There’s a Black Market for Botox & Other Things to Know Before Getting Injected

Botox might take years off your appearance, but before requesting your own injectable Fountain of Youth, make sure you know exactly what you're doing Botox Might Not Do What You Want It to Many people confuse what Botox actually does with other age-fighting beauty injectables. “[Botox's] only benefit is to render a muscle weaker for 3-4 months. It doesn't fill lines, it just makes it harder to make the muscle contraction that creates the lines,” explains board-certified dermatologist Dr. Misbah Khan, owner of M. Khan Dermatology in New York City. So will it work on those wrinkles around the mouth? “No. If you have smile lines [the parentheses around the mouth], you'll need a filler [like Restylane] to erase them.”There's a Black Market Many coupon services run deals for cheap series of Botox, and they’re probably all too good to be true. Before you buy into anything, know who and what you’re dealing with. “Do not look for the better deal. Make sure you know what’s going in your face. If it's too cheap, it may be acquired on the black market, or the Botox they’re using might be expired or about to expire," warns Dr. Khan.You Could Have an Allergic Reaction You may know that Botox is derived from the same bacteria as the toxin botulism, and while you absolutely cannot catch botulism from the use of Botox, there is a small chance that you could have an allergic reaction to preservatives and ingredients used. "Some reactions that have been reported include itching, rash, welts, asthma symptoms or feeling faint,” says Dr. Dennis Gross, founder of 900 5th Dermatology and creator of Dr. Dennis Gross Skincare. If you do have a reaction, call your doctor right away.An Unskilled Injector Might Leave You Lopsided “If the Botox is injected wrong in any part of your face, you may have a lopsided appearance,” says Dr. Gross. “Just remember that there is an artistry involved in the technique, so be sure your physician is highly experienced and skilled at administering it.”Overdoing It Could Lead to Drooping—or Worse
“Drooping of the eyebrows can happen even in the best of hands; it can occur if too much is injected in one place,” says Dr. Khan. And if you’re already using Botox, over-application could make it worse. “Overuse of Botox can cause the muscles to become so weak that they can't support the flesh.” The results can look unnatural, and even worse, be painful. “If too much Botox is applied during a neck rejuvenation, it can cause the side of the face to droop, or in some cases the muscles that hold the neck up weaken to the point where you can't swallow or hold your head up."Speaking Up Can Divert Disaster
You might think that you really, really want Botox no matter the small risks, but the pursuit of beauty is never worth harming your health. As with any other procedure, you should always disclose your full medical history before sitting in the chair. “Make sure to tell your doctor about all of your muscle or nerve conditions, as you may have an increased risk of serious side-effects, including difficulty swallowing and/or breathing,” cautions Dr. Gross. “Also, inform your doctor of any surgery plans, weakness of forehead muscles, recent injections, or medicines you are currently taking.” Dr. Gervaise Gerstner, L’Oréal Paris Consulting Dermatologist adds one more caution to that list: “Be sure to disclose any autoimmune neuromotor disease like myasenthia gravis.”Results Are Not Instant
“It takes about three to seven days to show the full effect, and results will last about four months,” says Dr. Gross. And those results vary, depending on the depth of your wrinkles. “If you start Botox treatments just as fine lines are beginning to appear and continue them as you age, you can prevent select expression lines from forming at all,” advises Dr. Gross. Patients who already have pronounced lines may see benefits in a bit more time, “It takes a few days to see results, and a full two weeks to see the full effects of a Botox treatment,” explains Dr. Khan.Botox is Not Painless Although getting Botox is not particularly painful for most patients, since there are needles involved, you can’t expect to feel absolutely nothing when getting injected. “During the procedure, you can expect a slight pinch from the needle. There are numbing creams available in topical and aesthetic forms,” says Dr. Gross. Dr. Khan is also known to use ice to numb the area for people who have a low tolerance or phobia of needles.Aspirin and Fish Oil Don't Mix With Botox“We tell our patients to stop using aspirin products up to a week before a treatment because they are blood thinners,” cautions Dr. Gross. "Discontinuing the use of aspirin the week before will help to keep bruising down. Also, we tell our patients to stop using fish oils a week beforehand because they also promote bruising for the same blood thinning reason.” Of course, always discuss changing the dosage of medicine with your primary physician beforehand.Hair-Drying Is Off Limits Right After the Procedure “There’s no lowering of the head for two hours post-procedure,” says Dr. Gerstner. “No yoga, no bending over, no blow drying your hair, no tight hats, no napping. In other words, heads up! It Might Cure More Than Wrinkles If you have excessive underarm or palm sweating or suffer from serious migraines, talk to your doctor about using Botox to cure these ills. It's been proven to diminish or stop excessive sweating, called hyperhidrosis, and to reduce the severity of migraines too—but don’t try tacking either treatment onto your cosmetic visit. You’ll need to book separate appointments. One quick tip: always take a quick peek at the box. “Botox meant for cosmetic purposes will say ‘Botox Cosmetic’ on the packaging,” says Dr. Khan. “Botox for medical purposes will say that on the package.”A Happier Look Might Actually Improve Your Mood If you’re prone to frowning, “eventually those muscles strengthen in that formation, which means it takes much effort to smile and look happy. When Botox relaxes those muscles, you look happier, which can really improve your mood and confidence,” says Dr. Gross.Kristin Booker is a contributing writer on iVillage. Follow her on Twitter andGoogle+.Connect with Us  Follow Our Pins Yummy recipes, DIY projects, home decor, fashion and more curated by iVillage staffers.

