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April 28th, 2009

Allure magazine has just reported the availability of a new injection material, Evolence.  Manufactured by  Ortho-McNeil-Janssen Pharmaceuticals, Inc.,  it received  FDA approved almost a year ag0.  Now available in the US, it gives another choice to patients requesting injectable wrinkle treatments.   Other injection materials include hyaluronic acid (Restylane ®, Juvéderm ®), hydroxyapitite (Radiesse ®), autologous fat (fat from your own body), and other collagen products (Zyderm ®, Zyplast ®, Hylaform ®, Cosmoplast ®).  

The Evolence  collagen is sourced from porcine (pig) tendons.   It is crosslinked using a patented technology using D-Ribose a natural sugar.   Due to the genetic similarity between pig and human collagen and the crosslinking process, dermal allergy pre-testing is not necessary.

The search for the ideal injection material to improve facial wrinkles, augment facial bones, and enlarge lips has endured over a century long pursuit for plastic surgeons.   The first material tried in the 19th century was paraffin or wax.   The chemical induced inflammation and ruled out this material out of the question very early on.   Interestingly, I recently saw a patient from Asia who had received such an injection in the 1990’s!  

Women searching for larger breasts in the 1940’s and 1950’s received silicone injections.   The reactions were so serious, it was banned in the US.   Unfortunately,  silicone breast injections  continued elsewhere in the world for some time.   In 1994, the FDA approved injectable silicone  for detached retina treatment.   The off-label (not approved) injection into the face has continued since that time.   Sadly this practice has migrated outside the standards and medical protocol of physician’s offices.  It can be found in home parties and offered at hotels where it is being injected by individuals without medical training.  Poor results are common.

Collagen injections were first approved by the FDA in 1981.   Since that time there has been a string of new collagen products, each trying to improve on the last.     Problems including allergic reactions, visible material under the skin, and skin loss (necrosis)  have plagued  these products.   Only widespread clinical use of Evolence will be able to confirm the reported risks and benefits for this product.

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Three Bears

April 27th, 2009

Can you tell Melissa has three small children?  In her latest blog, her analogy comparing breast size to “Goldilocks and the Three Bears” is apropos.  It is a fact that all patients want the perfect size after surgery.  So do I!  No one wants to go through the expense and risks of having surgery for a second time, in an effort to get the breast size they want.

Melissa’s choice should work very well for her.  I believe to achieve a natural result for Melissa, we must start by first matching the diameter of the implant to the diameter of her breast.  Placing the implant centered beneath the nipple will fill the breast and skin envelope symmetrically.  This combination should give her a natural tear drop shaped breast which looks most natural.

Based on my examination of Melissa and the size she has chosen, I expect to use a Mentor implant which has a minimum inflation volume of 275ml.  This matches her breast diameter best.  The manufacturer recommends inflation between 275ml to 300ml.  The plan will be to inflate this implant to the 300 ml she has chosen.  I do not exceed the manufacturer’s recommended inflation volumes.

The implant  will be inserted through a 20mm incision near the crease beneath each breast.  This inconspicuous scar will always be hidden by her clothing.  It will be inserted empty and inflated after being placed underneath the muscle and breast tissue.  This effective technique results in having the final scar measuring less than an inch long.

Based on this plan we should achieve Goldilock’s, “Just right!”

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