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The FDA issued a requirement for black box labeling on Allergan, Inc. Botox® and Botox Cosmetic®, Solstice Neruoscience’s Myobloc®, and Ipsen’s Dysport®, the newest formulation of botulinum toxin. Hospitalizations and deaths due to botulism poisoning have been reported, although a WebMD article of April 30, 2009 reports that the “Deaths among adults are suspected but could not be confirmed.” This report also states that no serious side effects have been confirmed due to cosmetic uses of Botox® and Myobloc®.

The key word in the above statements is “confirmed” as there have been a large number of reports filed. The decision to require the black box warning resulted from hospitalizations, including deaths of children with cerebral palsy who received botulinum toxin to treat muscle spasms. While reports indicate that the danger is associated with the higher doses used in therapeutic treatments, other reports suggest that cosmetic uses, especially the off-label uses have resulted in serious adverse reactions.

How bad can it get?

The FDA’s Adverse Event Database (AERS) reports 180 adverse events, of which there were 16 deaths. Many more are posted online from the European Union (EU). As of November 2005 693 cases were reported throughout its 27 member nations of which there were 17 deaths due to aspiration pneumonia.

The most common adverse events result from the toxin spreading from the injection site to distant sites where it has caused incontinence, drooping eyelids, double or blurred vision, difficulty talking, hoarseness, dry mouth, muscle weakness, breathing difficulties, and dysphagia (difficulty swallowing,) which leads to aspiration pneumonia due to weakness of the epiglottis and esophageal muscles. Weakened esophageal muscles can’t prevent reflux, and a weakened epiglottis doesn’t close off the airway sufficiently and allows stomach contents, or food or drink to enter the upper airways and lungs, a potentially fatal condition known as aspiration pneumonia.

Approved uses of botulinum toxin

There are two approved uses of botulinum toxin drugs. The first is therapeutic, primarily to treat cervical dystonia (uncontrolled muscle spasms in the neck and shoulder.) The second is cosmetic, to reduce frown lines between the eyebrows, or to treat excessive underarm sweating. Most cosmetic use of Botox® is not FDA approved and is considered off-label. Off-label uses of Botox® include injections in unapproved sites as well as in multiple sites.

According to the FDA, if the drug is used as descried on the label the likelihood of adverse reactions is near zero. Myobloc® is approved only for cervical dystonia. Because of dosage differences and type differences (Botox® is a type A and Myobloc® is a type B toxin) switching from one manufacturer’s formulation to another is a potential risk that can result in an overdose with the toxin spreading to unintended muscles.

The black box warning is accompanied by requirements to inform users in writing that botulinum toxin products have the potential for distant spread at the time of their injection. Manufacturers are to warn doctors and patients about the dangers of overdosing by substituting different botulinum products. Manufacturers are also to follow the outcomes of children and adults who receive their botulinum toxin drugs for involuntary muscle movement, and to submit safety data to the FDA.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

BOTOX® injections have been the number one non-invasive procedure for several years now – for both men and women, and in many age groups. That is not surprising since the BOTOX® results are visible quickly and the procedure is short and simple.

What is BOTOX®?
BOTOX® is the trade name for a substance made from the botulinum toxin. That toxin is produced by the bacterium Clostridium botulinum and when ingested in its natural form it is highly toxic. But in its purified form as BOTOX® it is not toxic at all.

BOTOX® has been used for years to treat conditions involving muscle dysfunction, such as Blepharospasm (twitching eyelids) and multiple sclerosis (MS). When a very tiny dose of the purified substance is injected into a specific muscle, it temporarily paralyzes that muscle. It prevents that muscle from contracting by blocking messages sent by the brain telling it to contract. This helps an MS patient, for example, by cutting down on involuntary movements and enabling more coordinated movements.

BOTOX® began getting FDA approvals for medical uses in 1989 and in 2002 was approved for cosmetic use.

BOTOX® For Cosmetic Use
If you make repeated facial expressions, those muscles work a lot. They contract a lot and squeeze the skin above them together, forming lines or wrinkles. Over the years, those lines and wrinkles become permanent and are reinforced daily by the repeated muscle use.

