, and a solid marketing strategy can help you make your way to Google’s 1st page, without being banned. Thus, it is important to keep marketing at a steady pace while still following the rules. In this case, we advise you to start LOCAL.

Local SEO could help boost your website’s visibility in your city or state.

When you search for Local SEO, Google My Business (GMB) always comes up. This is a great way to be known through the search engine. Google is very much intuitive, knowing one’s location as they search. Thus, it is important as you update or set-up your website, to have a GMB listing underway. Google My Business also added a feature which is schedule appointments.

NAP, NAP, NAP

No don’t take a NAP. NAP means Name, Address, and Phone. All of which should be consistent in all your pages or social media websites. Aside from NAP, you also have to input your times and days of operations.

List on Local Directories

All businesses can start by listing their companies on Google My Business, so should your medical practice. Local directories could also help you put your practice on the map. Here are several directories you can start listing in:

• Google
• Yahoo!
• Yelp
• Facebook

Ask for reviews with Podium's special offer for Medical Spa MD Members.

It’s not bad nor it doesn’t violate HIPAA practices when asking for reviews. After all, most patients look for reviews first prior to scheduling an appointment with the doctor. Ask your patients to include the location of your practice when you encourage them to write their review. If some patients have already submitted their own, you can filter out the bad reviews, if any. Note, never to call out the patients that gave you a bad review.

UVLrx Intravenous Light Therapy

New light thereapies are coming to market that are designed to operate inside the bloodstream. Will they find their way into cosmetic medicine?

One example of this is UVLrx Intravenous Light Therapy, a treatment that uses light delivered directly into the bloodstream intravenously. UVLrx is currently being tested for treatments ranging from a myriad of diseases; Lyne desease, Epstien Barr Virus, Hepatitis C, HIV, Dengue Fever, and even pain and general inflammation.

There are of course other light based blood therapies, but many of those involve drawing blood (roughly 5% of blood volume) that is then treated outside the body and injected back in the patient. These new therapies look to treat the full blood volume with less energy delivery. And, since the LED stays inside the peripheral intravascular catheter during the treatment, UVLrx says that they are in a "non-significant risk" status according to FDA guidelines.

Currently, the UVLrx device is not available for sale in the U.S. but according to their website they have already recieved ISO 13485 certification. 

Here's some more from their press release:

After a successful North American debut last month at the American Academy of Anti-Aging Medicine (A4M) in Las Vegas, UVLrx Therapeutics™ is pleased to announce the official European launch of its intravenous light therapy treatment system, the model UVL1500, at this year’s 14th Aesthetic & Anti-Aging Medicine World Congress (AMWC) from March 31st to April 2nd. Under the scientific supervision of the World Society of Interdisciplinary Anti-Aging Medicine (WOSIAM), the conference will attract over 10,000 physicians and researchers from more than 120 countries who are interested in the role of prevention in global aesthetic and anti-aging management. At the Congress, UVLrx Therapeutics™ will highlight the clinically proven benefits of light wavelengths utilized by its UVLrx™ Treatment System* for reducing inflammation, a key issue facing the entire $300 billion global industry today.

“We are especially excited that the theme of the Congress this year is prevention, given the clinically proven ability of the wavelengths utilized by the UVLrx Station™ to immediately reduce inflammation caused by such things as pathogens in the bloodstream, stress and a wide range of aesthetic surgical procedures.”

“Inflammation is a common side effect of all aesthetic procedures, whether they be facial laser treatments, injections or surgery,” said Michael Harter, CEO and president of UVLrx. “By immediately reducing inflammation caused by an aesthetic procedure, our technology will minimize pain and accelerate healing, which in turn will lead to better results and a more satisfied post-op patient.”

“Beyond aesthetic procedures, chronic inflammation can occur due to pathogens in the bloodstream and just everyday stress,” commented Rowland Hanson, chairman of UVLrx. “Left untreated, chronic inflammation accelerates the aging process and has been linked to heart disease, cancer and Alzheimer’s disease. This is why UVLrx is an essential adjunct therapy for physicians practicing both aesthetic and anti-aging medicine.”

In addition to its exhibitor booth at the Congress, UVLrx has secured an adjacent private salon for physician and distributor on-site demonstrations of its CE-marked UVLrx Station™ Model UVL1500. Moreover, UVLrx Chief Science Officer, Ryan Maloney, has been asked to speak at a special session at noon on Friday, April 1st, about the efficacy of ultraviolet light and UVLrx technology for both anti-aging and aesthetics purposes. To ensure that Congress attendees are aware of UVLrx Therapeutics’ participation at AMWC, the company has secured inside front cover advertising, as well as a two-page promotional article, in the March/April issue of PRIME Journal, which will be distributed to all Congress attendees as well as the publication’s nearly 100,000 additional print and online subscribers.

