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Points, practicalities of most practiced procedures


Among the certainties awaiting new dermatologists joining or starting a practice — especially one specializing in cosmetic dermatology — is this: They'll be doing a lot of procedures using Botox (Allergan) and fillers.

Editor's note: Every month in Residents' Forum, a dermatologist in practice or academia will discuss clinical and practice management issues affecting residents. If you're a resident and would like to see specific issues covered in this column, please e-mail the editor at mhrehocik@advanstar.com

"Botox and fillers are the ultimate nonsurgical, noninvasive rejuvenation procedures," says Susan H. Weinkle, M.D., in private practice in Bradenton, Fla., and assistant clinical professor of dermatology at the University of South Florida's College of Medicine, Tampa.

Practical tips

In addition to her private practice and academic pursuits, Dr. Weinkle speaks frequently at conferences and seminars geared toward residents readying to strike out on their own. Dr. Weinkle says she likes to offer residents a comprehensive background on Botox and fillers - and some practical tips on the use of both.

Originally used in the 1970s to treat strabismus, Botox eventually was observed to soften wrinkling in the glabellar area and by the 1990s was in relatively widespread use cosmetically. In 2003, the Food and Drug Administration (FDA) approved Botox for cosmetic use.

"Botox's onset of action is one to two weeks and duration of action is three to six months," Dr. Weinkle says. "It's most commonly used cosmetically to treat forehead lines, crow's feet, lines around the mouth and lips and neck bands."

Dr. Weinkle offers several points to remember when evaluating a patient for potential Botox treatment:

And she offers a list of what doctors should remember not to do where Botox is involved:

Know complications

"It's important to be aware of complications that can occur, and to learn as much about proper injection sites and techniques as you possibly can," Dr. Weinkle says, adding that if not done properly, Botox injections in the forehead, for example, can result in eyelid and lateral eyebrow ptosis, lack of expressivity, a change in brow shape or a quizzical look.

Similar complications can occur in other areas, as well.

"There are a couple of what I call 'tricks of the trade' I like to pass on to residents, like venting the Botox bottle and removing the cap to retrieve the very last drop," she says, "and I always offer this caveat: Botox manufacturer Allergan has estimated that some 200 dermatologists have ordered bogus Botox, resulting in some of them losing their medical licenses."

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