BOTOX® is most often injected into the frown muscle (the corrugator supercillii). When this small muscle is unable to contract, you do not frown. The vertical frown lines become smoother and the face takes on a more relaxed look.

BOTOX® is also used to smooth out horizontal forehead lines, crow’s feet and neck bands. Some wrinkles are caused by sun damage and some by the daily pull of gravity, and these types of wrinkle do not respond to BOTOX® treatments.

The BOTOX® Procedure
It takes just a few minutes to perform. You may be asked to avoid alcohol for a week or so before your treatment. To prevent bruising it is best to take no aspirin or anti-inflammatory medications for about two weeks before treatment.

No anesthetic is required, as the injection needle is so very fine. There may be some minor short-lived discomfort.

You will see results after a couple of days and they will last for up to four months. Gradually the effect wears off and a repeat treatment must be done.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

Scientists from the Scripps Research Institute in La Jolla, California have found a way to increase the potency of botulinum neurotoxin (Botox) which would be safer and could last longer.

The new combination of Botox could lead to lower price per dose because it would be a lower dose.  Lower doses of the botulinum neurotoxin could help to avoid a complication that can occur with the immune system.  The scientists also say the new combination of botulinum neurotoxin cosmetic treatment of wrinkles could last longer too.

Botulinum neurotoxin is one of the most deadly poisons and considered a possible bioterrorist weapon.  However in the medical world, it has helped treat migraine headaches, lazy eyes, and excessive sweating.  People treated for these other conditions had a side effect of wrinkles disappearing.  This happened because of the neurotoxin caused a paralyzing effects on the muscles.  That is when Botox came to be well known for the treatment of wrinkles.

The lead author of the study, Kim Janda, Ph.D., who is a chemistry professor at Scripps along with his colleagues found a way to make a synthetic molecule that causes the neurotoxin to be ‘superactivated’.  The synthetic molecule binds to specific proteins on the neurotoxin.  This causes the toxin’s paralyzing effects to be increased.  That makes it more potent with less of the toxin.  The scientists estimate that the ‘superactivator’ makes the toxin 14 times more potent than regular botulinum neurotoxin.

“We have developed a synthetic molecule that binds to the toxin and increases its normal function,” Janda said. “The discovery of small molecule activators may ultimately provide a valuable method for minimizing dosage, reducing resistance, and increasing its clinical efficacy.”

At this time the scientist have not tested the ‘superactivated’ botulinum neurotoxin on humans or animals and it would take at least 4 – 6 years for the proper testing to be completed before it is available to consumers.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

Porcelain veneers are thin wafers of ceramic material that are applied over the surface of the natural tooth. Porcelain mimics the tooth structure more closely than any other restorative material. Porcelain veneers are used to cover worn tooth enamel, to correct uneven tooth alignment or spacing and to cover chipped and cracked teeth. The porcelain veneers available today provide a totally more natural appearance than those veneers available in the past.

The placing of porcelain veneers usually involves three steps:
• Diagnosis and treatment planning
• Preparation
• Bonding

In the diagnosis and treatment planning phase, the dentist will discuss goals and what you hope to achieve with this procedure, examine your teeth and devise a treatment plan customized to fit your specific needs. The preparation phase involves preparing your natural teeth to accept the porcelain veneers. During the bonding phase the final adjustments are made to the porcelain veneers and they are permanently placed.

The placement of porcelain veneers requires artistry and skill. A highly trained cosmetic dentist has the skill and artistry needed for the expert placement of porcelain veneers. It usually requires three visits to achieve the desired results. Porcelain veneers are custom fitted and made specifically for your teeth, so you can improve the color of your smile, and cover chipped or crooked teeth all at the same time.

Who is a Good Candidate for Porcelain Veneers?

