We've relocated and are seeing patients at our new Lone Tree office!

Weber Facial Plastic Surgery has relocated and is open for business! Give us a call at (303) 792-2224 to schedule your next appointment.

9695 S. Yosemite Street, Suite 359
Lone Tree, CO 80124
(303) 792-2224
weberfacialplasticsurgery.com

Check out our Addy for more information and turn by turn directions to the new office.

See you soon!

Steve

Stephen Weber, M.D., F.A.C.S.

Are Blood Clots a Common Problem in Plastic Surgery Patients?

Recent media accounts regarding Hillary Clinton's blood clot have prompted several of our patients to ask what the real risk is of blood clots after Facial Plastic Surgery procedures. 

The good news is that the risk is low for healthy people without any underlying clotting conditions. There exists a perfect storm of factors referred to as Virchow's Triad. The triad includes pooling of blood in the legs, existence of a hypercoagulable state (more clotting) and injury to the inner blood vessel wall. 

Patients undergoing Facial Plastic Surgery procedures can minimize the risk by revealing any underlying blood clotting problems in themselves or family members. Further, depending upon the level of risk of blood clots (referred to as deep venous thrombosis), many maneuvers can be performed to prevent clot formation. These options include minimizing operative time, placing compressive stockings on the lower legs and using sequential compression devices to prevent pooling of blood in the legs. In more extreme cases, patients can be treated with short-term blood thinning medications to further reduce the risk. 

We are vigilant in identifying warning signs such as swelling, discomfort or pain the calf muscles following surgery. However, in our typically healthy population of patients, the risk of deep venous thrombosis is low.

Stephen Weber, MD, FACS
Lone Tree Facial Plastic Surgeon

Buyer Beware - "Illicit Botox Sparks Alert"

Illicit Botox Sparks Alert reads a recent headline in the Wall Street Journal. In the current case, physicians purchasing illicit Botox from outside the US likely received counterfeit medications. It is unclear whether the vials contain Botox and if they do whether the drug is provided at safe concentrations. 

Only MDs in the United States are allowed to purchase Botox from its manufacturer, Allergan. There are illegal arrangements where nurses, estheticians or those with even less training  obtain Botox from an absentee physician and then perform unsupervised injections. This practice is unsafe, unethical and unfortunate. This is, however, increasing in frequency as poorly trained "practitioners" or "injectors" swarm the field of cosmetic medicine and, in some tragic cases, plastic surgery.

Like many ethical issues, these practices result from financial pressure. An ethical physician would never put his or her patients at risk to make a profit. However, there are those physicians and other providers who have decided that offering cut rate injectable treatments (Botox, Dysport, Juvederm, Restylane, Perlane) is the path to a tidy sum. For very good reasons, legitimate FDA-approved drugs are not cheap (hence the higher cost of being treated by a reputable Plastic Surgeon or Dermatologist). 

When the $8 per unit Botox provider realizes that they lose money on every unit injected, there is tremendous pressure to reduce costs. This can sometimes involve overly diluting the medication such that patients receive fewer units of Botox than they paid for. Alternatively, medications can be purchased from foreign companies in India, China and Canada, to name a few. In some cases, there is no active medication in the purchased product. In other, more dangerous cases, there is excessive or non-medical grade product masquerading as an FDA-approved, safe medication. 

I am reminded of a case in which research grade Botulinum toxin was reconstituted and injected by a chiropractor. He injected himself, his (soon to be ex-) girlfriend and another couple. All four survived but wound up in the hospital for prolonged periods due to a ludicrous overdose of the drug. This type of complication is a "never event" and does not occur when Botox is purchased from its manufacturer in the US. 

The take home message is that there is an increasing number of unscrupulous providers entering the practice of cosmetic medicine. There will always be those that look to make a quick buck rather than building relationships and providing exceptional, long-term care to their patients. Warning signs include:

1. non-core physicians (those other than Facial Plastic Surgeons, Plastic Surgeons and Dermatologists) offering cosmetic services. Many among us have seen ads for injectable treatments at their internal medicine or OB-GYN office. A patient of mine was actually offered Botox by his gastroenterologist! 
2. non-physician "injectors" with no physician affiliation are suspect. To reiterate, they cannot legally buy the product they're offering to inject at bargain basement prices. Thus, you must ask where the product came from. 
3. prices that are too good to be true. In fact, they are. 

