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CNN Saturday Morning News

Interview with Pat Wexler

Aired March 08, 2003 - 08:29   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


ANDERSON COOPER, CNN CORRESPONDENT: Well, today on "Weekend House Call," getting rid of wrinkles. Sure, we've all heard of botox by now and seen plenty of celebrities with suspiciously wrinkle free faces. But there are a lot of newer treatments on the market and in the next half hour we're going to check them out, how well do the new treatments work, and, more importantly, are they safe.
Dr. Sanjay Gupta joins us with some answers -- doctor.

DR. SANJAY GUPTA, CNN CORRESPONDENT: All right, good to be here.

Thank you.

Yes.

Well, a lot of people are concerned about wrinkles, perhaps even with everything that's going on in the world, perhaps because of everything that's going on in the world, and there are a lot of new products out there, as well. We've all heard of botox, certainly. But how much do these products cost? How effective are they? And, really, how safe are they?

(BEGIN VIDEOTAPE)

GUPTA (voice-over): By now, we've all heard botox. In 2002 alone, over 1.6 million people received injections of botulinin toxin to temporarily erase the wrinkles of time. Now, new types of injectables called fillers are becoming popular. Unlike botox, which for about four months paralyzes muscles, fillers plump up the face from underneath the skin, actually filling in the wrinkles. For some who don't have the money, time or desire for a facelift, these new injectable fillers offer a cheaper alternative.

Fillers available in the U.S. today are made of collagen, human skin over the patient's own fat. However, there are newer options out there that are being used in other countries. Several of these products are currently under review by the FDA. Articol is a biological combination of collagen and synthetic material and is meant to be a permanent fix. Radiance is a product made of the same mineral components as bone and teeth and can last anywhere from two to seven years. It's available in the U.S. but not approved for cosmetic use. And Restolin (ph), made from highloronic acid, (ph) which is a material found between the cells in our bodies, can last anywhere from a few months up to a year.

As with other medical products, some doctors worry about side effects. In the case of fillers, they could include lumping and rejection.

Aging is still an unavoidable fact of life. But now we have new ways to mask it.

(END VIDEOTAPE)

GUPTA: All right, well, a lot of questions about this. We're going to let you call us. The phone number, 800-807-2620. The e- mail, housecall@cnn.com.

A lot of these products that we're going to talk about today are going to become household names and we want to spend just another minute or so telling you some specifics about them, starting off with botox. That's one that you've certainly all heard about.

That is the botulinin toxin. That's the ingredient. It's injected directly into the muscle. It lasts typically about three to four months. It costs about $300 to $400 a treatment. Just last year alone, 1.6 million injections. Now there are side effects to be concerned about, possibly a droopy eyelid. This is a medication that is FDA approved right now.

Restolin, that's one that people are starting to hear more and more about. That's a derivative of joint fluid actually injected underneath the skin. It can last about six months, cost $275 to $400 per treatment. Now, it hasn't been really used in the United States that much, but 200,000 people in 60 countries around the world do use it. Possible side effects here, redness and mild swelling. FDA approval is expected in this country as early as July of this year.

Articol, that's another one that people are going to start hearing more and more about. This is a combination of collagen and synthetic material also injected under the skin. This one is interesting because it's designed to be permanent. This is the permanent one. It costs about $800 per syringe. Now, most patients only require one or two applications. There are some side effects to be concerned about, again, lumpiness, actually, lumpiness where those wrinkles are or redness, moderate pain. FDA approval for this expected next year.

And finally Radiance. This is the one that's made from the same components as bone and teeth. That gets a lot of people's attention. That's injected under the skin, as well. It lasts about five years. The most expensive one, costing up to $1,200. Possible effects redness and lumpiness, as well, not yet FDA approved, not knowing if it's going to be FDA approved yet.

COOPER: Let me ask you about that. With that Articol, you say it's permanent. But it may have these side effects. Does that mean the side effects would be permanent?

GUPTA: Or you're going to require operations, actual operations to get rid of that lumpiness and things like that. That is the big concern about permanent applications.

As we mentioned, as soon as we've talked about this, the phone calls started coming in. The lines lit up. And we're going to take your phone calls.

To help us answer those, we have Dr. Pat Wexler who's joining us. There she is.

Dr. Wexler, thank you for joining us.

She's a well known dermatologist in Manhattan and is going to help us work through some of these issues today. A lot of questions coming in.