A good candidate for porcelain veneers will:
• Have good oral hygiene
• Want to improve their appearance
• Be well informed about the procedure
• Have realistic expectations of the results

Porcelain veneers are resistant to staining from coffee, tea or tobacco products. A porcelain veneer should last from 10 to 50 years, and are flossed, brushed and treated as you would your own natural teeth. Properly fitted porcelain veneers are indistinguishable from your natural teeth, except for their perfection.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

Restylane® is a cosmetic dermal filler use to help smooth out lines and wrinkles in the face. A clear, hyaluronic acid-based gel, Restylane® acts in two ways. The gel itself adds volume under the skin to diminish lines and wrinkles. The hyaluronic acid also naturally attracts water, giving natural-looking, long-lasting results.

Hyaluronic acid occurs naturally in the body. Higher levels of hyaluronic acid in children make their skin soft and smooth. As we grow older, the amount of hyaluronic acid diminishes, reducing the elasticity of the skin and causing wrinkles to form.

The hyaluronic acid used in Restylane® is not derived from animals. Instead, it’s produced in a sterile laboratory environment. This means of production greatly reduces chances of allergic reaction. In fact, allergy testing is not required before undergoing Restylane treatment.

The most common areas treated with Restylane® include:

• Nasolabial folds (lines from the nose to the corners of the mouth)
• “Frown lines” between the eyebrows
• Crow’s feet

Restylane® is also sometimes used to increase the fullness of the lips. This usage is more common outside the US, as Restylane® has not been approved for this usage by the FDA.

Treatment with Restylane® can be done in your doctor’s office and usually takes half an hour or less. Effects are visible immediately. Afterwards, there is no down time, and you can go on about your regular day. You might experience some pain or redness at the injection site, but bruising and swelling is generally minimal or even nonexistent.

The results of Restylane® injections last six to twelve months, after which you’ll need to have additional injections to maintain your more youthful look. Or, if you like the results of the Restylane treatment, you might decide to pursue a more permanent option, such as a facelift, chin lift, or brow lift.

For best results from treatment with Restylane® or any injectable filler, it’s best to work with a board certified plastic surgeon who is experienced with injectables and will be able to deliver the best possible results.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

Ultrasonic assisted liposuction (UAL) uses high-pitched sound waves to liquefy fat in a specific area before it is removed. UAL is liposuction used for fat removal in difficult to treat areas such as the chin, neck, cheeks, knees, calves and ankles. It most often serves as an addition to tumescent liposuction for people requiring precise body contouring. UAL is used on both men and women.

In an ultrasonic assisted liposuction procedure, tumescent fluid is injected into the area to be treated. Tumescent fluid is a mixture of anesthetic, saline solution, and epinephrine. This helps prevent fluid loss during the UAL procedure and makes the fat deposits easier to remove.

During an ultrasonic assisted liposuction procedure, sound waves are produced by a generator. The ultrasonic waves are transmitted to a thin, vacuum-like tube called a cannula. When the cannula comes into contact with fat cells, the fat cells liquefy and then are vacuumed out.

Benefits of UAL

One benefit of ultrasonic assisted liposuction is the ability to treat areas that have denser fat deposits and to remove large volumes of fat at one time. UAL is more precise and tightens the skin during the procedure also.

There is a risk of burns, blistering and scarring due to the heat created during ultrasonic assisted liposuction. A well qualified UAL surgeon will know how to deal with the heat generated, but it should be considered.

Treatment Areas

Ultrasonic assisted liposuction can be utilized in all areas that traditional liposuction is used, but it is especially useful in the abdominal area, the mid-section, male breast tissue, the chin and neck areas. Ultrasonic assisted liposuction has the ability to transform the body when performed by a skilled UAL surgeon.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

Very few of us were born with “the perfect body.” Supposing for a moment that we were, then we must factor in the negative effects of gravity, aging, childbirth, and other processes that work against our having that ideal physique. The fact of the matter is this: nearly everyone at some point in their life could benefit to some degree from the wide range of treatment options available in the field of plastic surgery.

Being comfortable with your appearance is essential to living a healthy life. Dissatisfaction with one’s own appearance can have many negative social, psychological, and economic effects, many of which may go unnoticed. Every year, millions of Americans who are self-conscious or embarrassed by their figure choose to be proactive about escaping such negative thoughts with the help of cosmetic surgery.

