Dr Michael Prager

http://www.dailymail.co.uk/femail/article-2034540/I-Dont-Know-How-She-Does-It-Whingeing-Women-depressing.html

As featured in the Sunday Times and picked up by the Daily Mail, there is a huge need for a new direction in cosmetic surgery. We all are so tired of funny looking faces. There is hardly a celebrity over 30 who has not had visible surgery in excess of $100.000. We do not begrudge the surgery, we just don’t want to see or know about it.
What is the New Ultimate? If you sit together with your friends discussing Botox and Surgery and they are saying you don’t need it yet, not knowing you have had treatment for the last 10 years, then you know that you have The New Ultimate!

By Dr Michael Prager

Dear Reader

In today’s Daily Mail, Claire Coleman is commenting on LaViv. The article did not add any more information on the procedure itself from what we have already discussed in our release dated August 28. However, there was some useful information on the rise and fall of the company that initiated the first launch of Isolagen. The interesting fact is indeed that once again the U.K. market has been used for human trials even after Isolagen was withdrawn from the market 1999. After the FDA approval (which, as mentioned yesterday is not all that meaningful) was in question over doubts in the initial trials.

Best Regards

Dr Michael Prager

http://www.dailymail.co.uk/femail/article-2031144/As-latest-anti-ageing-wonder-treatment-hits-U-S-autumn-investigate-new-Botox-puffed-be.html

The “Latest” alternative to Frozen Botox Faces… Daily Mail reports on LaViv

http://www.dailymail.co.uk/femail/article-2028456/New-biological-wrinkle-cure-touted-alternative-Botox-frozen-face.html

Basically 10 years after Isolagen went down with an estimated £300mio in fees and court costs, (it was trialled in the U.K. after been given FDA approval, because the U.K. is a less litigious place and it is more difficult to sue a company based in the U.S. overseas) here comes the same in green.

FDA approval only means that a drug, machine or application is safe to use, there is no reference to how or if it works in terms of beneficial results for the user. The European CE mark is a much more conclusive and in many ways better evaluation process. Some people say that the FDA approval is in many ways quite meaningless.

Isolagen has not worked then and it will most probably not work now as LaViv. There are autologous fat transplant methods which involve harvesting and culturing of cell which have a great yield in cells and can be injected successfully. This will become a big thing in the future.

LaViv is not it though. I have worked and grown smooth muscle cells and fibroblasts during my work as a PhD student and it is immensely difficult and virtually impossible to grow large enough amounts of cells on demand. Then you have to inject them in a viable state. Those things are extremely sensible. Keep the incubator door open for just a bit too long (2min) and they catch a cold and die. How on earth they shall come from the petri dish into your naso labial fold in a live state is a complete riddle to me.

Remember all the trouble practitioners and patients were in after Isolagen. Patients wanted their money back, as much as £4000 from the practitioner who only got around £500 out of the procedure, the rest went straight to Isolagen which never paid anybody. Some members of the BACD did as much as 120-150 patients in those days. That is roughly £500.000, enough to take a practitioner under, which some people think happened to Dr J. Otto, who was the spokes person for Isolagen at the time. He is no longer to be found….

Unfortunately the U.K. market is a great place for testing and promoting “new” technologies, especially from the USA. FDA approval sounds great but in reality it does not mean much. It helps selling a product in Europe before it goes on trial in the U.S.. Thermage is one of these trials. The early patients had massive problems because the radio frequency melted their facial fat, the radio frequency was dissolving the face. Later the machine was used to treat cellulite. It seems to be ok on the body, where you want to get rid of fat, in the face people pay large amount to have fat put back into their cheeks…

It needs a lot of research on this “New” technology, however I do not think it will be around for too long.

The “Frozen Face” is caused by a Doctor Frost. The beautiful faces are done by Dr Natural.

Best Regards

Dr Michael Prager

SKIN TEXUTURE, COLOUR, ELASTICITY

Non invasive treatments should cover most potential enquiries for face and body. A cosmetic doctor must offer non invasive Lipo, non invasive face-lift, and solutions for skin texture, skin volume, skin colour.