The missing well-being

Aaron has a post on the new JAMA article by Christopher Murray and a host of colleagues on “The State of US Health, 1990-2010.” Aaron is amazed by this study and I am too, in part because if anything the title understates the authors’ ambitions. Although the focus is on the US, they are actually describing health and its determinants throughout the developed world.The authors measured the health of 34 developed nations using age-standardized measures of death, morbidity, and disability. They then looked at how these measures and the rankings of the nations changed from 1990 to 2010.

The good news is that the US made progress on most measures. For example,US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010.However, as Harvey Fineberg summarizesthe health of the US population has improved only gradually and has fallen behind the pace of progress in many other wealthy nations. In fact, by every measure including death rates, life expectancy, and diminished function and quality of life as assessed by the authors, the US standing compared with 34 OECD countries declined between 1990 and 2010.

I have argued that absolute changes in health — where the US rose — are more important than comparative rankings — where the US fell. So is there a problem here?There is a tragic problem. Even though we have made progress, comparable countries did a lot better. We should have done as well as our peers did. Because we did not there was suffering we should have prevented and lives that we should have saved, but that were lost. Unrealized marginal improvements in health, accumulated over two decades and hundreds of millions of people, amount to many tens of millions of years of healthy life that Americans did not enjoy. Think of it as an invisible holocaust.

Why we did not enjoy these millions of years of healthy living is an enormously complex question. It is in part because of the manifold deficiencies of our health care system. But only in part. Population health is much more than just the performance of the health care system. It is also how we live: obesity in West Virginia, homicide in Flint, methamphetamine in Hawaii, and suicides in the Mountain West.And a huge amount of stress everywhere. I’m reading George Packer’s The Unwinding: An Inner History of the New America. Atul Gawande exactly captured my feelings about this book.My July4 wknd reading was George Packer’s The Unwinding. Sickening, riveting page turner on the financial destruction of the working class.Americans are extraordinarily creative and productive. But we do not realize the well-being that we should be deriving from our incredible effort, talent, and physical capital. We need to stop accepting substandard and inefficient performance from our health care system. And we need to reflect on how we are living and what we are living for.

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Stand Up! – July 10, 2013

I am a frequent guest on Stand Up! with Pete Dominick, which airs on Sirius/XM radio, channel 104 from 6-9AM Eastern. It immediately replays on the channel, so those on the West Coast can listen at the same times.We talk about the recent abortion legislation in Texas, price transparency, the employer penalty, and more.

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Does Medicare forbid posting surgery center prices?