Dr. Wexler, thank you.

Why don't we go straight to our first one, which comes from Taylor in Toronto. Taylor, thanks for calling in. Go ahead and ask your question.

TAYLOR: Hi, Dr. Gupta.

I wanted to ask you if think there would be a treatment that might be effective for small sag marks on my right cheek, this, too?

GUPTA: Small sag...

TAYLOR: And do you know what I'm talking about?

GUPTA: Well, yes, good question. And Dr. Wexler, a lot of people are concerned about the frown lines on the forehead and maybe the lines between their nose and their mouth. But what about things like just small sag lines like Taylor's asking?

DR. PAT WEXLER, DERMATOLOGIST: Well, small sag lines can be treated in a number of ways. Usually the best treatment would be a filler. For the past 20 years, we have been using bovine collagen, which is collagen derived from beef. And this is an excellent filler. It lasts anywhere from three to six months. It's several hundred dollars. And you have to be skin tested prior to the treatment because three to six percent of the population can be allergic to it.

A number of the other fillers you just spoke about will be good alternatives to this.

GUPTA: All right.

COOPER: That's interesting. We're going to take more calls when we come back from our break. And when we come back, we're going to talk also about how far people are willing to go to get one of these new wrinkle filling treatments. Some people are actually making a run for the border. Call us with your questions, 1-800-807-2620. Or you can send us an e-mail to housecall@cnn.com.

CNN "Weekend House Call" will be right back.

COMMERCIAL

COOPER: Well, this is CNN "Weekend House Call." We are talking about alternatives to botox, new wrinkle treatments and their safety. You can call us at 1-800-807-2620 or e-mail us, housecall@cnn.com.

We're back to answer your questions in 60 seconds.

COMMERCIAL

COOPER: I just noticed a new wrinkle on my hand. I was concerned.

Welcome back to "Weekend House Call."

As we just noted, Canadian plastic surgeons are noticing that more and more of their patients are coming from the U.S. Sanjay Gupta is here, Dr. Sanjay Gupta here joins us.

GUPTA: Yes, they put me with the only 21-year-old anchor from CNN to do this segment.

COOPER: Yes, right.

Thank you very much.

GUPTA: We do have a lot of e-mail questions, a lot of questions about this period.

Let's go to our first one. This comes from Ravensdale, Washington. The question is, "Where can I get Restolin in my area? I would go to Vancouver, Canada if necessary."

Dr. Wexler is joining us from Manhattan and I'm going to ask you to respond to this. You know, a lot of questions about if you can't get it here, where should we go or are people getting it elsewhere and bringing it back? What are you hearing, Dr. Wexler? What are you seeing?

WEXLER: Well, obviously people are leaving the country to obtain products for filling. I always caution my patients that everything that's new is not necessarily better. I think that Restolin and Hilaform (ph) will be great fillers and I think they have a high safety profile. But there are many other products that are available in Europe that are unsafe and have many complications.

So beware when you leave the country and you have filling that you may have problems. I've had patients come back with lumps, with draining abscesses. But these were not from Hilaform or Restolin. They were from products which have not been tested and not been approved.

COOPER: Well, you know, not only leaving, is leaving the country pretty controversial, but also you're hearing now about botox parties. I mean, you know, it used to be keg parties when I was in college. Now I guess people are having botox parties.

GUPTA: Yes.

COOPER: On the phone we have a call from Dean in Tampa, I think, who has a question about botox parties. Dean?

DEAN: Yes, sir, in fact, it begs the question, how do you know you're having a good time at a botox party because your face is frozen in one expression?

My question, folks, is regarding the, just the absolute abuse of this drug when you look at the fact that it gets in the hands of anybody, how do we actually regulate something like this? What are the long-term effects? And, also, we've seen with other operations that we're starting to see younger people and younger people doing this. What are the possible side effects for maybe perhaps children and adults having this, you know, fall in the wrong hands?

COOPER: It's a good question, Dean.

GUPTA: Right. Yes.

WEXLER: Well, these are multiple part questions, but they're all very good questions. Botox has been used for over 20 years for many medical uses. We actually use it for children with cerebral palsy muscle spasm. So it can be used very safely for non-cosmetic use in children.

So I'm not worried about the safety of botox. My father actually was treated over 20 years ago for Parkinson's spasm of the eyelids. So I knew then that it was a very safe drug.

