Prevelle Silk Enters Dallas Market: Pros and Cons
September 30, 2008 by dr. lam · Leave a Comment
prevelle silk
As mentioned in the last few blogs, new technology is always coming out quickly to the market. When I was in Chicago at the Fall Meeting of the American Academy of Facial Plastic & Reconstructive Surgery, I looked into Mentor’s new Prevelle Silk, which is another hyaluronic-acid (HA) based product to compete against Restylane, Perlane and Juvederm. The major benefit touted with this new product is that it contains Lidocaine in it to reduce the discomfort associated with injection. Although on the surface, this sounds good, I really do not encounter any discomfort with my patients owing to the short-acting block that I use during treatment.
Basically, Prevelle Silk contains 5.5 mg/cc of hyaluronic acid, which is a fourth of the content that is contained in Restylane, Perlane, and Juvederm. When I asked the Mentor rep in Chicago about this observation, I said, “Oh, that sounds like the exact amount that Captique had in their HA product.” He said, “Yeah, that’s because it is manufactured by Genzyme, who made Captique.” Aha! Prevelle basically is Captique with lidocaine. I used Captique in the past (which has fondly been called “Craptique”) because it simply lasts such a short time. With so little HA content in the product, longevity can be as short as 3 to 4 weeks in my experience. If you are lucky, perhaps 6 weeks or so. This is a product that I have no interest in incorporating into my practice at this time.
Here is a link to my video log on Evolence (if you missed that one) and on Prevelle Silk.
A Kosher Pig? Evaluating Evolence for the Dallas Market
September 29, 2008 by dr. lam · Leave a Comment
Two new cosmetic injectable fillers are arriving on the shelves: Evolence (Johnson and Johnson) and Prevelle Silk (Mentor). Today we will talk about Evolence and tomorrow we will address Prevelle Silk. Obviously, whenever a new filler hits the market, we are always interested in what this filler has to offer. Evolence has perhaps garnered the most attention in the media as a new, “longer lasting” injectable filler.
What is Evolence? Evolence comes from Israel and is a porcine product (that is, it comes from a pig). Reportedly, even though it is not “kosher” since a pig cannot be kosher, the killing of the animal follows prescribed rabbinical techniques for animal slaughter. The touted benefit of Evolence is that it may be lasting a bit longer than Restylane like close to a year. There is also reportedly less swelling during the first 3 days that follow the injection compared with Restylane and Perlane because hyaluronic acid products swell more in the first few days. Two major problems so far have already been bandied about (but may not be entirely accurate): it is hard to mold the product after the initial first few minutes to hours and it provides a lumpy injection. Speaking with a colleague of mine who has used the product, the latter criticism may be inaccurate because the product can be more evenly delivered when it is injected with the right needle, pressure, and depth. Finally, the big question out there is will an animal product create an early or late allergic reaction to it? No matter what data the company presents, I am still skeptical of the safety in regard to this issue.
Here are the reasons that I do not have any interest in offering the product (at least not for now): (1) I try not to use any animal products — not necessarily for humane purposes — but due to patient safety with the use of animal products as mentioned above (2) I really like how hyaluronic-acid based products like Restylane and Perlane are 100% reversible if you don’t like the result. That adds significant flexibility. (3) I don’t see a lot of swelling in the first few days with hyaluronic acids because I don’t put them in areas that lead to significant distortion like the lips. Since I use hyaluronic-acid products for volume balancing primarily, many patients actually do not mind the swelling because it looks closer to the volumes that I would use for fat transfer. In the long run, trading 2 to 3 days of mild swelling is worth it for a product that is not animal-based and can be easily reversed at any time. (4) The longevity that I have seen with Perlane is in many cases over a year, which competes effectively against Evolence. Also, I don’t believe that the product will last a year. I may believe it in a year from now when I talk with my colleauges not the company. For all of these reasons, I do not see any reason to use Evolence in my practice. I am not here to condemn a surgeon who decides to use the product but I am not going to be an early adopter on this one.
Here is a video log that I shot summarizing my thoughts on Evolence
Critical Thinking: When to Adopt New Technologies for Plastic Surgery and When Not To
September 26, 2008 by dr. lam · Leave a Comment
I was very honored that my mentor said to me in Chicago, “Sam, you are really a great thinker. You are one of the thinkers in our Academy.” I had another individual whom I respect say to a vendor, “You must talk with Sam because he is a really respected thinker in the Academy.” Finally, I talked with another colleague of mine from Florida who said, “I really like the way you think.” I was very touched by these words and took them to heart. I think many times we pass through life “satisfied” with where we are and really don’t exercise the noggin a bit to see if what we are doing is the best thing that we could do.
In Chicago last week, I spent as much time in the exhibit hall looking at new technology as I did in the lecture hall listening to scientific papers. I will be doing the same today, as I am lecturing In St. Louis. What I have learned to develop over time is a critical skepticism about new technologies out there. It is great to go to the annual meeting and see what is the latest thing that is out there and before jumping head first to sit back and evaluate the efficacy, safety, and “long-term” benefits that a new technology may have.