It is important to note, that fixing bad Botox is much more expensive than having it done right the first time. There is no substitute for exceptional training and experience.

If you would like to discuss Botox or other injectable treatments with a board-certified Facial Plastic Surgeon in the Denver area, schedule a consultation.

Stephen Weber, M.D., F.A.C.S.
Lone Tree, Colorado

What Can Be Done About Aging Hands?

My patients spend countless hours researching the best preventative and maintenance regimens for care of their facial skin. They return like clockwork for chemical peels, Botox and filler treatments. They perform exhaustive online research to evaluate surgical options for facial rejuvenation. Together, we make decisions on what treatments to pursue to achieve their goals. 

The one issue that is often falls through the cracks is aging of the hands. Second only to our face, the appearance of the hands is a dead giveaway of a person's age and the amount of sun damage they've experienced. Most importantly, if we don't address the hands, there is a discordance in the appearance of the face and hands that is noticeable.

So what options are available to rejuvenate and "spruce up" the appearance of hand aging? 

We perform an increasing number of filler treatments to the back of the hands and laser resurfacing of the hands to fill, tighten and rejuvenate the hands. Two syringes of a dermal filler such as Radiesse can be used to fill the back of the hands with several painless injections. The filler is then smoothed and massaged into the valleys between the tendons of the back of the hand to turn back the clock and plump the hands. These results last for over 12 months.

Once the hands have been filled and plumped we perform laser resurfacing to tighten the skin, eliminate irregular pigmentation and eliminate wrinkles in the hands. With the addition of topical numbing cream, this treatment is painless.

Before - Radiesse Hand Rejuvenation

After - Radiesse Hand Rejuvenation

This combination of treatments is safe and effective for both women and men. The treatments have a very high satisfaction rate and represent the icing on the cake that complements all of the effort we put forth to care for our faces.

Schedule a consultation today to learn more!

Stephen Weber, MD, FACS

Dr. Stephen Weber becomes Fellow of the American College of Surgeons

I am really excited to announce that I've been granted Fellow status in the American College of Surgeons. The college has a very rigorous screening process during which they extensively evaluate a candidate's education, training, professional background and competence in their area of specialization. Fellows must be board-certified in their practice specialty and embody strict ethical and professional principles in order to receive the F.A.C.S. designation. Most importantly, this distinction is one more indicator to our patients that they will be well cared for by an ethical and highly experienced Facial Plastic Surgeon.

Stephen Weber, M.D., F.A.C.S.

We've Just Rolled Out a New Website

We've just rolled out a new www.lonetreefacial.com . Please check it out and let me know what you think!

- Stephen Weber, M.D.

Guest on Lisa Linder's Our Community Radio Program / MileHiRadio Denver

This week I had the pleasure of being a guest on Lisa Linder's Our Community Radio Program. I had a great time with Lisa and her daughter Noel. 

We spent an hour talking about facial plastic surgery and all of the cosmetic and reconstructive surgery that I perform in my practice in Lone Tree, Colorado.

We also discussed my past and future humanitarian mission work. We spent alot of time discussing our recent surgical mission with Outreach Africa. We traveled this year to Tanzania and operated on 59 people and saw over 300 in the clinic over a two week period. You can also find photos of the trip on my Facebook page.

I hope you'll take a listen to the interview!

Transconjunctival vs. Transcutaneous Blepharoplasty: What Does All This Mean and Which is Right for You?

First off, what is a blepharoplasty?

Blepharoplasty, or an eyelid "lift", is one of the most common facial plastic surgery procedures performed worldwide. Both the upper and lower eyelids can be "lifted" but I'll focus on the lowers in this post. Lower blepharoplasty most often involves removing a "bag" or bulge of fat from the lower eyelid and, in some cases, removing extra skin from the lower eyelid as well. 

Before transcutaneous lower blepharoplasty.

After transcutaneous lower blepharoplasty.

What are the alternatives to lower blepharoplasty?

