​Botox and Xeomin Treatments

Botox, Xeomin and Dysport are trade names for a purified protein produced by the bacterium Clostridium Botulinum. There are 7 different toxins produced by the bacteria, and all three are made from toxin A. Botox and Xeomin are very similar, although Xeomin does not have protective proteins surrounding it, so in theory it is less likely to produce antibodies compared to Botox. Although Xeomin is the newest Botox alternative, I have used a significant amount of both of them, and they appear to be equal in strength and staying power. I use then interchangeably, and most of my patients have not noticed a difference or developed a preference for one over the other. Dysport, on the other hand, is a weaker toxin and requires more units to do the same job, and spreads more, so needs a different injection technique than Botox or Xeomin.

Botulinum toxins produce a temporary weakening of muscles by interfering with the release of the neurotransmitter acetylcholine. We can inject it into muscles of the face and neck to prevent their movement. If injected carefully into the proper muscles, wrinkles aren’t produced with movements (such as smiling). When done continuously over the long term, it is possible that wrinkles will never form. This smooths the skin lines, and over time, can even make wrinkles disappear. It is usually used to treat forehead wrinkles and crows feet, although other areas of the face and neck can also be successfully treated.

When a person smiles, creases are formed at the eyes (crow’s feet), and nose. Making an angry expression will also put creases at the bridge of the nose, and raising the eyebrows will give horizontal lines on the forehead. Over a span of many years, repeating these movements will cause the creases to become permanent, which we call wrinkles. If we weaken (or paralyze) the muscles that cause these lines-while leaving all the other surrounding muscles intact-we lose the creases while still keeping the ability to have an expressive face. That is the goal and challenge of botulinum toxin therapy.

Wrinkles present at rest will not respond, these are called static lines. Dynamic lines appear with muscular effort and vanish when muscles are at rest. These will be most likely to respond.

Safety

Botulinum toxins are extremely safe, as long as some basic precautions are used. In the past there have been less expensive versions of botulinum toxin available on the internet, but Botox, Xeomin and Dysport are the only ones approved by the FDA for cosmetic use in the US. It is carefully made by the manufacturers to be pure, free from contaminants, and of consistent dosage. Before being injected, make very sure you know what you are getting.

Adverse reactions to botulinum toxins are rare, and generally mild. A mild headache that may last a few days is sometimes seen. Possible reactions at the injection site include pain, bruising, bleeding, swelling and numbness. Even when injected properly, sometimes the botulinum toxins will weaken muscles we don’t want to be weakened. When that happens there can be a droopy eyelid or brow. Often, we can inject an opposing muscle to correct this.  Fortunately, since they gradually wear off in 3 months, even if we are unable to fix the issue it is only a temporary problem. Finally, it would take an enormous amount of Botulinum toxin to kill a person, which would be ridiculously expensive and not really worth considering as an adverse reaction.

Schedule

We can inject any muscle with Botox or Xeomin, but cosmetic botulinum toxin is used mostly in the face and neck. After injection you should avoid lying down for 4 hours. It will take up to 2 weeks for it to take effect, and I sometimes ask my patients to come in for a quick visit at that time (at least after the first injection) to see if they are happy with their treatment, and to do any touchups that may be necessary or desired. It does wear off, and needs to be repeated every 3-6 months. Wrinkles can only go away permanently if the injections are done regularly.