Botox/Dysport alternatives to high metabolizers.

Question

In my 30s i had botox done twice with 2 different doctors and lasted maybe weeks. I was working out alot then. Im 46 now workout 3-4/week and decided to try dysport on my 11s to see how long it lasts. Its been 6 weeks and it appears to be wearing off. I dont want to go for another touch up because this product is supposed to last 4-6 months. Thoughts? Suggestions? Alternatives? Love the stuff but need it to last! Thank you!

Jason Emer, MD · Answer

You may need more dosing or a touch up dose at 4 weeks to keep the longevity. Some people require that despite their age or previous treatments.  Xeomin can be tried if botox and dysport fail for you.  Best, Dr. Emer.

Kenneth D. Steinsapir, MD · Answer

Botulinum toxin does not get "metabolized."  Generally there is a misunderstanding of what to expect from these treatments.  There are some differences among these products but mostly it is just a question of dose.  First, these treatments do not really last 6 months.  They really last 3 to 4 months.  There is a bit of muscle retraining. This can lead to the very pleasant situation of the service appearing to last longer than this time frame.  The reality is that it takes about 24 hours to see a treatment effect. The service is maximal at about 2-3 weeks.  It stays about the same for the next 6 weeks but the truth is that it is gradually wearing off.  Some individuals do not always get the treatment that they need and for others, treatment no longer has the impact it once had.  Sometimes people go to cut rate providers and get less botulinum toxin than they paid for.  Yes, that is not honest and you see it in the treatment effect.  Before you sign off on this highly valuable service, do your homework and find the best injector in your area.  You will likely pay more for that persons service and you may not be willing to pay a premium in the future but this will help you understand what is going on.

Manjula Jegasothy, MD · Answer

Expect any of the neuromodulators, Botox Cosmetic®/Dysport®/Xeomin® to last an average of 3 months, not 4-6 months. Try the more recently FDA approved neuromodulator Xeomin® and see if it lasts longer. For the overall best result with the best longevity, please consult a board certified aesthetic dermatologist for a consultation.

David P. Mueller, DDS · Answer

There are many myths and misconceptions spread about botulinum toxin. Some of these are via the Internet, and some are by under educated injectors who take a weekend course.  First of all, there is no such phenomenon as "fast metabolizers." Once the botulinum molecule attaches to the endplate, it is metabolized within 10 hours. At 24 hours, 60% of it is already excreted in the urine. Onset of action is 2 to 8 days. Everyone metabolizes the botulinum toxin at essentially the same rate.There are many factors associated with duration of action. The number of units per injection (and total dose), the dilution of the botulinum toxin, and operator experience are the 3 most common reasons for variations in results. I have nearly 20 years experience with botulinum toxin. I can tell you that the single greatest factor seems to be dilution concentration. While some surgeons reconstitute the Botox vial with anywhere from 2 to 8 mL, I dilute my vial with one mL of preservative-free saline. What this means is that the amount injected per injection site is more concentrated in a small area of the muscle, versus a large amount of fluid that leeches out of the muscle and into the soft tissues. Now, every injector is different in their dilution, their injection pattern, and the amount that they inject. People who routinely state that they are "fast metabolizers" and state that they are building up a "resistance" are, a majority of the time, "price shoppers." While some state that the non--protein bound botulinum toxins, i.e.,Xeomin, etc., are better because they do not lead to "resistance," this has yet to be scientifically proven. "Price shoppers" hop from office to office depending on who has the better price, who is offering a groupon, or who "charges by the area instead of per unit." If you are getting charged by the "area," you are either being overcharged or undertreated. I say this, because everybody has a different dosage and a different injection pattern, based on their anatomy. Charging by the area means that everybody is getting the same amount of botulinum toxin for the same area. Charging "per unit" means that you are getting exactly what you are paying for. "Price shoppers" never get the same treatment twice, because they are getting a different number of units, a different injection pattern, a different dilution, and a different experience with each new doctor that they go to. My advice is to stick with the doctor who gives you the best results, and pay per unit.... And do not keep switching injectors based on price. In the end, you will be wasting money. If you want to try a different botulinum toxin, try it for the sake of trying it. There is no scientific proof that protein-bound botulinum toxin leads to "resistance."  Thank you very much for the question.Dr. David Mueller, DDS, FABOMS

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  It appears as if you are being inadequately dosed or you may require a touchup at a month to extend out the longevity.  As well Zinc supplementation may increase the duration of your toxin, there were some small studies a number of years ago that showed this may be true but no one is exactly sure as most people have adequate levels of zinc in their body.  Lastly, you can try Xeomin since it is a pure toxin without complexing proteins so it is unlikely to be affected antibodies to botox/xeomin.  Regards, Dr. Matt Elias

Marcus A. Jimenez, MD, FACS · Answer

This is a problem that we see in our office many times a month. There are a small percentage of patients who have had botulinum toxin injections in the past who go on to form antibodies to the product. However, this is a very small percentage of the patients we see with poor longevity of effect. The biggest culprit is usually using a dose which is inadequate in the first place.  When properly dosed, botulinum toxin's effects last 3 1/2 - 4 months. During this time, the muscle gets smaller like and underutilized muscle would. If the next dose is given prior to the complete loss of effect, you get an even better response because you are treating a smaller more relaxed muscle. After 3 or 4 proper doses, many patients can start to decrease the amount they use and still maintain the same effect.  The key is using enough toxin and returning before the effect is completely lost. Like many things, proper maintenance results in the best overall result.

Botox/Dysport alternatives to high metabolizers.

Answers (6)

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