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Botox

Botox, Dysport, Xeomin or Jeuvveau?

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Botox & Dysport…What is it used for and what age should I start? It might seem hard to imagine there was ever a time before Botox, but it is actually newer than you probably think. Botulinum toxin A has only been used for cosmetic purposes since 1996.  Over the course of its short history, Botox has become a household name. New applications have also been found for Botox in the cosmetic realm, from scalp injections to keep hair clean and styled longer, to foot injections to help avoid the pain associated with wearing high heels. Botox is used for treating areas of the face that are prone to developing lines and wrinkles from muscle activity.  Botox will typically last about 3-4 months, depending on the person and their activity level.  We find that people who workout a lot tend to need Botox / Dysport much sooner.  Immediately after the injections you can expect small bumps in the area that the Botox / Dysport was injected.  These small bumps will resolve in about 5-10 minutes as it is absorbed into the muscle. How long until it begins to work?  Botox will usually start working in 8-10 days, where Dysport will begin working in 3-4 days.  Xeomin and Jeuveau will typically take about a week to start working.  We recommend waiting at least 2 weeks before you see your final results. Which one will last the longest?  This is a very difficult question to answer, because there are many factors.  Some men have very strong muscles and may need more botox than others.  The more Botox, Dysport, Xeomin ect. that you put in, the longer it will typically last.  When you only use a small amount of Botox, Dysport the results tend to not last as long.  It is a very personal preference regarding how much Botox a person may want, and how much movement they want as well.  Too much Botox or Dysport may tend to have a negative effect by causing the eye lids to become droopy. What age should I begin Botox or Dysport?  This question should really be – How strong are the muscles?  I have women in their 50’s who have never had Botox or Dysport and they have no wrinkles.  I have women in their early 20’s already developing deep lines, so I goes to show age has nothing to do with it.  I generally recommend around 30 being a good age to start with a small amount.  Women doing Botox or Dsyport in their early 20’s as a means of prevention, I will recommend smaller doses at 6-9 months or even once a year.

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Botox – Dysport

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Botox is great for helping to reduce the lines on the forehead, between the eye brows and around the eyes.  Botox works in the muscle by blocking the impulse going to the muscle which causes it to contract.  When there are strong muscles, it causes micro injuries into the epidermis of the skin which cause lines to form where the muscle squeezes together.  Botox or Dysport will not fill in deep lines or wrinkles, so we suggest a “filler” at the point.  Fillers are gel substances that help plump up sunken areas or deep lines. What is a good age to start Botox?  It is hard to say exactly what age is appropriate, but we typically recommend around the age of 30.  A lot of this has to do with the strength of the muscles, and not so much about the age of the person.  We have had 20 year old women with very strong muscles, and I have had 60 year old women with no lines and have never had Botox or Dysport before.  When you are younger, we typically recommend Botox every 6-9 months as more of a preventative measure. Is Botox Safe?  We uses thousands of units every month and have never experienced any severe side effects.  Possible side effects may include a slight headache, blurred vision and flu like symptoms.  These possible side effects only last 24-48 hours and resolve on their own.

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Botox

Botox /

When injecting Botox, you can not inject everyone the same way.  Muscles vary in location from one person to the next.  Having a trained injector who has a great deal of knowledge about the facial muscles will make your Botox come out much better.  When doing an assessment of a person’s facial muscles it is best to have them make different facial expressions to evaluate the muscles. When going to a new place, it is important to know what you want and what you don’t want.  Many places work on commission and will try and up sell you on more Botox than you may even need.  The problem is, when you have too much Botox it can cause the forehead to get very heavy and make the eyelids droopy.  If you don’t get enough injected you will still have a lot of movement and the lines will never go away.  The other problem with treating sub-therapeutically, or placing too small of an amount is that it will not last very long. Typically for the forehead I find the sweet spot to be 30 units of Botox or 60 units of Dysport.  Around the eyes can be a tricky place to inject because it is the highest rate of bruising associated with this area.  Blood vessels are very difficult to see around the eyes and it is a very tender area.  If you place too much Botox around the eyes it will effect the way you smile.

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Will I bruise with Botox

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When doing Botox, it is hard to say if you will bruise.  There area areas that have a higher tendency to bruise, such as around the eyes.  There area a few things that will help reduce the chances of bruising, but there is never 100% chance of not bruising.  Many times it depends on the injector, whether they are aggressive with the needle, or do they take their time to look for blood vessels.  Things you can do to help reduce your chances of bruising are – Arnica Montana is a great homeopathic drug sold over the counter.  I typically recommend starting Arnica 3-4 days before injections.  Avoiding alcohol for a couple days before any injections will also help keep your blood from getting too thin.  Do not apply numbing cream to the area where you are getting injections.  Numbing cream causes the blood vessels to become dilated and puts you at a higher risk.  Ice before hand can help, but I never recommend ice after Botox, because it will interfere with the absorption.  If you get a really bad bruise, IPL laser can help break down the blood and help it heal much quicker.

