Many men are sheepish about visiting a Dallas plastic surgeon. The perception, after all, is that plastic surgeons primarily treat women. While it is true that female patients are much more prevalent in my office, more and more men are taking the cosmetic surgery plunge.

What are men getting done? The most popular treatment for men is liposuction. Many areas of the male body which are effectively treated by liposuction.  Liposuction can dramatically reduce the size of the flanks (love handles) which is the most common source of fat deposition in many men.  Even with proper diet and strict exercise, many men have a hard time losing weight in this area.   Liposuction of the flanks, particularly in combination with liposuction of the abdomen, can help contour and slim the entire trunk. Liposuction for men is not just limited to the body, however. These days more and more men are turning to liposuction to rejuvenate their faces and necks. Removing excessive fatty deposits from these areas can help to restore lost definition to facial features and provide the patient with a more youthful and rested appearance.

Without a doubt, the most common site for male liposuction is a male breast reduction. Many men suffer from gynecomastia (enlargement of the male breast). Often times, this can limit clothing options for men and make it uncomfortable for them to remove their shirts in public. Liposuction, particularly in combination with an ultrasound, can be used to reduce the size and volume of male breasts. Liposuction of the male breast is performed through small incisions and scarring is minimal.

Botox® and Dysport injections are also becoming increasingly popular for men. BOTOX® and Dysport injections are a convenient way for men to enhance and rejuvenate their appearance without undergoing surgery. BOTOX® and Dysport treatment temporarily paralyzes the facial muscles that cause the lines and wrinkles associated with aging. Within days of treatment, troublesome frown lines, forehead creases, and crow’s feet begin fade or disappear. Results are evident from 1-7 days after the procedure, and generally last anywhere from 3-6 months. Although results are not nearly as long lasting as surgery, the procedure is quick and associated with virtually no down time. The convenience of BOTOX® and Dysport treatment have made it a popular cosmetic option for men. The procedure generally takes about 15 minutes, which allows even very busy patients to schedule appointments. In addition, the injections cause only minor discomfort; the sensation is often compared to the sting of an ant bite and usually lasts only a few seconds.

If you’d like to learn more, please do not hesitate to contact our office as 214.827.2814

This story was published in the New York Times, March 11, 2010 (http://www.nytimes.com/2010/03/12/business/media/12wrinkle.html?ref=health)

To Take on Botox, Rival Tries Rebate

By NATASHA SINGER / Published March 11, 2010

Allergan makes Botox Cosmetic, the well-known injectable anti-wrinkle treatment. Medicis markets Dysport, a competing anti-wrinkle shot, in the United States. The Food and Drug Administration has approved both drugs to smooth skin furrows between the eyebrows.

And now Medicis has introduced a new marketing campaign that pits Dysport directly against Botox, essentially issuing a Pepsi challenge for the wrinkle wars. The campaign is even called the Dysport challenge.

Medicis is offering more than rebates on its own product. For customers who feel unsatisfied after trying Dysport, the company is also offering a rebate on a treatment with Allergan’s Botox.

“We are so confident that we are literally willing to bet our money that patients will love their Dysport treatment,” said Jonah Shacknai, the chief executive of Medicis.

The Dysport campaign, which runs through April 30, is thought to be the first time a drug maker has offered a rebate on a competing drug. But it is hardly the first instance of pushing pharmaceuticals with a marketing zeal more typical of consumer products that do not carry a risk of medical side effects.

These days, hoping to inspire patient loyalty, various makers of prescription drugs are promoting giveaways, rebates and discounts. Sepracor, for instance, is offering a seven-day free trial of its popular sleeping pill Lunesta. Merck is running a print ad with a voucher for a free 30-day supply of its Januvia tablets for Type 2 diabetes. Another Merck ad carries a $20 coupon for the allergy and asthma drug Singulair.

But it is vanity medicine — including products like Botox and Dysport — that has been at the forefront of consumer enticement programs. That is because insurance typically does not cover such medical products, meaning consumers must pay for them out of pocket, buying directly from physicians. Volume discounts or rebates for the doctors have also been part of the marketing push.

Some medical ethicists worry that the discounts and deals may prompt doctors and patients to make decisions based on money rather than efficacy and safety. When doctors sell cosmetic medical treatments on which they themselves receive rebates, it poses inherent conflicts of interest, said Dr. Carl Elliott, a professor of bioethics at the University of Minnesota medical school

“It’s like a doctor who has his own drugstore, and he’s writing the prescriptions and selling them,” Dr. Elliott said. “It’s the treatment of medicine as a consumer product that seems a little creepy.”

Neither Botox nor Dysport is entirely risk-free. Both are purified forms of botulinum toxin — a nerve poison produced by the bacteria that can cause botulism. The injections have occasionally resulted in temporary cosmetic problems like droopy eyelids or uneven eyebrows. And such drugs now display federally mandated “black box” warnings on their labels stating that botulinum toxins have been associated with rare but potentially life-threatening health problems.