The options are few. However, lower eyelid bags can be camouflaged (not removed but covered up) with injectable filler such as Juvederm or Restylane. This should last somewhere between 6-12 months and must be repeated to maintain the effect. Extra lower eyelid skin can also be treated with CO2 laser resurfacing to tighten rather than remove the extra skin. This is a long-lasting result but is less robust than surgically removing that crepey skin.

What is the difference between a transconjunctival and transcutaneous blepharoplasty?

Transconjunctival means "through the conjunctiva" or pink tissue on the back of the eyelid. Transconjunctival blepharoplasty involves a small incision hidden on the backside of the lower eyelid. The fat pockets are visualized and the fat is either conservatively removed or rearranged to eliminate the bag. The incision heals very nicely and should not cause any problems with lower eyelid position if performed by an experienced plastic surgeon. This approach does not remove or tighten the lower eyelid skin. To achieve this a small amount of skin is removed via a separate skin incision under the eyelashes ("skin pinch") or the lower eyelid skin can be resurfaced with the CO2 laser at the same time.

Transcutaneous means "through the skin." Transcutaneous blepharoplasty is performed through a single incision just below the eyelashes. This same incision can be used to remove the lower eyelid bag and tighten the lower eyelid skin. For this reason, it is much more straight-forward to perform the transcutaneous approach. Many patients are concerned about the appearance of an incision in this location. I can tell you it heals very, very well. In fact, I've had several patients ask why I didn't make the incision in this area at their one week post-surgery appointment. I did.... They just couldn't see it, even one week after surgery.

So which is better?

These two approaches to blepharoplasty are just tools. If performed properly in an appropriately selected patient, they are both highly effective. A consultation is required to discuss the option, surgical or non-surgical, that is most appropriate for you.

To schedule a consultation you can reach my office at (303) 788-6632 or email info@lonetreefacial.com .

Your Anesthesia Options

I am often asked what type of anesthesia will be required for Facial Plastic Surgery.

The most appropriate option depends upon the surgery being performed and the underlying health of the patient. I've listed below the options that I frequently employ and a discussion of their pros and cons.

Local Anesthesia

Local anesthesia involves the infiltration of a numbing solution (Lidocaine and Marcaine) that includes some epinephrine (adrenaline) to constrict blood vessels and minimize bleeding. The area is numbed nearly instantaneously. You do feel a "pinch" or "bee sting" but the area that is infiltrated will remain numb during surgery and for three to five hours afterward. Local anesthesia can be combined with oral sedation (Xanax, Ativan, Valium) to provide relief for anxious patients.

This option is most appropriate for small soft tissue procedures:

• Upper Blepharoplasty
• Mole Removal
• Scar Revision
• Skin Cancer Reconstruction
• Earlobe Repair
• Laceration Repair

IV Sedation (Twilight Anesthesia, Monitored Anesthesia Care, MAC)

IV sedation uses safe doses of common intravenous medications to provide procedural sedation. Medications used include Versed and Fentanyl among others. This is often combined with local anesthesia to provide local relief of discomfort and minimize bleeding during the procedure. IV sedation allows a patient to "sleep" through the procedure without the need for a breathing tube in their airway. 

IV sedation is effective for nearly all facial plastic surgery procedures including:

• Facelift
• Necklift
• Browlift
• Upper and Lower Blepharoplasty
• Rhinoplasty
• Cheek Implants
• Chin Implant
• Liposuction
• Otoplasty
• Deep Laser Resurfacing

General Anesthesia

General anesthesia is what most people think of when they refer to "being under" or "being asleep." General anesthesia results in loss of consciousness that requires a breathing tube to be placed to assist the patient in breathing. When performing face or neck surgery, general anesthesia is only required for cases such as reconstruction of severe nasal defects where it is expected that some blood might enter the airway. In these cases, we need a breathing tube in place to protect the airway and maintain breathing. 

While many facilities will perform general anesthesia for Facial Plastic Surgery, this is not required as IV sedation is safe and effective in most cases. 

For further information about your options, call (303) 788-6632 or email info@lonetreefacial.com .

What can be done about my torn, stretched or "gauged" earlobes?

I am always surprised when I encounter a patient in the office who was unaware that torn, stretched or gauged earlobes can be repaired with a straight-forward office procedure.

Patient 1 - Typical stretched
ear piercing.

