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Botox 'on the go' hits potholes

Irvine, Calif. — A new service based here promises to bring Botox Cosmetic (botulinum toxin type A, Allergan) and injectable facial fillers to patients' workplaces.

For sources contacted by Cosmetic Surgery Times, however, the service raises concerns about the treatments' quality, efficacy and safety, while highlighting the issue of nonphysician medical practice.


Dr. Katz
Robert Fisher says the idea for MobileBotox came to him while brainstorming ideas to help New You Luxury Medspas (NYLM), a new medical spa company of which he is CEO, grow into multiple locations (its first opened in Irvine in January). Because traffic can turn a 30-minute appointment at a traditional medspa into a two-hour ordeal, he explains, he developed the idea of taking a limited menu of medspa services to patients during their lunch hours. Mr. Fisher says, "It's not a mobile medspa as much as mobile injectables," namely, botulinum toxin and fillers including hyaluronic acid and collagen, delivered and injected by NYLM's two physician assistants (PAs). First-visit consultations will take under an hour; follow-ups, 15 or 20 minutes, he adds.

Dr. Narurkar
The program, which debuted in May, charges $10 per unit of Botox used (plus a $10 destination fee — waived if multiple patients are treated at one site). At press time, it had drawn a handful of inquiries, but had not yet booked any clients.

Like any new service, Mr. Fisher says, "It will take a little time. But I'm sure it will catch on."

Red flags raised

Already, the service is raising red flags among dermatologists and plastic surgeons.

"It has a lot of potential problems," says Bruce E. Katz, M.D., director of Juva Skin & Laser Center in New York and clinical professor of dermatology at Mount Sinai School of Medicine.

Dr. Katz raises two concerns.

Botox must be kept cold but not frozen, he notes, because temperature extremes impair its potency, as does shaking.

"A patient might not be in a comfortable chair, and can move when they're being injected," resulting in a needle in the eye, he adds.

Mr. Fisher counters that to prevent problems, MobileBotox uses the same procedures as its brick-and-mortar counterpart, on the advice of NYLM's medical director, Neil Neimark, M.D.

He adds, "The PA has ultimate authority" to deny treatment if a workplace fails to meet sanitary or other requirements.


Dr. Papel
Likewise, he says PAs know not to inject clients seated in chairs that move. As for Botox handling and storage, Mr. Fisher says padded cases containing dry ice allow traveling PAs to meet all manufacturer specifications.

"I'm quite surprised that this is taking place, because none of the consultations or treatments are done by a physician," says Vic A. Narurkar, M.D., a San Francisco-based dermatologist in private practice, assistant clinical professor of dermatology at University of California, Davis, Medical Center and president of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS).


Dr. Wells
He says that his review of 123 complications resulting from laser treatment by nonphysicians shows that more than 75 percent occurred in nontraditional facilities such as shopping mall laser centers (Narurkar VA. Paper presented at: Annual Meeting of the American Society for Laser Medicine and Surgery; March 31-April 4, 2004; Dallas).

Dr. Narurkar also expresses concern that Dr. Neimark is a general practitioner, not a dermatologist, plastic surgeon or other core specialist. Dr. Narurkar says he and some colleagues are conducting an ongoing multicenter study cross-referencing complications resulting from nonphysician treatment with medspa medical directors' specialties.

According to preliminary findings, he says, "The majority of complications occur in situations where there isn't a dermatologist or plastic surgeon who is the physician of record."

"We don't have that concern," Mr. Fisher says. "Dr. Neimark is getting hands-on training for all the injectables from the manufacturers," he says.


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