I don't approve of botox parties. I think we should treat it as a medical treatment and I don't believe in serving wine and giving medical treatments at the same time. And I think you should be very careful to go to a doctor who has been trained in giving these treatments. It shouldn't be done in a beauty parlor or a salon or a gym.

And I think that it is very difficult to control how this gets into unskilled hands and I think you get what you pay for. And when people look to get a bargain by going to a party and having some cosmetician giving the injections, you are risking complications. But the good news is all the complications from botox are temporary.

COOPER: All right, our next caller, Robert in California.

Robert, what's your question?

ROBERT: Dr. Gupta?

GUPTA: Yes, sir?

ROBERT: From one nurse to a physician that I really appreciate your expertise on whatever matters that you discuss on CNN, without FDA approval, are these clinical trials for profit and does any physician other than cosmetic physicians, are they allowed to use this product?

GUPTA: OK, well, that's a very important question. There's been a lot of articles actually written about this. A two part question.

First of all, with regards to trials, the way trials are typically conducted is that grant money comes in, a grant is applied for and either the government or another organization pays for the trial to actually be conducted. They are called a trial because they are not yet approved, but patients can sometimes get the procedure or the product or whatever done underneath that trial.

Now, as far as in the long run, I'm sorry, the second part of your question as far as the long run, the procedure itself, if it is approved, the doctors will actually get reimbursed if the insurance companies actually reimburse for that.

Was that the second part of your question?

OK. All right. I think we answered that.

Dr. Wexler, have you got anything to add to that?

WEXLER: No. I think you took care of that very nicely.

Thank you.

GUPTA: All right, let's go to another e-mail. We're getting a lot of those, as well. And this, you know, you talk about facelifts, you talk about these actual medical products being injected, things like that, but even one step short of that creams. Do the topical creams which included copper actually do any good or is it more hype?

Dr. Wexler, what about that? Why not just creams? They seem to work pretty well, don't they?

WEXLER: Creams work well in preventing sun damage. They work well to reverse some of the signs of sun damage, brown spots, irregular pigmentation, a dull, lackluster effect of the skin. But they're not going to take away deep wrinkles and they're certainly not going to increase significant amounts of elasticity in the skin.

COOPER: I don't know if we can...

WEXLER: But they are beneficial.

COOPER: I'd like to actually ask you a question, Dr. Wexler.

Do you have, I mean, not necessarily your patients in particular, but do you ever have to tell people, you know, it's time to stop doing this stuff? Like, you know, you've gone too far? I mean there are so many people you run across who, you know, sort of become overwhelmed with this and with the potential for it. Do you ever have to cancel patients, you know, where this isn't a good idea? Or, you know, maybe the time is, you know, you've just got to give in to time.

WEXLER: All the time. All the time. I think it's a doctor's obligation to tell a patient when they're becoming obsessed or when they have an unrealistic expectation. I think we see examples all the time of actors and actresses that have gone too far and certainly I don't want patients like that in my waiting room, looking as if they've done too much and they look Draconian.

So I think it's up to the doctor to say you really have to accept the fact that we're not going to turn the clock back to 20. We have to look the best we can for our age and look naturally and expressive. You know, when you talk about looking frozen, nobody should be abusing botox to the point where they do look frozen. We should keep our expressions. Botox is great for over expressive muscles, but then we use fillers for around the mouth. You don't want to get rid of expressions around the mouth. I like to smile.

COOPER: It must be a hard message to tell some patients.

When we come...

WEXLER: It takes longer to say no than yes.

COOPER: Yes, I'll bet it does.

Well, when we come back, we're going to look more at botox. Can it do more than erase wrinkles? Dr. Wexler mentioned her father was treated with it for Parkinson's. Well, some of its new uses may surprise you, as well.

Stay with us.

"Weekend House Call" will be right back.

COMMERCIAL

COOPER: Well, that's quite a remarkable listing of things botox can apparently be used to treat.

GUPTA: Yes.

COOPER: Welcome back to "Weekend House Call."

Botox, that's the topic and other treatments. It's got a lot of other uses. It's not just for wrinkles anymore apparently. I mean I just saw that graphic.

GUPTA: It's an awful long list, isn't it?

COOPER: Yes.

GUPTA: I mean this medication has been around for a long time. Everyone has focused attention on it because it recently got FDA approval for these you know. But as Dr. Wexler will tell you, as well, they've been using it for wrinkles sort of off label for a long time. So, yes, it is becoming more popular. 1.6 million of these for wrinkles just last year alone, botox.

