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QUESTION:
Dr. Levine, I am finally starting my procedures in a medical spa owned by a plastic surgeon. I wanted to clarify the mixture and amount recommended for Sculptra and Botox, Sculptra dilute 3cc Lidocaine, 3cc bacteripstatic water and how many cc/'s do i typically use in one foot for the injection unter metatarsal? Botox you reccomend diluting 4cc with bacteriostatic water use .05 - .08 per injection to monitor would a tuberculin syringe be more advantageous to measure out .05 - .08 and recommended 30 - 60 injection per foot is that below toxic level? PLEASE TRY TO EMAIL ME ASAP, STARTING IN 1 WEEK AND VERY EXCITED!
Meredith B. Stuart, D.P.M
Gershon Goldman
Use of the Starlux IPL - can any of my staff, properly trained, of course, administer treatment it? And, can they do so in my absence or to do so must they be a licensed beautician or aesthetician? I understand that I can use the laser on removal of any body hair, as even a salon can do this. But, what about lesions on the upper body? Don't salons treat facial erythema or even acne or "age spots" with dermabrasion-and can't I then treat these with the IPL? At what point does this become "Dermatology" and "Out of scope"?
Courtesy of Palomar Medical on 2/7/06
Answer: The use of the StarLux by trained staff members (whether they are cosmetologists, aestheticians, electrologists, nurses, etc) is determined by the licensing regulations within each state. In most states, a Podiatrist can purchase a StarLux and use it below the knee or ankle (again, depending on the defined scope of practice for a Podiatrist in that state) and he/she can delegate the use of the StarLux to the above listed staff members if their licenses permit that as well. Typically, a Podiatrist can purchase the StarLux and then have an aesthetician treat the upper body and do hair removal. In most states, non-physicians can in fact treat a variety of cosmetic problems all over the body. These include, pigmented spots, vascular lesions, unwanted hair, acne, etc. It again depends on the state and in fact within each state, it is a function of the different governing boards or committees for each group (nurses, aestheticians, etc). The StarLux can be used very effectively to remove "age spots" and related sun damage, as well as treat acne and a variety of other lesions and produce outstanding results. Generically, not all IPL's are equal, so not all systems yield equally excellent results. A legal opinion should be obtained from a doctor's legal counsel as a final determinant for utilization of IPL's and Lasers in their respective states.
Pedram Hendizadeh, DPM
I wanted to find out where I could get brochures for patients, the agents for the vein treatment, the 5FU injections etc. Not sure if you have a list of vendors that you could pass along.
Answer: Brochures for patients are available on this web site or by calling our office, 212-535-0229.
The agent for the vein treatments is Polidocanol as described above.
Recommended vendors will be linked to this site soon.
Ray Noonan DPM
· A few people that I have talked with in Atlanta are concerned with the granulomas that develop with using sculptra and prefer radiance for the injectible. What have been your findings? How often do you get the granulomas? Why do they occur, poor technique? How do you treat them? I understand that a Medrol type steroid will work. Usually how many injections? I will assume that the symptom would be a painful lump? The people down here when it occurs in the face just inject the radiance around the granuloma. I am cautious as it is off label use by a DPM
a. Answer: Sculptra and all other injectable implants can rarely cause granulomata. Hyaluronic acid products are very unlikely to have this complication, Sculptra is probably slightly more likely. Sculptra (unlike its previous incarnation as New Fill) is a volume replacement agent and is therefore given deeper, more dilute, and with fewer complications or granuloma. No patient of mine has had this complication. I do not treat granulomata, as I have not yet had one—luckily? The treatment is judicious use of intragranulomata steroid. Judicious, because you don’t want skin atrophy. To hide the granuloma with Radiance—interesting?
· How long will radiance last 6-9mo? Have you used in the foot. The person I talked with had it injected in the foot and worked well.
Can you inject on bony prominence (ie 5 toe corns?)
a. Answer: I have not used Radiance, patients have had it elsewhere and complain to me of lumps, especially in the lips. The company claims 3-5 years.
· Charges? I assume you double the cost of medication and divide by # of units injected? If you are not injecting on regular basis,
product can go bad and can be costly.
a. Answer: Your assumption is incorrect. Practice inventory control. Don’t over order.
· Complex green tea antioxidant- that was not used in the foot facial. When is it used & for what & why?
a. Answer: The best antioxidant. Free radicals beware! Protects against free radical damage caused by UV light, smoking, pollution, and normal metabolic activities. Should be used sparingly, daily.
· Recovery complex- I do not think that it was used in foot facial… what is it used for ?
a. Answer: It is an excellent treatment for post laser and post peel. It helps soothe and protect the skin.
Joaquin Balaguer
Point of interest: there is a huge debate here in Puerto Rico, as the Board of Medical Examiners recently restricted the use of Restylane, BOTOX, Sculptra, etc to only Dermatologists and Plastic Surgeons. Even tough, we are not regulated locally by them it is a sticky situation for us Podiatrists to make any kind of noise on this subject now as it may backfire on us. We have come a long way recently in the past couple of years to start getting some recognition by MD's and health plans to trigger anything with our profession at this time. I intend to start just doing internal marketing, and seeing the results before I launch a full blast campaign (which I intend to do when all these issues with Dermatologists and Plastic surgeons resolve).
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