An article linked by Tyler Cowen suggests that Medicare forbids posting of surgery center prices. I don’t think it’s true. CMS is moving towards pricing transparency in many initiatives. Here’s the quote from the underlying article:Surgery Center of Oklahoma does accept private insurance, but the center does not accept Medicaid or Medicare.Dr. Smith said federal Medicare regulation would not allow for their online price menu.They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments.

Several medical facilities in Oklahoma are posting their prices online through The Kempton Group’s website, in order to circumvent that Medicare guideline.Medicare pays ambulatory surgery centers (ASCs) based on an administrative pricing model. ASC rates are generally lower than hospital inpatient rates for the same procedure, which has fueled the huge shift to outpatient and freestanding ASC procedures in the US over the past few decades. The government doesn’t pay the posted rate – they have a fixed price.But fraud & abuse laws prohibit paying anything of value to induce someone to use a particular Medicare service or provider. You can’t attract Medicare customers by offering a $500 cash payment to the patient. That is an illegal kickback. In a similar vein, providers (such as ASCs) can’t routinely waive the copays and deductibles that Medicare beneficiaries are required to pay. Those cost-sharing mechanisms are in Medicare for a reason, to give the patient some incentive to ration care. If the ASC routinely waived co-pays or deductibles, Medicare can treat them as illegal kickbacks.

There is nothing wrong with posting your ASC prices on the internet. Legal troubles begin if the ASC uses the lower posted fee as the basis for calculating copays and deductibles, while charging Medicare the larger fee proscribed by the government.The Surgery Center of Oklahoma may also have given up on Medicare to avoid other regulations, such as restrictions on who can own and refer to a surgery center. But I don’t think Medicare bans posting ASC prices.

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Think Outside the Box: 27 Unique Engagement Rings

Whether you choose a sapphire engagement ring or a black diamond solitaire, the ring you'll wear for the rest of your life should fit your unique style. Get inspired by these unusual emeralds, rubies and lesser-known gems, which are just as dazzling -- and a whole lot less expected By Katie Alberts - June 21, 2013 Halle Berry’s got an emerald engagement ring, Jessica Simpson wears a ruby, Kristen Bell has a brown diamond and then of course there’s Kate Middleton’s royal sapphire… Looks like colored engagement rings are here to stay — and we found 27 worthy of your finger. kwiat.comKwiat Argyle emerald and diamond ring, $10,300 at kwiat.com  kwiat.comKwiat square ruby and diamond ring, $7,250 at kwiat.com kwiat.comwiat sapphire and diamond band, $3,100 at kwiat.com greenwichjewelers.com Greenwich Collection spinel and diamond ring, $3,025 atgreenwichjewelers.com twistonline.com.Cathy Waterman purple sapphire frame ring, $5,620 at twistonline.com  kwiat.com.Kwiat yellow diamond ring, price upon request at kwiat.com  clay-pot.com.Kamofie yellow sapphire solitaire, $1,575 at clay-pot.com debeers.com.De Beers ‘Enchanted Lotus’ band, $10,000 at debeers.com  thenaturalsapphirecompany.com.The Natural Sapphire Company cognac sapphire ring, $12,500 at thenaturalsapphirecompany.com  mc2jewels.com.McTeigue & McClelland ‘Flora Embrace’ ring, price upon request at mc2jewels.com  carelle.com.Carelle oval peridot ring, $1,265 at carelle.com  betteridge.com.Paolo Costagli mint tourmaline and sapphire ring, $15,000 at betteridge.com  mc2jewels.com.McTeigue & McClelland sapphire and diamond ‘Fleur de Lis’ ring, $10,600 at mc2jewels.com mc2jewels.com.McTeigue & McClelland ‘Blossom’ ring, price upon request at mc2jewels.com  tiffany.com.Tiffany ‘Soleste’ tanzanite ring, $8,500 at tiffany.com greenwichjewelers.com.Anna Sheffield ‘Bea’ ring, $5,880 at greenwichjewelers.com  barneys.com.MPL black diamond ‘Kite’ ring, $13,000 at barneys.com  catbirdnyc.com.Lauren Wolf sapphire ring, $1,100 at catbirdnyc.com mc2jewels.com.McTeigue & McClelland ruby and diamond ‘Flora’ ring, price upon request at mc2jewels.com  thenaturalsapphirecompany.com.The Natural Sapphire Company pink sapphire and yellow diamond ring, $45,000 at thenaturalsapphirecompany.com  clay-pot.com.Jennifer Dawes Victorian Ruby Solitaire, $1,630 at clay-pot.com  amazon.com.Amazon Curated Collection rose gold morganite and diamond ring, $560 at amazon.com  thenaturalsapphirecompany.com.The Natural Sapphire Company Burmese star ruby ring, $6,600 at thenaturalsapphirecompany.com reinsteinross.com.Reinstein Ross ‘Yamuna Archer’ ring, price upon request at reinsteinross.com twistonline.com.Suzanne Kalan blue topaz ring, $700 at twistonline.com  clay-pot.com.Anne Sportun Gray Diamond Solitaire, $4,630 at clay-pot.com Connect with Us  Follow Our Pins .Yummy recipes, DIY projects, home decor, fashion and more curated by iVillage staffers.The very dirty truth about fashion internships...