COOPER: Amazing.

GUPTA: A lot of calls out there. We're going to take another call right now, I guess, from Leslie in Missouri has a question.

Go ahead, Leslie.

LESLIE: Good morning.

GUPTA: Good morning.

LESLIE: I have cervical dystonia, which I'm sure you're aware of, but for people who don't know, my neck muscle spasm which pulls my head to the left something terrible. And I've been taking botox injections for the past two or three years every couple months, several injections at a pop, I might add. It kind of hurts.

I was wondering if any of these new treatments or if you know anything new that may be coming out that would help in the treatment of dystonia?

Thank you.

GUPTA: Thank you for your question, Leslie.

And I'll take a crack at that first, Dr. Wexler. I'd love to have your input. But cervical dystonia basically a contraction of the muscles literally forces your neck off to one side. If you've perhaps seen somebody like that, it can be quite significant. Botox, again, paralyzes those muscles, allowing people to come back to a normal sort of stature, holding their neck more normal, moving it around. There are some good medications out there, as well, Leslie, that may work.

Some of the medications under development to try and treat dystonia, an operation to actually cut some of those muscles may be sort of a long-term resort, as well.

Dr. Wexler, anything, do you see any patients with this sort of thing, as well, in your practice?

WEXLER: Well, yes, I have seen patients with this. There is another botulinin toxin called Botulinin B which is Myobloc (ph), which has also been used for cervical dystonia. And some patients who have not had as good a result with A do switch to the botox B. And that might be something you might investigate if you're not getting adequate results with the A toxin.

COOPER: We have another call from Steven in Miami. Steven, what's your question?

STEVEN: How you doing?

My girlfriend gets extremely debilitating headaches like migraines. She went in and got botox treatment, not for the migraines, but just for the wrinkles, and the headaches went away. But however, she's a super sensitive person and it seemed like she had like chronic internal problems like something got paralyzed from the botox for about four or five weeks, extreme nausea, constipation, just overall terrible.

COOPER: Well, let's try to find out about it. Dr. Gupta, do you, side effects?

GUPTA: Right. Well, botox certainly does have some side effects that people are concerned about. It does require injections. Sometimes the medication -- it's a paralytic. If this medication gets in the muscles other than the ones you're trying to paralyze, in this case muscles that are causing spasm related to headaches or the muscles that cause wrinkles, it can cause things like a droopy eyelid, a frozen mouth, things like that. It can actually paralyze some of those muscles. That's one of the concerns about botox.

Again, this is a potentially very dangerous substance.

Dr. Wexler, have you seen any of that at all in your practice?

WEXLER: You know, we do talk about side effects like a temporary eyelid droop but the side effects you're describing with your girlfriend are distant side effects and you certainly cannot get a distant paralysis from an injection given for cosmetic or migraine use. So it does sound like she had a flu like syndrome, which can be reported with botox in a very, very rare number of cases.

GUPTA: All right, great.

WEXLER: But it's not due to a paralysis. It's just a flu like syndrome.

GUPTA: A different sort -- a lot of things to be concerned about.

We do have to take a break right now.

But we're going to have some final thoughts about these new wrinkle removers when we come back.

Stay with us.

COMMERCIAL

GUPTA: All right, well, it's time for final thoughts.

Back in Manhattan, Dr. Pat Wexler, do you have a one sentence final thought for viewers today?

WEXLER: Remember, botox paralyzes unwanted expression lines, fillers fill. Go to an experienced physician who can make you, help you make a decision that fits your lifestyle and budget.

GUPTA: All right, excellent final thought. And let me remind viewers, as well, that a lot of these products are coming through the pipeline now. They've not been FDA approved. But remember, the FDA approval process is there for a reason. Remember silicon. It was supposed to be safe, it was supposed to be harmless and to have all these wonderful effects. In fact, it caused a lot of problems and came under a lot of controversy. So there was a lot of concerns.

There will be a lot of products out there. Keep an eye out for them.

Hopefully you learned something today.

That's all the time we have for today.

Make sure to catch us tomorrow. We're going to talk about headaches. Now, everyone gets them, but few really know their causes and how to treat them. We're going to take your questions tomorrow at 8:30 a.m. in the East. Please e-mail us, as well, housecall@cnn.com.

Thanks for watching.