Mr. Shacknai of Medicis said he understood ethicists’ concerns about the marketing of medications prescribed to treat specific diseases. But Dysport and Restylane, a skin-plumping injection marketed by Medicis, are not disease treatments, he said, but cosmetic products intended to improve the appearance.

“What we are doing with the Dysport challenge and ongoing promotions for Restylane,” he said, “is to make it easier financially for people to try our products after consulting with a physician and determining if it’s right for them.”

The Dysport promotion, running on the product’s Web site and in a few glossy magazines like Us Weekly, offers a $75 rebate check on an initial Dysport treatment for wrinkles between the eyebrows, a procedure that can cost consumers $300 to $500.

The “challenge” comes into play for those who elect to have a second procedure three months later. Satisfied customers can receive a $75 rebate on a follow-up Dysport treatment, while dissatisfied customers who want to switch can receive a $75 rebate on a Botox treatment.

“This is really a novel spin,” said Dr. Kenneth Beer, a dermatologist in West Palm Beach, Fla., who is a paid investigator, consultant and speaker for both Allergan and Medicis. “There are always loyalty or affinity rebates, but they never come in and say, ‘Check out the neighborhood and, if you don’t like it, we’ll pay you to move back.’ ”

The campaign demonstrates the lengths to which a new entrant to the wrinkle-smoother category will go to gain market share from Botox, which enjoyed a virtual monopoly on injectable toxins in the United States until the introduction of Dysport last year.

Botox, a drug that has both cosmetic and medical uses, had worldwide sales last year of about $1.3 billion. Gary Nachman, an analyst at the health care investment bank Leerink Swann, estimated that Dysport could eventually gain a 20 to 25 percent market share in the United States. He described the Dysport rebate effort as a kind of “Hail Mary pass” that could help Medicis get to that point faster.

Last month, Medicis sent out a mass message about the rebate to its physician customers.

“Financially speaking, there’s no reason not to try Dysport,” said the Medicis message. “This offer is so unique that we expect plenty of news coverage. And we have promotional items for use in your office.”

Caroline Van Hove, an Allergan spokeswoman, responded to a reporter’s query with an e-mail message that described the Dysport promotion as a price-cutting exercise meant to cannibalize the market — at the expense of patient education. She wrote that “incentive programs like Medicis’s engage consumers for the wrong reasons, deflecting their attention to bargain shopping versus proper physician dialogue on product benefits/safety.”

Mr. Shacknai of Medicis said the Dysport promotion “understandably would create fear and concern with our competitors” because the rebate could lead to a significant shift in market share.

Drug advertising is often expensive. But given the economics, the Dysport rebate promotion is not sustainable for long, said Ronny Gal, an analyst at the research firm Sanford C. Bernstein & Company.

With a list price to physicians of $475 per vial — enough to treat the eyebrow furrows of perhaps five patients — Dysport brings Medicis about $100 per treatment, he said, so a $75 rebate for each is steep. Moreover, the rebate program effectively repositions Dysport as a value brand, a risky strategy in the luxury sector of vanity medicine, Mr. Gal said.

In any case, critics like Dr. Elliott of Minnesota say this latest wrinkle in the wrinkle wars pushes drug marketing one step further away from evidence-based medicine and deeper into the realm of product promotion.

“I’m not fan of turning medicine into a consumer product,” Dr. Elliot said. “But we are so far into it already that I don’t see the tide turning back.”

This is taken from Bloomberg.com (http://www.bloomberg.com/apps/news?pid=20601202&sid=ak2D4ZZWD498)

Feb. 15 (Bloomberg) — Allergan Inc.’s Botox, given in the doses used to reduce facial wrinkles, may stop certain kinds of migraines that patients describe as crushing or “eye-popping” more than other types, a study found.

Patients who responded to Botox reported their migraines were reduced to fewer than 1 day a month from almost 7, according to a study of 18 people published today in the Archives of Dermatology. The researchers said that people with migraine pain called “imploding” — that felt like a vise was tightened around their heads — were helped more than those whose migraine pain felt “explosive.”

Medical trials have reported inconsistent data on how much Botox helps reduce migraine pain, the researchers said. Irvine, California-based Allergan has filed for approval with the U.S. Food and Drug Administration to market Botox as a treatment for chronic migraines, which affects about three million Americans, company spokeswoman Crystal Muilenburg said.

“This could revolutionize the way people with these migraines are treated,” said one author of today’s study, Jeffrey Dover, an associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut, in a Feb. 12 telephone interview. “It was the imploding headaches that responded and the ocular headaches,” Dover said. “They required little to no pain medication for headaches in the months after their Botox treatment.”

Today’s study was funded in part by Allergan and the National Institutes of Health.

Injection

Botox, a purified form of the poison botulinum, is administered by doctors as an injection. It is approved as a short-term treatment to smooth wrinkles in facial skin by temporarily paralyzing the muscles underneath. Americans underwent almost 2.5 million Botox procedures in 2008, the latest year for which data is available, according to the American Society for Aesthetic Plastic Surgery.

