test
retinol tolerance

Retinol Tolerance: What You Need to Know | Medica Depot

General Public / By  Nina Petrovic, CANS

15 Jan

Retinol Tolerance: What You Need to Know

Retinoids are found in the skincare routines of many, as these are the second-best methods for preventing aging, right after sunscreen. Comprising vitamin A and its derivatives, retinoids work by binding to nuclear receptors and modulating the expression of genes that regulate cell differentiation and proliferation. This causes normalisation of cell keratinisation, which is the process of the outermost cells of the epidermis being replaced by keratin.

Tretinoin is a natural retinoid available by prescription, and tazarotene and adapalene are synthetic retinoids. There are also many over the counter products made with retinol and retinyl esters, such as the Zo product line, that are easy to incorporate into a routine for people seeking skin rejuvenation and a youthful complexion. While retinoids are sometimes avoided due to their side effects, these can be overcome with proper use.

Benefits of Topical Retinoids

When Kligman and Willis introduced the first topical retinoids in 1975, they noted beneficial properties of the active compounds, including the improvement of wrinkles, skin texture, and skin tone. Histological experiments demonstrated that retinoids reduce corneocyte adhesion and epidermal hyperplasia, and increase collagen and elastin production. Five years later, they discovered that they could also block collagenase activity, which is an enzyme responsible for collagen degradation.

Most literature mentions tretinoin when discussing retinoids, and how the benefits of topical vitamin A derivatives manifest on the skin. Tretinoin enhances cell turnover in the epidermis and promotes the loss of pigment through epidermopoiesis. This is what creates the more even complexion. Furthermore, numerous clinical trials have reproduced the findings and are the reason why dermatologists recommend this product to patients seeking smooth, firm, and evenly pigmented skin.

Retinoids should be used continuously to see the best results as they do not show up until three months into regular product use. Smoother skin, however, will be visible after one month. Using retinoids long-term is required to maintain results, and there is no limit to treatment duration. Pregnant and breastfeeding women are the exception and must avoid these products due to teratogenic effects on fetuses.

Patient Tolerability

Retinoids unfortunately cause retinoid dermatitis in 95% of patients – this redness, flaking, and sensitivity can be unpleasant and limit patient tolerability and compliance to long-term use. Retinol has been reported to cause similar cellular changes to retinoids, but it is milder and has less side-effects. In studies comparing the two compounds, it is assumed that retinol induces the same effects but at a lower magnitude. The most attractive aspect is the milder side-effects.

Treatment should be individualized to increase patient compliance, and other skincare products may be used if needed, such as Sculptra. For example, patients should be advised that dermatitis is normal and will appear within the first two weeks of use but subside after approximately one month of use. Scaling and stinging are normal and are even a good way to know that the product has been properly dosed. Application frequency may be adjusted by the patient to prevent these side effects, according to the recommendations of their dermatologist.

Tips for Compliance

The following are tips adapted from the original Tretinoin product guidelines by Kligman:

• Patients should begin treatment with a low dose of retinol – the strength can be increased over time. It is best to start at 0.3% retinol.

• The face should be cleansed in the morning and evening, using warm water and clean hands. The skin must be dried thoroughly before using retinol. Moisturizer can be used in the morning.

• Due to its photosensitizing properties, retinoids should be used at night. A pea-sized amount is enough. Stinging will indicate the correct amount of product was used. It should be applied alone as other products might dilute the retinoid.

• A good daytime moisturizer can reduce peeling – if acne is a concern, lighter moisturizers are better. Continue to moisturize even on days retinoids are not used. At night once it has been applied, wait 30 minutes to moisturize so that the retinol fully absorbs first.

• Retinoids should be introduced slowly by tapering the application frequency, especially for those with sensitive skin. Short-contact therapy can also be used by rinsing the product off 30 minutes after application.

• Retinoids can also treat hands and forearms, but the eyes and lips should be avoided as they are sensitive. However, the product can be applied right up to the margins. Eye products have been designed with much lower concentrations of retinol. The décolletage should also be treated with caution as it is thin – treat it every third night.

• Patients should be advised of side effects as some will experience retinoid dermatitis beyond one month – they should know that this is normal, and not a reason to quit treatment.

• The retinol dose can be slowly increased after three months of use. Eventually, a retinoid prescription may be given by a dermatologist, and patients may experience irritation or dryness even if they managed to avoid it at lower doses.

• Sunscreen with SPF 30 minimum must be used while using retinoids due to the thinning of the stratum corneum. Avoid products such as scrubs and enzyme peels, as they can cause irritation.

• Results will be evident after three months of use, and continuing use is a must in order to maintain results. After about eight months, the number of applications can be reduced to twice weekly.

Conclusions

Retinols and retinoids can largely improve the appearance of skin by reducing wrinkles, increasing smoothness, and evening out skin tone. Retinols are milder than prescription retinoids and will help patients gain similar effects without irritation. Retinoid dermatitis is often unavoidable but resolves quickly – patients should be educated about the side effects in order to increase their compliance and allow them to achieve optimal results.

what are dermal fillers

What Are Dermal Fillers: Types, Usage, and Benefits

Dermal Fillers / By  Nina Petrovic, CANS

16 Oct

In the pursuit of youthful and radiant skin, patients are increasingly turning to dermal fillers as a safe and effective non-surgical option. They have gained immense popularity in recent years, offering a way to combat the signs of aging without the need for invasive procedures. But what are dermal fillers, and are they all the same?

From plumping lips to rejuvenating sunken cheeks, dermal fillers offer a customizable solution for individuals seeking a refreshed and more youthful appearance. Join us as we explore the world of dermal fillers and uncover the secrets behind their transformative effects.

