Lorrie Klein, MD

I recommend you see a board-certified dermatologist, facial plastic surgeon, oculoplastic surgeon or plastic surgeon. With all due respect to Dr. Trevisani, plastic surgeons are not the only physicians to do non- and minimally invasive procedures, in fact, most of them have their nurses do their injectable and laser treatments because they spend most of their time doing surgery. As a cosmetic dermatologist, I spend 99% of my time doing Jeuveau, Botox and fillers. You are probably too young for thread lifts to be useful but a consultation is needed to determine what is best for you. We recommend patients time their Jeuveau or Botox treatments first, then their laser and light-based devices, and lastly fillers.

Both Botox and Jeuveau are type A neuromodulators.  They have the same molecular weight, same potential side effects, are injected exactly the same way and in the US studies worked equally well and lasted equally long.  The European/Canadian studies actually showed Jeuveau to be 4-8% superior to Botox.  I have seen it kick in sooner than Botox as well.  The processing technology is different, with Botox being freeze dried and Jeuveau being vacuum dried, which might account for it’s superiority.

Jeuveau is a type A neuromodulator, just like Botox.  It has the same molecular weight and has the exact same side effect profile.  Potential side effects that we rarely see are: bruising, eyelid ptosis (droop) and eyebrow ptosis (droop), which are all temporary.  While eyelid ptosis is the worst of these, it is not dangerous but does look bad.  It has a 1% risk among all injectors but in our office we see it less than 1 per 1000 treatments.

Jeuveau is a type A neuromoduoator, like Botox, with an identical molecular weight to Botox.  Dysport and Xeomin are also type A neuromodulators.  Theoretically, if one didn’t work none of them would work.  It is extremely rare for someone to get desensitized to any of these products, where they would stop working and usually only with frequent treatments using very high doses for medical uses.  Also, if you were desensitized it would not work at all.  If it seems to not be working as well it could be for one of the following reasons:1. You went to a new injector who is injecting you in a different pattern or with lower doses.2. You did not get Botox but instead a weaker product like Xeomin or Dysport.3. You are “recruiting” other parts of the muscles or surrounding muscles around the treated areas which are now moving because you can’t move the areas that were injected.  This is your brain trying to find a work-around.If your injector is experienced and customizes your treatments he or she should be able to change your dose and/or injection sites to fix this problem, with either Botox or Jeuveau.

Jeuveau may be priced slightly less than Botox Cosmetic but it will be close in price in most offices since it is a premium product.  In studies and in my experience, it works as well as Botox Cosmetic and possibly slightly better.  Patients have already told me it is kicking in faster than Botox Cosmetic did for them.

Jeuveau is a neuromoduoator and the same molecular weight as Botox.  In clinical studies it performed as well, or slightly better, than Botox.  

Jeuveau is safe to use if you are allergic to eggs or anything else.  It is a very safe product that is very similar to Botox Cosmetic.

Besides avoiding aspirin, ibuprofen, fish oil, etc. for 1-2 weeks prior to a filler treatment I recommend Cearna Ocumend hydrogel pads immediately after Botox and filler treatments.  These deliver a very high, concentrated dose of Arnica Montana directly to the areas where it is needed.  In my experience it reduces bruising significantly, especially in those people who tend to bruise frequently.  oral Arnica is also helpful but most of what you ingest does not reach your skin in the treated area.

Besides avoiding aspirin, ibuprofen, fish oil, etc. for 1-2 weeks prior to a filler treatment I recommend Cearna Ocumend hydrogel pads immediately after filler treatments.  These deliver a very high, concentrated dose of Arnica Montana directly to the areas where it is needed.  In my experience it reduces bruising significantly, especially in those people who tend to bruise frequently.

I routinely fix eyebrow asymmetry with Botox but it is not always possible to lift it as high as the other eyebrow. Sometimes we then lower the higher eyebrow with Botox by injecting above that eyebrow.  Another possible solution is to use a filler, such as Juvederm or Voluma, under the eyebrow to lift it by restoring volume that is lost with age.  This is an advanced use of fillers so make sure you go to someone very experienced in this area.