Heavy earrings tend to stretch the earlobe and widen the piercing. After years of wearing these baubles, women will typically present with a stretched piercing and very droopy earlobes. The stretched piercing will typically not retain small earrings and they will either fall out or point toward the floor!

Patient 2 - Torn earlobe.

Many women will at one point catch an earring on their clothing or a pillow causing the earlobe to tear. The normal healing process will frequently leave a notch in that torn earlobe that will never heal without surgery. 











Likewise, "gauging" the earlobes can result in earlobes that elongate with a large healed hole in the middle of the earlobe. The lobe will never shrink and the hole will not close properly without surgery. Of note, the popularity of earlobe repair among males has surged since the military will not allow men with gauged earlobes to enlist. In cases like these, a thirty minute office procedure enables these young men to enlist and pursue a military career.

Patient 1 - After earlobe repair.

As I've already alluded to, the only option for repair of stretched, torn or gauged earlobes are surgical in nature. However, the procedure is a quick in office procedure that can be performed in the office on the lunch hour. There is no "downtime." The edges of the torn or stretched earlobe are freshened and the tear is then meticulously closed with dissolving sutures. The gauged earlobe presents a special case since the margin of the gauged piercing is typically very delicate. Thus, gauged earlobes are slightly more complex to repair but can still be fixed with a straight-forward office procedure. 

Patient 2 - After earlobe repair.

The incisions heal very nicely and rarely objectionable. Patients with darker skin can form keloid scars but if you did not keloid from the piercing the chances are very good that you will not keloid following the repair (see Patient 2 at right). Infection is very rare after this procedure. Your new earlobe can be pierced in the office three to four weeks after the procedure.

For more information or to schedule repair of your torn, stretched or gauged earlobe call us at (303) 788-6632 or email info@lonetreefacial.com . 

What's the difference between a browlift and a blepharoplasty? Which do you need?

This is a very frequent question in my practice. Maybe my patient saw something on TV or spoke with a friend but they're convinced that they need a specific procedure to rejuvenate their face. This is incredibly common when talking about the eyes and upper face and there is alot of confusion out there.

What is a browlift?

Women tend to have refined, arched eyebrows which sit above the bony rim of the eye socket. Men, on the other hand, tend to have flat eyebrows with minimal arch and their brows tend to sit right on top of the framework of the eye socket. The browlift procedure is designed to lift and reshape the eyebrows. 

Does the browlift procedure differ in women vs. men?

The procedure is technically the same. However, I aim for a refined, arched brow in women and a flatter, less elevated brow in men to maintain the natural cues of a feminine or masculine face. One major mistake for men seeking brow or eyelid surgery is undergoing a procedure with a plastic surgeon who does not frequently operate on men. The result is often a feminized appearance that clashes with the rest of the man's masculine appearance.

What is a blepharoplasty?

Both upper and lower blepharoplasty are frequently performed. This is the most common procedure performed in my practice for women and men. 

An upper blepharoplasty is performed to remove extra skin from the upper eyelid, a small strip of muscle and occasionally a pocket of fat near the nose. This recreates the natural eyelid crease and "opens" the eyes making a person look more rested and more youthful.

Lower blepharoplasty most often involves removing fat that forms a "bag" or a bulge in the lower eyelid. This is typically performed with an incision hidden on the back of the eyelid. In patients with extra skin in the lower eyelid, a small incision is placed below the eyelashes to remove the extra skin.

So which do I need?

Drooping eyebrows AND extra upper eyelid
skin require both a blepharoplasty and browlift.

• If your eyebrows are drooping AND there is extra skin in the upper eyelid when the brow is lifted to its natural position, you need a browlift AND a blepharoplasty.

Drooping eyebrows but NO extra upper eyelid
skin require a browlift only. 

• If your eyebrows droop but there is no extra skin in the upper eyelid when the brow is lifted to its natural position, you need a browlift only. 

Eyebrows in good position but extra upper
eyelid skin require a blepharoplasty. 

• If your eyebrows are in good position but your upper eyelids are full, you need an upper blepharoplasty.

How can I learn more?

