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This blog will look into the facts related to common heart problems. I talked about the three most likely conditions that lead to premature disability or death. They include neurocognitive decline, like, Alzheimer's or dementia, cancer, and cardiovascular diseases such as heart attacks and stroke.

Healthcare and healthcare insurance revolves around managing diseases when they occur and relate to a very little degree prevention of disease. There is screening for cancers, doing EKGs, measuring blood pressure, measuring cholesterol, and other soft preventative measures.

Point to Ponder: Where Does Health Insurance Factor in?

Does your health insurance focus on reversing disease, when it occurs, or preventing it in the first place?

The Big Focus: Cardiovascular Age & Ways to Measure It

Here we will be focusing on cardiovascular aging due to health disorders such as hypertension, heart attack, stroke, and peripheral artery diseases.

The reality is that health insurance is very reactive. There are criteria for age or other risk factors that stimulate the need for screening, measuring your cholesterol. You might get a stress test done if you're having chest pain or shortness of breath without explanation.

Cholesterol: An Indicator of Cardiovascular Aging

Cholesterol is not a great predictor of the presence or absence of cardiovascular disease. It is a marker of what you track that does not tell you if you have existing cardiovascular disease or if your cardiovascular age is older or younger than your chronological age. To learn more about the 

A stress test is even cruder. During this test, the patient is requested to exercise, generally on a treadmill, and hooked up to an electrocardiogram (ECG) machine. Afterward, the physician checks your risk of getting a heart attack. Wouldn’t it be nice to know that your risk for heart attack is a decade or so in advance versus a few months?

How to Measure the Probability of Having Cardiovascular Disease

Two commonly performed tests can be helpful to predict your probability of having current cardiovascular disease. One is a CT scan that detects calcium deposits in your coronary arteries, the arteries that feed your heart. It is a very inexpensive test that is easy to perform and interpret. The other test is called a CIMT or carotid intima-media thickness test. This test looks for the thickness of the lining of your blood vessels as well as fat or calcium deposits in the blood vessels.

The advantage to the calcium score over a CAT scan is that it is inexpensive, less than a hundred dollars, easy to perform, easy to interpret, and widely available. The limitation to a calcium score is that you cannot track the progression or regression of cardiovascular disease in response to therapy. Moreover, the calcium score is not accurate in African-American men and women or women regardless of race. These are huge limitations.

For screening tests, we wanted to be usable regardless of ethnicity or sex. We want a screening test to be eligible to show that things are getting better or worse over time.

A CIMY is an ultrasound that takes about 15 minutes, and it has to be performed by an expert vascular tech and interpreted by a physician experienced in reading ultrasounds. However, CIMT ultrasound tests are performed quite commonly and there are clear standards that we can utilize to determine if somebody has more advanced cardiovascular age than their chronological age or vice versa.

Additionally, we can track whether or not an intervention is causing stabilization of cardiovascular age, regression of cardiovascular age, or progression of cardiovascular age.

 that have meaning in tracking the progression or regression of cardiovascular disease. There is the thickness of the lining of the vessel increases by about 0.01 millimeters per year. There is also what I refer to as "plaque burden". The plaque burden is the presence of abnormal atherosclerotic plaques in the vessel lining that could be measured.

, an African-American female at age 55 would typically have a lining thickness of 0.668 mm. This is called the 50 percentile. If that person's lining thickness is 0.764mm, she is at 75 percentile, and if it is 0.578mm, she is at the 25 percentile for her age but at the 50 percentile for a 45-year-old African-American woman.

So for a 55 -year-old African-American woman who had a 0.58 mm CIMT we would say that she is average for a 45-year-old African-American woman.If CIMT were 0.75mm, we would say that she is average for a 65-year-old African-American woman.

My Own Experience with CIMT Ultrasound Testing

If this concept sounds confusing, allow me to use myself as an example,

Although I have a strong family history of cardiovascular disease, I am going to share my heart disease reversal success story. My father had cardiac bypass surgery at 44 years of age, and he had a stroke at 45 years. He ultimately died of cardiovascular disease. I've always watched it, my diet and exercise, but I went through a period of two years where I had an unrelated illness that did some damage to my cardiovascular system.

