Botox New Jersey
What is Botox? What is Xeomin? What is Jeuveau? What is Dysport?
What is Botulinum toxin? What is chemodenervation? What is a Neuromodulator?
These are all generally the same question. Botox, Xeomin, Jeuveau, and Dysport are the various brand names and formulations of Botulinum Toxin, which is a type of neuromodulator.
Botulinum toxin itself is a chemical that when injected into a muscle, decreases it’s activity by blocking the nerve signal to that specific region. This paralyzes or weakens the muscle. Thus it is called a neuromodulator; a substance that modulates the nerve activity.
Chemodenervation is a fancy word that describes the process of using a chemical to denervate or remove nerve signal from the target muscle.
What is a “unit” of Botox, Xeomin, Jeuveau, or Dysport mean?
This is simply a practical way of measuring the amount of toxin so that doctors know how much they are injecting into a specific area. A “unit” of each product has a specific number of molecules of that given toxin, and so we know how much of an effect it will have when injected.
It is better understood if we use something like salt for an example. If 100 tiny little grains of salt are considered a unit, it would be much more practical to say that we added 5 units of salt, rather than 500 grains of salt.
What is the difference between Botox, Xeomin, Jeuveau, and Dysport?
Each of these brand name products is a slightly different formulation of botulinum toxin. In the end, they do they same thing. The minor differences in efficacy, duration, and onset are controversial and most doctors use them interchangeably. Some patients have a preference because they have seen better results with a given product. Although there are some people that are “nonresponders” to certain toxins, these are fairly rare. Dr. Z believes that such “nonresponsive results” can also be attributed to injection technique, how the toxin was diluted, how long the toxin has been diluted, and how the toxin was stored.
Botox paved the way as it was the first of these products to be FDA approved in 2002. Xeomin came later and is known for the fact that the toxin is not bound to a protein, thus theoretically lessening the chance of the body creating an antibody and tolerance. Jeuveau is the lastest of the products and has been working very well in the hands of Dr. Z thus far.
Dr. Z uses Botox, Xeomin, and Jeuveau. He does not have a favorite and is able to achieve very good and predictable results with all 3 products. In certain cases, he may be more inclined to use a specific product, but this is on a very individual basis.
How long does Botox last? How long does Xeomin last? How long does Jeuveau last?
Again, these are very similar questions as these products are very similar in their duration. The general answer is 3 – 4 months. Some other factors that can alter the duration are how and when the toxin was diluted, the concentration of the product used, how often the patient has been getting injections, and how active is the area treated.
When does Botox, Xeomin, and/or Jeuveau start to work?
There are some differences that have been observed in the onset of these products. The general range is 3-5 days, however Dr. Z has observed that in many cases Jeuveau starts to work on days 1-2. Regardless of how soon the initial results are seen, the full effect of the toxins is often appreciated after 5-7 days.
A very important phenomenon that Dr. Z has noticed is the rebalancing of facial muscles, especially in those that have never had botulinum toxin injections, or have not had them in a long time. Since the facial muscles are like pulleys or rubber bands, each pulling in their own direction, when we weaken certain muscles, the opposing muscles can over contract temporarily. They eventually find a new balance point, but this can take another 5-7 days. Therefore, Dr. Z recommends allowing at least 10 – 14 days before any special events such as weddings, galas, etc…
How long do the injections take and how are they performed? Can I go to work right after the injections?
The injections themselves take approximately 1-2 minutes. The whole process may take approximately 10 minutes as the skin is first cleansed of any makeup in the target areas. Then the muscles are evaluated as the patient is asked to make a few faces in order to exaggerate the muscles. A very small needle (even smaller than that used by diabetic patients to inject insulin daily) is used to inject at target locations.
Most people can, and do go back to work or about the rest of their day right after injections. The primary restriction is to avoid exercise, laying flat, being upside down, or vigorously rubbing the area for approximately 6 hours.
Many patients reapply their makeup immediately after injections. While Dr. Z is OK with this, he CAUTIONS to BE GENTLE! Vigorous application can push the toxin into unwanted areas!
The injection sites will often have a mild blush (redness) and sometimes mild protuberance for 10 – 60 minutes. Bruises and increased redness can occur at the sites but are fairly rare.
How are Botox, Xeomin, and Jeuveau used to improve facial appearance and aesthetics?
As mentioned, these products weaken selective muscles and these are tools that we use to achieve a desired appearance. These 3 products each have their own set of FDA approved uses as these were the areas evaluated for approval purposes. However, as they are tools, many doctors use them as such in “off-label” ways.
The most common areas of use are around the eyes (crow’s feet), the forehead, and in between the eyes (glabella). These are 3 areas prone to dynamic wrinkles. Dynamic wrinkles are those that result from the movement of facial muscles, which pull and fold the skin above them. By injecting these muscles, we release them, thus flattening and smoothing the overlying skin. These are also areas that have a lot of counter traction between the muscles. The muscles around the eyes (crow’s feet), as well as those between the eyes (glabella) not only wrinkle the skin, but they also pull DOWNWARD of the eyebrows. The forehead muscle (frontalis) pulls UPWARD on the eyebrows. Overactivity of the muscles pulling down (depressors) can lead to a heavy low brow appearance that obscures the appearance of the eyes. Thus, by weakening and releasing the depressor muscles, we can achieve a mild lifting effect, and a more “open eye” appearance. While we are also weakening the forehead muscle to get rid of forehead wrinkles, this is done only in selective areas, preventing the eyebrows from dropping. It all comes down to finding the right balance.
What are the other uses for Botox, Xeomin, and Jeuveau?
In additional to the common areas, there are several uses that are “off-label” for these products. We have depicted some of these in the diagram, BUT these must be used with CAUTION. It is very important to have an evaluation with a physician that understands facial anatomy, facial dynamics, facial aesthetics, and also your aesthetic goals.
If you are interested in any of the other uses, Dr. Z will be happy to explain them, as well as to advise if they are the right choice for you.
Just because something CAN BE DONE, does not mean it will improve facial aesthetics. One example is masseter reduction. By injecting the masseter muscle near the angles of the jaw, we can create a more appealing and softer lower face. This works great for females with a square face or wide face as it tapers it down into more of a heart shape. HOWEVER, it can worsen the appearance when the patient has a long or oval face, as it would exaggerate the length.