What is Juvéderm VOLUMA™ XC?

Allergan recently released Juvéderm VOLUMA™ XC and the company has been marketing the product heavily.  You may have seen the ads that compare the apples of your cheeks to, well, apples.  So how is this product different from the original Juvéderm™?  And how is it different from the many other fillers on the market?

The original Juvéderm™ is a hyaluronic acid filler, which is the fluid that lubricates your joints.  It was created to fill lines and wrinkles, and is most frequently used to add volume to the lips and to fill the smile lines (nasolabial folds) around the mouth.  The new product is more highly cross-linked, meaning the individual molecules have more connections between them.  This results in a product that is a little thicker and less pliable than the original.  Juvéderm VOLUMA™ XC was created specifically to add volume to the cheeks, and cannot be used in any other location.

There are currently two other products on the market that can also be used to add volume to the cheeks (although neither is specifically FDA-approved for this purpose): Radiesse™ and Sculptra™.

  • Radiesse™ is made of calcium hydroxylapatite, a mineral found in bones and teeth.  It is administered in a single treatment.  The results are immediate, and last for about 9-12 months.
  • Sculptra™ works by stimulating your body to make collagen, so the results take several weeks to develop, and do not necessarily diminish with time (i.e. the change may be permanent).

In comparison, Juvéderm VOLUMA™ XC lasts up to two years, but is not permanent.  It is administered in a single treatment and results are immediately visible.  The cost falls somewhere in the middle of the spectrum between Radiesse™ and Sculptra™.  I haven’t personally used the product yet- we have the clinical trainer scheduled to come to our office in September- but I’m excited to see how it compares.
Have you ever had filler to add volume to your cheeks?  What did you think of the result?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Why Does My Sebaceous Cyst Keep Coming Back?

I frequently see patients who complain that they had a sebaceous cyst drained, but that it came back.  Why does this happen? To answer this question, let’s discuss what a cyst actually is.  The medical definition of a cyst is a sac lined with cells.  Cysts can occur within organs such as the ovaries, kidneys and liver, or can occur on the skin.  Cysts of the skin are commonly referred to as sebaceous cysts, but there are actually several different types of skin cysts, depending on the cell type of origin:

  • A sebaceous cyst arises from the oil glands
  • An epidermal inclusion cyst arises from the epidermal skin cells
  • A pilar cyst arises from the hair follicles

All three types cysts appear identical on exam; they appear as a large lump.  Squeezing this lump may produce a thick, white, cheesy substance (you may have seen videos of this uploaded to You Tube, or posted on Facebook.)  This thick white substance is composed of oil and dead skin cells made by the cells lining the cyst.  As the lining cells make more oil and skin cells, the cyst slowly becomes larger.  Cysts can also become infected.   In this instance, the cyst becomes red, hot to the touch, swollen, and painful as in the photo below.

"Inflamed epidermal inclusion cyst" by Steven Fruitsmaak - Own work. Licensed under Creative Commons Attribution-Share Alike 3.0 via Wikimedia Commons

“Inflamed epidermal inclusion cyst” by Steven Fruitsmaak – Own work. Licensed under Creative Commons Attribution-Share Alike 3.0 via Wikimedia Commons

To treat an inflamed or infected cyst your doctor may drain the infection and place you on antibiotics.  But draining the contents of the cyst does not remove the cyst cavity itself.  So the cyst “comes back” when it fills back up with oil and dead skin cells. Actually removing a cyst involves making an incision in the skin.  The cyst is removed, and the incision is sutured closed.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Is My Nose Broken?

Broken noses happen.  Pretty frequently in fact, especially in individuals who have a propensity for getting hit in the face (hello, contact sports!)  But I think there are a lot of misconceptions out there about how to tell if a nose is broken, and what to do about it.

Broken noses can be difficult to diagnose.  The bones are very thin, so x-rays are not helpful in determining if a nose is broken.  Yet I still see patients in my office who are x-rayed by well-meaning ER physicians.  My first piece of advice for you today- if you go to the ER with a possibly broken nose, and the doctor orders an x-ray, politely decline.  It’s just not useful, and whatever specialist they refer you to (Plastics or ENT are the options) will not need the films.  Or the ER may order a CT scan- this is useful if the doctor suspects you may have broken bones in your face other than your nose.  But if the nose is your only injury, CT is overkill.