What Are Dermal Filler Injections?

Dermal fillers are products used in cosmetic procedures that involve strategically injecting substances into the skin to restore volume, smoothen wrinkles, and enhance facial contours. These injections are typically composed of various materials, with hyaluronic acid and collagen-stimulating agents being the most commonly used.

During the procedure, a trained medical professional carefully administers the filler solution into specific areas of the face, such as the cheeks, lips, nasolabial folds, or under-eye hollows, based on the desired outcome. The fillers work by plumping and lifting the skin, reducing the appearance of wrinkles, fine lines, and sagging.

The filler injections are popular due to their non-surgical nature, providing individuals with a convenient and relatively low-risk option for rejuvenating their appearance. The results are usually immediate and, depending on the type of filler used, can last anywhere from several months to a year or more.

Dermal Filler Usage and Application

The process of injecting dermal fillers involves several key steps to ensure safe and effective administration. The procedure should only be performed by a qualified medical professional, such as a dermatologist or a plastic surgeon, who has received specialized training in aesthetic treatments.

The practitioner assesses the patient’s facial anatomy, skin condition, and areas that require treatment. They explain the available options, discuss expectations, and address any questions or concerns. Topical numbing cream or local anesthesia may be applied to minimize discomfort during the procedure, depending on the patient’s preference and the type of filler used.

The practitioner injects the dermal filler into the predetermined sites using a fine needle or a blunt-tipped cannula. They may use a combination of techniques, such as linear threading, fanning, or cross-hatching, depending on the treatment area and the specific goals of the procedure.

It’s important to note that the exact process may vary depending on the specific dermal filler being used, the treatment area, and the individual patient’s needs. The entire procedure is typically completed within a relatively short time, usually ranging from 15 minutes to an hour, depending on the extent of the treatment.

Indications and Contraindications of Dermal Fillers

Now that we answered the question “What are dermal fillers?” and know what they are typically used for, it’s time to discuss the ideal candidate for the procedure. Can anyone get this treatment, and what indications should potential patients know about?

Dermal fillers are generally safe and suitable for a wide range of individuals seeking aesthetic enhancements or facial rejuvenation. However, certain factors may influence whether someone is an adequate candidate for this procedure, and some individuals should avoid getting dermal fillers.

Here is some general guidance on who can get dermal fillers:

  • Adults over the age of 18: Dermal fillers are typically recommended only for individuals who have reached adulthood.
  • Healthy individuals: Good overall health is essential for undergoing any cosmetic procedure.
  • Those with specific cosmetic concerns: Dermal fillers can address a variety of concerns, such as wrinkles, volume loss, and facial asymmetry. They can also enhance specific features like lips or cheeks.
  • Realistic expectations: Candidates should have realistic expectations about the potential outcomes when using dermal filler treatments.
  • Non-smokers: Smoking can affect the healing process and increase the risk of complications, so avoiding smoking before and after the procedure is generally advised.

As for the dermal filler contraindications, they’re as follows:

  • Pregnant or breastfeeding women: The safety of dermal fillers during pregnancy or breastfeeding has not been established, so it is generally recommended to postpone the treatment.
  • Allergic reactions: Individuals with known allergies to specific dermal filler substances or their components should avoid using those fillers.
  • Active skin infections or inflammation: Dermal fillers should not be administered in areas with active infections or inflammation to minimize the risk of complications.
  • Bleeding disorders or medications: People actively taking medications that increase the risk of bleeding, such as blood thinners, may need to avoid dermal fillers or adjust their medication regimen under the guidance of their healthcare provider.
  • Compromised immune systems: Individuals with certain autoimmune diseases or weakened immune systems may have an increased risk of complications and should consult their healthcare provider before considering dermal filler treatments.

Consultations and proper medical assessment for dermal filler indications are required before proceeding with the treatment.

Different Dermal Filler Types

Not all dermal fillers are the same. Over the years, manufacturers have developed different methods of producing filler products, each with unique composition and properties.

Here are the most common types of filler products:

  • Hyaluronic Acid Fillers: These fillers contain hyaluronic acid, a naturally occurring substance in the body that helps maintain skin hydration and volume. HA fillers are versatile and can be used to add volume, smooth wrinkles, and enhance facial contours. They provide natural-looking results and are reversible if necessary.
  • Calcium Hydroxylapatite (CaHA) Fillers: CaHA fillers contain tiny calcium microspheres suspended in a gel-like solution. They stimulate collagen production and provide both immediate and long-lasting results. These fillers often treat moderate to severe facial wrinkles and volume loss.
  • Poly-L-Lactic Acid (PLLA) Fillers: PLLA fillers stimulate collagen production over time, gradually improving volume and skin texture. They are typically used for deeper facial folds and to restore facial contours affected by age-related volume loss.
  • Polymethylmethacrylate (PMMA) Fillers: One of the less common types of dermal fillers. These products consist of tiny PMMA microspheres suspended in a collagen gel. They provide immediate volume and stimulate collagen production for long-term results. PMMA fillers are often used to correct deep wrinkles and acne scars and augment facial features.

Dermal Filler Aftercare

As we’ve previously established, the process of injecting dermal fillers is quick and painless. Patients can continue their daily activities immediately, which is one of the main reasons this procedure has become so popular. Having no downtime is a significant upside for many people.

But that doesn’t mean your patients should be completely careless if they wish to achieve optimal treatment results. Since the effects of dermal fillers can last for up to 18 months, it’s crucial to instruct the patients on proper aftercare.