Today’s technology and refined surgical techniques make cosmetic surgery safer, more affordable, and more convenient than ever. In fact, many procedures can be done in less than an hour. Procedures that were only accessible to society’s elite are now available at a cost within the means of the average American.

What can plastic surgery do for you?

Many cosmetic surgery patients report the feeling of being “reborn” after their procedure, and many of them regret not having done it sooner. Most patients will agree that the benefits of cosmetic surgery far outweigh the costs, both in the short and long term. With these benefits in mind, let’s take a brief look at a few of the more popular surgical and non-surgical cosmetic treatments available:

• Facial augmentation – Virtually anything can be done to enhance your facial features, from ten minute Botox or Restylane treatments to facelifts, eyelifts, forehead lifts, ear reshaping, and rhinoplasty. Get rid of unwanted wrinkles, baggy eyes, and neck fat to restore your youthful appearance.

• Breast augmentation – Multiple options are available to increase the size, firmness, and projection of your breasts.

• Body re-contouring – Spot-treat trouble areas with liposuction or get rid of unwanted abdominal fat and sagging with a tummy tuck.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

Cosmetic surgery leaves no scars.

Many men and women considering cosmetic surgery often have the misconception that there will be absolutely no scarring after their cosmetic surgery. While cosmetic surgeons work as hard as possible to place incisions in unnoticeable locations, when an incision is made or when skin is removed, it is inevitable that a scar will develop. By choosing an experienced, specially trained cosmetic surgeon, patients can make sure that incisions are made as small as possible and concealed by the natural curves of their bodies.

Cosmetic surgery is dangerous.

Cosmetic surgery is a medical procedure and as with all surgeries, there are risks associated for every patient. Recovery times vary, but dangerous is not an accurate word to describe some of the fascinating procedures cosmetic surgeons perform on men and women of all ages every day. Patients should choose a board certified surgeon with adequate experience and training in the type of cosmetic surgery you are considering.

Shopping for the lowest price on a procedure is the best way to find a cosmetic surgeon.

Cosmetic surgery yields permanent physical results and is serious business. Searching for the lowest price cosmetic surgeon in your area is not the best way to choose a cosmetic surgeon. Patients considering cosmetic surgery should find a cosmetic surgeon who is honest with them about the cost, risk, and results of their procedure. Cost must be considered, but it is more important to have a safe procedure performed by a gifted surgery that produces magnificent results.

All cosmetic surgeons are the same.

While cosmetic surgeons may share similar backgrounds, their skill level, experience, and training varies widely. During your initial consultation you should ask your potential cosmetic surgeon about his background and why he’s the best choice for your particular aesthetic goals.

Cosmetic surgeons only perform breast surgery.

While some cosmetic surgeons concentrate on just one or two specific procedures, many cosmetic surgeons provide patients with a wide array of cosmetic surgery options such as:

• Abdominoplasty
• BOTOX®
• Arm reduction
• Liposuction
• Facelift
• Rhinoplasty

Recovery from cosmetic surgery is very painful.

Most cosmetic surgery patients find that the recovery period from cosmetic surgery is not nearly as painful as they thought. People who are considering cosmetic surgery, but are wary of the pain associated with the recovery, should schedule an initial consultation with a cosmetic surgeon in their area. During an initial consultation, your cosmetic surgeon will inform you of exactly what you can expect before, during and after cosmetic surgery.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

As breast augmentation grows in popularity, women from an increasingly diverse demographic and age range are opting for the surgery. When considering this procedure, it is important to determine if the surgery is right for you at the current moment in your life. While you might be a viable candidate for breast enlargement, you may find that based on your circumstances, it might be wiser to wait a few years.

Technically, all women ages 18-50 are potentially candidates for breast augmentation. However, the decision to get breast implants is a very personal one, and the ideal age varies depending on the woman.

Implants for Teenagers

Breast augmentation for teenagers is on the rise, as each year, many parents are surprising their daughters with implants as a birthday or graduation gift.