I'll see you tomorrow.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired March 8, 2003 - 08:29   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ANDERSON COOPER, CNN CORRESPONDENT: Well, today on "Weekend House Call," getting rid of wrinkles. Sure, we've all heard of botox by now and seen plenty of celebrities with suspiciously wrinkle free faces. But there are a lot of newer treatments on the market and in the next half hour we're going to check them out, how well do the new treatments work, and, more importantly, are they safe.
Dr. Sanjay Gupta joins us with some answers -- doctor.

DR. SANJAY GUPTA, CNN CORRESPONDENT: All right, good to be here.

Thank you.

Yes.

Well, a lot of people are concerned about wrinkles, perhaps even with everything that's going on in the world, perhaps because of everything that's going on in the world, and there are a lot of new products out there, as well. We've all heard of botox, certainly. But how much do these products cost? How effective are they? And, really, how safe are they?

(BEGIN VIDEOTAPE)

GUPTA (voice-over): By now, we've all heard botox. In 2002 alone, over 1.6 million people received injections of botulinin toxin to temporarily erase the wrinkles of time. Now, new types of injectables called fillers are becoming popular. Unlike botox, which for about four months paralyzes muscles, fillers plump up the face from underneath the skin, actually filling in the wrinkles. For some who don't have the money, time or desire for a facelift, these new injectable fillers offer a cheaper alternative.

Fillers available in the U.S. today are made of collagen, human skin over the patient's own fat. However, there are newer options out there that are being used in other countries. Several of these products are currently under review by the FDA. Articol is a biological combination of collagen and synthetic material and is meant to be a permanent fix. Radiance is a product made of the same mineral components as bone and teeth and can last anywhere from two to seven years. It's available in the U.S. but not approved for cosmetic use. And Restolin (ph), made from highloronic acid, (ph) which is a material found between the cells in our bodies, can last anywhere from a few months up to a year.

As with other medical products, some doctors worry about side effects. In the case of fillers, they could include lumping and rejection.

Aging is still an unavoidable fact of life. But now we have new ways to mask it.

(END VIDEOTAPE)

GUPTA: All right, well, a lot of questions about this. We're going to let you call us. The phone number, 800-807-2620. The e- mail, housecall@cnn.com.

A lot of these products that we're going to talk about today are going to become household names and we want to spend just another minute or so telling you some specifics about them, starting off with botox. That's one that you've certainly all heard about.

That is the botulinin toxin. That's the ingredient. It's injected directly into the muscle. It lasts typically about three to four months. It costs about $300 to $400 a treatment. Just last year alone, 1.6 million injections. Now there are side effects to be concerned about, possibly a droopy eyelid. This is a medication that is FDA approved right now.

Restolin, that's one that people are starting to hear more and more about. That's a derivative of joint fluid actually injected underneath the skin. It can last about six months, cost $275 to $400 per treatment. Now, it hasn't been really used in the United States that much, but 200,000 people in 60 countries around the world do use it. Possible side effects here, redness and mild swelling. FDA approval is expected in this country as early as July of this year.

Articol, that's another one that people are going to start hearing more and more about. This is a combination of collagen and synthetic material also injected under the skin. This one is interesting because it's designed to be permanent. This is the permanent one. It costs about $800 per syringe. Now, most patients only require one or two applications. There are some side effects to be concerned about, again, lumpiness, actually, lumpiness where those wrinkles are or redness, moderate pain. FDA approval for this expected next year.

And finally Radiance. This is the one that's made from the same components as bone and teeth. That gets a lot of people's attention. That's injected under the skin, as well. It lasts about five years. The most expensive one, costing up to $1,200. Possible effects redness and lumpiness, as well, not yet FDA approved, not knowing if it's going to be FDA approved yet.

COOPER: Let me ask you about that. With that Articol, you say it's permanent. But it may have these side effects. Does that mean the side effects would be permanent?

GUPTA: Or you're going to require operations, actual operations to get rid of that lumpiness and things like that. That is the big concern about permanent applications.

As we mentioned, as soon as we've talked about this, the phone calls started coming in. The lines lit up. And we're going to take your phone calls.

To help us answer those, we have Dr. Pat Wexler who's joining us. There she is.

Dr. Wexler, thank you for joining us.

She's a well known dermatologist in Manhattan and is going to help us work through some of these issues today. A lot of questions coming in.

Dr. Wexler, thank you.