The most crucial period is the first 24 hours. This is the time during which the fillers are settling in, so it’s essential to prevent them from shifting around the treated area. Patients should avoid certain activities, including:

  • Touching or applying pressure to the treated area;
  • Strenuous activities and exercise;
  • Alcohol consumption;
  • Putting on makeup if it would cover the treated area;
  • Exposure to extreme temperatures and humidity (saunas, hammams, solariums).

Proper hydration is vital during this time. If the patient experiences pain and severe discomfort, they may apply an icepack to the treated area and use painkillers.

Conclusion

By now, you should have a better understanding of what facial and dermal filters are and the different types of these products available on the market. Their popularity is on the rise as patients continue to seek rejuvenation methods that do not involve invasive procedures or surgeries. Although not a permanent solution, dermal fillers are an efficient and effective way to restore one’s youthful appearance with near-immediate results.

FAQ

How long do dermal fillers last?

Typically, dermal fillers last anywhere from 12 to 18 months. This highly depends on the type of filler, the amount of product used, and the patient’s metabolism, age, and lifestyle.

What is the difference between Botox and dermal fillers?

Aside from the differences in their contents – Botox is based on botulinum toxin while dermal fillers typically contain hyaluronic acid – their method of action is also vastly different. Botox works by relaxing muscles. What are dermal fillers, then? They are fillers that improve volume and stimulate collagen production, giving patients a rejuvenated look.

How risky are dermal fillers?

Dermal fillers are generally considered safe, and if injected in a sterile environment by a medical professional, the risk of infection or complications is nonexistent. Still, certain people do have allergic reactions to these products, while most patients tend to experience slight bruising and an itching sensation in the treated areas.

juvederm voluma

Juvéderm Voluma: Cost, Results, & Side Effects

General Public / By  Nina Petrovic, CANS

21 Aug

Juvéderm Voluma XC, also recognized as Voluma, distinguishes itself as a highly sought-after dermal filler in the comprehensive Juvederm product lineup. Developed by industry pioneer Allergan, this hyaluronic acid-based dermal filler received prompt approval from the Food and Drug Administration (FDA). Positioned as a versatile solution, Juvéderm Voluma XC is FDA-approved for augmenting volume in the cheeks and midface. Beyond its sanctioned applications, it finds extensive use in off-label treatments, effectively addressing areas such as the nose, temples, and chin. Explore the benefits of buying Juvéderm for your aesthetic practice today.

Its mild side effects include swelling and its effects last for up to 2 years. Juvederm Voluma XC costs up to $1000 per syringe and treatment cost varies depending upon individual clients needs.

What is Juvéderm Voluma?

Juvéderm Voluma is a smooth gel that retains its shape over a long period of time. It is commonly used to correct symptoms of aging, such as volume loss in the cheeks and surrounding areas.

All of the Juvéderm fillers beginning with the letter V are created using Vycross technology. This method is highly concentrated and cross-linked, allowing for more points of attachment between molecules.

Hyaluronic acid (HA), the main active compound in Voluma, is a naturally occurring sugar that is found in the human body. It also contains lidocaine, an anesthetic that reduces pain and discomfort in the treated area.

Where Should Juvéderm Voluma be Used?

Voluma was developed for use in the midface and cheek areas and is currently only FDA-approved for this. That being said, there are a handful of off-label uses for the dermal filler that have had desirable results, such as around the nose, chin, temples and under the eyes.

Aesthetic Surgery Journal found Voluma nose injections to have a positive effect in 96% of people who used the product, while JAMA Facial Plastic Surgery looked at Voluma for use in the undereye area, with 71% of patients reporting great results. In a study done in Europe, Voluma injections into the chin found a 98% success rate in improving the aesthetic.

Although further study may prove positive, currently Juvéderm Voluma is not a suitable filler to use in the lips and the surrounding areas. Due to high viscosity, this may result in a lumpy appearance.

Treating these areas may not be FDA-approved due to a lack of published evidence supporting the effectiveness or due to the manufacturer not seeking approval.

How Does Juvéderm Voluma Work?

Juvéderm Voluma operates similarly to other dermal fillers. It is injected into the desired area and the areas surrounding it, penetrating deep into the skin. It is then massaged evenly into the treatment area. The result is a plumper face with more volume in the cheeks.

How Effective is Juvéderm Voluma?

In order to achieve FDA approval, a 2-year controlled clinic trial was performed. Random and multicentered, its goal was to prove the safety and effectiveness of Juvéderm Voluma XC.

The study found that nearly 50% of the group maintained their positive outcomes for 24 months, with most of the patients experiencing an objective improvement in volume and appearance.

Many subjects reported looking an average of 5 years younger, with full results being seen after only 6 months of treatment. 90% of subjects felt satisfied with the results after 6 to 12 months.

Two additional studies corroborated this outcome, with the first seeing a 95% satisfaction rate in patients after only 3 weeks. The second study ran for 2 years and found 91% of patients to be satisfied with the results of Voluma.

All of the studies conducted concluded that Voluma is effective with very few negative side effects.

Safety and Side Effects

All dermal fillers, Voluma included, are considered safe treatments. All studies have shown serious complications and side effects to be rare and not directly linked to the use of Voluma alone.

However, some side effects can occur with the use of Juvéderm, including pain, redness, itching, swelling, tenderness and bruising after treatment.

In 94% of cases, these issues resolved themselves in an average of 2 weeks, although some subjects experienced infections and longer lasting side effects.

A small number of these cases required additional treatment with antibiotics, hyaluronidase or anti-inflammatories. Side effects are also noted to have lasted longer in subjects who are over the age of 50, and who received larger volumes Voluma.

In all cases, the symptoms were resolved either naturally or with treatment.

Aftercare and Recovery

Following treatment, it is advised that you avoid physically taxing activities, such as sports and exercising, harshly washing your face for 24 to 48 hours and direct sunlight for 24 to 48 hours.