Researchers don’t know how Botox works to stop migraine pain, said study co-author Rami Burstein, a professor of anesthesia at Harvard Medical School in Boston. The drug may block the signals in sensory nerves located on the outside of the head that may cause the migraines called imploding and ocular, he said in a Feb. 12 telephone interview.

The study looked at 18 migraine sufferers who had already received or were planning to get Botox injections for cosmetic purposes. Each was interviewed and asked to describe their pain. Of the 18, 10 said they had so-called imploding migraines or ocular migraines. Eight patients had exploding, or splitting, headaches. One patient was in both groups.

Relief

Three months after the injections, 13 patients said they had a reduction in migraine pain, including 10 who had the imploding or “eye-popping” headaches and three with exploding pain, the researchers found. Their average frequency of migraines dropped to 0.7 days per month from 6.8 days before they had the Botox.

Among the 10 who had imploding or ocular headaches, their migraine frequency dropped even more to 0.6 days a month from an average of 7.1 days a month, the study showed. The other three with exploding headaches had a drop in migraine frequency to 9.4 days a month from 11.4 days.

All those who did not report significant relief from Botox had explosive migraines.

In the study, the researchers gave patients a dose of Botox used for cosmetic purposes, which was lower than doses previously used to treat migraines, Dover said. Also, the patients in this study were already scheduled to get Botox for cosmetic purposes rather than for migraines, so that alleviated some potential bias from patients who may say the injection works just to receive free treatment, he said.

Cost

Botox cosmetic treatments cost $700 to $1,000 on average for one session, said Dover, who is also director of SkinCare Physicians, a practice specializing in dermatology treatments in Chestnut Hill, Massachusetts. Migraine sufferers would need about four sessions a year for as long as their headaches return, he said.

Burstein is a consultant to Allergan and receives payment for lectures and grants for clinical and animal research.

Research presented last year at the International Headache Congress in Philadelphia showed that patients on Botox had 7.8 fewer days per month afflicted with any headaches including migraines, compared with 6.4 fewer headache days on placebo.

Allergan’s Muilenburg said the company may win U.S. approval later this year.

Migraine treatments include over-the-counter painkillers, as well as Johnson & Johnson’s Topamax and GlaxoSmithKline Plc’s Imitrex. Map Pharmaceuticals Inc. is developing an inhaled migraine therapy called Levadex.

Dysport is the first competitor to Botox  in the U.S., but has been used in Europe in for several years.  These products seem relatively similar; a great analogy is Coke versus Pepsi. Competition can only be a good thing for pricing, though, and  that should become evident over the next couple of years, as more products are released.

That being said, the major differences between Dysport and Botox seem to be the following:

1) A faster onset of effects is noted with Dysport in some patients.  Whereas Botox may take 3-7 days to take effect, some patients who receive Dysport see results in a day.

2) Some studies indicate a slightly longer duration of effect, but not all of them.  Clinical experience in the U.S. over the next several months will help guide consensus on this.

3) The dosing for Botox and Dysport is different.  A Botox unit is not equivalent to a Dysport unit.  The converision is approximately 2.5 Dysport units to 1 Botox unit, but there is some variation between the upper and lower face, as well as variations based on the patient’s facial muscle mass.

A recently published study showed Dysport is highly effective in women, as well as highly effective and longer lasting in African Americans.  It also demonstrated that Dysport was highly effective in patients who previously had a good response to Botox.Right now is a great time to try Dysport - our office is offering $50 off your initial treatment.  If you’ve had a good response to Botox in the past, or have simply wanted to try it, the time may be right to try Dysport.

The FDA announced on Monday (8/3/09) that it had approved a revised “black box” warning on Botox Cosmetic, following up on its April 2009 announcement.  The new warnings came after reports of breathing problems and a “handful” of deaths in some patients when Botox was being used for offlabel use.  Most of the deaths and serious problems were reported in children being treated for cerebral palsy-associated limb spasticity.

What should we make of this?  It’s important to note some of key differences in Botox usage for cosmetic purposes versus its utilization in the treatment of children with cerebral palsy.  First, the dosages typically given to patients with muscle spasticity tend to be much higher.  In adult patients with spasticity, it is not uncommon to administer several hundred units per treatment, and sometimes, even greater than a thousand units.  In comparison, most patients receiving botox for cosmetic purposes typically receive under a hundred units per treatment.  Second, although highly effective in treating with children with cerebral palsy, the optimal dosing to prevent distant spread in children under the age of 12 years has yet to be fully elucidated.  Third, the FDA said it had not received reports of distant spread of toxin associated with Botox when used at recommended doses for treating frown lines as well as severe underarm sweating, two uses which do have FDA approval.  The FDA has also not received reports involving distant spread of toxin iwhen used at approved doses for eyelid twitches or for crossed eyes.

Botox, and its competitor, Dysport, remains an effective and safe treatment for the treatment of forehead wrinkles and brow lines.  Dysport and Botox also continue to have FDA approval for these treatments.