Chad L. Prather, MD

Thanks for your question about Botox and neck banding. The banding in your photos seems to be present when you "clench" your jaw and neck, which indicates a hyperdynamic platysma muscle of the neck. I would recommend that you see a board certified dermatologist or plastic surgeon to confirm this, as this is the type of issue that Botox and Dysport can improve. Small doses of Botox to the muscle superficially can improve platysmal neck banding for months at a time, and would be an ideal start to improvement over more invasive procedures.

When it comes to enhancing lips, each patient has a unique foundation (starting point) and unique goals. Perhaps with no other area is it more important to have a quality injector (board certified dermatologist or plastic surgeon) and to discuss what your desired outcome is. It may not always be achievable, but it certainly won't if you and your physician aren't on the same page. Some patient want more volume, some more definition, some to enhance particular micro-areas over others, and each takes a different approach, and often different products. Lips don't often take large volumes of filler... just the right product in the right place. Typically the cupid's bow is best enhanced with small volumes of a lip-specific filler (like Volbella) along the philtral ridges and at focal points at the  lateral peaks of cupid's bow. This is not the same as volumization of the upper and lower lip, and is why many patients leave unhappy after a session with an inexperienced injector. They may have come for volumization and left with a thick line along the upper lip, or came for better definition and left with volume instead. It usually is possible to enhance the cupid's bow, either along with, or separate from, more volume. Please see a board-certified physician that you trust and bring this question so that he or she can give you a realistic scenario for your particular desired outcome.

Thanks for a great question on a topic that runs through all of our minds when researching any purchase or service. It reminds me of a funny image you may have seen online (link below): "You can always find someone who will do it cheaper.... but at what cost?". We are always searching for better value, defined as an equal or better outcome for less money. Sometimes one is willing to sacrifice a good or better outcome for a cheaper cost, but I wouldn't recommend doing that when it comes to your health and appearance. The cost in the long run - the potential for a poor outcome - just isn't worth it. I think the question comes down to, "Who are you going to trust with your face?". If you have a board-certified dermatologist or plastic surgeon that you trust, that you've had a good experience with, I would suggest that it is worth the higher price, particularly with Botox and fillers.

Thank you for your photos and question about improving the chin area. While it is important to be evaluated in person so that your board certified dermatologist or plastic surgeon can assess your chin from various angles and while in motion, botox and fillers are typically used to improve this area. They may be a great option for you as well, particularly in combination. Botox is used to improve hyperactive muscles, or lines and wrinkles that happen with motion. Your physician may recommend small doses of botox to the mentalis muscle of the chin or the depressor anguli oris (DAO) muscle of the lower face to help with a "dimpled" chin in motion. Results will typically last for 3 months, after which repeat injections can help maintain results. Fillers can also be used along the jawline to help support any volume deficit that may be contributing to the issue as well, particularly along the pre-jowl sulcus area of the jawline near the chin. In general, if the issue happens during motion, we think of Botox first, while if it happens during rest, fillers may be your preferred option. And often, both together can give the best result.

You're absolutely correct that there are different brands of botulinum toxin. In the U.S., these are known as Botox, Dysport, and Xeomin (brand names). Each is a slightly different molecule, but the basically have the same effects. While there are minor differences in onset and duration, none are considered "better" or "worse". Some physicians and patients just have different preferences, and the costs may vary a bit. Image the different brands of "soda" such as Coke, Pepsi, and Dr. Pepper. They're all soda, with basically the same effects, but you may prefer one over the others. Botox has been around the longest, and is still the most popular. Dysport was second, and is the second most popular. And Xeomin is the most recent addition. All can work well to achieve the "Botox" effect (see link below for the most common areas of treatment).

They are dosed differently, so the most important point is that, if you change brands, you may need more or less than you did with the other brand. 100 units of Botox does not equal 100 units of Dysport, so the most important thing is that your injector is experienced and well-trained in the one you're receiving. Most patients stick with the brand they've grown to know and trust, and there are options!