If you are taking any type of herbal supplement or medication, primarily those that thin the blood, you may be at risk of bleeding during Voluma treatment.

All Juvéderm products have a typically short recovery time. In almost all cases the swelling, redness, and tenderness go away within 15 days.

If you experience symptoms that last longer or are more painful than expected, please contact your doctor immediately.

How Much Does Juvéderm Voluma Cost?

The average price of Juvéderm Voluma is $800 to $1,000 per syringe. Most treatments require only one syringe, but some may require more. For example, injections to the midface on those who are over 50 years old are likely to need 2 syringes, as well as treatments to the nose ands chin.

Due to the difference in desired results, the Voluma filler price varies and can be as high as $1,500 or more per syringe. Additionally, you are required to pay facility and physician fees, which also vary depending on the treatment and desired results.

While the price varies, Juvéderm Voluma generally provides a cost-effective alternative to other, more invasive, solutions for improving these areas.

Why is Juvéderm Voluma so expensive?

The cost of Juvederm Voluma is contingent upon the amount used, reflecting its tailored approach to achieving optimal results for each individual. Recognized for its robust lifting properties, Voluma stands at the forefront of advanced dermal fillers, providing a rejuvenating enhancement that goes beyond mere superficial changes.

Its long-lasting effects further contribute to the overall value, ensuring a sustained and natural-looking outcome. The meticulous formulation of Voluma, combined with its innovative technology, results in a product that commands a premium in the market. This investment, however, translates into a cosmetic solution that not only addresses immediate concerns but also offers a lasting and gratifying transformation over time. In essence, the elevated cost of Juvederm Voluma mirrors the exceptional quality and enduring benefits it brings to those seeking a superior and long-term solution for facial volume and contouring.

Juvéderm Voluma is a safe and effective facial dermal filler offering long-lasting results of up to 2 years. While Voluma is only approved for the cheek area by the Food and Drug Administration (FDA), it has had great results in the nose, chin, and undereye areas as well.

piggy vegan

Are Botox and Dysport Vegan? What About Juvederm?

General Public / By  Nina Petrovic, CANS

30 Jul

As the popularity of the vegan lifestyle and of minimally invasive cosmetic treatments grows, it can only lead to one thing: more patient inquiries regarding vegan-friendly cosmetic injections. While you may be an expert at restoring youth and beauty, these lifestyle questions can be difficult to address. Read on to find out whether top brand names like Juvederm, Restylane, Botox, and more fit the bill.

What makes a product vegan?

Two main factors determine if a product is vegan: its ingredients and its testing.

Ingredients

For a product to be considered vegan, it must contain no animal products and no ingredients derived from animals. A vegan individual does not consume meat, eggs, dairy or other products obtained from animals and also does not wear leather, fur or wool.

Product testing

For a product to be considered vegan, it must not be tested on animals. While, legally, a product can be labelled as vegan if it does not contain animal ingredients, most vegans prefer that their products not be tested on animals.

Is Botox vegan?

Among the most popular cosmetic injectables, Botox contains botulinum toxin, which is produced by Clostridium botulinum bacteria. While this ingredient is vegan, a secondary ingredient in Botox’s product line is human albumin, which is a protein from human blood. Although the main ingredient in Botox comes from bacteria, Botox is not vegan.

Botox is also tested on animals. To determine the Lethal Dose (LD50) of each batch, Allergan injects mice with the solution and records how many die. Allergan is working to reduce its animal testing by 95% by switching to a cell-based assay. Although this has not completely eliminated their animal testing, it is a large improvement.

Are other botulinum toxins vegan?

Botox’s main rivals, available products from Xeomin/Bocouture and injections from Dysport/AZZALURE®, also contain human albumin. The two manufacturers also test on animals, although Merz is switching testing types for a 95% reduction in animal testing for Xeomin and Bocouture products. Ipsen has pledged to stop animal testing of its Dysport and injections from AZZALURE®.

The South Korean company Medytox produces a botulinum toxin that does not contain human albumin. Neuronox contains a plant protein, which makes its ingredients vegan and, arguably, safer for human use. Unfortunately, this vegan Botox alternative is not available in the U.S.

Is Juvederm vegan?

Juvederm products are made of hyaluronic acid, which is a natural wrinkle-filling substance found throughout animal tissues. While many orthopedic injectables are made with hyaluronic acid found in rooster combs, most dermal fillers, including Juvederm, source theirs from bacterial fermentation. Since Juvederm fillers are produced using bacterial fermentation, their ingredients are vegan.

However, most medical products, including dermal fillers, are required by law to be tested. Juvederm has been tested on animals, but just as with Botox, Allergan has committed to greatly reducing their animal testing.

Is Restylane vegan?

Like Juvederm, Restylane fillers are made from non-animal hyaluronic acid. Produced by bacterial fermentation, this hyaluronic acid does not come from animal sources, and is therefore vegan-friendly. However, Restylane has been tested on animals.

Is Filorga vegan?

Similar to Juvederm and Restylane, Filorga fillers are made with vegan hyaluronic acid that is produced through bacterial fermentation. According to Filorga, they do not test their cosmetic products on animals, although it is unclear if this applies to their cosmetic injectables as well.

Are other lip fillers and dermal fillers vegan?

Most lip fillers and dermal fillers are made of hyaluronic acid from bacterial fermentation. Although this is a vegan-friendly ingredient, most medical products in the U.S. have undergone some sort of animal testing, which means that these fillers are likely not cruelty-free, even products similar to Synvisc.

Can vegans receive cosmetic injections?

As more people choose to become vegan, and still others become more aware of animal testing and other ethical concerns, you will likely receive more questions about the ingredients and testing of the products in your clinic.