Setup a complimentary consultation with me to discuss browlift, blepharoplasty or any aspect of facial rejuvenation surgery. You can reach my office at (303) 788-6632. For your convenience, I have office hours on Wednesday evenings and Saturdays available.

Financing Offered by Weber Facial Plastic Surgery

Weber Facial Plastic Surgery has been offering our patients the convenience of CareCredit financing. This plan can be used for all cosmetic treatments as well as cosmetic surgical procedures offered in our office. It is simple to determine whether you qualify for CareCredit financing either online or via phone and we can walk you through the process following your appointment with Dr. Weber. No-interest financing for 6 months is a win-win!

From the CareCredit website:
"Many patients put off treatments and procedures because they cannot afford to pay. Doctors offer CareCredit payment plans as a convenient option to consumer credit cards, cash or checks. CareCredit allows you to pay over time often without incurring interest charges instead of a lump sum prior to treatment. Offering CareCredit removes the accounts receivable responsibilities from the doctor and allows them to focus on recommending and providing the best care to their patients."

For more information, call us at (303) 792-2224 or visit Weber Facial Plastic Surgery.

Botox, Dysport, Xeomin: How Many Neuromodulators Should Your Practice Offer?

Excerpted from an article I authored at medicalspamd.com:


http://medicalspamd.com/the-blog/2012/6/11/botox-dysport-xeomin-how-many-neuromodulators-should-your-pr.html

With Botox, Dysport, and Xeomin available and being marketed directly to your patients by their manufacturers, how many — and which ones — do you need?

In the United States, we currently have three neuromodulator products (Botox - Allergan, Dysport - Medicis and Xeomin - Merz) approved by the FDA for treatment of the glabella complex.

These products are also frequently used “off-label” for treatment of the upper-, mid- and lower-face. Botox has over a ten year-track record of safe and effective use and is the best-selling neuromodulator worldwide. Dysport was similarly approved as a cosmetic treatment in 2009. Of note, a recent injunction against Merz unrelated to safety or efficacy has delayed the nationwide rollout of Xeomin.

Given that we have multiple agents to choose from, there are a number of issues to consider when choosing which neuromodulator(s) to offer to your patients. I’ll focus on Botox and Dysport as Xeomin is currently unavailable and has yet to receive its nationwide rollout pending the legal controversy.

Is one agent safer and/or more effective?

Clearly safety and efficacy are paramount when it comes to choosing a neuromodulator. All available neuromodulators are FDA-approved for treatment of the glabella and are frequently used off label with a favorable safety profile. There is evidence that Dysport has a greater tendency to diffuse and most injectors at some point will experience this. The risk of diffusion appears to be higher with more dilute/ larger volume injections. This is worth considering if you have less experienced injectors in your practice.

With regard to effectiveness, an important point that should be well understood by all injectors is that 2.5 Dysport units are typically required to provide an effect and duration similar to 1 unit of Botox. The issues that we often see with the effectiveness of Dysport are often remedied when patients are treated with an adequate dose of Dysport. When patients are treated with adequate amounts of either agent, similar clinical effects are typically observed.

Does one injectable last longer or have faster onset?

In some studies, Dysport has a slight advantage in time to effect over Botox but this is a small difference. Duration of action will clearly differ depending upon the number of units administered and treatment must be tailored to the patient’s muscle bulk. While Dysport is often touted as having longer duration of action, I have not found this to be the case in practice. In my experience Botox and Dysport have similar onset (about 3 days) and length of efficacy (about 3 months). Again, the issue of appropriate dosing is critical. As long as a 2.5: 1 unit ratio of Dysport to Botox is provided, most patients can expect at least three months of benefit. Those patients who require a higher dose of one agent due to relatively greater muscle mass typically require similarly elevated doses of another agent. This reinforces the point that treatment must be tailored to the patient's anatomy regardless of which agent is chosen. 

Is there a certain facial region that is more suited to a certain agent?

While several studies have suggested that one agent is more effective than another in certain facial regions, I have found the difference to be negligible in practice. 

Does one drug have a higher incidence of "non-responders" or "resistance"?

“Resistance” to neuromodulator is highly uncommon. I have not seen this in the past four years of using both Botox and Dysport. I have experienced the patient who describes a neuromodulator “not working” who then responded beautifully to a repeat treatment. There are obviously numerous injector and toxin preparation explanations for this failure but this is clearly not immunologically-based resistance to treatment. Further, in my experience, patients who do require higher doses of one agent typically require higher doses of another. 