 

Chart of the day: The hospital productivity problem

The ACA calls for annual reductions in Medicare payments to hospitals to the tune of (an expected) 1.1% below what they would otherwise be (PDF). This (expected) number is the law’s so-called “productivity adjustment,” and is the rate at which private, non-farm multifactor productivity* is expected to increase. Essentially, Medicare is telling hospitals that they had better increase their productivity at least at the rate that the rest of private industry does (apart from farms) or else payments will fall behind. This, along with other assumptions, gives rise to a frightening chart (see Figure 1, here).

The question is, can hospitals increase productivity at this rate? For good reason, as far as I can tell, the answer is “no.” For example, here’s a comparison of percent changes in economywide multifactor productivity to two different methods of computing changes in hospital multifactor productivity from 1990 through 2005. (For the purposes of this chart, “economywide” means “private, non-farm,” per the chart’s footnote.)

The paper (PDF) that is the source of this chart discusses the challenges of estimating hospital productivity. I suppose one could argue that both ways it does so cause computation of changes to be biased downwards, but I don’t know how that argument would go. So, in the absence of such an argument, it looks pretty likely that hospitals have never been able to increase productivity at the rate of the rest of the economy. That’s not surprising to me.With that as a starting point, for what reason do we think hospitals will suddenly be able to increase productivity at least at the rate of the rest of the economy under the ACA? I guess the typical answer is to point to ACOs, bundled payments, pay-for-performance, etc., but I don’t buy that they will close the gap. I would buy that they might narrow the gap.

Moreover, is it even fair to single out one industry and demand that it begin to track the average productivity increase of the rest of the other industries? After all, productivity growth certainly must vary across industries. It’s not unreasonable that some would be systematically low over long periods of time, given, say, their structure or the nature of technological developments. (See Baumol’s cost disease. I blogged through his book here.)Can hospitals really grow productivity as quickly as all other (non-farm) private industry? How? What’s the best answer to this hospital productivity problem?

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Childhood obesity going… down?

There’s usually so much bad news when it comes to obesity in the US, it’s hard to take good news at face value. But it seems to be real:

Nearly one-third of children and teens are overweight or obese. But growing evidence suggests that places making strong, far-reaching changes—those that make healthy foods available in schools and communities and integrate physical activity into people’s daily lives—are seeing reductions in their childhood obesity rates. More efforts are needed to implement these types of changes nationwide and to address persistent health disparities.

Obesity rates aren’t going up everywhere. Go read the RWJF brief. In Anchorage (where I will be flying next week, by the way), childhood obesity declined 3% from 2003/4 to 2010/11. In Mississippi, in dropped 13% from 2005 to 2011. In Eastern Massachusetts, it dropped 21% from 2004 to 2008.There isn’t one thing they did. Each area tried its own plan. But it’s heartening to see that some things do seem to work.

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