10 years ago, I did a CAT scan calcium score which showed that my cardiovascular age was younger than my chronological age. But then, because of a period of an illness unrelated to cardiovascular disease, inflammation led to my genetic predisposition towards developing atherosclerosis.

In April 2019 the right side of my CIMT read much younger than my chronological age, while the left was at the 55 percentile. This made me 3 years older than my actual age. The left side disparity suggests it is related to inflammation and blood pressure. We base the cardiovascular age on the worst side which is generally the left.  

I did a two-year intervention which was a combination of specific cardiovascular activities, for instance, sauna two or three times a week, monitoring my nitric oxide level, taking dietary supplements which had shown to reverse the cardiovascular aging, and stepped up my exercise and helped in maintaining a healthy diet.

Two years after the intervention, my cardiovascular age was 14 years younger than my chronological age. In August 2021, 2.5 years later, my cardiovascular age was average of a 44-year-old white male. 

Recently, our nurse Molly Landis RN became certified in a program called 

 that involves evaluating an individual's genetic risk and CIMT and using lifestyle intervention tailored to the individual to reverse cardiovascular age. A study published in 2015 involved the nurse-managed cardiac prevention clinic over eight years, and the average CIMT reduced by 0.01 mm per year. In other words, when using the standardized nursing-led approach towards lifestyle intervention along with specific drugs, people's cardiovascular age reversed by approximately one year for every year they lived.

To be prudent, after eight years of using the BaleDoneen method, people were eight years younger than they started from a cardiovascular age standpoint. Knowing this, I went on a much more aggressive approach to reverse 16 years in a two-year timeframe. My cardiovascular age was 58, and now it is 44 or 14 years younger, but I've aged two years chronologically due to why I say 16 years.

Key Take Away: Know Your 'Real' Age with CIMT Ultrasound Test

In summary, you may or may not have cardiovascular disease, but you do have options when it comes to advocating for yourself. The standard American healthcare practice is to wait until you start having chest pains or symptoms of a stroke and only then, you have to deal with it. Or you can test and see if you have any risk at all and if you do, modify your symptoms.

Dr. Charles Mok of Allure Medical gets into the facts related to common heart problems. I talked about the three most likely conditions that lead to premature disability or death. They include neurocognitive decline, like, Alzheimer's or dementia, cancer, and cardiovascular diseases such as heart attacks and stroke.

CIMT Ultrasound Tests & More to Reverse Cardiovascular Aging

Botox®, Xeomin®, Dysport®, what is the difference?

Botox® is a household name, and if you are reading this, you may be familiar with Botox®, or just learning about it. Botox® is a neuromodulator that blocks messages from the nerve to the muscle to lessen the appearance of wrinkles as well as to improve the appearance of your face through lifting things like your eyebrows or corners of your mouth.

There are also several non cosmetic uses of Botox® such as for sweating, muscle spasm, and migraine headaches to name a few.

I am going to assume for this post that you have some familiarity with Botox® so we can talk about what is different between Botox® and other neuromodulators and only discuss these neuromodulators in relationship to cosmetic facial treatments.

I have by far the most experience with Botox® (over 16 years)and love using it. But there are some newer neuromodulators that we need to be aware of in order to make an informed decision.

After I had years of experience with Botox®, Dysport® came on the market and I tried it out on several hundred patients. The units of Dysport® do not correspond to Botox®, and they behave somewhat differently, so there was a learning curve.1 unit of Botox® corresponds approximately to 3 units of disport.1 bottle of Botox® has 100units, and one bottle of disport has 300 units. Most practitioners add the same amount of saline to disport as they do to Botox® so there is less confusion in dosing.

One notable difference that I and other doctors noted with Dysport® vs Botox® was the spread of the neuromodulator. Botox® injected into a muscle only treats a small area of that muscle and doesn’t spread to other muscles much. Dysport®, on the other hand, spreads further and can affect muscles I wasn’t intending to treat. This has been noted in clinical studies as well.

Clinically what I observed was less lifting of the droopy eyebrows, and often more drooping of already droopy eyebrows, if I treated the “11’s” the lines between the eyes.

