BOTOX^® & DERMAL FILLERS^® – Is it for me?

by Erin Owoc, Dermatology Nurse Practitioner

BOTOX^®

Are you starting to pay more attention to the wrinkles across your forehead, the lines between your eyes, or your crow’s feet? If those areas are starting to bother you, BOTOX^® might be the answer for you. BOTOX^® provides the ability to relax the muscles around your forehead, between your eyes and by your crow’s feet to “smooth out” these wrinkles and is extremely effective. BOTOX^® Cosmetic is a very safe and quick procedure that has no down time and is virtually painless. It is best to choose a medical practitioner that has artistic skills and listens to what expectations you may have to be able to achieve your desired results. Make sure your medical practitioner uses only FDA approved ALLERGAN. (YES YOU MUST ASK THAT.)

You will start seeing results within 7 days and the results from BOTOX^® typically last 3-4 months. I get asked a lot on what age someone concerned about their wrinkles should start using BOTOX^®. Some people start aging very early (especially if they have been in the sun a lot or a smoker). My answer is generally when you start seeing the lines “at rest”, which means you are starting to see the lines while having no facial expression. Right when you start seeing the lines would be a good time to start using BOTOX^® to prevent the “etching” in your skin and to avoid deep wrinkles that would follow. I am also asked quite often about the safety concerns on injecting BOTOX^® in your skin. BOTOX^® is quite safe and is FDA approved. The average cost per area is $250-$380.

FILLERS

Are you starting to notice the lines running between your nose and your mouth? If so, dermal fillers might be the answer for you. As our skin ages, the dermis gradually loses its major constituents: collagen, elastin and hyaluronic acid. Collagen acts as the major support protein for our skin; elastin allows our skin to stay firm and resist wrinkles; hyaluronic acid helps to trap water and add volume and shape to our skin. A Dermal Filler a compound made up of Hyaluronic Acid that is a proven cure to virtually eliminate the deep lines around your nasolabial folds (lines between your nose and mouth) and other moderate to severe facial folds on your face. Dermal Fillers also enhance the facial contouring and can physically enhance the lips. Because Hyaluronic Acid occurs naturally in the body, it dissolves naturally with time and requires no allergy testing prior to treatment.

The three most popular dermal fillers on the market are; Restylane^®, Perlane^® and Juvederm^®. The most popular is Restylane^® because it has been around the longest. Juvederm^® is quickly gaining popularity because of it’s ability to last longer. However selecting a filler with your medical practitioner will depend on area treated and desired outcome. Most results last up to six months to a little over a year. The most common side effect is a little bruising after the injections. Some mild burning and stinging is normal and quickly resolves. Injection of fillers usually requires the use of either a topical numbing cream or a local injection of numbing medication. Then, using a small needle, the dermal filler is injected into each wrinkle or scar that requires treatment. The average cost for a Juvederm® syringe is $500 to $650 per area.

Summary

The use of BOTOX^® and/or Dermal Fillers are proven to truly take many years off the age of your face and are shown to be very safe when administered by an experienced medical practitioner.

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Botox vs. Dysport to Smooth Wrinkles

I have been injecting BOTOX for the past 9 years to well over 3,500 patients, with a 99% client satisfaction rate.  We are currently one of the few PLATINUM level medical providers with Allergan Botox in South Florida. I have personally injected over 550 patients in the past 12 months alone so I have a ton of experience on this topic.  In the past 6 months we have been learning more about Dysport, the new injectable treatment for wrinkles.  I wanted to update everyone about what Dysport is, and what is the same and different about it versus BOTOX.

Dysport is a new injectable treatment for wrinkles made from the same neurotoxin (botulinum toxin type A) as Botox.  Dysport has been used to smooth wrinkles in Europe, South America, and elsewhere for several years. Dysport does now have the approval of the FDA for use in the US and may become popular. Botox is currently the most popular cosmetic procedure in the US.

The differences between Botox and Dysport are actually very small.  Both drugs contain the same main ingredient: the botulinum toxin. Like Botox, Dysport temporarily immobilizes the muscles that cause facial wrinkles. The drug specifically targets the glabellar muscles of the forehead—the ones that create frowns.  What it’s doing is really blocking the signal between the nerve and the muscle, so when you tell yourself to frown, the muscle really never gets that message.  

RISKS- Injected in small amounts, Dysport and Botox offer the same results with the similar side effects, too – such as possible bruising at the site (which I must say very rarely happens when I inject BOTOX to my clients).   However, because of the “3 times” more volume required with Dysport compared to BOTOX, Dysport potentially diffuses a bit farther than Botox from the injection point: one to three centimeters compared to Botox’s one centimeter (based on standard reconstitution). This means that fewer injections are needed, but it also means that the health professional doing the injections must be very skilled to ensure that the drug does not spread to nearby muscles and cause eyelid and/or eyebrow drooping or other unwanted side effects.  This is always a concern when injecting BOTOX and now a bigger concern with Dysport.

INITIAL RESPONSE AND LONGEVITY -There is another difference in the botulinum toxins as well.  Dysport™ seems to have a faster onset, with results beginning to appear within one to seven days of treatment, while Botox takes between three and ten days to become effective.  This does vary between patients, however there is no difference in longevity, which is about 3 to 5 months.

COST- Some of my patients’ main concerns is the cost of Dysport compared to Botox.  Dysport is approximately 1/3 the cost per unit of Botox; however, it is also 1/3 the strength. This means you will need about three times as many units of Dysport to get the same results as you would with one unit of Botox.  As a result, we find that the cost of a Dysport treatment is the about the same as Botox.

PROLONGING THE EFFECTS OF EITHER -The beneficial effects of both Botox and Dysport can be prolonged, sometimes for quite some time longer than the ordinary 3 to 5 month duration, by suggesting that the patient undergo a series of three or four initial treatments, spaced at four month intervals. It seems that the continual presence of the Botox or Dysport in the muscle tissue during that period "teaches" the muscles of facial expression not to contract as actively as they did before treatment. It is this learned "lesson" that is believed responsible for the more prolonged response seen in many people, even after all the toxin has been metabolized away by the body.

In summary, clinically both BOTOX and Dysport stop the muscle from moving when used in appropriate doses. The only perceived advantage of Dysport is that many patients have seen earlier onset (one day on average). However the increased volume could potentially increase the risk around the eyes and eyebrows of eyebrow/eyelid droops. So because of this along with no real cost benefit and BOTOX’s proven record, unless our patient is not getting great results with BOTOX, we are not recommending Dysport as the first option for our patients at this time.

Erin Owoc has been practicing cosmetic dermatology for the last 8 years in Florida. An accomplished medical professional, Erin continually enhances her knowledge and skills through advanced training in the latest aesthetic techniques and laser technology. Erin received her bachelor’s degree from the Univ. of Florida & her master’s degree from the Univ. of South Florida. Erin can be reached at (954) 680-8330 or Erin@HaveAgelessSkin.com.