BOTOX®/DYSPORT/XEOMIN Injection

Facial lines and wrinkles are caused by several factors: aging, heredity, sun damage, stress, smoking and muscle action. The wrinkles seen when the face is at rest are called static wrinkles. The wrinkles caused by muscle action are called dynamic wrinkles. Muscles of facial expression cause the following dynamic wrinkles; frown lines, horizontal, forehead lines, and crow’s feet.

Injections of a very small amount of BOTOX® Cosmetic, a purified protein produced by the bacterium clostridium botulinum, into a specific muscle causes relaxation of that muscle. This results in improvement of the wrinkles that the muscle has formed. The effect is more dramatic during actual voluntary muscle contraction. However, some effect is seen even at rest especially in younger patients. DYSPORT and XEOMIN are very similar products made by different companies. All are FDA approved.

This response is usually seen two to three days after the injection, often sooner with DYSPORT. The muscle action (and wrinkles) will return in three to four months. At this point repeat treatment will relax the muscle and soften the wrinkles again.

Fresno surgeon Dr Peter Truong is Fellowship-trained in Ophthalmic Plastic Surgery and is an unequalled expert in Botox injection in the face. He has achieved the Botox Gold Level for Allergan.

Risks and Complications
Side effects include: bruising, drooping of eyelids, asymmetry (one side different than the other), dry eyes, pain during injections, drooping of eyebrow, double vision (very rare), inability to close eye completely (all these side effects are temporary).

Occasionally, the injection does not last as long as usual. The purified toxin is packaged with human albumin. There is a theoretical risk of infection from heretofore unknown or undiscovered agents.

Contraindications
Pregnant women and patients with significant neurological disease that affect muscles should not receive BOTOX® Cosmetic.

Limitations
BOTOX® Cosmetic/DYSPORT is not effective in treating wrinkles caused by excess skin or gravity induced tissue sagging. Elderly patients will not respond as well because with time dynamic wrinkles set in and will have a significant static component which does not respond to BOTOX® Cosmetic. Static wrinkles respond better to some type of skin resurfacing procedure such as chemical peel or CO2 laser resurfacing.

Alternatives
Dysport is available and is a good alternative to Botox. Dysport is manufactured by Medicis and is also a botulinum toxin type A like Botox. Its effects are very similar to Botox with the advantage that it is priced more competitively.

Xeomin is the newest botulinum neurotoxin and can be thought of as a purified form of Botox. Both Botox and Dysport come with foreign complexing proteins while Xeomin does not. Xeomin is safer in that it is less likely to elicit an immune response which would make the treatment not work in the future.