“We look forward to sharing our technology with the global aesthetics and anti-aging community at AMWC 2016 and demonstrating, in person, how the UVLrx Treatment System will benefit all physicians practicing in this field,” added UVLrx CSO Ryan Maloney. “We are especially excited that the theme of the Congress this year is prevention, given the clinically proven ability of the wavelengths utilized by the UVLrx Station™ to immediately reduce inflammation caused by such things as pathogens in the bloodstream, stress and a wide range of aesthetic surgical procedures.”

Ultraviolet blood irradiation (UBI) has been used for over a century to treat bacterial and viral infections and was awarded a Nobel Prize for treating lupus in 1903. Routinely used in hospitals around the world, this form of light therapy fell out of prominence in the U.S. with the advent of antibiotics in the 1950s. With the recent expansion of drug-resistant infections, blood irradiation offers significant advantages to pharmaceutical therapies. Furthermore, UVLrx’s intravenous system is superior to existing ultraviolet blood irradiation (UBI) in that it does not require removal of blood from the body.

About UVLrx Therapeutics

Based in Oldsmar, Florida, UVLrx Therapeutics is dedicated to evidence-based medicine in the field of light therapy and offers the first intravenous, concurrent delivery of ultraviolet-A (UVA) and multiple visible light wavelengths for treating a variety of medical indications. In addition to two Nobel Prizes and NASA-backed research, hundreds of international clinical trials have verified the health benefits of UV and other wavelengths of light utilized in the UVLrx™ Treatment System. 

Here's their website: http://uvlrx.com/

Soft Tissue Fillers May Be Causing Blindness in Patients?

The rising popularity of soft tissue fillers has led to a rise in reports of side effects such as blindess.

The FDA approved the use of soft tissue fillers for the correction of moderate to severe facial wrinkles and skin folds (like the nasolabial folds). Some soft tissue fillers are approved for the restoration or correction of facial fat loss in people with HIV.

But according to the Food and Drug Administration, there are risks associated with the use of these fillers.

 Any soft tissue filler can cause long-term side effects, permanent side effects, or both. However, most side effects associated with soft tissue fillers happen shortly after injection and most go away in less than two weeks.

Swelling and pain after hand treatment may last a month or more. In some cases, side effects may appear weeks, months, or years after injection.

Among the rare side effects reported to the FDA are severe allergic reactions which require immediate emergency medical assistance, migration or movement of filler material from the site of injection, leakage, or rupture of the filler material at the injection site or through the skin (which may result from tissue reaction or infection).

There were also rare reports of formation of permanent hard nodules in the face or hand, vision abnormalities, including blindness, stroke, injury to the blood supply, and damage to the skin or the lips.

Recent reports by the American Society for Dermatologic Surgery, Inc. and published by Wolters Kluwer Health, Inc. showed that with the rising popularity of soft tissue fillers has led to a rise in reports of adverse events.

The study conducted a literature review of the reported cases of blindness after the filler injection. The study also examined some prevention and management strategies that may be done.

The results were as follows:

• 98 cases of vision changes from filler were identified.
• The sites that were high risk for complications were the glabella (38.8%), nasal region (25.5%), nasolabial fold (13.3%), and forehead (12.2%).
• Autologous fat (47.9%) was the most common filler type to cause this complication, followed by hyaluronic acid (23.5%).
• The most common symptoms were immediate vision loss and pain and most of the cases of vision loss did not recover.
• Central nervous system complications were seen in 23.5% of the cases. No treatments were found to be consistently successful in treating blindness. 

Even though the risk of blindness from fillers is rare, researchers concluded that it is critical for injecting physicians to have a firm knowledge of the vascular anatomy and to understand key prevention and management strategies.

For more information: http://journals.lww.com/dermatologicsurgery/Abstract/2015/10000/Avoiding_and_Treating_Blindness_From_Fillers___A.1.aspx

Pfizer's Inversion Of $160 Billion Allergan Deal Called Off

Pfizer terminated it's $160 billion agreement to aquire Botox marker Allergan.

It's something of a victory for lawmakers looking to stop corporate mergers designed to reduce taxes in the US. It would have cut Pfizer's tax bill by 'relocating' the company to Ireland where Allergan is registered.

In backing out of the deal Phiser will have to pay Allergan up to $400 million for it's expenses according to the merger aggrement. (Who negotiated that?)

The Treasury Dept. also implement a new rule that does not allow stock accumulated through a foreign company's U.S. deals in the last 3 years to count towards the "book value" needed to meet this new inversion threshold.