Botox and fillers are not interchangable.

It has become increasingly clear to me that people often use the terms "Botox" and "dermal filler" interchangeably, thinking that they are either one and the same or that they perform essentially the same function. Since that is not at all the case, let us talk about each one individually.

Botox.
Botox is a chemical that paralyzes any section of the  muscle into which it is injected. Since it acts only locally - at the injection site - it is often necessary to perform a number of individual injections in order to weaken or paralyze the entire muscle. The number of the injections depends on the size of the muscle. Once a Botox molecule attaches itself to the muscle, our body's immune system begins to destroy it. Thus, the length of time when Botox  is active depends directly on the strength of our immune system.

Traditionally, the areas best suited for Botox treatments were the forehead, the frown lines and the laugh lines around the eyes. More recently, Botox was used on the upper lip to reduce the vertical wrinkles and in the neck to reduce prominent muscle bands. I also started using Botox in the temple and jaw area to ease the TMJ pain, or to produce narrrowing of the face for people who feel their faces are too wide. Botox is also used now to help people with migraine headaches.

You can expect Botox treatment to last about three to four months initially, but with continued use this interval can be extended for up to six months.

Dermal fillers.
Dermal fillers are either naturally occuring substances such as hyaluronic acids - Juvederm, Restylane and Prevelle - or synthetic compounds - Radiesse - which can be injected under the folds and wrinkles to reduce or even eliminate their appearance. Fillers have no effect on the muscles. Traditionally, fillers are used to fill in nasolabial folds - folds which run fron the nose to the corners of the lips - the marionette lines - lines from the corners of the lips to the chin - and to plump up thin lips. Radius cannot be used in the lips and is reserved for deeper lines.

Our body's immune system destroys dermall fillers. The time that they last in the face depends on the strength of the immune system. Juvederm and Restylane can last up to nine months and Radius can last for over a year.

Both Botox and dermal fillers are distinct but equally important tools in facial rejuvenation.

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Saline versus silicone breast implants.

There seems to be a lot of confusion out there about what distinguishes saline and silicone breast implants currently available in this country. I would like to take this opportunity to clarify some misunderstandings. First of all, the shell of both implants is the same - medical grade silicone. What is different is what the shell is filled with. Saline, which is a salt water solution, is used to fill the saline implants and silicone gel is used fill the silicone implants. Because the two substances have different chemical composition, they behave differently in the body. While the look either kind of implants delivers to the patient is very similar, the feel of the implants differs significantly. There is no question in my mind that the silicone implants provide the softest, most natural feel to the patients, particularly to the women with thinner breast tissue and skin. The chances of developing rippling is lower with silicone implants. However, silicone implants are more expensive then saline implants and this needs to be considered in your decision making. What I tell my patients is that if a natural feel is the most important issue for them, to choose silicone. If size improvement is the primary concern and the feel a secondary one, then saline will do the job very well.

Another issue which is often brought up during consultations is relative safety of the implants. Even though the FDA released silicone implants for unrestricted use to general public, the perception that saline is safer persists. In fact, the notion that silicone is harmful is just a myth. Silicone is probably the most studied implantable material available today. After over 35 well-conducted studies of new generation silicone implants from many countries, it seems certain that this material does not cause disease. The results of more than 7 long-term follow-up studies show that women with implants have a reduced incidence of breast cancer than is otherwise expected in the general population, though there is no hard evidence why this may be so and I would not count on implants to reduce your breast cancer risk. No hard evidence reveals that a broken implant is harmful. I have not seen any problems with silicone implants in my practice.

The best thing for any patient to do is to bring up all of her concerns during the consultation and to ask as many questions as is needed to make her comfortable with the decision. Remember, our first job as surgeons is to educate our patients.

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