Expect to pay more in big cities and on the East Coast, but I wouldn’t make my choice based on price, but on the qualifications and experience of the plastic surgeon or dermatologist. And while you may have heard of “Botox parties” (most common in California)…personally, I would run away from any doctor who participated in such an event. Injecting “the most potent toxin known to man” is not a trivial medical procedure; it carries risks and you want it done in a relatively sterile environment, with the doctor paying attention only to you, not to a crowd and with an eye on his marketing presence.

The second Botox issue is that a new type of Botulinum toxin should be FDA approved this year; a decision is expected by mid-April.  Apparently the new form (brand name Reloxin, and already available in Europe as Dysport), has several potential advantages over the current Botox made by the Allergan Corporation.

The cost to your doctor for each vial of Reloxin will be lower than the cost of Botox, so the cost to the patient should be less. And while the new form is also, like Botox, a form of Botulinum toxin A—and very similar to the standard Botox—Reloxin contains less “protein load” so it is thought patients might form less antibodies to this new toxin, and so the beneficial effect might last longer. And the onset of action is said to be somewhat faster, though this is probably no big advantage.

Once Reloxin is released, for me personally, I wouldn’t run out and be one of my doctor’s first patients. Reloxin is said to spread in the tissues more than Botox, and the concentration of Reloxin is different than Botox, and for any new procedure, there is a “learning curve” for your doctor while she or he gets acquainted with the nuances of the new medicine. I’ll give another update when the drug is released. Some cosmetic experts are expecting “price wars”, but for sure, expect to see lots of new ads…

Next post….pills people are taking to boost brain power!

(this is not me)

One of my best friends is a cosmetic dermatologist, and two weeks ago I got a call from his nurse: could I come in right now? My friend had an unexpected opening, and he knew I “needed” a botox treatment. Since it had been about six months since my last treatment and the worry lines in my forehead had returned, I jumped at the chance and the appointment time.

(photos from http://www.botoxcosmetic.com)

I like botox for myself because over the years I developed (a family characteristic) “worry lines” in my forehead and particularly between my eyes, and when I looked in the mirror, I didn’t appreciate the stressed-worried look, even when I wasn’t. With a few botox shots, the lines literally melted away, making me feel at least more relaxed, and friends would occasionally comment (after botox) that I looked like I had a good vacation.

Botox is actually one of the strongest toxic substances known to man—a small quantity can kill you by arresting your respiratory muscles, but in very small, super-diluted doses and when applied with a fine needle into muscles, only those muscles will stop contracting, for up to six months, leaving the overlying skin free of the characteristic furrows from muscular contraction. Botox is FDA approved only for the lines on the lower forehead between your eyes (the glabellar region), but most doctors use it elsewhere around the forehead and eyes with good results. Botox can work to cut the “crows feet” lines at the corners of your eyes, but it has no place around your mouth (injection there could disturb your eating and speech functions, besides making you look bizarre), and it won’t help for the fine wrinkles caused by sun damage and inelastic, saggy skin (which sunscreens help prevent and other measures like laser could improve.)

My experience a couple weeks ago was uneventful, as my doctor friend is a true artist with the needle, ever careful not to overdue things…the best results just take the tenseness out of the forehead area without impeding facial expressions. You certainly don’t want an overdone “frozen” look, commonly seen for example in United States senators.

The procedure starts by the nurse applying a local anesthetic cream and then I lay back for about 45 minutes so the cream works to maximum effect. (A couple times I had the procedure done without anesthesia, and it’s tolerable, but much more comfortable with the cream first.) Then I sit up and make expressions as my friend carefully marks out the points for the needle sticks. Then—my eyes are closed so I don’t see the needles—about eight shots, mild pain only, a bit more in the center at the root of the nose. As for most medical procedures, the best approach while having something done is just try to be still and concentrate on slow breathing.

Then a couple superficial shots near the corners of my eyes (to kill the crows feet lines). For the actual needle part, less than 10 minutes total. Done. Then, no pain or problems at all, just slight mosquito-bite sized swellings at the site of each shot, which disappear in an hour, and for four hours, I’m conscious to keep my head higher than my heart level. In a day or so, the lines start flattening but the full result takes about two weeks. Then I’m good for a number of months. About four months from now I’ll notice the worry lines starting to return, and at about six months I’ll bother my friend again to fit me in for another session.