Why less lift and more drooping? We have muscles in our face that lift things (think upward smile) and things that lower things (think frown).For our upper face the lifter muscle is called the frontalis. The frontalis is the muscle that causes the furrows or lines in your forehead, but it is also the muscle that lifts the eyebrows.

The muscles that lower your eyebrow (there are 7 lowering muscles vs 1 lifting) are the oribicularis occuli (2), depressor supercilli(2), corregator supercilli (2), and procerus (1).

These 7 muscles are my primary focus when I want to treat a droopy eyebrow and create youth in the face of tired appearing eyes. When I inject disport into these muscles, the neuromodulator bled into the frontalis and gave me less lift, and in some cases made the droopiness worse.

Many clinicians overcome this by either accepting less lift, or altering the dose or the concentrations when using disport.

There are times when more neuromodulator diffusion is favorable. When treating the forehead and the crow’s feet (lines at the sides of your eyes).A case could be made for using Botox® (less spread) at the gabella (central lowering muscles) and disport for the crow’s feet and forehead.

Many clinicians also note that Dysport® just seems to work stronger. The literature doesn’t consistently support this, but when talking to other top injectors, this is something we have observed.

Xeomin® is equivalent in potency per unit to Botox® and spread to Botox®.Xeomin® has the theoretical advantage of having less possibility of resistance than Botox® due to lack of additional proteins, but resistance is very rare to begin with.

There have been studies to address these two very similar neuromodulators (Botox® and Xeomin®), and I will briefly review 2 that were head to head comparisons treating different conditions.

In a 2013 study comparing Botox®, Xeomin®, (and Dysport®) for the treatment of gabellar lines (the 11’s between the eyes), the investigators used identical units of Botox® and Xeomin® (21 U).neither the doctor nor the patient knew which product they are going to get (double blinded study).There were 60 subjects in each neuromodulator group.(1)

The patients were injected identically, and checked at2, 3, 4, 5, 6, 7, 8, 90, 120, 150, and 180 days. Interestingly the Xeomin® subjects were blocked (less muscle movement) at 3 days on average, whereas the Botox® patients took on average 5 days for effectiveness. This reached statistical significance.

The other observation was that Xeomin® tended to last longer than Botox®. In males, both neuromodulators lasted an average of 115-121 days, and females it lasted 139-146 days. Xeomin® was slightly longer lasting than Botox®, but not of significance.

a 2014 clinical study comparing the effectiveness of Botox® vs Xeomin® in a condition called blepharospasm. This is an unpleasant twitching of the eye. In this study, they did what is called a “split face study” which is where one side was treated with Botox® and the other with Xeomin®.48 people with blepharospasm were treated and there was no difference between the 2 neuromodulators in terms of effectiveness, duration or satisfaction.(4)

In another study much higher doses of Botox® and Xeomin® were assed and over several years (2-17 years)for neck muscle spasm. (2).They found identical potency between the two neuromodulators.

There are a few factors to consider: cost of the drug, experience of the provider with the particular neuromodulator, and unique features discussed above.

While Botox® and Dysport® do not behave in the same way and the provider needs to be aware of the characteristics of each and inject differently (3), Botox® and Xeomin® are virtually identical.

There is also the issue of brand name comfort that Botox®® owns. This was the first neuromodulator on the market, by far the most market share in the USA, and a sales and training team second to none.

Xeomin® is the new kid on the block, is a little more pure (some call it “naked” Botox® because of the lack of additional useless proteins), and less expensive. Xeomin® appears to work at least as well as Botox® with no clear drawbacks.

1: Onset and duration of effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinAin the treatment of glabellar frown lines:a randomized, double-blind study.Clinical, Cosmetic and Investigational Dermatology 2013:6 211–219.Thomas Rappl et al

2: Botulinum toxin therapy of cervical dystonia: comparing onabotulinumtoxinA (Botox®) and incobotulinumtoxinA (Xeomin®).J Neural Transm (2014) 121:29–31.Dirk Dressler et al

3: Global Aesthetics Consensus: Botulinum Toxin Type A—Evidence-Based Review, Emerging Concepts, and Consensus Recommendationsfor Aesthetic Use, Including Updateson Complications.PRSJ Vol 137 No 3 518e-.Hema Sundaram et al.