Why don't we go straight to our first one, which comes from Taylor in Toronto. Taylor, thanks for calling in. Go ahead and ask your question.

TAYLOR: Hi, Dr. Gupta.

I wanted to ask you if think there would be a treatment that might be effective for small sag marks on my right cheek, this, too?

GUPTA: Small sag...

TAYLOR: And do you know what I'm talking about?

GUPTA: Well, yes, good question. And Dr. Wexler, a lot of people are concerned about the frown lines on the forehead and maybe the lines between their nose and their mouth. But what about things like just small sag lines like Taylor's asking?

DR. PAT WEXLER, DERMATOLOGIST: Well, small sag lines can be treated in a number of ways. Usually the best treatment would be a filler. For the past 20 years, we have been using bovine collagen, which is collagen derived from beef. And this is an excellent filler. It lasts anywhere from three to six months. It's several hundred dollars. And you have to be skin tested prior to the treatment because three to six percent of the population can be allergic to it.

A number of the other fillers you just spoke about will be good alternatives to this.

GUPTA: All right.

COOPER: That's interesting. We're going to take more calls when we come back from our break. And when we come back, we're going to talk also about how far people are willing to go to get one of these new wrinkle filling treatments. Some people are actually making a run for the border. Call us with your questions, 1-800-807-2620. Or you can send us an e-mail to housecall@cnn.com.

CNN "Weekend House Call" will be right back.

COMMERCIAL

COOPER: Well, this is CNN "Weekend House Call." We are talking about alternatives to botox, new wrinkle treatments and their safety. You can call us at 1-800-807-2620 or e-mail us, housecall@cnn.com.

We're back to answer your questions in 60 seconds.

COMMERCIAL

COOPER: I just noticed a new wrinkle on my hand. I was concerned.

Welcome back to "Weekend House Call."

As we just noted, Canadian plastic surgeons are noticing that more and more of their patients are coming from the U.S. Sanjay Gupta is here, Dr. Sanjay Gupta here joins us.

GUPTA: Yes, they put me with the only 21-year-old anchor from CNN to do this segment.

COOPER: Yes, right.

Thank you very much.

GUPTA: We do have a lot of e-mail questions, a lot of questions about this period.

Let's go to our first one. This comes from Ravensdale, Washington. The question is, "Where can I get Restolin in my area? I would go to Vancouver, Canada if necessary."

Dr. Wexler is joining us from Manhattan and I'm going to ask you to respond to this. You know, a lot of questions about if you can't get it here, where should we go or are people getting it elsewhere and bringing it back? What are you hearing, Dr. Wexler? What are you seeing?

WEXLER: Well, obviously people are leaving the country to obtain products for filling. I always caution my patients that everything that's new is not necessarily better. I think that Restolin and Hilaform (ph) will be great fillers and I think they have a high safety profile. But there are many other products that are available in Europe that are unsafe and have many complications.

So beware when you leave the country and you have filling that you may have problems. I've had patients come back with lumps, with draining abscesses. But these were not from Hilaform or Restolin. They were from products which have not been tested and not been approved.

COOPER: Well, you know, not only leaving, is leaving the country pretty controversial, but also you're hearing now about botox parties. I mean, you know, it used to be keg parties when I was in college. Now I guess people are having botox parties.

GUPTA: Yes.

COOPER: On the phone we have a call from Dean in Tampa, I think, who has a question about botox parties. Dean?

DEAN: Yes, sir, in fact, it begs the question, how do you know you're having a good time at a botox party because your face is frozen in one expression?

My question, folks, is regarding the, just the absolute abuse of this drug when you look at the fact that it gets in the hands of anybody, how do we actually regulate something like this? What are the long-term effects? And, also, we've seen with other operations that we're starting to see younger people and younger people doing this. What are the possible side effects for maybe perhaps children and adults having this, you know, fall in the wrong hands?

COOPER: It's a good question, Dean.

GUPTA: Right. Yes.

WEXLER: Well, these are multiple part questions, but they're all very good questions. Botox has been used for over 20 years for many medical uses. We actually use it for children with cerebral palsy muscle spasm. So it can be used very safely for non-cosmetic use in children.

So I'm not worried about the safety of botox. My father actually was treated over 20 years ago for Parkinson's spasm of the eyelids. So I knew then that it was a very safe drug.