Physiology of Skin Ageing and Anti-ageing skin treatments

Generally any skin treatment aimed at texture, sun damage, fine lines and wrinkles, skin pore size, pigmentation is a skin resurfacing treatment. Ageing of the skin is mainly loss of skin collagen. The difference between old and young skin is the amount of collagen in the skin. It is estimated that at 40 we have half the amount of collagen in the skin from when we were 20. Collagen is what makes the skin elastic and hydrated. The skin cells that produce collagen are called Fibroblasts. The Fibroblasts reduce the production of skin collagen as we age naturally. The skin loses elasticity, tone, thickness and moisture. UV exposure meaning tanning, smoking, bad diet and stress can damage Fibroblasts and reduce their activity even more. This is also called Free Radical Damage. Topical Anti Oxidants such as Skin Ceuticals can neutralize free radical damage. Vitamin C, tomatoes, berries, vegetables, green tea… contain anti oxidants and work internally.  Fibroblasts are found in the Dermis. The Dermis starts at about 1.5mm skin depth. This is why we use Dermaroller between 1.5-3mm in length.

1. Skin Texture Treatment Options

Skin injury stimulates the production of skin collagen. There are two kinds of skin injury used in cosmetic medicine:

• Superficial/Dermal: burn, scrape, scratch, cut… (Laser, Fraxel®, IPL, peel, Dermaroller)
• Intra Dermal: Heat, Radiation (any radiofrequency treatment, Thermage®, Syneron®, Accent®…) or more exotic stuff such as Carboxy or Oxygen therapy, basically inflating the skin with gas
• Meso-Therapy injection or Transderm®

Physiology of skin rejuvenation

Skin rejuvenation treatments aim at stimulating the Fibroblasts to produce more collagen. The basic principle is skin injury. Skin injury releases signals called Growth Factors in the tissue which stimulate the Fibroblasts to produce more collagen. Topical Growth Factors such as in Revive or TNS can also stimulate Fibroblast activity. They can work very well, especially in combination with Dermaroller, Laser or other skin injury when rapid healing is desired, such as for burns or large skin defects. Any injury that causes bleeding can stimulate collagen production. Bleeding is the main source of growth factors that stimulate the fibroblasts to produce more collagen. The most effective skin rejuvenation treatments are the ones that cause the most bleeding. The deeper the injury in form of burning (laser or chemical peels) or mechanical abrasion the “better” the cosmetic result. The skin injury causes a wound healing response.  Newly built skin collagen closes the tissue damage. This new skin is rich in collagen, even though it is scar collagen, which is different from the original skin collagen. It is often pale, whiter and can be shiny. After complete CO2 Laser resurfacing, deep dermabrasion or deep peel the patients are in bandages for 2-3 weeks, bleeding, seeping… sometimes scarring. Results are good but the skin is discoloured afterwards and total sun avoidance is often necessary. The discolouration comes as a result of the damage to the skin cells that produce the skin pigment called melanin. Deep and aggressive procedures can Not really appealing to most people. That’s when Fraxel® was invented.

1. Superficial Skin Treatments

Fraxel®

Basically the same as above, a skin burning laser but instead of taking all the skin off the Fraxel® works like a Dermaroller: it shoots needle fine holes into the skin, leaving islands of unburned skin in between. This makes the healing quicker, the treatment is less dramatic, shorter downtime and less risk.

Conclusion

Fraxel® is expensive, one treatment costs between £800-1200, a course of 4-6 treatments is needed which makes it a £4-6000 procedure. The results are not very good. I have never had a patient who said they had Fraxel® and it was great! I have seen scarring and pigmentation problems. Nick Lowe, Rita Rakus and Sebagh do a lot of it.

Resurfacing Laser Treatments

Most resurfacing laser treatments are done with a CO2 Laser. The laser burns off the complete top layer of the skin. Long downtime, massive side effects make it not really popular. Results can be very good but always compromise with sun exposure and discolourisation.

