The Center for Disease Prevention & Reversal Blog

Fraud of any kind is never a good thing, especially when it taints a whole community.
This past month, Lisa Madigan, the attorney general of Illinois filed a lawsuit against the Chicago area Nu U spas. This could actually be a very good thing as they had allegedly been practicing medical aesthetics without a physician.

They were presumably giving very "hard sells" to their clients by having them sign documents committing them to several treatments at thousands of dollars per contract.

I had heard a few times from patients coming to my office that they had seen an aesthetician at a NU U spa claiming she was going to be delivering the treatments herself. And, they reported feeling pressured into signing paperwork committing them to many treatments. So, I was very glad to hear that they were finally being called on suspicious behavior. However, I was very concerned to read the press release out of Madigan's office. It implied that lipodissolve itself was dangerous and illegal. They stated that the treatment was not FDA approved.

While technically, this is true, it is very misleading. The FDA has no jurisdiction over procedures, only drugs and medical devices.

It is true that phosphatidyl choline (lecithin) and deoxycholate (bile salts) are not FDA approved drugs. They are both naturally occurring and not patentable, just like a vitamin b 12 injection. It would be illegal to market them to the public as drugs.

Physicians that are trained and certified in lipodissolve perform the procedure with the aforementioned agents. This is not illegal. Nor is it dangerous. There has never been a single death, hospitalization or a serious side effect from the procedure being performed by a physician. There has a reported case of uneven fat removal under the eyes by a physician who was not trained in the procedure.

That is an amazing record. Compare that to allergy shots, which cause death by anaphylactic reaction in a handful of patients each year in the US, or to liposuction, that has the highest death rate among elective procedures.

Physicians in the plastic surgery department at UCLA performed an extensive study of outcomes and side effects of lipodissolve. The results and conclusions were overwhelmingly positive.

Both American Academies of Plastic Surgeons, view lipodissolve as an economic threat. Liposuction bookings have fallen drastically since news surfaced that liposuction has the highest death rate of any elective procedure. Lipodissolve's emergence as a safer, less expensive alternative to liposuction has made many plastic surgeons nervous.

In reality, many plastic surgery offices are now offering lipodissolve, and you can bet that the surgeons have the nurses performing the procedure, as it is not worth the surgeon's time in dollars.

Is it necessary to look like a kissing trout or a parading duck after having your lips augmented and having the lines of your top lip filled in?

I think not. I notice in my Chicago practice, many women walking around with lips like Daffy Duck. It has become a look that has been accepted and even revered.

This 'look' occurs because the vermillion border of the lip gets overfilled along with some of the vertical lines. And, If the nasolabial lines are filled completely, the top lip is driven inside causing the physician to then over fill the top lip.

From the doctors perspective, the more filler they sell, the more money they make.
The plastic surgeons have created this extreme look and women flock to it.

Often this Daffy Duck look goes along with huge breast implants and 6-inch high heels.
I believe that hyaluronic filler for facial enhancement should be applied in order to turn the clock back, not to create the look of another species.

Less is more. The results of having filler applied in wrinkles, and in an ever-disappearing mouth should simply be a return to a more youthful look of the person: shallower wrinkles and a neutral position of the corners of the mouth.

There are many techniques when filling in lines, some of the techniques just fill in lines and some techniques actually stimulate collagen production.

When I teach "filler technique" I encourage my students to use techniques that stimulate collagen production and not to overfill lines and wrinkles. In essence, I try to encourage a return to a more youthful look as the doctor-patient goal.

In my Chicago area office, I see many women who have used botox repeatedly over the years. They often have flat foreheads and abnormally shiny skin from muscular atrophy.
Often their eyebrows are too high on the foreheads giving them a look I affectionately call "Mrs. Surprise".

The question is; is this the necessary outcome after using years of botox? And the answer is; it doesn't have to be.

Training courses for physicians often focus on the marketing and financial aspects of learning a new technique. The plastic surgeon I initially heard speak about botox had a frozen expression and stated he used a whole vial (100 units) in each of his patients face. He was supposedly excited about the topic but I couldn't tell. He spoke about getting the patients "hooked" on their freshly ironed face and returning every three months for their eight hundred to twelve hundred dollar treatment.

I don't love my "elevens" but I can tell you that weakening the muscles (by using less botox per area) as opposed to paralyzing them is a better way to go in the longterm. This isn't the norm as it is not how we're taught in training courses, and it's not a good business model, since we charge per unit of botox. And, to be fair, there are many patients who want their face immobilized.

I encourage my patients to sit down with me and talk about expectations, short and longterm. This way I can explain that weakening the musculature that causes excessive wrinkling is often a better option than completely paralyzing facial expressions. Besides, next time you're feeling something, don't you want others to know it.