For vegan patients with dynamic wrinkles, there is no botulinum toxin currently available in the U.S. that is both made with vegan ingredients and not tested on animals. Some vegan patients may opt for lip and dermal fillers, as the majority of hyaluronic acid fillers are produced with bacterial fermentation, making them non-animal products. However, most have been tested on animals. While some vegan individuals may accept products that have been tested on animals, others may not. It is important to provide all relevant information to your patients and let them determine what they are comfortable with.

two silhouettes discuss using Botox for Incontinence

Botox for Incontinence: Complete Guide

General Public / By  Nina Petrovic, CANS

26 Jul

The loss of bladder control is a common condition, especially in women. This condition, which is also known as urinary incontinence or bladder leakage, can be caused by muscular factors—such as the weakening of the pelvic wall, a condition commonly seen after childbirth—or by neurological factors due to the uncontrolled contractions or spasm of the bladder wall. Botulinum toxin products, especially Botox, have been used in the treatment of incontinence caused by muscle hyperactivity for over a decade. In the United States, the FDA has granted approval for Botox to treat two types of bladder dysfunction: an overactive bladder, and detrusor overactivity associated with a neurologic condition.This article will delve deeper into the use of Botox for treating urinary incontinence in part by focusing how Botox works and how to administer the drug.

What is botulinum toxin and how does it treat urinary incontinence?

Botulinum toxin treatments are best known as a type of cosmetic injection. For aesthetic indications like the treatment of dynamic facial wrinkles, toxins like Botox treat these wrinkles in order to counteract the effects of aging. However, that is not all that botulinum toxins can do. Botox is a highly versatile injectable, and this is due in part to its ability to relax treated muscles and prevent them from contracting. This mechanism of action makes Botox very useful in the treatment of movement and neuromuscular disorders; certain pain-associated disorders, such as chronic migraines; and certain bladder dysfunctions.

When treating an overactive bladder or detrusor overactivity associated with a neurologic condition, Botox is injected into the detrusor, the muscle in the bladder wall, to prevent hyperactivity.

Which patients are not good candidates for Botox treatment?

Patients that have an existing medical condition that may impede on neuromuscular function-such as myasthenia gravis, Eaton-Lambert syndrome, or amyotrophic lateral sclerosis-should not receive Botox treatment. Additionally, female patients who are expecting or nursing should be excluded from treatment. Finally, patients who currently have a urinary tract infection (UTI) or are not able to empty their bladder on their own (and are not routinely catheterizing) should not receive Botox injections for their bladder dysfunction.

Administration of Botox: professionals

For these purposes, Botox is administered to the detrusor muscle via cystoscopy. Botox is supplied in the form of a white lyophilized powder that will have to be reconstituted prior to use. To reconstitute Botox, the following steps are recommended:

• The diluent of choice is sterile, preservative-free 0.9% sodium chloride Injection, USP.

• Determine the appropriate dose. For an overactive bladder, the recommended dilution is 100 units/10ml; for detrusor overactivity associated with a neurologic condition, the recommended dilution is 200 units/30 ml. Draw up the suitable amount of diluent in an appropriately-sized syringe, and slowly dispense the diluent into the vial by injection. Gently mix by rotating the vial.

• Store the reconstituted solution in a refrigerator (2-8°C). Administer the solution within 24 hours after reconstitution.

The following are considerations and precautions of treating bladder dysfunction with Botox injections:

• Prior to treatment, start the patient on a course of prophylactic antibiotics that excludes aminoglycosides three days before treatment and extends this course to one to three days post-treatment. This is to minimize the risk of contracting a urinary tract infection.

• If the patient is receiving anti-platelet therapy, they should stop taking the medication at least three days before the injection procedure. These patients should be managed with caution to prevent excessive bleeding.

• Choice of anesthesia comprises either the intravesical instillation of diluted local anaesthetic with or without sedation, or general anaesthesia. If a local anesthetic instillation is used, the bladder should be drained and irrigated with saline before injection.

• Prior to the cystoscopy procedure, instil the bladder with saline with an amount sufficient for visualization but not enough to cause overdistension.

• Prime the needle with 1ml of reconstituted Botox before the start of injections to remove any air.

To administer Botox for the treatment of an overactive bladder, do the following:

• Inject reconstituted Botox solution into the detrusor muscle in 20 injections of 0.5ml each for a total volume of 10ml. Injection should be achieved via a rigid or flexible cystoscope. Be sure to avoid the trigone when injecting.

• The needle should be injected about 2mm into the detrusor.

• Once the procedure is complete, the patient should be observed for 30 minutes and should be released only once they have demonstrated their ability to adequately discharge urine.

To administer Botox for the treatment of detrusor overactivity associated with a neurologic condition, do the following:

• Inject reconstituted Botox solution into the detrusor muscle while avoiding the trigone. The injection regimen entails a total of 30 injections of 1ml each for a total volume of 30ml. Injection should be achieved via a rigid or flexible cystoscope.

• The needle should be inserted approximately 2mm into the detrusor.

• Upon completion of the procedure, drain the bladder of the saline used for visualization. The patient should be then observed for half an hour.

What are the complications that can potentially develop as a result of Botox treatment?

After treatment, Botox will start to take effect after about two weeks, and patients should plan for repeat treatments about every six months but no sooner than three months from the preceding treatment. The side effects associated with Botox treatment for overactive bladder are mild and minimal. They can include dysuria (pain during urination), urinary tract infection, and temporary urinary retention (inability to empty the bladder spontaneously).