The Food and Drug Administration (FDA) only approves breast enlargement for women over 18. However, many 16 and 17 year old girls are still opting for the procedure, ignoring the recommendations of the FDA.

Getting implants while you are a teenager may be a bit premature. Most girls’ breasts continue to develop into their early 20’s. It is much better to wait until your breasts are fully formed before undergoing surgery. Otherwise, you run the risk of complications.
Implants for Women Ages 20-35

Most of the women getting breast augmentation fall into this age range. While this may make sense, since these women are in their most vibrant, youthful stage of adulthood, there are still a few factors to consider before deciding to go ahead with the procedure.

Women in their early 20’s may have breasts that are still developing. Breast enlargement at this stage in a woman’s development can adversely affect the results of the surgery.

Many women in this age range still plan on having children at a later date. This is a very important factor to consider when deciding on breast implants. It is generally a good idea to wait until after childbirth to get an enlargement, since the surgery can potentially affect your ability to breast feed. Also, the change in size of a woman’s breasts during pregnancy can lead to sagging, misshapen breasts if implants have already been inserted.
Implants for Women Over 35

This is also a very common age for women to get breast augmentation. In many ways, this is a good time in your life to opt for the surgery. Your breasts will be fully formed, eliminating any complications as a result of inserting implants when you are too young. Also, most women in this age range have already had their children, making complications related to pregnancy irrelevant.

Whatever your age, the most important factor in this decision is whether or not you feel breast enlargement is right for you at this particular stage of your life. It is important to discuss your medical history and goals for the procedure with an experienced cosmetic surgeon who can help you through this decision.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com

A beautiful smile requires more than just healthy teeth. Your gums play a large role. The importance of gum health goes beyond cosmetics. Gum disease is painful, can cause you to lose teeth, lead to deterioration of your jaw bone, and to other health problems. Periodontal therapy treats and prevents gum disease, for a beautiful, healthy smile.

Healthy gums for a beautiful smile

Gum disease can cause your gums to be red and puffy. It can cause your gum line to recede making you look older than you really are. It will eventually affect the health of your teeth and you may even lose teeth. Periodontal therapy protects your gums and gets rid of gum disease. If you already have permanent damage to the look of your gums you can also have a procedure called gum recontouring to restore the beauty of your gums after the disease has been treated.

Gum disease

Poor oral hygiene will cause gum disease, but even if your oral hygiene is great other factors can cause the problem. Genetics, poor nutrition, a weakened immune system, diabetes, a misaligned bite, and even stress can lead to gum disease. Brushing too vigorously and using a brush that is too hard can also damage your gums.

Gum disease can usually be prevented by proper oral hygiene at home, but when bacteria get trapped deep inside your gums your normal routine cannot reach it and get rid of it.

It starts with plaque that gets beneath your gum line. This causes your gums to be inflamed and allows the bacteria to spread. Next, your gums pull away from your teeth creating pockets. The bacteria get trapped in these pockets and your gums become infected. Your gums continue to be irritated allowing more bacteria to enter and keeping the process going.

During this process you will notice pain in your gums, a tendency to bleed when you brush or floss, redness and swelling, and if left untreated, your gums will begin to recede.

Eventually, this can lead to tooth loss and even damage to your jawbone.

Types of gum disease

You have probably heard of gingivitis which causes redness, swelling, and bleeding, but there are several other types of gum disease including:

• Chronic periodontitis causes progressive gum detachment, receding gum line, inflammation of the supporting structures of the teeth, and bone loss.
• Aggressive periodontitis causes rapid detachment of the gums and bone destruction
• Necrotizing periodontal diseases cause death of the gum tissue, periodontal ligament, and the alveolar bone.
• Periodontitis that is caused by systematic diseases.

The solution

Periodontal therapy removes the bacteria from deep inside of your gums. This stops the infection, irritation, and inflammation ad allows your gums to heal so the pockets can close keeping the bacteria out.

ArrivaCostaRica.com is the primary web site for information about plastic surgery and dentistry in Costa Rica. See www.arrivacostarica.com