BOTOX AND DYSPORT

Botox Cosmetic and Dysport are a non-invasive treatments that is used to eliminate the frown lines between the brows, flatten deep forehead wrinkles, and soften the ‘crow’s feet’ eye wrinkles. They work by relaxing the muscles of the face, which help to produce a smooth and relaxed appearance. Contrary to what some believe, the aim of this treatment is not to create a frozen look with no expression; the goal is to soften lines with preservation of a natural appearance. The treatment is usually done in about 10 minutes, and patients can immediately return to normal activities.

The most common areas treated with Botox or Dysport are the glabellar lines (in between the brows), forehead wrinkles, and crows feet. There are “specialty” areas listed below that our plastic surgeons could treat:

  • Gummy Smile Reduction
  • Masseter Reduction for jawline slimming
  • Mentalis Muscle for chin dimpling
  • Platysma muscle for neck wrinkles and muscle banding

FAQS

  • There is no downtime after this treatment.
  • Patients can return immediately to work after treatment.
  • Most patients will notice an improvement within 3 – 5 days, but the maximum effect may take up to two weeks.
  • Most patients experience little to no pain during treatment.
  • While most patients experience results for three to four months, some may note results lasting up to six months.
  • This treatment is not performed on women planning to get pregnant, pregnant women or breast feeding women.

There is very little preparation for a treatment. However, patients should avoid taking aspirin, non-steroidal anti-inflammatory medications, St. John’s wort, or high doses of Vitamin E supplements for one week prior to treatment. These agents could lead to bruising after injection. Also, patients who have previously suffered from facial cold sores are sometimes prescribed a medication to minimize recurrence.

The difference between the two products comes down to varying formula characteristics:

Dilution:

Dysport is diluted differently than botox. So if a patient is used to a certain number of Botox units for a treatment they will likely need to increase the number of units when switching to Dysport (or vice versa). However, greater dilution does not mean that Dysport is less effective than Botox. It just means that a higher quantity of Dysport is needed to achieve the same level of result.  For clinics that price the products by the unit, you will find that that price per unit of Dysport is typically much lower than the price per unit of Botox, but to get a similar treatment result the final cost may be about the same.

Molecule size:

The Dysport formula contains smaller molecules compared to Botox, which may be beneficial. Smaller molecules enable Dysport to work faster than Botox and a larger area of spreading. In some areas this is beneficial and in some areas this is not. That is why it is very important to go to a provider who has lots of experience and expertise in proper dosing and placement of your neurotoxin.

Diffusion:

Dysport tends to diffuse more than Botox, causing it to spread to a broader area after it’s injected. This means a larger treatment area can be addressed in fewer injections, which can be beneficial when addressing larger treatment areas. However, this diffusion means Dysport is less effective in treating smaller areas where more precision is needed or areas with thicker muscles.

Onset:

Compared to Botox, Dysport has the quickest “onset” of action; typically requiring 24 hours for all results to be realized. Botox can take up to 72 hours for results to fully establish.

DERMAL FILLERS

What are dermal fillers?

Dermal fillers help to diminish facial lines and restore volume and fullness in the face.  As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow’s feet become more apparent. The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity and lifestyle.

What dermal fillers can do

  • Plump thin lips
  • Enhance shallow contours
  • Soften facial creases and wrinkles
  • Improve the appearance of recessed scars
  • Reconstruct contour deformities in the face
  • Decrease or remove the shadow of the lower lids

Don’t confuse dermal fillers with other injectables like Botox or Dysport, which are wrinkle relaxers. Although, like fillers, these products are injectables, they work very differently—by temporarily paralyzing muscles that cause crow’s feet, forehead furrows, and the “eleven” lines between the eyebrows. They don’t fill, plump, or enhance an area. They can, however, be used along with fillers.

What dermal fillers can’t do

Nonsurgical rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results as surgical procedures like facelifts and brow lifts, but may help delay the time when consideration of a facelift becomes appropriate. It is important to remember that dermal fillers are temporary treatments for facial aging and that ongoing treatments will be needed for long-term results.

There are many dermal filler products on the market.

Dermal fillers differ in chemical makeup, longevity and have varying degrees of softness. Softer fillers are used in the lips, for example, while sturdier fillers might be desired to enhance cheekbones. Your injector will determine with you the best type and volume of filler needed for your particular areas of concern.

Hyaluronic acid

Restylane-L, Restylane Lyft, Restylan Silk, Juvederm Ultra XC, Vobella XC

Hyaluronic acid is a naturally occurring sugar found in the body that gives the skin moisture, volume, and elasticity.  HA acts like a sponge to attract water into the skin. As a result, it plumps up the area in which it was injected. It also boost the skin’s own production of collagen so fewer touch-ups may be needed and less material necessary when they are. Most HA fillers are infused with the anesthetic lidocaine to minimize discomfort during and after treatment. If you don’t love your result, fear not, fillers that contain HA can be partially or completely removed with hyaluronidase, an enzyme that breaks down HA.

Calcium hydroxylapatite

Radiesse

Calcium hydroxylapatite is found naturally in human bones and is a mineral-like compound. When used in a filler, the calcium particles are tiny and suspended in a thick gel-like solution. While Radiesse immediately replenishes lost volume, over time the gel is absorbed and the body metabolizes the calcium, leaving behind your own collagen. It’s often used to treat moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines, enhance fullness of the cheeks and other facial contours, improve volume in areas of facial wasting such as can occur in HIV-positive people taking certain medications.

Calcium hydroxylapatite is biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required.

Recovery

Recovery time varies for each patient and for each type of filler injected. You can resume most activities right away, but it is generally recommended that you avoid intense physical activity for the first 24-48 hours to minimize swelling and bruising.   Your initial appearance after treatment with any dermal filler may include: an “overfilled” appearance to treated areas, swelling or bruising ranging from mild to severe, temporary numbness or redness, palpable lumps or hard areas at the injection sites, hypersensitivity reaction that can seem like an allergic reaction with hives and swelling. Most conditions can be alleviated with topical icing and massage and will improve within a matter of hours or just a few days. Some reactions may require more aggressive treatment with medications or injections.

Results

The results of soft tissue augmentation using dermal fillers are apparent immediately and will last from 6 to 18 months depending on the filler used and the patient injected. Depending on the material,some are thinner and more “flowy,” others thicker, so they can potentially last longer.  Maintaining good overall health and maintaining healthy and strong skin with appropriate products and skin treatments will improve the results and longevity.

Risks

Severe complications from dermal fillers are uncommon. Potential risks vary depending on the specific filler used and the relative permanence of the filler substance and include: acne-like skin eruptions, asymmetry, bruising, bleeding from the injection site, swelling, damage to the skin that results in a wound and possible scarring, infection at the injection site, lumps, palpability of the filler under the surface of the skin, skin rash with itching, skin redness, under- or over-correction of wrinkles, blindness, a bluish discoloration (Tyndall effect) and skin necrosis (ulceration or loss of skin from disruption of blood flow).

Your injector will carefully explain:

  • Your course of treatment
  • The type of filler recommended in your case and why
  • Expected results
  • The longevity of the result
  • Cost

Cost is always a consideration in an elective procedure or treatment. The cost of dermal filler injections may vary based on the expertise and qualifications of the person performing the treatment, the type of product used, time and effort the treatment requires.