Conclusion

Painful and aggressive treatment for deep skin resurfacing, bad acne or small pocks scars. More or less replaced by Fraxel®.

Deep Skin Peels

Chemical peels burn off the top to medium layer of the skin. Most peels are either lighter TCA peels, Easy Peel®, Obagi Blue Peel® or the deeper Phenol peels. Results can be very good on white skin. TCA peels need to be repeated 4-6 times in order to achieve the same results as a deep Phenol peel. Deep peels can be very scary, long downtime and possible de-pigmentation of the skin. Difficult to treat darker skin types, can cause bad hyper pigmentation.

Conclusion

TCA and Phenol peels are still popular. I no longer do TCA because the Combined Dermaroller is so much easier and has  far less side effects.

Normal Dermaroller

The Dermalroller is a very good procedure. The treatment needs to be repeated 4-6 times with about 3-6 weeks inbetween

Conclusion

The normal Dermaroller is priced at about £250-300 per treatment. 4-6 treatments are usually necessary to achieve the results we can get with our Combined Dermaroller. This makes the normal Dermaroller pretty expensive.

The Combined Dermaroller

Exclusive to Dr Michael Prager the Combined Dermaroller achieves in my opinion better results with one treatment than a course of Fraxel®, Thermage®, Obagi Blue Peel®, TCA Easy Peel® or conventional Laser Skin Resurfacing. The Combined Dermaroller is a combination treatment.

1. 1. Dermaroller to stimulate the skin’s own collagen production. This can also improve pigmentation and uneven skin colouration
   2. Transderm® to infuse a combination of hyaluronic acids into the skin. This gives an immediate skin plumping effect. The mixture contains a blend of hyaluronic acids, minerals and vitamins.
   3. Topical Growth factors applied to the skin improve and speed up the healing and recovery.

The benefits of Combined Dermaroller are:

a. Short downtime usually between 1-3 days, no interruption of social life necessary.

b. Immediate Results due to the skin plumping effect of Tranderm®

c. Results after one treatment. Our Combined Dermaroller shows better results after one treatment compared to 4-6 Fraxel® or Thermage® sessions. We advise a booster treatment maybe 6-9 months following the first procedure

Maintenance 1-2 times per year.

d. Price: Combined Dermaroller is far less expensive than any of the above mentioned treatments. At £980 per session and with only 1-2 treatments in the first year it is more effective and better value for money than any other skin resurfacing treatment available

e. Combined Dermaroller can treat any skin type and skin colour! Peels, laser, IPL is always a risk for hyper or depigmentation. Combined Dermaroller has zero permanent side effects, it is safer than any other treatment for skin rejuvenation.

Today I had a chat with an editor for a famous fashion magazine. We both agreed that women must be given a choice on how to age. At the moment it seems it is either looking old or looking strange. Strange because the way most cosmetic or plastic procedures and treatments are performed leaves a very obvious look on the patients faces. My way of performing subtle, preventative and ultimately very attractive but invisible treatments is starting to become mainstream. However we still have to convince some of the die hard frozen face celebrities that movement on the forehead is not a bad thing! The good new is that we see less and less freakish looking faces on TV and in the press and the truly beautiful way of ageless elegance is starting to spread through the media. I can proudly say that I have been instrumental in creating a new image for cosmetic medicine, which will appeal to every woman and man who is interested in looking better not just different.