With regard to the newcomer Xeomin, it’s formulated as a “naked” toxin without other associated proteins. Thus, it is possible that the risk of immunologic reactivity will be lower following Xeomin treatment but this theory will takes years to be fully investigated. 

Is one neuromodulator “cheaper”?

While Dysport was initially touted as being cheaper to the patient than Botox, this has not been the case. When patients are treated to effect, most injectors will agree that a ratio of 2.5 Dysport U: 1 Botox U is most appropriate. At current pricing in the Denver area ($12/ Botox U and $5/ Dysport U) the cost to the consumer is actually slightly higher for Dysport than Botox. 

Does one company offer better rebates to our patients?

Both Allergan and Medicis offer consumer rebates of similar dollar amounts to assist patients in purchasing their products. Allergan typically provides instant rebates for product which reduces the point of sale cost to patients. Medicis provides mail-in rebates that are received after the treatment is rendered. 

Allergan also offers the Brilliant Distinctions program that provides “points” for future purchases of Botox, Juvederm and Vivité skin care products. This builds brand loyalty for Allergan by reducing the cost of future treatments but also appears to build practice loyalty. Although, these points can be used at any practice we find that the vast majority of these patients return to our practice to use their points for future treatments, aiding us with patient retention. 

Does one manufacturer offer better customer (physician) support?

Both Allergan and Medicis offer significant support of injectors. Both companies also provide product and experts to train new injectors and expand the skill set of advanced injectors. Both offer volume discounts that increase as practices begin ordering larger amounts of product. Of note, Allergan also makes available marketing and practice building experts to its higher volume customers. As far as I am aware, this service is not offered by Medicis. 

Conclusion

As a Facial Plastic Surgeon with a busy medi-spa component to my practice, I've considered which products we need to offer to our patients. Our goals are to provide the safest and most effective treatments to our patients, to minimize our cost, to maximize our ability to generate revenue and to grow our business. Promoting a single neuromodulator product, in our case Botox, has allowed us to create a clear, consistent marketing message. We have also been able to boost our volume discounts and achieve a lower cost for Allergan products including Botox, Juvederm and Vivité products. This has allowed us to offer better package pricing and cross-promote neuromodulator, dermal filler and skincare products. We’ve also been able to tap the wealth of Allergan’s marketing expertise to better promote our practice at minimal additional cost.

An additional advantage we’ve noted is less confusion among our patients. When most new patients ask for “Botox” they’re actually requesting a result rather than a specific product. Patients are seeking an improvement in their appearance, not a fellowship in available neuromodulator products! It is our job to determine which product will be most effective at delivering that result while at the same time allowing us to cover our overhead. Thus, the choice of which neuromodulator(s) to offer is a very personal decision based on concrete data and anecdotal experience. I’ve tried to outline our reasoning for limiting our practice to a single agent and I hope you’ve found this to be helpful

Sculptra Aesthetic Now Available at Lone Tree Facial Plastic & Cosmetic Surgery Center!

Sculptra Aesthetic is an FDA-approved injectable treatment designed to correct aging-related facial volume loss and sagging of facial tissues. I have extensive experience with Sculptra treatment and think that in the properly selected patient, the results are outstanding.

Sculptra Aesthetic is composed of poly-L-lactic acid which triggers your body to create its own new collagen, resulting in tighter and fuller facial tissues. Unlike short-term filler products, Sculptra Aesthetic treatment causes your body to lay down its own collagen resulting in long-lasting benefits. Treatment results in gradual, progressive restoration of facial volume and the facial contours associated with youth. We can restore lost volume in the temples, cheeks and lines around the mouth to create the youthful appearance of midface volume and counter the tendency of our volume to shift to the jowls and neck, both obvious signs of facial aging. 

Most of our patients require three to four treatment sessions in the office, each separated by one month. You can return to work or your daily activities the morning following each treatment. Creation of new collagen takes place gradually during the course of treatment resulting in long-lasting improvement in facial contours. The results should last two years

If you are interested in learning more about Sculptra Aesthetic, I am happy to answer your questions. I've been using this product for four years and have had great results with Sculptra Aesthetic for the treatment of aging-related facial volume loss as well as treatment of lipodystrophy. In the properly-selected patient, Sculptra Aesthetic can produce life-changing results.

