Thank you for your question maura1216. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Botox (onabolutimun toxin) is what we call a neuromodulator. This means that it controls nerves to relax the muscles by preventing them from contracting. Botox is the most popular neuromodulator available, has been the most studied, and is cleared for the most number of indications. Other neuromodulators available in the United States include Dysport (abobolutimun toxin), Xeomin (incobolutimun toxin), and Mybloc (rimabolutimun toxin). Botox, Dysport, and Xeomin are type A toxins while Myobloc is a type B toxin. This means the structure of the protein is slightly different. Overseas many others are also available. Dysport is the most commonly used neuromodulator other than Botox in the United States. The dosing for Dysport is different than that for Botox. Approximately 2.5 to 3 units of Dysport are required for every unit of Botox. For example, in the glabella 20 units of Botox is most commonly used. If Dysport were to be used in this area 50 to 60 units of Dysport would be required. The investment per unit of Dysport is approximately 2.5 to 3 times less than that of Botox. While the manufacturer states that the units of Xeomin are a one to one equivalent of Botox, many doctors find that a higher dose of Xeomin is required to produce the same effects as Botox. Each product has slight differences, but all of them work. Dysport, for example, is known to spread more than Botox. This makes it useful in places like the underarms where it can be used for excessive sweating. However, if it spreads near the eyes it can lead to side effects such as a droopy eyelid. Xeomin is also called a naked protein, because it does not contain the accessory proteins that are included with Botox or Dysport. It is thought to have a slightly faster onset (by one to two days faster) than Botox or Dysport. It is also thought to have a decreased likelihood for allergic reactions, although allergic reactions to Botox and Dysport are incredibly rare. In the United States Myobloc is not FDA cleared for cosmetic use and is primarily used for muscle pain in those with cervical dystonia. The majority of our patients find that they like the results of Botox the best. Additionally, Allergan, the maker of Botox, offers the Brilliant Distinctions Program. This is a rewards program where patients receive points from their Botox treatments which can be used toward discounts at subsequent treatments. Points are also received when patients purchase other treatments in the Allergan portfolio including Juvederm Ultra, Juvederm Ultra Plus, Voluma, Volbella, Vollure, and Kybella or products such as Latisse or Skin Medica products.In rare cases, some people are resistant to a certain neuromodulator such as Botox. In this case the treatment can be repeated using a different neuromodulator such as Dysport or Xeomin. Mybloc is a less common neuromodulator that can be used.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific recommendations. Good luck!