Michael Prager

Going out in London, New York or any other big city in the world you cannot help but noticing strange looking faces. I should be amused because obviously my competitors are not terribly good at their work, trust me I am not. My mission is to make people look better after treating them with Botox and Dermal fillers, not just obviously different and artificial. That is all nice, but how do you do it. The way injection treatments have been practiced and still being done, it would be very difficult to treat a person without signs of artificial enhancement. There are several reasons for this. Medicine likes statistics. Measuring, counting, success and failure easily documented in normal medicine. Cosmetics is different. We are trying to achieve beauty. Beauty however you cannot measure. It has been tried for centuries to count and classify beauty, proportions, ideal length of nose to chin, eye shape so forth. And still there is no ultimate guide line on what is beautiful. Similarly aging is difficult to describe, count and measure, however it is a bit easier. Still, within the last 10 years things have changed so much that you would imagine we are still far away from knowing where we are going at the moment. Aging is most difficult to understand and in reverse, what can you do to make an aged face look more attractive again. Instead of just isolating parts that we can identify easily, (such as lips losing volume with age and therefore making them bigger again should be anti-aging), we need use our judgement for the time being. Ultimately we want to treat and be treated to enhance our attractiveness. That should be the one and only reason to seek treatment, apart from medical indications of course. Now let’s see, has cosmetic and plastic medicine delivered on that point? If we take our favorite celebs as a guideline, not really. A lot of great looking faces but also a lot of OTT work. For now, I am not completely impressed yet. Also, we constantly seem to look to America for inspiration. Within aesthetics I think that is a mistake, we are in Europe and our understanding of what is good or bad looking differs distinctly from that in L.A. The first breast implants were devised,tried and tested in the Porn industry, some of what we see on TV and in the movies still seems to have some roots there. I have had many patients from Beverly Hills, New York, Brazil, and I always find that we are actually very good at what we are doing right here in London. Even though of course, as explained, we are still getting better at it. More later. Thank you all very much for the comments, taking the time to read and visiting this blog.

All the best,

Michael Prager

Hello,

last weeks Grazia Magazine featured an article by Leah Hardy on Liposuction, Fraxel® and filler treatments. I really enjoy Leah’s writing and I think she has a great way of bringing you up to date information with a tongue in cheek twist. However, in this article, Grazia, 8 November, Make ours… a midi, she mentions a couple of weird and maybe wonderful treatments but I am not sure.

She writes about a filler which sounds so very much like the stuff doctors warn their patients about. Ellanse. It contains poly-caprolactone, according to wikipedia a biodegradable polyester, derived form the chemical synthesis of crude oil. Sounds very much like plastic to me. We had all that before: Dermalive®, Artecoll®, Aquamid®… problems. Novabel was a brief encounter with a non Hyaluronic Acid based filler and it has been a choppy ride. It will come back and I am waiting for it. In my eyes it is still the very best product and it will be the future, at least with regards to viscosity of dermal fillers. Thinner is better. Back to the plastic, definitely not!

Hot Skin Tightener: Everybody in the industry knows that Thermage® is dead. Use it for cellulite and fat melting, skin tightening has never taken off, midi-medi, there are enough machines that deliver radio frequency for a fraction of the the cost. I used a Syneron and it works very well for sagging skin around the neck and chin where the problems are linked to excess fat.

Fraxel Dual®. We all know that Dermaroller® is the best skin rejuvenation treatment based on fractional skin puncture injury. It is simple, cause bleeding and get a healing response. Healing response equals increased collagen in the skin. Do we need £ 100k kit for that? No. A simple needle does it nicely and very well. Benefits are: no burns, no pigmentation and better results than laser because thermal injury causes cauterization and coagulation of the capillaries which reduces bleeding and therefore the potential for collagen stimulation. Have a look at the 10 years younger video on my webpage and you will see how well.

Lastly Fat Melting Lipo: Again, Smart Lipo was the first break through Lipo done in minor surgery environment 6-7 years ago. Has it worked? Not really because most patients did not see the results, therefore Vaser came along to redo all those patients who did not get a result with Smart Lipo. 3 weeks ago I spoke to a friend of mine who was raving about Vaser 2 years ago. I asked him how is the Vaser doing (I almost felt a bit silly for being so over-cautious and not doing it). Simple answer: “I couldn’t be bothered anymore, I have plastic surgeon to do it for me now”.

As I said, I do like Leah’s writings but this time I am not completely sold on it.

All the best,

Michael Prager