I don't approve of botox parties. I think we should treat it as a medical treatment and I don't believe in serving wine and giving medical treatments at the same time. And I think you should be very careful to go to a doctor who has been trained in giving these treatments. It shouldn't be done in a beauty parlor or a salon or a gym.

And I think that it is very difficult to control how this gets into unskilled hands and I think you get what you pay for. And when people look to get a bargain by going to a party and having some cosmetician giving the injections, you are risking complications. But the good news is all the complications from botox are temporary.

COOPER: All right, our next caller, Robert in California.

Robert, what's your question?

ROBERT: Dr. Gupta?

GUPTA: Yes, sir?

ROBERT: From one nurse to a physician that I really appreciate your expertise on whatever matters that you discuss on CNN, without FDA approval, are these clinical trials for profit and does any physician other than cosmetic physicians, are they allowed to use this product?

GUPTA: OK, well, that's a very important question. There's been a lot of articles actually written about this. A two part question.

First of all, with regards to trials, the way trials are typically conducted is that grant money comes in, a grant is applied for and either the government or another organization pays for the trial to actually be conducted. They are called a trial because they are not yet approved, but patients can sometimes get the procedure or the product or whatever done underneath that trial.

Now, as far as in the long run, I'm sorry, the second part of your question as far as the long run, the procedure itself, if it is approved, the doctors will actually get reimbursed if the insurance companies actually reimburse for that.

Was that the second part of your question?

OK. All right. I think we answered that.

Dr. Wexler, have you got anything to add to that?

WEXLER: No. I think you took care of that very nicely.

Thank you.

GUPTA: All right, let's go to another e-mail. We're getting a lot of those, as well. And this, you know, you talk about facelifts, you talk about these actual medical products being injected, things like that, but even one step short of that creams. Do the topical creams which included copper actually do any good or is it more hype?

Dr. Wexler, what about that? Why not just creams? They seem to work pretty well, don't they?

WEXLER: Creams work well in preventing sun damage. They work well to reverse some of the signs of sun damage, brown spots, irregular pigmentation, a dull, lackluster effect of the skin. But they're not going to take away deep wrinkles and they're certainly not going to increase significant amounts of elasticity in the skin.

COOPER: I don't know if we can...

WEXLER: But they are beneficial.

COOPER: I'd like to actually ask you a question, Dr. Wexler.

Do you have, I mean, not necessarily your patients in particular, but do you ever have to tell people, you know, it's time to stop doing this stuff? Like, you know, you've gone too far? I mean there are so many people you run across who, you know, sort of become overwhelmed with this and with the potential for it. Do you ever have to cancel patients, you know, where this isn't a good idea? Or, you know, maybe the time is, you know, you've just got to give in to time.

WEXLER: All the time. All the time. I think it's a doctor's obligation to tell a patient when they're becoming obsessed or when they have an unrealistic expectation. I think we see examples all the time of actors and actresses that have gone too far and certainly I don't want patients like that in my waiting room, looking as if they've done too much and they look Draconian.

So I think it's up to the doctor to say you really have to accept the fact that we're not going to turn the clock back to 20. We have to look the best we can for our age and look naturally and expressive. You know, when you talk about looking frozen, nobody should be abusing botox to the point where they do look frozen. We should keep our expressions. Botox is great for over expressive muscles, but then we use fillers for around the mouth. You don't want to get rid of expressions around the mouth. I like to smile.

COOPER: It must be a hard message to tell some patients.

When we come...

WEXLER: It takes longer to say no than yes.

COOPER: Yes, I'll bet it does.

Well, when we come back, we're going to look more at botox. Can it do more than erase wrinkles? Dr. Wexler mentioned her father was treated with it for Parkinson's. Well, some of its new uses may surprise you, as well.

Stay with us.

"Weekend House Call" will be right back.

COMMERCIAL

COOPER: Well, that's quite a remarkable listing of things botox can apparently be used to treat.

GUPTA: Yes.

COOPER: Welcome back to "Weekend House Call."

Botox, that's the topic and other treatments. It's got a lot of other uses. It's not just for wrinkles anymore apparently. I mean I just saw that graphic.

GUPTA: It's an awful long list, isn't it?

COOPER: Yes.

GUPTA: I mean this medication has been around for a long time. Everyone has focused attention on it because it recently got FDA approval for these you know. But as Dr. Wexler will tell you, as well, they've been using it for wrinkles sort of off label for a long time. So, yes, it is becoming more popular. 1.6 million of these for wrinkles just last year alone, botox.