Call us at (303) 788-6632 or visit Lone Tree Facial Plastic & Cosmetic Surgery Center for more information.

Before (left) and after (right) four Sculptra treatments.

Before (left) and after (right) four Sculptra treatments.

Dr. Stephen Weber Becomes Diplomate of American Board of Facial Plastic & Reconstructive Surgery

The American Board of Facial Plastic & Reconstructive Surgery recently certified me as a "Diplomate" of the  board. This connotes board certification in the highly-competitive field of Facial Plastic & Reconstructive Surgery. At Lone Tree Facial Plastic & Cosmetic Surgery Center we seek to uphold the rigorous standards of the ABFPRS and provide cutting-edge, safe, ethical care to our patients. Both Dr. Schaler and I maintain double board certification in Facial Plastic & Reconstructive Surgery and Otolaryngology and Head & Neck Surgery.

"The ABFPRS credential signifies that your surgeon:   

1. Has completed an approved residency after medical school in one of two surgical specialties focusing on facial plastic surgery (otolaryngology-head and neck surgery or plastic surgery);
2. Is double boarded, having earned prior certification in one of those specialties through the American Board of Medical Specialties or the Royal College of Physicians and Surgeons in Canada;
3. Has successfully completed a two-day examination;
4. Has submitted for peer-review an acceptable record of at least two years’ clinical experience, including operative reports of a minimum 100 facial plastic surgeries;
5. Operates in an accredited facility; and
6. Holds proper licensure and subscribes to the ABFPRS Code of Ethics."

- From the ABFPRS website (11/2/11)

Is there a clinically-significant difference between Botox and Dysport?

This is a common question among our patients at Lone Tree Facial Plastic & Cosmetic Surgery Center. We answer alot of specific questions about these products. Some ask for Brand X or Y because they saw an ad or because a girlfriend recommended it. Some of our clients have been told to "avoid" certain products. I hope to dispel some of this misinformation and allow you to become a more informed consumer of neuromodulator products by answering a series of questions for you.

What is the difference between these two products?

Botox (onabotulinumtoxin A) and Dysport (abobotulinumtoxin A) are different at a molecular level but act via the same mechanism. They block communication between nerve endings and the facial muscles that those nerves control. The clinical effect is softening or weakening of muscle contraction rather than "paralysis." The effects are temporary and any muscle weakening resolves once new nerve endings have sprouted and connected with the muscle. This typically requires two to three months.

Of note, Dysport is a smaller molecule and thus has some tendency to "spread" from the site of injection. In my experience this is an issue when higher dilutions (larger volumes of injection) of the product are used. This is mainly a concern during injection of the forehead, where excess "spread" can lead to temporary heaviness of the eyebrow. The best option when treating forehead wrinkles in a person who already has heavy brows is to use a lower dilution of the product (we always do) or using Botox to minimize the risk of "spread" and excessive forehead weakening. 

Are Botox and Dysport safe? 

Yes. Both Botox and Dysport are FDA-approved for the treatment of dynamic facial wrinkles. They have both undergone significant study demonstrating their effectiveness and safety. The doses used for aesthetic treatments are significantly lower than those used for treatment of medical problems such as cervical dystonia. 

Do the risks or side effects differ between the two products?


Both Botox and Dysport have similar side effect profiles. The most common risk is a bruise at the site of injection. This is uncommon but can be camouflaged with makeup immediately. Most complications with neuromodulator products result from injection technique. If the wrong muscle is injected or if the target muscle is overtreated, inadvertent or excessive muscle weakness can result. For example, overtreatment of the forehead can result in drooping of the eyebrows and increased fullness in the eyelids. Temporary headache, allergy and lack of effect have also been described but are unusual.

Can these products be used together or sequentially?  

