Friday, October 21, 2011


A conversation /presentation-Dr.Z.Paul Lorenc, MD FACS

Are facelifts---so old school-like Windows 95?

Certainly seems that way to us---AND “…in about ten years…” according to one of our most trusted resources and experienced practitioners for what’s new in the aesthetic anti-aging world…Z. Paul Lorenc, M.D. F.A.C.S.

Of course, that happy circumstance applies to those that have healthy habits: non-smoking, sunscreen wearing/sun blocking habits…

But there definitely seems to be enough new longer lasting fillers and non-or less invasive laser treatments that stimulate new collagen, even out skin tones, smooth away fine lines and wrinkles, plump up deeper lines, volume loss etc, and tighten up sags…without the wind tunnel look of yesteryears plastic surgery ---to banish scalpels to the bottom drawer.

At a recent event held for media types downtown…and a follow-up conversation with Lorenc, MD FACS-we got a bit of insight into what’s new.

Longer lasting fillers---are desirable usually---the cost and time-both factor in--- even to the most dedicated.

Artefill® Dermal Filler is a third generation filler that has "been approved by the FDA in 2006 for the correction of nasolabial folds (those lines that form from the corner of the nose down to the corner of the mouth). Currently, a five year study, now in its fourth year-so we were told is on-going- "to validate its safety and patients' satisfaction with the product." Curious sounding to us though "this will be the largest study ever conducted on a filler when its completed" --- and we later learned,  after further queries, that it is not uncommon for the FDA to request a post-marketing study...referred to as "Phase IV."

Considered a biostimulatory filler-meaning it stimulates one’s own collagen to grow---Artefill® is considered a “good safe product,” by Lorenc…and is suitable “for the right person” ---i.e. for someone looking to build up cheekbones or for a recessed chin…instead of undergoing surgery for permanent implants.

We interpreted the ‘process’ …what we learned about Artefill®-now owned by San Diego based SunevaMedical as a two part happening…with bovine collagen, sourced in the USA (one has to be tested for this btw-as mandated by the FDA)-providing the immediate desired filler results for wrinkles…eventually being absorbed into the body-while the second part occurs over time-meaning one’s own collagen gets stimulated to encapsulate the Artefill® microspheres –made from the same biopolymer /inert plastic as inter-ocular lenses in the eyes that get implanted during a surgical procedure. Clearly, tiny microspheres---“not like silicone” and we were told a 26-gauge needle is used to inject-“similar to other dermal fillers.”

Two-three injections per area being treated are typically required for the desired results---spaced a month or two apart---and therefore ”not a quick fix…but an investment ” as the cost is higher than other  (temporary) fillers.

The most important factor we think…

 “Technique is key,” according to Lorenc…and why anyone would go get any injections for anything from anyone not an experienced practitioner- such as a dermatologist or plastic surgeon for derma fillers- is beyond our comprehension.

IMHO: This is probably not the dermal filler for people who have never had a temporary dermal filler before--- or for those concerned about anything being in their body for a long time---though those other temporary fillers “degrade” in the body.

But for those wanting to plump up areas that used to have volume via fat cells (where we would want them)…facial areas on top of a bone---the cheeks or chin facial locales  (NOT lips)…Artefill® is a dermal filler some aesthetic anti-aging medical practices are considering.

Laviv™ –owned by Fibrocell Technologies, Inc is an autologous cell therapy- whereby one’s own skin tissue-fibroblast cells- are harvested, processed for 90 days in a laboratory…and injected, via a syringe, as a filler. Benefits are using one’s own cells, and it’s FDA approved for mild to severe deep nasolabial fold wrinkles. The costs for this dermal filler- are up there…about $3000 for four syringes according to Lorenc MD, FACS. Still, “there’s a place for it,” and the results, achieved over time- are variable in duration-from 6 months to maybe 2-3 years at the injection site.

It’s believed that Laviv™ stimulates one’s own collagen to grow too according to the FDA briefing document we read---

Botox® Cosmetic and Dysport®  are very VERY popular prescription injections used as a means to temporarily smooth away those frown lines between the eyebrows (aka the glabella area)…

Lasting for about 3-4 months, though anecdotally, we’ve heard that over time, the effects can be longer lasting, Botox® and Dysport® has smoothed away millions of men and women in the USA alone---including individuals with migraine headaches and/or abnormal eyelid spasms.

Now –there’s a new neurotoxin (botulinum toxin Type A), Xeomin®-that’s already FDA approved for non-cosmetic and cosmetic use as of thus summer.

Competition for Botox® and Dysport®?

 Dr. Lorenc explained the differences- which in his experience-includes immediate onset –within a day…and ---there’s “no accessory proteins in Xeomin®”  (due to a “proprietary manufacturing process that isolates the therapeutic component…”  -so it can be stored at room temperature-unlike the competition that requires refrigeration- a big plus for medical practices.

“It’s the same injection amount as Botox®, “ Dr. Lorenc added- and “the characteristics are more like Botox® (versus Dysport®)…but there’s less of a chance for any allergic reactions with Xeomin® “ ---because of the removal of the aforementioned accessory proteins.

We thought-ahhh, maybe, finally real price competition vs. the temporary price reductions like those coupon rebates that are often available already on the companies’ websites?

AND as we mentioned prior---technique is key. We know plenty of people who had differing results with these temporary muscle activities decreasers-depending on who injects them.