Let’s start the discussion by speaking about Dysport and Botox. They are both botulinum toxin A and thus almost identical. I tend to use Botox for medical purposes such as for migraines or bruxism (teeth grinding). I have found Dysport to work very smoothly cosmetically. With respect to the Dysport, I give it a full 10-14 days until it exerts its maximal effect. It will likely start to kick in beforehand, but the peak starts at 10-14 days and lasts about 3 months in the average person based on their metabolism. I don’t cheapen it by purchasing black market, counterfeit product and do not over dilute it and water it down so I can treat more patients with the same vial. I leave it up to you, the patient, to decide when to come back in for your next treatment as you will notice when the movement and lines are becoming troublesome. Part of your treatment includes a review of anatomy so you know where and why I will be injecting. Patient education about Botox/Dysport, fillers and skin care are stressed in detail when I am your physician.
Initially, I thought Botox and Dysport would only provide temporary relief and that the patients would have to start from square one. That’s what all physicians thought. However, we are noticing that with regular use 3-4 times a year, the lines begin to permanently reverse in some cases. The wrinkles and lines certainly do not progress as rapidly than if you did not use it. Basically, what happens is you learn not to make those harder expressions which cause the lines to become etched. As a result, the lines start to soften and sometimes even seem to fill in again. To test this, I received Dysport every 3 months for a year. A month after I was due for my next treatment, I had movement but could barely see the lines! Interestingly, studies were performed on identical twins where one twin received the Botox/Dysport, and the other did not. By the time they were in their fifties, the siblings using the Botox in their thirties and forties looked noticeably younger.
Xeomin is another form of botulinum toxin that I am investigating. One of the benefits is that it is thought that because an animal protein in the form of albumin is used to make Dysport and Botox, some people may become resistant. Xeomin is not made with albumin and thus it is hoped that Xeomin will work on people who develop resistance.
There is a new (as of October 2022), long-acting botulinum toxin called Daxxify which apparently lasts six months as opposed to the 3 months for Dysport and Botox. It has been FDA-approved and will likely be released in 2023. Whenever a new medication or procedure is released, I always wait to make sure they “work out the kinks” and that it is safe and either as effective or more effective than what I typically use. I would also be wary of having such a long-acting toxin in the event there is an unwanted effect. I will update this segment with time.
Thus, that is what my practice is all about… maintenance and prevention. We all must age, but doing conservative interventions regularly prevents the cascade of effects that lead to less than graceful aging, and/or an unnatural appearance. The goal is to look youthful and refreshed, but never overdone.
With respect to the filler, it is natural to feel concerned, so I will just suggest doing it when you feel comfortable. I have created a method called the Vertical Volume Lift Technique which treats the cause of volume loss instead of the effect. By doing so, it minimizes pain and bruising, and the downstream effects often correct automatically. Swelling is normal as although I am probably the gentlest injector you will meet, your body still understands that you had a small needle break the skin barrier and this triggers the immune system to send fluid there as a protective response. Ice, ibuprofen and Arnica Montana sublingual pellets and cream/gel (this is a homeopathic remedy), all minimize this. Also, being conservative also helps. You can always add more if you need to, but I encourage you not to go too aggressive at first. So, when I see you again, I will reevaluate if you need only one syringe or more. If we can get away with one syringe, then great. The important thing is we should never add too much. It is a fine balance, as if we spread the filler too thin, you will not get the longevity out of it and if you add too much, it will look unnatural. This is where the art of cosmetic work enters the picture, and you want your injector to be an experienced artist. As soon as I do the first injection, I will see how your body reacts and I will know how much you require to create a youthful and refreshed, but natural appearance.
