Botox® Xoemin® Dysport®

Why have them?

Because they work!!! Regular botulinum injections is considered the best way to delay the ageing process by preventing and softening the appearance of fine lines and wrinkles. It can achieve an overall fresh rejuvenated look which helps improve ones self confidence and self worth.

How do they work?

Our unique facial expressions are caused by muscles in our face contracting, and over time this repetitive movement results in the development of wrinkles. Botulinum injections help to counter this by reducing the muscles ability to contract, thus suppressing movement and consequently reducing the appearance of fine lines and wrinkles.

What are they used to treat?

• Frowns

• Forehead lines

• Crow’s

• Excessive Sweating

What does treatment involve?

A thorough Consultation is first and foremost. This is an integral part of the treatment process that takes time and should not be underestimated or rushed. It is extremely important to ensure clients are well informed before consenting to any procedure and equally for the clinician to ascertain health wise if a client is appropriate for treatment or not. Treating a few days after the consultation is recommended as it gives the client time to think and weigh up whether or not treatment is for them.

Treatment itself requires a few injections of Botulinum toxin type A. The procedure is reasonably quick and simple, taking approximately 15 minutes but it does require administration by an experienced Registered Cosmetic Nurse or Doctor who are well versed in facial anatomy. Tiny needles are used to deposit product precisely into an isolated muscle at the right depth, position and dose. We isolate the muscle by making you pull funny exaggerated faces. This allows us to recognise the muscle, interpret how strong or weak it is and then work out a prescription accordingly. It can take up to 10 days for the full effect of the treatment to take place. This is why at two weeks it is encourage that a follow up appointment is booked in order to fully assess the treatment to ensure the prescription administered is perfect. Very infrequently one or two additional injections may be required at this time to fine tune any imperfections.

Does it hurt?

The injections can be uncomfortable, annoying and may sting for a few seconds but the discomfort is brief and resolves quickly. I liken it to having my eyebrows shaped - its completely annoying with elements of pain but fairly short lived. And like with a good eyebrow shape the results are very worth it!

Is there any down time?

Lunchtime appointments are the first to go because the downtime post treatment is minimal. Immediately after a treatment the injected area may appear slightly red with a few blebs or lumps, but this soon settles and by the time you put your jacket back on and head to the office no one would be any the wiser!

How often do I need it?

There will always be variations but I tend to recommend approximately three monthly treatments for the first year and four monthly treatments the following. After this time the muscle memory appears to have been altered (if you don’t use it you lose it) and sufficient atrophying (shrinking) of the muscle will have occurred rendering it weaker than before and therefore limiting its wrinkle creating capacity. I find committing to a schedule like this initially allows for greater flexibility going forward and treatment intervals can easily be tailored according to the clients preference. Some will continue to have a close treatment interval as they enjoy their appearance with minimal movement, others will extend their interval to just keep the ageing process at bay.

Are there any side effects?

Like with most prescription medication there are documented side effects. However my understanding is that it has been used in the cosmetic industry for over 25 years and there has been no serious or long term side effects reported. Potential side effects include burning, stinging, bruising, swelling or redness at the injection site but these are mild and temporary. Anecdotally areas can feel heavy post treatment due to the localised muscle weakness. An alteration in brow position can result depending on where product is placed - desirable at times, not so at others!! Clients with heavy eyelids are at increased risk of swelling and drooping in this area so extra care needs to be taken to minimise this effect. There have also been reports of headaches, nausea and flu-like symptoms post treatment. I can report developing a headache after my first treatment but I think it was due to anticipating it was going to be more uncomfortable than it was. Possibly an anxiety related headache which dissipated quickly with the help of paracetamol - I have had no issues since.

Can anyone have it?

NO it is not safe for everyone.

Treatment is absolutely contraindicated if you are pregnant or breastfeeding or have a neuromuscular disorder such as Multiple Sclerosis, Myasthenia Gravis, Eaton Lambert Syndrome, Amyotrophic Lateral Sclerosis, Muscular Dystrophy to name a few. If you have a sensitivity to human albumin or a history of anaphylaxis it is obviously not advised. A psychiatric condition which renders a clients understanding and consent as unreliable, would also be a reason not to treat.

There are several other reasons why treatment may not be right for you. Including other medical conditions not listed above that carry risk, various medications and pharmaceuticals need to be taken into account, age may be a factor and a straight up needle phobia could stop the best of us in our tracks. These variations are all addressed in the `Patient history form’ where completion is required prior to treatment and would be discussed in detail during the consultation process.

Can a treatment be combined with other products and procedures?

A combination of cosmetic products and/or procedures in addition to regular botulinum injections is often recommended.

The use of dermal filler helps to contour the face and helps replace volume loss due to the aging process.

Skin treatments including but not limited to Sunekos, Profhilo, Viscoderm, Exosomes, Mesotherapy, Microneedling, and Peels - help boost collagen, lighten pigmentation, firm and tighten loose skin, reduce the appearance of scaring and have pore reducing abilities.

Topical serums and skin care are like the icing on the cake, they further enhance the appearance of the skin by evening skin tones, plumping, hydrating, nourishing, and probably most importantly protecting it.

