Botox, Dysport, Xeomin
Neuromuscular Modulators. Otherwise known as muscle relaxers, or muscle freezers. While it is true they are all derived from the Botulism bacteria. It is important to know this bacteria is a chain of 100 different proteins, and that just one of these proteins is replicated to produce the temporary muscle relaxation.
All three have the same mechanism of action, and are manufactured by different companies. Each is an injectable liquid that temporarily inhibits the movement of any given muscle, the cause of wrinkles. Botox was the pioneer, discovered in the 1950’s, and was approved for medical use in 1989. It’s original use was for treating eyelid spasms, and a lazy eye. By 2002, Botox was FDA approved for cosmetic treatments, and has gained overwhelming popularity since that time. To date, Botox is the number one cosmetic injectable treatment worldwide. The other two, Dysport and Xeomin gained FDA approval over the past 10 years.
Common Regions of Treatment
Angry lines (between the eyebrows), forehead (worry lines), crows feet (tiny lines at the outer corner of the eyes), bunny lines (lines at the inner corners of the eyes on the nose), frown lines, upper lip lines, chin, nose, gummy smile, square jaw line, saggy neck, enhances lips, allow the eyes to look more open, fine lines and wrinkles on the face, neck and chest.
A “treatment” for any of the above neuromuscular modulators is done via an injectable “unit”. Unit is a liquid measurement on a medical syringe that delivers the selected amount. For example, the angry lines between the eyebrows may require anywhere from 10-30 liquid measured units for a treatment.
Builds confidence, makes one feel more attractive, look less tired, less angry, more refreshed, less sad, less saggy, more youthful, smoother skin, and studies show reduces depression.
- Botox: Starts taking effect in 4-5 days, lasts 3-4 months.
- Dysport: Starts taking effect in 2 days, lasts 3-4 months.
- Xeomin: Starts taking effect in 2-3 days, lasts 3-4 months.
Most common is bruising, though is rare. Eye droop, which is secondary to incorrect placement. The good news is that if you aren’t happy with the results, they will wear off!
My Personal Favorite
Botox and Dysport, because they both last the longest for me.
For a treatment of one region, like the forehead, you can expect to pay anywhere from $120-$360. The forehead may require anywhere from 10-50 injected units. The number of units required is based on each individuals anatomy. For example those with thick skin and thick muscles require a higher quantity of units. Likewise, those with thinner skin and thinner muscles, require a smaller quantity of units. Men typically require more units than women.
Juvederm, Voluma, Volbella, Vollure, Restylane, Belotero, Radiesse, Scupltra, Bellafil.
Each has unique qualities, and can be used to enhance, enlarge, correct, lift, or subtly make a person look more youthful. Most people do not want others to know they have had something “done”, most want others to think they just look great naturally. Which is a look that is easy to achieve when you inject a smaller volume of fillers with the most precise placement.
Juvederm, Voluma, Volbella, Vollure, Belotero and the Restylane Family
All products in this group are Hyaluronic Acid dermal fillers (a gel), which is a naturally occurring substance in the skin, joints and eyeballs. Each has a unique quality, and thickness, making them lend to one area of the face over another. For example: Volume is a thicker and heavier gel, so is best used to lift the cheeks, where as it would be too hard for use in the lips.
All last for 9 months, except the Voluma, and Vollure which are each 2 years. However, keep in mind that your birthday’s aren’t stopping, and the again process continues. Therefore some fillers might not seem to last as long as you think they should. Though, over time the fillers are replaced with collagen, and have a lasting effect from the accumulation of new collagen.
The most common treatment approach in my practice is very conservative one. I gradually restore lost volume by placing a moderate amount of a dermal filler at 4-6 week intervals until the patient has their desired outcome. Once this goal is obtained, the patient will go on a maintenance schedule, and have filler added again at anywhere from 6 months to 2 years later. Keep in mind what you had enhanced, or corrected 6 months ago with a 9 month dermal filler, may need to be treated again at an earlier time than what you expected. This is the case the more mature we are, and depending on what degree of correction you desire to maintain.
My personal choices for where to use each of the above
Laugh lines, frown lines, cheeks, lip lines, lips, chin, jowls, around the eyes, between the eyebrows. Any of the above regions can be injected to enhance or correct, all depends on the volume of the filler you inject, and what your desired outcome is.
Calcium based filler which is great for those with thicker skin. This filler is expected to last 18 months. But keep in mind that you may like it for less time, or longer.
My personal choice for where to use this filler
Cheeks, laugh lines, frown lines, chin, jowls, and the back of the hands (remember they give away your age too!). This product is too thick and hard for use in the lips.
Lactic Acid crystals suspended in liquid. This product is not a filler per se, rather it is a liquid injected deep into the skin that stimulates the production of collagen over time (up to and beyond 2 years).
This product is vey nice to address the thinning of skin as we mature. For most people this requires a few treatments, but is very nice when combined with the dermal fillers. This product does not wear off over any given amount of time, as it’s end result is to thicken the collagen in your skin. The aging process is what causes the collagen layer to thin, and that process will continue on, but this will lessen and repair that process quite nicely.
Bovine suspended poylmers (tiny plastic beads). This product is also not a filler per se, it stimulates the production of collagen over time. I do not inject this product, as the polymers are in the skin forever and do not dissolve, along with allergic reactions to the bovine suspension. This product will not wear off over any given amount of time. Keep in mind, the polymers are there forever.
Treatment Effects of Dermal Fillers
More youthful and refreshed appearance. Enhanced self esteem. Less saggy appearance. If done in a conservative manner, like the majority of my patient population, injected with a moderate amount of product at 4-6 weeks intervals, you will slowly create a youthful look over a period of time. Others will just think you had a really good night’s sleep, not realizing they are looking at rejuvenation with dermal fillers! What I call a “Liquid Facelift.”
Side Effects of all Dermal Fillers
Swelling, and bruising are the most common and if they occur will only last a few days. There is always a risk of infection, though if proper techniques are used this is rare. The good news with fillers is that if you are not happy, they eventually wear off. There is also an injectable antidote to “erase” any of the Hyaluronic Acid fillers if needed.
My Personal Favorites
Juvederm, Voluma, Volbella, Vollure, Restylane, and Scupltra.
Prices range from $450-$900 per syringe, depending on the filler.
How to Choose a Cosmetic Injector
Shop around! Ask your friends! Make phone calls and ask about the injector, how many years of experience, how were they trained, where did they attend medical school, and what year did they graduate. Go in for a consultation and meet the injector. The best way to know if the medical provider is licensed and certified in cosmetic injectables, is to confirm their credentials through the medical board in which they are licensed. This research can easily be done online.
I caution to not choose the injector who has the lowest price, it is ALWAYS worth it to pay for experience! Remember this is your face, and it is the first thing anyone sees on you!