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Botulinum Toxin A, which one is best?

Non-surgical cosmetics procedures

Botulinum toxin A (Xeomin®, Botox®, Dysport®) to relax wrinkles

Collectively referred to as “botox,” this is the most well-known and commonly used nonsurgical cosmetic treatment, with 4,597,886 performed in the U.S. in 2016.

This naturally-produced neuromodulator is injected into the face muscles responsible for wrinkles, temporarily paralyzing them so they cannot create wrinkles. It works great in the forehead creases, crow’s feet (quint lines at the corner of the eyes), scowl lines (between the eyebrows), and many more face wrinkle areas, shown below. This is the quickest and easiest anti-aging facial skin treatment for both men and women. When done correctly, it should still allow you to make facial expressions, but static lines (all face muscles relaxed) should be gone.

Expect to pay $300 to $500 for a full treatment of all these areas. Results are seen in 3-5 days and last 3-5 months per treatment. Side effects are not serious, such as localized redness, irritation or swelling.

Safety of botox for cosmetic uses is proven over the past 20+ years and is approved in approximately 80 countries. A 2014 review of 35 clinical trials with 8,787 participants receiving botulinum toxin showed a minor side effects rate of only three percent.

Long-term wrinkle reversal and prevention: Botulinum toxin is now being used not just to temporarily reverse facial wrinkles, but for long-term reversal. In fact, just two years of consistent use in the same facial area is thought to cause deeper wrinkles to continue to soften as the dermis layer of the skin heals and remodels its shape.

The latest discovery is that younger patients can prevent wrinkles from even forming! I recommend my patients avoid creases from developing by starting botox treatments when they notice static wrinkles (at rest) where they have the most facial animation. It could possibly fit into a budget even at the age of 25 to 30 years of age (younger wrinkles need almost half the full treatment).

Botulinum toxin can work even after age 60, but larger amounts are needed in deeper wrinkles. When larger amounts won’t work, then dermal fillers are used to smooth and fill deeper crevices.

Xeomin is as good (if not better) than Botox. Xeomin (by Merz) is botulinum toxin type A, similar to Botox (by Allergan). Xeomin has been safely and effectively used in Europe since 2008 and is currently FDA approved in the U.S. for facial skin wrinkle treatment just as Botox.

Xeomin has been well proven to be equally effective as Botox, with one unit of Xeomin equal to one unit of Botox. Xeomin and Botox have identical side effects (minor swelling, bruising, headache, and soreness). However, Xeomin has a few benefits over Botox:

1. Xeomin is a pure botulinum toxin A without additives. One benefit of a pure botulinum toxin A is that the human body is less likely to become resistant to it. Some patients have developed antibodies to Botox.

2. Xeomin is the only one of the three botulinum toxin A products that does not need to sent on ice before being reconstituted in normal saline for use. Whereas, Botox must be manufactured and then shipped on dry ice and kept in a freezer until reconstituted.

3. With Allergan’s market dominance and aggressive advertising, they have significantly raised the purchase price for Botox, which gets translated to higher prices for healthcare providers and, therefore, patients.

For these reasons, Xeomin is becoming the preferred botulinum toxin A by doctors and patients.

Botulinum toxin A injection sites

Where are the usual places to have botulinum toxin A injected? These include the following locations:

· eyebrow lift (lateral brow)

· lower eyelid wrinkles

· smoker’s lines (above lips)

· bunny lines (mid nose)

· smile lift (corners of mouth)

· chin dimples

· platysmal bands (neck strands)

· …and more.

In my next article, I’ll discuss my next favorite skin procedure: dermal fillers.

To feeling and looking your best,

-Michael Cutler, M.D.

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