Collectively a combination of these treatments will facilitate a more youthful rejuvenated appearance overall. Timing tends to be the issue with combination treatments and it is important you let your Cosmetic Nurse or Doctor know if you have recently had a skin treatment of any kind. There is often a recommended downtime between treatments to ensure optimal results and to avoid adverse effects of one treatment interfering with another.

Are all Neuromodulators the same?

Botox®, Xeomin® and Dysport® all have the capacity to block the signals from the nerves to the muscles by blocking the neurotransmitters that stimulate muscles to contract. As a result, reducing the targeted muscles ability to contract, suppresses movement and consequently reduces the appearance of fine lines and wrinkles. They all basically produce the same result but they do have subtle clinical differences.

Botox® was the first neuromodulator to the market and has really become the household name for all botulinum toxin type A treatments. Even while the alternative products Xeomin® and Dysport® are lifting their profile and becoming more known to industry consumers, the procedure itself still gets referred to as Botox®. It has been tried and trusted for over 25 years and colloquially is the mainstay of cosmetic medicine making it incredibly competitive and dominant when it comes to market share. “You can’t underestimate the power of a brand” ( Allergan Chief Commercial Officer Bill Meury 8/4/2019). Botox® is also the most researched neuromodulator due to its longevity in the market which only reinforces its reliability as a product and has set the gold standard for those that follow.

Xeomin® is the newest neuromodulator on the block and is the “naked injectable,” meaning that it does not contain any additives. Botox® and Dysport® are encased within a protein structure, while Xeomin® lacks this protein covering. A benefit of a pure-form injectable is that theoretically the human body is less likely to become resistant to it. Because of its lack of additives, it also does not need to be refrigerated whereas neuromodulators with additives require refrigeration and cold chain management. In most cases, Xeomin can be offered if patients develop antibodies to Botox® or Dysport®.

Dysport® has been shown to `drift’ or diffuse more than Botox® or Xeomin® and has a feathering type effect - meaning, the effects gradually taper off as you move away from the center of injection. This can be both a good thing and a bad thing. The tapering off effect allows for a subtle transition from a treated area to a non treated area allowing for a nice natural result which is obviously a good thing. However because of its diffusion there is an increased chance of an accidental droopy eyelid or unintentional relaxation of a neighboring muscle. Dysport® is dosed and injected slightly differently than Botox® and Xeomin® - the volume is often less and the units are often more. Standard Dysport® frown treatment is 50 units with a volume of 0.25 ml whereas Botox® and Xeomin® the equivalent is 20 units with a volume of 0.5 ml - some would argue Dysport® is more comfortable with the smaller volumes injected.

I am not convinced any of these neuromodulators can claim a superior status. I believe your registered Cosmetic Nurse or Doctor will choose the product he or she considers most appropriate for you. Clinically, I believe all brands produce fantastic and comparable results. Xeomin® may have an additional benefit of less chance of treatment failure in the long term, however, treatment failure from Botulinum Toxin antibody production is not a common occurrence, and happens more with frequent treatments where large dosages are required – Personally, I have yet to encounter a case of treatment failure with any neuromodulator treatment.

What happens if I stop?

If you decide to stop having treatment with botulinum toxin injections you will find after several months full movement return and the treated area will return to its original state.

BOTOX is a prescription medicine containing 100 units of Clostridium Botulinum Type A toxin complex for injection. It is used for the treatment of severe frown lines and associated ‘crow’s feet’ around the eyes. It should be administered only by trained medical professionals. Talk to your specialists about the benefits/risks of this procedure in appearance medicine. Cautions: people with neuro-muscular transmission disorders, presence of infection at site of injection, pregnancy and lactation. Possible side effects include headaches, pain, burning sensation or redness at injection site, temporary local muscle weakness including eyelid droop, decreased sensation and nausea. If you have side effects or concerns, talk to your doctor. A charge applies. Allergan Pharmaceutical, Auckland.

Xeomin® is a Prescription Medicine containing 50, 100 LD50 Units of clostridium botulinum Type A toxin complex for injection. It is used for the treatment of frown lines on the forehead in adults. It should be administered only by trained medical professionals. Talk to your specialist about the benefits/risks of this procedure in appearance medicine. Xeomin treatment lasts about four months and further courses of treatment may be necessary. Cautions: Generalised disorders of muscle activity; Infection or inflammation at the proposed injection sites, pregnancy and lactation. Possible side effects: headache, pain, swelling or infection at injection site, local muscle weakness including drooping eye lids, lack of feeling & nausea. You will need to pay for this medicine. Discuss with your specialist if Xeomin is right for you. For more information or for a copy of CMI please contact the NZ distributor: NZMS Ltd: 2a Fisher Crescent, Mt Wellington, Auckland, Ph 09 259 4062.TAPS NA7621.

Dysport® is a prescription medicine containing Clostridium Botulinum Type A toxin complex for injection. It is used for the treatment of frown lines and excessive sweating. It should be administered only by trained medical professionals. Cautions: people with defective neuro-muscular transmission disorders, infection at site of injection, pregnancy and lactation. Possible side effects include headaches, pain, burning or redness at injection site, local muscle weakness including drooping eye lids, lack of feeling or nausea or compensatory sweating in other skin areas. Talk to your specialist about the benefits/risks of this procedure. A charge applies. Dysport® treatment lasts about four months and after this time further courses of treatment may be necessary. Speak to your specialist about your own situation.