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Dr. Marwan Khalifeh: The Dysport is actually very similar to Botox but it's made by the manufacturers that create Restylane, where Botox is made by Allergan, the people that make Juvederm. Dysport was in Europe for a long time under the name Reloxin and it came to the US by a year to a year and a half ago and it's a nice little alternative to Botox, very similar, slight little differences. Some people noticed that it works a little bit quicker. So for example if you want to get Botox but it's a Tuesday and you've got a party on Thursday and you wanted to start showing some effects, you may want to try Dysport because it kicks in a little bit faster. They both can take up to two weeks to work; however, Dysport may start working even with a day or two. As far as longevity, it depends on the dose. They both last somewhere between three or four or five months. The higher dose they use is a little bit longer longevity you get out of it.
If you skip out on the dose, it will wear out quicker but really it doesn't last more than four months or so although some people claimed that it will last up to five months. Most of the time that's because you've forgotten how to make the movement and it takes about a month or so for those muscle membranes to come back again. Finally some people say that Dysport hurts less. At the end of the day, the pain is patient dependent. Each patient is different. The same level of pain that hurt to somebody barely hurts anybody else and injection technique is important. Size of the needle is important and the location that you're injected. So today we're going to do a little bit of Dysport. If we actually look at our volunteer patient today, we can take a look at where she smiles on her nose.
Give me a big, big smile, bigger, bigger smile and let me have you kind of do your typical frowning. See what happens. As she frowns, she gets these bunny lines and they're actually kind of wrinkle where right now, she's nice and young and the skin is elastic and it's not an issue. But if she keeps smiling with these bunny lines, what's going to happen about five or ten years, these lines will form permanently and the fact that she has little bit darker skin tones prohibits us from doing aggressive lasers or chemical peels or dermabrasion. So the best answer is to prevent these lines from forming. We're also going to do the crow's feet and the central forehead a little bit as well. So we've got Dysport. It comes in a smaller-looking bottle, but the reconstitution again depends on how much saline you put in just like Botox. It comes as a pattern and you add saline to it to mix it.
You draw it up depending on how many units you like to get out of it. Typically it comes in a 300 unit vial. I like to add 2 cc of saline to it and then it gives me a 3 to 1 relationship to Botox. So for example, if I was going to do 20 units of Botox, I would do 60 units of Dysport. So my typical dose for the glabella is 20 units of Botox and for Dysport, it's about 60 units of Dysport and the thing about Dysport is that travels a little bit more so you want to be careful where you inject it. So we're going to get started. I'm going to have you close your eyes. I've already prepped her face with alcohol. We're going to start from the nose and work outwards. Ready?
Female Voice: Mm-hmm.
Dr. Marwan Khalifeh: Okay. Couple of little injections, very tiny, very tiny doses. The nose is very sensitive. This will give her a really nice result when it kicks in. So this should not bruise. She did really well there. Now I like to go and actually take care of the crow's feet and lower lids for her. The injection is right under the skin. You can see the bleb forming. You do not want to be deep. If you're deep, you'll get into the muscle and if you'll get into the muscle, you get the bruising and bleeding. It's very gently right under the skin and you want to see the bleb forming. These blebs go away in about 15 to 20 minutes. Now typically most people do these three injections. I do an extra one underneath the eyelids because what happens is if we just do the crow's feet and not do the eyelids, this area smoothes out and then when you smile, the lower eyelid lines actually stand up more.
So I'm going to have you hold this for me while I go to the other side. So switch hands, perfect. Right. So we're going to repeat again. Same thing. I'm going to go right under the skin to barely penetrate. You see the bleb form. I pull the eyebrow up because you want to go underneath the eyebrow but outside of the orbital rim. Doing okay?
Female Voice: Mm-hmm.
….
If you skip out on the dose, it will wear out quicker but really it doesn't last more than four months or so although some people claimed that it will last up to five months. Most of the time that's because you've forgotten how to make the movement and it takes about a month or so for those muscle membranes to come back again. Finally some people say that Dysport hurts less. At the end of the day, the pain is patient dependent. Each patient is different. The same level of pain that hurt to somebody barely hurts anybody else and injection technique is important. Size of the needle is important and the location that you're injected. So today we're going to do a little bit of Dysport. If we actually look at our volunteer patient today, we can take a look at where she smiles on her nose.
Give me a big, big smile, bigger, bigger smile and let me have you kind of do your typical frowning. See what happens. As she frowns, she gets these bunny lines and they're actually kind of wrinkle where right now, she's nice and young and the skin is elastic and it's not an issue. But if she keeps smiling with these bunny lines, what's going to happen about five or ten years, these lines will form permanently and the fact that she has little bit darker skin tones prohibits us from doing aggressive lasers or chemical peels or dermabrasion. So the best answer is to prevent these lines from forming. We're also going to do the crow's feet and the central forehead a little bit as well. So we've got Dysport. It comes in a smaller-looking bottle, but the reconstitution again depends on how much saline you put in just like Botox. It comes as a pattern and you add saline to it to mix it.
You draw it up depending on how many units you like to get out of it. Typically it comes in a 300 unit vial. I like to add 2 cc of saline to it and then it gives me a 3 to 1 relationship to Botox. So for example, if I was going to do 20 units of Botox, I would do 60 units of Dysport. So my typical dose for the glabella is 20 units of Botox and for Dysport, it's about 60 units of Dysport and the thing about Dysport is that travels a little bit more so you want to be careful where you inject it. So we're going to get started. I'm going to have you close your eyes. I've already prepped her face with alcohol. We're going to start from the nose and work outwards. Ready?
Female Voice: Mm-hmm.
Dr. Marwan Khalifeh: Okay. Couple of little injections, very tiny, very tiny doses. The nose is very sensitive. This will give her a really nice result when it kicks in. So this should not bruise. She did really well there. Now I like to go and actually take care of the crow's feet and lower lids for her. The injection is right under the skin. You can see the bleb forming. You do not want to be deep. If you're deep, you'll get into the muscle and if you'll get into the muscle, you get the bruising and bleeding. It's very gently right under the skin and you want to see the bleb forming. These blebs go away in about 15 to 20 minutes. Now typically most people do these three injections. I do an extra one underneath the eyelids because what happens is if we just do the crow's feet and not do the eyelids, this area smoothes out and then when you smile, the lower eyelid lines actually stand up more.
So I'm going to have you hold this for me while I go to the other side. So switch hands, perfect. Right. So we're going to repeat again. Same thing. I'm going to go right under the skin to barely penetrate. You see the bleb form. I pull the eyebrow up because you want to go underneath the eyebrow but outside of the orbital rim. Doing okay?
Female Voice: Mm-hmm.
….
Dysport Injection To Frown Lines, Crows Feet, and Forehead
Three problem areas are addressed by using Dysport on a patient who shows the formation of crows feet and frown lines.