If you’re interested in botox, talk to any friends who may have had the procedure, and find an experienced, licensed M.D. and make an appointment. Not everyone is a good candidate, and there are risks.  While you can find family practice doctors, nurses and even skin spa personnel who do this procedure, I would only have it done by a board-certified plastic surgeon, dermatologist, or otolaryngologist (ear, nose, throat surgeon).

So for me, I’m hooked. It’s a quite simple, relatively painless procedure and I like the results. It’s a lot cheaper, easier, less risky, and more effective than many of the alternatives in the world of medical aesthetics.

Few people are outside. Most all stores are shut. Good luck if your refrigerator is empty; maybe you’ll find a pastry shop open somewhere. Many people today seem more depressed than happy. Last night they were out late and relationships were tested. As in many cities and countries, walking around late at night here—depending on where you are—can be a little dicey. Elite police units were out in force and the streets swirled and danced with frenetic people; I saw no violence…

It was great that so many readers commented on the “Carnival begins” post. Comments tell me about you the audience, and help me write a better blog with the subjects you want. I encourage you to read the comments for views different from mine.

I am beta-testing a new widget application for LLAW, called QWIDGET, and it’s a way for people to leave comments more easily (I hope). Plus you can interact with others leaving feedback if you wish. Try it out by answering the question further along in this post. See what you think, and tell me if you’d like this QWIDGET to be part of the blog.

Last post I introduced the idea of cosmetic procedures and how Brazilians—seemingly more than U.S. Americans—seem more attuned to looking good (I enjoyed the one comment that Brazilians are more appearance-oriented because they go to the beach more, need to show skin, and want to avoid “visual pollution”…haha.) But beyond that, from the phone calls and emails I received, I know that cosmetic surgery is probably a more explosive topic than even cultural comparisons. Everyone seems to have a pretty strong opinion one way or the other, and here are some comments I have heard over the years:

1.    It’s great, I want it as soon as I need it, or before.
2.    No way, never. I’m happy the way I am.
3.    Do you know any good surgeons?
4.    It’s just wrong. We have so many bigger problems, plus the economy. There are many more important things to worry about.
5.    People who resort to plastic surgery are sad people. Just accept yourself the way you are.
6.    If someone wants plastic surgery, it’s fine, but it’s not for me.
7.    You can spend money on a trip or a piece of art or an expensive watch so why not this if you want?
8.    Too many people everywhere lack access to basic healthcare so why are we even considering this?
9.    Maybe if things get really bad, I’ll do something.

[qwidget question="173"]

My opinion, and this philosophy is incorporated into my book, is that you have the right to cosmetic surgery if you want, but consider other simpler measures first. Many people get good results from treatments like facial peeling or lasers or botox and sometimes even a different hairstyle or better posture will do more good than surgery, and with those you don’t run the risk, downtime, and expense of plastic surgery. Sometimes you just need more exercise and a better diet and six months.

The Brazilian attitudes about plastic surgery are more casual than in the United States. Friends and acquaintances here freely admit if they had some procedure. There is no shame here really, and there shouldn’t be. If you want it, maybe do it, and if you don’t like the idea, that’s great too. Just don’t be too quick to judge other people about plastic surgery, whatever their choice or belief….ok, some thoughts about cosmetic surgery:
1.    Don’t try to do too much (many complications occur because some patients push for multiple or excessive procedures all at the same time).
2.    Know the risks and that not everyone is happy afterwards, but most people get good results if they do the procedure they “need” and find a good surgeon.
3.    Find the best plastic surgeon you can.
4.    Research the various procedures and options.
5.    Be in good physical and mental shape before any surgery to decrease risks and maximize good healing. If you are depressed, surgery won’t cure your depression—better to see a psychologist or a doctor you trust first. If you smoke, don’t get plastic surgery.
6.    Ask lots of questions.

Next: follow-up “botox emergency”.