I will be introducing a couple of new injectable fillers on Monday and Tuesday’s blogs that I have true skepticism about and I will tell you why. Does that mean I won’t ever be using these products? No. That may not be the case. I just want to have you understand where I see that technology today. I also was looking at some new laser/light technology that I am a year away from adopting if ever. I studiously evaluated each system by asking the individual about the pros and cons (which is obviously extremely prejudiced information) and then will be doing some clinical tests over the next year to see for myself any validity. There is a good saying, “Don’t be the first person on the block to do something and don’t be the last person on the block to do something.” Those are words to live by.
Two errors I made in the past by adopting technology too fast were the Threadlift and the Surgiwire. Both technologies proved to be useless and did not live up to the brand quality that I have established when you come to see me as a surgeon and practitioner. I have promised my patient base that I will not jump blindly into new technology but evaluate that technology over time to ensure that it is what it is touted to be. At the same time, many surgeons never go to a meeting, whereas I go to 10 to 12 meetings a year. So it is very important to keep up with the latest thinking and techniques but only to adopt that technology and technique when sufficient time has passed to see whether that technology merits incorporation into a plastic surgery practice. That is my promise to you.
Perspective Part III: The Last Word
September 25, 2008 by dr. lam · Leave a Comment
This is a follow-up to a series of blogs on “Perspective”. As part of being a leader for my surgery center and for the larger wellness building, I have to sift through many perspectives and try to attain some “truth” to a problem that is presented to me. First of all, it is my job to understand each different personality with whom I work. Believe me, each person has his/her own personality differences that make that individual unique. I keep a mental scorecard on every staff member and individual in my wellness building of their pluses and minuses. We all have this scorecard, including me. I try not to look at an individual’s negatives but focus on their positives. However, by knowing their negatives, I know how to minimize their biases and to try to maintain a more balanced perspective on a given issue.
Since I have multiple layers of leaders under me, I don’t manage many of the day-to-day affairs of the building but ultimately I do. When one of my leaders comes to report a problem to me, I usually hear the voice of the last person my leader talked to. In fact, in the words used, I can truly hear that person’s voice and I can at times guess, “Oh, I see, you must have just spoken to Susan (made up name to protect the not-so innocent).” Every time we speak to someone, that individual will present himself/herself in the most glowing light since it is never that person’s fault. How ever moral and ethical we are, we have a tendency to inflate ourselves and to blame others for a problem. We are always the angel, and they are always the devil. And, believe me, I can hear the angel and devil scenario presented to me.
If you have ever seen Akira Kurosawa’s classic, Rashomon, you know the inability at getting toward a knowable truth because of the human biases involved in recounting an event. In the black-and-white film, there is a rape and a murder that are recounted from multiple vantage points. Each time the story is retold through a different person’s voice, the bias is clearly evident and the taint of the storyline is apparent.
If you are called to be a leader (in whatever capacity) or even have to deal with another human being (in other words, this blog relates to you unless you are Robinson Crusoe), I would say that we all have to deal with human bias. How, we can intelligently handle that information depends on our emotional intelligence, something that we are born with but that we can also improve upon.
There are always two sides to a story. Whenever you get too much bias from one party, try to see if you can get the other side of the story too. Just remember the truth probably lies somewhere in between two extremes presented. Then reflect on the reliability factor of that person’s commentary. There are some people that tend to be very biased in their comments and then there are some people that tend to be biased more with certain topics that are particularly sensitive to them. Reading another individual can help you break free partially from untruths toward a more enlightened reading of a problem and help to solve problematic human interactions. Don’t be a prisoner to the last person you spoke with. Don’t be subjugated by the “last word.”
Understanding the Nature of a Transplant Part III
September 24, 2008 by dr. lam · Leave a Comment
In my quest to continually understand the nature of fat transfer and any kind of free graft, I am constantly thinking about the evolution of a result. Not just the result at a short time point like 1 month out but how does that result shape up over time. I am happy to report after coming back from Chicago and listening to a talk that a colleague of mine gave on long-term volumetric changes with fat transfer using computer modeling, the longevity of fat transfer is now unequivocal.
Using advanced computer modeling software, a single session of fat transfer was evaluated before the procedure, at 3 months and followed up to 18 months after the procedure. What was interesting was that at times there was such a significant dip in the result at 3 months that the volumes shown on the computer were the same as before the procedure. Nevertheless, in every case where the 3-month dip was present, the volumes steadily increased until 18 months.
This study is the first conclusive, scientific proof that validates 3 important findings that I have been observing clinically but only had photographic evidence of my thinking, namely: 1) fat transfer can dip mildly to significantly at 3 months following a procedure (and therefore a touch-up procedure should not be performed too quickly), 2) that fat grafting continues to improve between 6 months to 18 months, and 3) that a single session of fat grafting has unequivocal longevity.
Obviously, safe and long-lasting fat grafting is completely technique dependent. Many practitioners out there simply cannot attain longevity or safe, smooth results so I want to be careful with the information provided in this study. Further, the artistic interpretation is critical to attaining a balanced, youthful, and attractive result. Fat transfer is not just about making a big cheek or filling in the hollow eye. It is about a face that expresses natural beauty by emphasizing harmonious structures.