COOPER: Amazing.

GUPTA: A lot of calls out there. We're going to take another call right now, I guess, from Leslie in Missouri has a question.

Go ahead, Leslie.

LESLIE: Good morning.

GUPTA: Good morning.

LESLIE: I have cervical dystonia, which I'm sure you're aware of, but for people who don't know, my neck muscle spasm which pulls my head to the left something terrible. And I've been taking botox injections for the past two or three years every couple months, several injections at a pop, I might add. It kind of hurts.

I was wondering if any of these new treatments or if you know anything new that may be coming out that would help in the treatment of dystonia?

Thank you.

GUPTA: Thank you for your question, Leslie.

And I'll take a crack at that first, Dr. Wexler. I'd love to have your input. But cervical dystonia basically a contraction of the muscles literally forces your neck off to one side. If you've perhaps seen somebody like that, it can be quite significant. Botox, again, paralyzes those muscles, allowing people to come back to a normal sort of stature, holding their neck more normal, moving it around. There are some good medications out there, as well, Leslie, that may work.

Some of the medications under development to try and treat dystonia, an operation to actually cut some of those muscles may be sort of a long-term resort, as well.

Dr. Wexler, anything, do you see any patients with this sort of thing, as well, in your practice?

WEXLER: Well, yes, I have seen patients with this. There is another botulinin toxin called Botulinin B which is Myobloc (ph), which has also been used for cervical dystonia. And some patients who have not had as good a result with A do switch to the botox B. And that might be something you might investigate if you're not getting adequate results with the A toxin.

COOPER: We have another call from Steven in Miami. Steven, what's your question?

STEVEN: How you doing?

My girlfriend gets extremely debilitating headaches like migraines. She went in and got botox treatment, not for the migraines, but just for the wrinkles, and the headaches went away. But however, she's a super sensitive person and it seemed like she had like chronic internal problems like something got paralyzed from the botox for about four or five weeks, extreme nausea, constipation, just overall terrible.

COOPER: Well, let's try to find out about it. Dr. Gupta, do you, side effects?

GUPTA: Right. Well, botox certainly does have some side effects that people are concerned about. It does require injections. Sometimes the medication -- it's a paralytic. If this medication gets in the muscles other than the ones you're trying to paralyze, in this case muscles that are causing spasm related to headaches or the muscles that cause wrinkles, it can cause things like a droopy eyelid, a frozen mouth, things like that. It can actually paralyze some of those muscles. That's one of the concerns about botox.

Again, this is a potentially very dangerous substance.

Dr. Wexler, have you seen any of that at all in your practice?

WEXLER: You know, we do talk about side effects like a temporary eyelid droop but the side effects you're describing with your girlfriend are distant side effects and you certainly cannot get a distant paralysis from an injection given for cosmetic or migraine use. So it does sound like she had a flu like syndrome, which can be reported with botox in a very, very rare number of cases.

GUPTA: All right, great.

WEXLER: But it's not due to a paralysis. It's just a flu like syndrome.

GUPTA: A different sort -- a lot of things to be concerned about.

We do have to take a break right now.

But we're going to have some final thoughts about these new wrinkle removers when we come back.

Stay with us.

COMMERCIAL

GUPTA: All right, well, it's time for final thoughts.

Back in Manhattan, Dr. Pat Wexler, do you have a one sentence final thought for viewers today?

WEXLER: Remember, botox paralyzes unwanted expression lines, fillers fill. Go to an experienced physician who can make you, help you make a decision that fits your lifestyle and budget.

GUPTA: All right, excellent final thought. And let me remind viewers, as well, that a lot of these products are coming through the pipeline now. They've not been FDA approved. But remember, the FDA approval process is there for a reason. Remember silicon. It was supposed to be safe, it was supposed to be harmless and to have all these wonderful effects. In fact, it caused a lot of problems and came under a lot of controversy. So there was a lot of concerns.

There will be a lot of products out there. Keep an eye out for them.

Hopefully you learned something today.

That's all the time we have for today.

Make sure to catch us tomorrow. We're going to talk about headaches. Now, everyone gets them, but few really know their causes and how to treat them. We're going to take your questions tomorrow at 8:30 a.m. in the East. Please e-mail us, as well, housecall@cnn.com.

Thanks for watching.

I'll see you tomorrow.

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