4: A direct comparison of onabotulinumtoxina (Botox) and IncobotulinumtoxinA (Xeomin) in the treatment of benign essential blepharospasm: a split-face technique.J Neuroophthalmol 2014 Sep;34(3):233-6.Saad, j et al.

What's the difference between Botox, Xeomin, and Dysport? Read about what you need to know and how to choose between them.

Botox vs Xeomin vs Dysport | Allure Medical

Botox® vs Xeomin® vs Dysport®

I think of lip enhancement as restoring lost lip volume, and augmenting for someone who wants fuller lips.

The most common thing I hear is “I don’t want to be too big, I have a friend with crazy big lips”. To this I respond, “the crazy big lips are not a direct result of the lip filler, it is from the addiction to lip filler”. That is to say that 1-2 syringes of filler will enhance a lip, but the oversized lips takes multiple sessions to build to that unnatural appearance.

At one time we used collagen, and that was a great treatment with no swelling and instant results. But the collagen only lasted on the order of weeks, so collagen has been replaced with 

.HA is a naturally occurring substance in our body that supports certain tissues.

The HA’s for lip filler are the same as HA fillers used in other parts of the face. They are “cross linked” meaning they have been modified to last longer than naturally occurring HA.

The filler is added to the lip with a needle or cannula (which is a device that is less likely to bruise than a needle and is safer).

The weird looing “duck lips” are from improper filler application. The unnatural appearance to the lip after fillers is most likely from only filling the upper lip which leads to over projection, or from falling outside of the natural tubercles of the lip. The lip has 3 tubercles of the upper lip, and 2 of the lower lip.

The anatomy of the lip tubercles are outside the scope of this post. Internally, when we train injectors, a crucial part of that training is the location of these tubercles and how to properly fill them.

Enhance deflated lips with 2 syringes of HA modified with sugar alcohol to make the filler softer and longer lasting:

Enhance lip with 1 syringe of sugar alcohol modified HA (also had Botox to masseters to slim jaw line):

Mild enhancement with modified HA (equivalent of 1 syringe):

Enhancement with 2 syringes of modified HA:

Depends on the lip size at baseline, and the amount of correction desired.

In a study of two brands of lip filler, the average was 1.5 syringes to get to what is called a “one grade improvement”. A small lip requires less filler to look fuller than a larger lip. So that is contradictory to what we may assume, but think of it this way. If the lip is thin, there is little surface area to fill. Whereas a fuller or wider lip requires more filler to contact the volume of the lip.

This refers to injecting Botox® (Or Xeomin®, Dysport® etc) into the upper lip.It only takes 4-6 units, and the injections are done superficially into the lip so that the deep muscles of the lip contract and turn the lip out slightly.

It is not that impressive, and doesn’t last very long (say 10 weeks or so), but it is a very inexpensive way to enhance the lips without making them bigger.

Someone with an average or fuller lip who may have fine wrinkles or just wants a little more lip.Smaller, thin lips are not good candidates as the lip will further thin out over repeated treatments. A filler should be used in this case.

Lip Flip 5 units Botox® upper lip to soften wrinkles and subtle increase lip exposure:

How long does it last, can they be done together?

Lip flip can be used with lip filler. The lip flip lasts about 10 weeks and lip filler lasts 6-12 months (the first time, subsequent lip filler can last longer).

Lip enhancement is restoring lost lip volume, and augmenting for someone who wants fuller lips.

Specials & Offers

Blog

Specials & Offers

$4,995 Breast Augmentation - No Hidden Fees

$8/unit Xeomin®

$399 Lip Filler Treatment

$8/unit Botox®

$8/unit Botox®

$8/unit Xeomin®

Lip Filler Treatment for $399

Blog

CIMT Ultrasound Tests & More to Reverse Cardiovascular Aging

Botox® vs Xeomin® vs Dysport®

Pucker Up! Let's Talk About Lip Enhancement