Conclusion

Botox has a wide variety of therapeutic indications, including the management of symptoms of certain types of bladder dysfunction. If you think you could benefit from Botox for incontinence, talk to your doctor about treatment options.

euflexxa synvisc

EUFLEXXA® vs. Synvisc: Which One Is Best?

General Public / By  Nina Petrovic, CANS

26 Jul

What Are They? Synvisc (Hylan G-F 20) is the brand name for the high-molecular-weight injectable fluid that contains both hylan A and hylan B polymers. The polymers in Synvisc, like most hyaluronic derivatives, are derived from rooster combs and are classified as avian-derived hyaluronic acid (AV-HA).

EUFLEXXA® injectables, on the other hand, is made from a very highly purified product extracted from bacterial cells. Euflexxa is a polysaccharide consisting of a repeating disaccharide of N-Acetylglucosamine and sodium glucuronate that are linked by glycosidic bonds.

What are the Differences?

While viscosupplements from Supartz, Synvisc, and other AV-HA brands are similar in their efficacy, Synvisc offers a one-dose treatment that prevents multiple trips to a doctor’s office. According to the National Institute of Health, AV-HA treatments all appear to relieve pain for between 4 and 14 weeks by restoring both mechanical and biomechanical homeostasis in the joint.

A difference in price gives EUFLEXXA® a bit of an edge. At present, EUFLEXXA® is about 20% cheaper than AV-HA treatments. However, in a free-market economy, the price difference between EUFLEXXA® and AV-HA treatments is likely to switch repeatedly. Both treatments are significantly cheaper than total knee replacement, which can cost over $20,000 in the United States.

Hyaluronic Derivative Treatments for Osteoarthritic Joints

Hyaluronic derivatives, called antirheumatics, are used for treating osteoarthritis and other joint conditions in which the body’s natural lubricant no longer functions as an adequate shock absorber—this is most notable in the arthritic knee.

These pharmaceuticals are used when other treatments fail. Viscous substances, they are injected into the osteoarthritic joint, lubricating it and thereby diminishing friction, inflammation, and the resulting pain.

The real benefit of this treatment is to delay— or even prevent—total knee replacement. This is especially important because artificial knees have a short life span, so a young knee-replacement recipient would be likely to require a second replacement.

The Importance of Sodium Hyaluronate

Sodium hyaluronate is a natural and common polysaccharide that is found in both connective tissue and synovial fluid. The lubricative properties in synovial fluid are important to the smooth functioning of a joint. Because it is both viscous and elastic, sodium hyaluronate injections can help supplement joint lubrication when the natural processes fall short.

Most hyaluronic derivatives come from rooster combs. One hyaluronic derivative in particular— EUFLEXXA®— is different in that it is produced commercially from bacterial cells. Thus, EUFLEXXA® is the first non-avian-derived hyaluronic derivative.

Treatment Considerations

Typically, the treatment prescribed is based on a risk-vs-benefit scale. Cost-effectiveness also comes into play when third-party payers implement cost-containment measures.

Sometimes the cost of these treatments can be misleading. For example, the cost of the single dose Synvisc One is about three times higher than the cost of the same treatment given in three weekly doses. Therefore, the only savings would come from fewer co-pays resulting from fewer office visits.

However, the scientific literature on various joint treatments incorporates a very important factor into the cost: the delay in total knee replacement that can be achieved. The longer the delay, the more the cost savings. It is on this measure that Euflexxia seems to score slightly higher than other hyaluronic derivatives.

Disclaimer: The contents of this article are not to be constructed as medical advise but for informational purposes only. MedicaDepot staff does not review any of this articles for medical validity. Opinions and views expressed in this article are not endorsed by MedicaDepot. Please always consult your doctor for professional medical advise.


juvederm ultra

Juvéderm Ultra XC: Cost, Uses & Benefits

General Public / By  Nina Petrovic, CANS

11 Jul

Juvéderm Ultra XC is a dermal filler that was approved by the Food and Drug Administration (FDA) in 2010. It is used most commonly to increase the fullness of the lip area, as well as treat facial wrinkles.

The product contains hyaluronic acid (HA), lidocaine, and water. The formula plumps the patient’s skin by increasing the overall volume from beneath. Treatment is intended for adults who want to improve the look of their face and lips. The active ingredients are well tolerated, and allergic reactions are rare.

Juvéderm injections are quick and take an average of half an hour. No recovery time is required and the average cost of treatment is $750, although costs vary according to patient needs and desired result. Results are seen immediately after treatement and last for up to 1 year.

How Does Juvéderm Ultra XC Work?

Juvéderm Ultra XC works by combining hyaluronic acid with water, which results in a gel-like substance that creates volume when injected underneath the skin. The injection process reduces the appearance of wrinkles, providing a more youthful appearance.

The XC variant includes lidocaine, a local anesthetic that reduces pain and discomfort during treatment. Additionally, it saves time that would otherwise be spent applying a separate numbing agent and/or pain reliever.

Similar Treatments to Juvéderm Ultra

Juvéderm Ultra XC is part of the Juvéderm family of products. A range of formulas can be used to obtain the same results as Juvéderm Ultra.

The main alternatives to Juvéderm Ultra are:

1.  Juvéderm Voluma XC, which is primarily used for the cheeks.

2. Juvéderm Vollure XC, which is primarily used for parentheses lines.

3. Restylane, a different brand of dermal filler.

4. Botox treatments are commonly used for the same areas treated by Juvéderm Ultra.

While Botox is commonly used to treat wrinkles, it will not last as long as Juvéderm Ultra and is a more invasive procedure. Botox relaxes your muscles to reduces wrinkles, while Juvéderm Ultra plumps the skin.

Where Does Juvéderm Ultra Work?