Here’s my second piece of advice for you today: the important question is actually not if the nose is broken, but whether or not it needs treatment.  A broken nose may need to be treated operatively for two possible reasons:

broken nose - shutterstock.com

broken nose – shutterstock.com

  1. If the nose is crooked.  It may appear flattened, or pushed off to one side. Check out the photo to the right to see what I mean- this nose is definitely broken. (Does anyone else wonder why Shutterstock has stock photos of broken noses?)
  2. If there is breathing obstruction.  There will be some breathing obstruction for the first 7-10 days due to swelling, but this should resolve as the swelling goes down.

Treatment of a broken nose involves a trip to the operating room, where your nose and septum are straightened out. This should be done within about three weeks of the injury, or the bones will have started to heal.  Afterwards you have a splint over your nose, and packing inside of your nose.  This packing stays in about a week, and the external splint stays on for about two weeks.

If your nose looks like it did before you got hit, and you are not having difficulty breathing, then you don’t need treatment even if your nose is actually broken. It will heal on its own over a period of about 6 weeks.  I would recommend not getting hit in the face during that time period, although honestly I have a general policy against getting hit in the face at all.

 

Have you ever had a broken nose?  How did it happen?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is the Difference Between Botox, Dysport and Xeomin?

Botox® Cosmetic entered the market in 2002, when it was FDA-approved for the treatment of glabellar frown lines (between the eyebrows).  It was the only player in the game until 2010, when Dysport® was FDA-approved for the same indication, with Xeomin following closely on its heels.

botox bottle

So what is the difference between the three, and why should you care?

Let’s answer the second question first.  You, the consumer, may come across the other neurotoxins, Dysport® and Xeomin®, because they are often offered at a lower price compared to Botox® Cosmetic.  Knowing a little bit about the three medications allows you to make a more informed decision, rather than just assuming that Dysport® and Xeomin® are “alternative brands of Botox”.

This brings us to the first question- how do the medications differ?  Dysport® and Xeomin® are only FDA-approved to treat glabellar frown lines, but Botox® Cosmetic is also FDA-approved to treat crow’s feet.  This additional FDA approval means that Botox® Cosmetic has been studied more thoroughly than the other two medications for safety and effectiveness.  This doesn’t mean you can’t use Dysport® or Xeomin over crow’s feet, or Botox® Cosmetic over the forehead, but this is considered an off-label use.  All three neurotoxins work by blocking cell acetylcholine receptors, resulting in muscle paralysis where the medication is injected.  But the three medications differ in how they are made, how they are processed, and what inactive ingredients are part of the formulation.  These differences mean that the three neurotoxins are not interchangeable.  So it is important that your physician be very experienced in whichever neurotoxin he or she is using.

Experience injecting Botox® Cosmetic does not translate to being able to provide safe, consistent results with another product such as Dysport®.

The dosing is also different between the products: Dysport® often requires over twice as much product as Botox® Cosmetic, so even if the per unit price is half the cost of Botox® Cosmetic, you may end up paying more.  If you are considering one of the other neurotoxins, I recommend asking your injector how much experience he or she has with that specific medication, and what the estimated price would be for the area you would like treated, not just the per unit price.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is a Mini-Brachioplasty?

An arm lift, or brachioplasty, is an operation to remove excess skin over the upper arm.  This is commonly done after weight loss, but may also be done to remove the “bat wings” that develop in aging arm skin.  In a traditional brachioplasty, excess skin is removed along the entire length of the upper arm (see the area marked out in blue on the diagram below).

original photo from shutterstock.com

original photo from shutterstock.com

This results in a scar which is very noticeable.  Not only does it run down the back or inside of the entire upper arm, but scars in this area tend to widen and thicken as well.  Some patients are turning toward a mini-brachioplasty to avoid this significant scar.  In a mini-brachioplasty the incision is horizontally oriented along the edge of the underarm area, making it much less visible. This is only able to remove excess skin from the proximal part of the upper arm, right near the underarm (the area marked in green on the diagram).  The mini-brachioplasty may also be combined with liposuction to address excess fat further down the upper arm.  Not everyone is a candidate for the mini procedure, however, as it only addresses excess skin over the upper ⅓ of the arm.  If there is excess skin along the entire upper arm, a traditional brachioplasty would still be needed.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.