The much heralded success of Botox in cosmetic enhancement applications has stimulated the development of other neurotoxins for cosmetic use. Two of the newest and most effective cosmetic neurotoxins are Dysport and Xeomin. Botox was initially FDA approved in 1989 to treat medical conditions such as blepharospasm and cervical dystonia – a painful contraction of neck muscles that causes the head and neck to twist and turn to one side. Eventually in the 1990’s, doctors began using it cosmetically for wrinkles and in 2002 it was finally FDA approved to treat frown lines. Today, it is one of the most popular non-surgical cosmetic procedures in the world. As the popularity of these neurotoxins grows, doctors in other specialties are finding new uses for them in their own practice. Most notably, Botox was also approved in 2010 to be used to treat chronic migraines and 2012 to treat bladder conditions.
Neurotoxins are naturally occurring toxins made by the clostridium botulinum bacteria. In the manufacturing of the neurotoxins, the protein is purified to avoid any unwanted effects. By using a very small amount it can be controlled; hence, the benefits – reduction of muscle contraction allowing for wrinkle reduction.
How Neurotoxins Work
Neurotoxins interfere with the ability of neurons – or nerve cells – to communicate with the muscles. In cosmetic applications, they decrease the ability of the muscles to contract the facial muscles. These relaxed muscles give the skin a smoother appearance and smooth out wrinkles. They are injected just under the skin when used to smooth out wrinkles in the frown, forehead, lines around the eyes (crow’s feet). For optimal results, they are combined with other cosmetic treatments like lasers and dermal fillers.
Differences Between Botox, Dysport, and Xeomin
The big three cosmetic neurotoxins – Botox, Dysport, and Xeomin – are much more similar than they are different. They can all be used for the same clinical applications. However, they are all different in size and weight giving them different characteristics. Based upon these minor differences,Dysport works faster (2-3 daysvs 3-5 days in Botox) and has a greater field of effect (spreads further than Botox). In some patients, Dysport may have a longer duration of effect (3-4 months vs 3 months in Botox).
Of the three, Xeomin is the newest just being FDA approved in 2011. The Xeomin product is the smallest protein since it does not have any accessory proteins. Unlike its predecessors, Xeomin does not need to be refrigerated. In the long term, this might make it easier to handle and at this point the price may be lower than Dysport and Botox. At this point, Xeomin appears to have the same duration as Botox.
Effective Use Of Neurotoxins
These neurotoxins have been approved by the Federal Drug Administration (FDA) for cosmetic use to reduce frown/glabellar lines caused by the corrugator muscles. However, they are also effective for the following off label uses as well:
- Lessening crow’s feet
- Softening forehead creases
- Elevating eyebrows
- Tightening drooping eyelids
- Enlarging the appearance of the eyes
- Softening lines around the upper lip
- Turning up drooping lip corners
- Improving gummy smiles
- Elevating nose tips
- Softening neck bands
In 2010, the FDA approved Botox for use as a treatment for chronic migraine headaches, but has so far only proved to be mildly effective. In 2011, Botox was approved to treat urinary incontinence for people with multiple sclerosis or spinal cord injuries who have overactive bladders. Other FDA approved uses include treatment for profuse underarm sweating, cervical dystonia, and blepharospasm (twitching eyelid).
Common Myths Debunked
Some people claim that cosmetic neurotoxins can cause paralysis. There have been no such reported cases in its cosmetic use since they are not used in amounts large enough to cause such a widespread effect. Another myth is that wrinkles can get worse if one stops using Botox. This is also not true. However, stopping their use can cause wrinkles to return, and they might seem worse than before when compared to the patient’s appearance during treatments.
With Botox and Xeomin, full effects can be seen in about a week. Dysport works faster, showing effects in only 2 to 3 days. Neurotoxins rarely interact with other drugs and there are few side effects. Some rare allergic reactions have been reported. Other side effects can include nausea, bruising around the injection site, eyelid swelling or drooping, upper respiratory infections, sinus inflammation, and headaches. There are patients who are not good candidates such as: any patient with a neuromuscular disorder such as Lou Gehrig’s disease or Grave’s disease, patients with active skin infections, cancer, or severe respiratory conditions.
With possible side effects, Botox, Dysport, and Xeomin should only be used in consultation with a physician. Call 408-740-5320 or email us to setup a consultation with Dr. John Tang.