Juvéderm Ultra reduces wrinkles that form around the sides of your mouth as you age. This effect is more noticeable in smokers and is commonly referred to as smile lines or laugh lines.

This dermal filler is also suitable for:

1. Lip augmentation

2. Wrinkles in the cheek area

3. Wrinkles under the eyes

Expected Results of Juvéderm Ultra XC

With any Juvéderm injection, you can expect to see the effects of treatment immediately. The results, on average, last between 6 months and 1 year. Follow-up treatments are required for maintenance.

There is no recovery time associated with Juvéderm Ultra, however, during the first 24 hours it is recommended that you avoid:

1.  Strenuous exercise from activities like sports or heavy work.

2. Direct sun exposure.

3. Consuming alcohol.

4. Failure to do so could result in increased itching, swelling, and redness in the treated area.

Juvéderm Ultra XC Preparation and Procedure

Very little is needed in order to prepare for your appointment. While the total time required for the appointment will vary by patient, you can expect treatment to take no longer than an hour.

As Juvéderm Ultra XC contains lidocaine, a topical anesthetic is not required. This is only offered with the XC variant and is not found in Juvéderm Ultra alone.

During the procedure, you should feel little to no pain. Most commonly, patients feel slight pressure and tingling in the area of injection.

It is recommended that patients arrive early to make payment and complete paperwork. As there is no recovery time, patients can safely drive home following their appointment.

Juvéderm Ultra XC Side Effects and Risks

While this dermal filler is considered safe for most patients, potential side effects include the following:

  1. Redness, swelling, and bruising.
  2. Tenderness, firmness, and lumps in the treated area.
  3. Skin discoloration in the treated area.

These are typically mild in nature and often clear up within a week without further intervention.

While rare, allergic reactions to Juvéderm can happen and are sometimes serious in nature. Medical attention may be required if a patient experiences any of the follwoing:

  1. Hives forming around the treated area.
  2. Difficulty breathing.
  3. A rash in the treated area.
  4. Signs of infection in, or scarring of, the treated skin.

Patients with a known allergy to hyaluronic acid or lidocaine should not use Juvéderm products.

How Much Does Juvéderm Ultra XC Cost?

Curious about the cost of Juvéderm treatments? On average, a session with Juvéderm Ultra XC is priced at approximately $750. However, this cost varies based on individual needs and desired results. Factors such as location and the number of injections required can influence the overall expense of each treatment. To delve deeper into understanding the factors influencing Juvéderm costs and explore ways to manage expenses, check out our comprehensive blog post on “What does Juvederm cost?”. It’s important to note that Juvéderm products fall under the cosmetic category and are typically not covered by insurance. Fortunately, many physicians offer monthly payment plans, providing patients with accessible options to finance their procedures.

juvederm nasolabial

Using Juvederm to Treat Nasolabial Folds

Dermal Fillers / By  Nina Petrovic, CANS

10 Jul

What are nasolabial folds?

Nasolabial folds, which are also referred to as “smile lines,” “parentheses lines,” and “laugh lines,” are the deep wrinkles that extend from both sides of the nose down to the corners of the mouth.

When a person smiles, nasolabial folds become more pronounced. The depth varies among individuals; however, as people age, the folds become thicker and more pronounced.

In comparison, nasolabial folds are not present in babies and children. This is due to the quantity and quality of hyaluronic acid, a substance that gives skin its firmness and elasticity, within the skin, which decreases during aging. As the skin loses its firmness and elasticity, nasolabial folds become more prominent.

While prominent nasolabial folds tend to occur in older individuals, people in their 20s may also notice them.

Why choose Juvederm?

Juvederm is a popular brand of injectable dermal fillers made from non-animal hyaluronic acid. It was approved by the Food and Drug Administration (FDA) in 2006, but has been on the market in Europe and Canada since 2003. The collection includes Juvederm Hydrate, Volbella, Voluma, Ultra XC, Ultra 4, and more.

While some dermal fillers have a granular consistency, Juvederm comes in the form of a smooth gel. Some Juvederm products contain lidocaine, a local anesthetic that numbs the area being treated in a matter of seconds. Juvederm is used to plump up the skin, smooth out lines and wrinkles and correct moderate to severe nasolabial folds. It is also used to augment the lips, correct marionette folds, and correct acne scars.

How does Juvederm help get rid of nasolabial folds?

Juvederm is injected subcutaneously, where it attracts and holds moisture. The region below the nasolabial folds swells up, adding volume to and smoothing away the wrinkles. Juvederm’s smooth consistency will leave your patient with results that appear and feel quite natural.

In a multicenter, double-blind, randomized, controlled study with 87 subjects, 98% of patients treated with Juvederm Ultra Plus maintained significant correction after 24 weeks. Due to their unique consistency, Juvederm fillers allow for more precise injection and more natural results. Juvederm Ultra, Ultra 2 and Ultra 4 are also ideal for the treatment of nasolabial folds.

How much Juvederm is needed to treat nasolabial folds?

Depending on the severity of the nasolabial folds, patients may need up to 1.6ml, which was the average amount needed for correction in a recent study.

How long does Juvederm last?

Juvederm is biodegradable and is broken down and absorbed by the body around 12 months after treatment. In the same study mentioned, 81% of patients maintained their results for up to a year or more. After the filler starts to be metabolized, your patient can opt for maintenance treatments. After the initial treatment, patients typically require a smaller amount of filler for optimal correction.