Botox and Dysport can be used at the same time. For example, for a woman with drooping eyebrows Botox might be used in the forehead to minimize the risk of spread which could result in further drooping of the eyebrows. In this case, Dysport might be used to treat the remainder of the upper facial areas. This is typically not necessary as an experienced injector who does not over-dilute Dysport should not have significant difficulty preventing drooping of the eyebrows. These products can also be alternated - Botox today and Dysport in three months when the wrinkles need to be re-treated. 

What's the deal with the "units" of Botox and Dysport? Are they the same?

No, units of Botox and Dysport cannot be compared as these are similar but different medications. Most injectors will agree that roughly 2.5 to 3 units of Dysport are required to achieve results equivalent to 1 unit of Botox. If Dysport seems like a "steal" on a per unit cost basis, there's a very good reason for this. You will need alot more units of Dysport to achieve the same effect. In practice, I find that the cost is roughly the same when achieving a similar result.

Is there a cost difference for either product? 

No. I do not believe so. In our hands, 2.5 to 3 times the number of Dysport units is required to achieve the same results as Botox. In most practices, ours included, the cost of Botox is about 2.5 times higher per unit than Dysport. Given the need for more Dysport to achieve equivalence with Botox this results in a similar cost. Of course, this is practice specific.

Which should I choose?


This is a great question! The answer does differ from person to person. Some of our patients prefer one product over the other for reasons including a more natural effect, longer duration of effect or better response to X over Y. Some patients will request Botox specifically after having had a previous issue with drooping of the eyebrows after Dysport treatment. As mentioned earlier, this issue is probably related to the manner in which the product was injected rather than the product itself. Most importantly, the practical consideration of cost is highly important to our patients. Because of this, we'll perform more injections with a given neuromodulator product if the manufactured is offering a special that month. As both products are safe and effective and well-researched this makes perfect sense.

I hope that this post answers some questions you might have had about Botox and Dysport. I will be updating this post as our experience with Xeomin, the newest neuromodulator product, grows.

I encourage you to visit Lone Tree Facial Plastic & Cosmetic Surgery Center if you have any additional questions.

Restylane now FDA-approved for in-office lip augmentation

Restylane, a hyaluronic acid dermal filler, was recently approved by the FDA for lip augmentation. We have been filling lips for years with Restylane to provide more volume, better symmetry and more definition in an "off label" fashion. However, the recent nod by the FDA should provide patients with additional comfort and confidence that Restylane can be safely used in the office for lip augmentation. Of note, this is the only hyaluronic acid filler on the market in the US that has this indication. Juvederm will still remain a great option for filling lips but does not carry this stamp of FDA approval.

Interestingly, in the study on which approval was based the most common problems following injection were bruising, swelling, redness and tenderness. However, over 80% of patients chose to be re-treated at six months suggesting that the overwhelming majority were happy with treatment. These results are consistent with what we have found at Lone Tree Facial Plastic and Cosmetic Surgery Center.

Treatments are performed in the office. The procedure requires roughly thirty minutes and is most often performed after applying a topical numbing gel. Dental blocks can also be used to increase comfort but are typically not required. A small volume goes a long way when augmenting lips so it is critically important to find an experienced injector when looking to plump your lips. Complications are highly unusual following lip augmentation.

If you're interested in further information or would like to schedule lip augmentation, give us a call at (303) 788-6632.

Medicis Press Release

Trust Your Face to a Specialist

Dr. Stephen Weber is a double board-certified Facial Plastic and Reconstructive Surgeon who practices at Lone Tree Facial Plastic & Cosmetic Surgery Center in the Denver metro area. His practice involves all aspects of facial cosmetic surgery including facelift, browlift, blepharoplasty, rhinoplasty, otoplasty, facial implants, facial resurfacing and scar revision. Lone Tree Facial Plastic Surgery also provides comprehensive treatments for facial aging including Botox and Dysport to reduce facial wrinkles, dermal fillers to minimize facial lines and folds as well as cutting-edge fractional laser (Fraxel and MiXto) resurfacing.

Dr. Weber is also highly experienced in facial reconstruction following removal of skin cancer, repair of facial fractures and complex lacerations and repair of ear, cleft lip and palate malformations. He takes part in annual humanitarian mission surgical trips providing free care to medically isolated, indigent patients.

In his free time, Dr. Weber enjoys skiing, mountaineering, flying, photography, travel and spending time with his family.