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Botox

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What to know before getting your first Botox treatment.  First, it is important to know if you have any muscular issues such as myasthenia gravis or bell’s palsy.  Many times when someone is getting Botox for the first time I recommend being a bit conservative.  With Botox, you can always put more in, but you can’t take it out.  By being a little more conservative it will possibly keep you from having any complications.  The dose of Botox needs to be enough to achieve results, but too much may cause complete lack of movement or possibly a droopy eye.  Typically it is not recommended to have Botox when you are pregnant or breast feeding.  Although Botox does not have systemic effects, I always recommend to be safe, rather than sorry. Is bruising common?  The face have many blood vessels and the chances of bruising is always present.  The most common place for bruising to occur is around the eyes.  The bruising has no effect on the results of the Botox.  Above all else, I always recommend doing your research and you get what you pay for.

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Botox or Dysport

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The question for years has been which is better, Botox or Dysport?  A lot of this depends on what your trying to accomplish.  Botox is a very well known brand and does a great job.  Dysport has been out for about 8 or so years and also does a great job, but not as well known as Botox.  The molecular structure of each is slightly different.  Botox has a small extra protein strand attached to it that Dysport does not have. Dysport will tend to have a faster onset (the time it takes to kick in) where as Botox will take about 5-7 days.  The length of time the both last has been argued, but they should both last about 3-4 months.  I do have a few clients that Botox will last up to 6 months on.  I highly recommend trying both and seeing which one will last longer for you, which will save you money in the long run. At the end of the day, Dysport will end up saving you more money, but there are some people who simply respond better to Botox.  Both do the exact same thing in the end.

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What type of filler should I use??

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A common question I get is… What is a good filler for my lips?  Companies put a lot of money into marketing new products and creating a “Buzz”.  I can honestly say that I have tried every filler out on the market, with the exception of Radiesse (which will cause granulomas) in the lips.  I have tried Voluma thinking that the larger molecule and G-prime would make it last longer, but no such luck.  I have tried Volbella, Belotero, Volure, Juvederm ultra, Juvederm ultra plus, Restylane and none of them lasted very long.  Restylane is by far THE WORST choice for lip filler.  The problem is that it is a very small molecule and spreads out too thin.  Many inexperienced people like Restylane because it is very forgiving if they make a mistake. In the past I used Juvederm Ultra Plus XC, because the drug reps at Allergan told me it is better than regular old Juvederm Ultra.  Guess what…Juvederm Ultra lasts longer.  Why did Allergan tell me to buy more Juvederm Ultra Plus?  Because it is more expensive! I have tried EVERYTHING in my years of injecting and I keep coming back to Juvederm Ultra XC.  Juvederm Ultra is a little stiffer feeling as you inject than Ultra Plus XC.  I have heard that there are some great products in Canada that will be coming down to the US for lips that last a very long time.  I will keep you posted if anything better comes onto the market.

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Juvederm or Botox?

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Many times people who are new to having procedures done are not familiar with terminology used.  I many times hear people ask for Botox to be placed in the nasolabial folds “Laugh Lines”.  An easy way to remember the difference is that fillers like Juvederm “Fill In” low spots or wrinkles.  Botox works on the muscle to help it not move.  Botox does not paralyze the muscle, but rather weakens it so that it does not temporarily not move.  Botox typically comes in units whereas Juvederm and fillers come in a pre-filled syringe.  Juvederm is a gel like substance, and Botox is a fine powder until mixed with sodium chloride to reconstitute it.  Can you “water down” juvederm or fillers?  Absolutely not.  I have read about people thinking they are getting scammed on juvederm by someone watering it down…impossible.  Can Botox be over diluted and “watered down”…yes!  In my own personal opinion I don’t feel it is morally right to cheat someone out of something if they paid for it, but other shady med spas have no problem doing it.  How do you know if it is watered down?  It is extremely difficult to determine if Botox is over diluted, unless your the one doing it.  This is why it is so important to deal with a reputable office.  A few times I have treated people and they said it didn’t work completely, so I re-treat them at no charge.  Do your homework and find a great place to go, and more importantly people you trust.  I always recommend Yelp for honest reviews or Google+.

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The Difference Between Botox & Juvederm

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Many times I am asked the difference between Botox and Juvederm.   With so many names of different products out there it can be hard to figure out what goes where.  I always recommend coming in for a consultation first, because there may be a primary issue that solves a secondary issue. Botox, Dysport & Xeomin are neurotoxins that work with the muscle to block impulses to the muscle that cause it to move.  Most times Botox is used between the eye brows, forehead, and crow’s feet (around the eyes).  Botox will typically last 3-4 months.  For many women in their early 20’s using botox for preventative measures I recommend every 6  to 12 months.  For women looking to reverse the signs of aging I recommend Botox every 3-4 months.  Botox typically will take about a week to start seeing the results, so be patient.  Dysport will typically start working in 3-4 days.  Dyport is a smaller molecule than Botox and theoretically should not last as long as Botox, but there are always people who get the opposite effect.    I have stopped using Xeomin due to the short duration it works. Juvederm, Restylane, Voluma, ect…are all “Fillers” or “Dermal Fillers” which is a broad term.  The main purpose of “Fillers” is to plump up and fill in lines and add volume.  A common area for volume deficit is in the cheek area under the eyes.  Juvederm is what I typically use in the lips for lip augmentation.  I have tried in the lips Belotero, Restylane, Voluma, Volbella, Juvederm and I find Juvederm lasts the longest.  The worst thing to place in the lips is Restylane, due to the small molecular size it breaks down very quickly.  You will find inexperienced injectors will use Restylane because it allows a lot of room for error.  With fillers, simply think of “Plumping up” areas or filling in cracks and lines.  With so many different dermal fillers, I highly recommend a consultation first.

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