Internationally recognized, Juvederm is one of the most popular cosmetic filler brands on the market. Its high safety profile and long-lasting results make it an optimal treatment for superficial to severe facial wrinkles and folds.

botox dysport

Botox vs Dysport: Similarities and Differences Reviewed

Botulinum Toxins / By  Nina Petrovic, CANS

09 Jul

Both Dysport and Botox Contain Botulinum Toxin

In 2009, a new competitor for Botox was approved for the US market, under the brand Dysport (abobotulinumtoxinA). Like Botox, Dysport is a botulinum toxin treatment indicated for wrinkle correction as well as certain movement disorders like spasticity and cervical dystonia. However, these two botulinum neurotoxin preparations were manufactured and purified via distinct, proprietary manufacturing processes. As such, injectables from Dysport and Botox have different properties in terms of duration of results, diffusion, adverse event profile, and potency, when compared to Fillmed and similar products.

Botox (onabotulinumtoxin a) is primarily known as a cosmetic injectable that treats wrinkles like glabellar lines; however, it has many more therapeutic uses. As a neurotoxin, it causes chemical denervation in cholinergic neurons, thus impacting signal transmission between these nerves to other cells. It is for this reason that Botox has many therapeutic applications. For instance, Botox is indicated in the treatment of various neuromuscular disorders like cervical dystonia and blepharospasm, and recently has been implicated in conditions associated with pain, like chronic migraines, and urologic conditions affecting bladder control, like overactive bladder. Botox has immense therapeutic benefits for patients from a wide spectrum of neurological disorders.

Differences Between Botox and Dysport Preparations

As stated previously, both products are very similar; they are both type A botulinum toxins with similar modes of action and established safety profiles. However, studies examining the composition of these 2 preparations have demonstrated notable differences in the structure of the active substrates. Botulinum toxin type A exists in nature as a 150-kDa protein surrounded by nontoxic, accessory proteins. These accessory proteins, together with the toxin, form complexes as a way to confer stability and prevent degradation. This difference in composition has striking effects on each preparation’s clinical activity and adverse event profile via its impact on diffusion potential.

Differences in Dosing for Botox and Dysport

It is well-established in the literature and through clinical use that these two preparations do not have the same bioactivity and are not bioequivalent to each other. In other words, one unit of Botox is not the same as one unit of Dysport. Various clinical studies have been conducted to elucidate the clinical equivalence of the two formulations for various indications. For these cases, Dysport-Botox ratios used ranged from 3:1 to 6:1 and for the most part, produced similar results to each other in the patients. The dose equivalency ratio of botulinum toxin preparations like Botox and Dysport is an issue that is still being debated on and studied to date.

A study on the actual doses used in clinical settings for cervical dystonia and blepharospasm determined that Dysport to Botox ratios used in clinical practice ranged from a low of 2:1 to a high of 11:1. As well, 31% of patients fell into the Dysport-to-Botox group of 5:1 to less than 6:1, while 30% of patients were in the Dysport-to-Botox group of 4:1 to less than 5:1, and 21% of patients studied were treated with a Dysport-to-Botox dose ratio between 3:1 to less than 4:1. Taken together, this data suggests that a consensus for an empirically-derived ratio that will deliver consistent, reliable effects has not been reached currently, which further implies that a simple conversion factor does not exist.

Dysport Diffuses More Than Botox

The physical characteristics of the neurotoxins differ as well. Practitioners have noted the tendency of Dysport to diffuse, or spread more easily, than Botox. In a published study by Ranoux et al., the authors noted an increase in side effects with Dysport, and posited that the cause behind the increased adverse event profile may be associated with the higher diffusion rate Dysport has compared with Botox. This was further evidenced in a study by Nüβgens and Roggenkämper, which resulted in a similar enhanced adverse event profile with Dysport in the form of a significant increase in occurrence of ptosis.

With the previously mentioned study, this was suggested to be due to the difference in diffusibility of the 2 preparations. In a review by de Almeida and de Boulle, it was suggested, from an analysis of studies examining the diffusion characteristics of neurotoxin properties including Dysport and Botox, that Botox appeared to diffuse less than Dysport. Differences in diffusion has its own advantages and disadvantages, and will perform differently in different applications. Some practitioners find the increased diffusion rate of Dysport useful when treating larger areas, like in men or in the forehead, while Botox is considered better for situations where precision in placement is important.

In conclusion, various clinical studies with head-to-head comparisons of Botox with Dysport have found significant differences in their composition, which further translated to application differences like diffusion potential, potencies, adverse event profile, and duration of effect. Aesthetic practitioners should always keep in mind the non-bioequivalency of these two preparations it prohibits dose-conversion between each other.

sculptura last

How Long Does Sculptra Last? One to two years, studies find

General Public / By  Nina Petrovic, CANS

09 Jul

The duration of Sculptra’s effects has been studied extensively in the treatment of patients with HIV-related facial lipoatrophy. Based off the findings of multiple clinical trials, including the Vega study and the Blue Pacific study, among others, the duration of effect of Sculptra was seen to last up to 24 months, with increases in skin thickness and high patient satisfaction. Furthermore, the durable results of Sculptra can be further extended with retreatment. In one case study, the correction of HIV-associated facial lipoatrophy seen in a 45-year-old patient who underwent retreatment with Sculptra was maintained for two years and seven months.The duration of effect of Sculptra was examined further in a 2015 study that assessed the length of effect of Sculptra by using 3D imaging to quantitatively measure midface volume changes in 15 patients who received Sculptra treatment for aesthetic purposes over a one-year period. They found that treatment starts to take effect as early as 12 weeks following the last injection and that these results are maintained over a year later.

Due to its different mode of action as a collagen biostimulator, the duration of action of Sculptra is significantly longer than that of volume replacement fillers. Numerous years of studies and extensive clinical use have demonstrated Sculptra’s safety and efficacy as a dermal filler and proven its place in the aesthetic doctor’s arsenal of injectable soft tissue fillers.