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Botox: Everything you Wanted to Know

BOTOX®, Dysport®, XEOMIN® & Jeuveau®

Botox® is the most common cosmetic treatment I perform in the office. If you are looking for a quick, simple and effective non-surgical treatment to help minimize the signs of aging on the face then Botox® may be the treatment for you. In all practicality, Botox® and the other neuromodulators like Dysport®, Xeomin® & Jeuveau® work about the same. The different brand names are simply slightly different versions of the same product, similar to Coca-Cola® vs. Pepsi®. I prefer treating my patients with either Botox® or Dysport® as they have been on the market longer than Xeomin® & Juveau®, and therefore have a longer track record of safety. 

How do neuromodulators work?

As we age, repeated muscle movements like smiling, frowning and squinting, leads to the formation of dynamic wrinkles. These dynamic wrinkles differ from static wrinkles, which develop over time as our skin produces less collagen and elastin, combined with effects from sun exposure and other cumulative environmental factors.

Neuromodulators such as Botox®, Dysport®, Xeomin® & Jeuveau® work by blocking the nerve signals that cause specific muscle groups to contract. This causes the treated muscles to relax, thereby reducing the appearance of wrinkles in targeted areas.

What areas can I treat?

Common areas of dynamic wrinkling targeted by Botox injections include:

  • Vertical frown lines between the eyebrows (commonly called “the 11s”)
  • Horizontal forehead lines
  • Periocular lines (Crow’s feet)
  • Nasal squint lines (Bunny lines)
  • Horizontal neck lines

I also use Botox off-label to help with many other areas including:

  • Chin dimpling (Mentalis relaxation)
  • Vertical neck banding (Platysma relaxation)
  • Frown muscles (DAO relaxation)
  • TMJ, jaw tension and teeth grinding (Masseter relaxation)
  • Gummy smile
  • Vertical upper lip lines
  • Botox “lip flip”

Not only do we use botulinum toxin (Botox) injections to reduce and prevent wrinkles, but we can also use them to help stop excessive sweating (hyperhidrosis). Botox injections are FDA approved to treat hyperhidrosis of the underarms only. However, myself and many other dermatologists use this medication off-label to treat other areas including the hands and feet.

When should I start treating?

Botox works best when it is started early before static lines (lines present at rest) develop. We frequently have patients starting Botox injections in their 20’s and 30’s to help prevent their expression lines from developing. Once static lines are present, it may take several treatments to obtain the best result.

What happens during the procedure?

When treating areas on the face and neck, no topical numbing medication is required prior to treatment. During the procedure, small amounts of a liquid solution (Botox®, Dysport®, Xeomin® or Jeuveau®) are injected with a very small needle into targeted muscle groups usually on the face or neck. The injections are minimally painful and are usually very well tolerated. No bandages are required after treatment.

When treating excessive sweating of the underarms, hands, or feet we often use a topical numbing medication to help minimize injection site pain as those areas can be quite sensitive. Injections are then made directly into the skin of the axillae, hands, and/or feet. Each injection is spaced about 1 cm apart when treating these areas.

How long does botox last?

Each Botox treatment typically works for about 3-5 months and then needs to be repeated to maintain effect. Typically, my patients return every 3-4 months for their next treatment.

When treating excessive sweating (hyperhidrosis), treatments are often helpful for up to 6 months.  

Is there any downtime after treatment?

Typically, there is no downtime after the procedure and patients can go about their normal routine immediately after the procedure, provided it does not involve strenuous exercise. To help avoid product migration to unwanted areas after the procedure, I advise patients not to exercise for 24 hours. I also advise them not to lay down for 4 hours and to avoid rubbing or massaging the areas that were treated for 4 hours. This includes taking care not to rub the treated areas while applying makeup within 4 hours after treatment.

After treatment, there is often a small bump (smaller than a pea) at each injection site where the product is placed. This bump slowly dissolves over the next hour and is frequently not noticeable by the time our patients leave the office.

What are the common side effects?

We make safety our No. 1 priority and have extensive experience in treating thousands of patients with a variety of neuromodulators including Botox. Side effects are typically mild in nature and include bruising at the injection site, swelling, redness, soreness, and headache (uncommon). Rarely, weakness in nearby muscle groups leading to a temporary eyebrow or eyelid droop (ptosis) can occur.

When treating the hands for hyperhidrosis I always counsel my patients that temporary hand muscle weakness is a potential side effect.

According to the American Academy of Dermatology, “when used by a dermatologist to treat signs of aging or excessive sweating, no serious side effects like problems breathing or swallowing have ever been reported”.

The providers here at Feinstein Dermatology & Cosmetic Surgery have treated thousands of patients with BOTOX and other neuromodulators. Many other treatment options for wrinkles and aging are also available at our clinic. To discover which treatment is best for you, schedule a consultation with one of our providers by calling (561) 498-4407.

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