Blog • Osman Dermatology

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How Effective is Botox for Under Eye Wrinkles?

Under eye wrinkles are a distressing concern to those who have them (and just about all of us eventually get them). One treatment option is Botox. The question is, how effective is Botox for under eye wrinkles?

Before answering this question, we have to understand what causes under eye wrinkles and how Botox works.

What Causes Under Eye Wrinkles

Under eye wrinkles are primarily caused by the combination of both skin looseness and dynamic tension on that skin. In the early stages, dynamic tension on the skin from muscles in the lower eye area plays a bigger role.

With age, skin becomes so weak and lax that the effect of muscle tension becomes less significant. This is because weak skin remains very wrinkled even at rest.

How Botox Works

Botox and its alternatives work by reducing the ability of muscles to contract. When injected near muscles of facial expression, Botox minimizes muscle contraction and the resulting overlying wrinkles.

An important and interesting concept is that many muscles of facial expression are flexed a little bit even when they are not being contracted. So, there is a certain amount of tension that causes overlying wrinkles even at rest.

Botox for Under Eye Wrinkles

Knowing that underlying muscle movement and tension contribute in part to under eye wrinkles, it makes sense that Botox would improve these lines.

And, it does.

How much Botox helps depends on how much muscle forces contribute to the lines. For most people, it’s age dependent. Younger patients see more improvement than older ones. In many patients, Botox is enough to provide very good improvement and may be all that is needed.

Additional Treatments for Under Eye Wrinkles

When Botox is not enough, and in those patients who have such loose skin that Botox won’t help, other treatments may be needed.

The most effective way to tighten lower eyelid skin is arguably laser resurfacing, especially with a CO2 laser. This laser zaps the lower eyelid skin creating a controlled injury. The skin heals firmer and smoother as it heals.

Laser resurfacing helps those with moderate laxity (looseness of the skin). For those with very loose skin, lower eyelid surgery may be the best option.

Chemical peels are another option to tighten skin but generally do not work as well as lasers.

Fillers can also improve lower eyelid wrinkles in two ways. Firstly, lower eyelid hollows can be filled with Restylane. By filling the tear trough deformity, the overlying skin is raised in 3-dimensions tightening it.

Image of Tear Trough

Also, Belotero can be carefully injected into the very fine lines of the lower eyelid skin and fill them.

Downsides of Botox for Under Eye Wrinkles

In terms of medical risks, one potential drawback of injecting Botox for under eye wrinkles is weakness of the lower eyelid margin. A weak lower eyelid margin leads to a slight droop in the edge of the lower eyelid. This is not ideal.

For this reason, only those with a strong lower eyelid should have Botox in this area, and Botox should not be used in those patients who depend on their muscle tension to keep their eyelid in place.

A simple test to evaluate the strength of the lower eyelid margin is one called the snap test. In this test, an injector will gently pinch and pull the lower eyelid away from the eyeball and watch it as it snaps back into place. If it does not snap back, you are probably not be a good candidate.

Cost

It doesn’t take many units of Botox to treat the muscle of the lower eyelid, generally about 2 per side. It is often best to treat the crows feet in addition to the lower eyelid muscle which requires 8-15 units per eye.

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What Areas of the Face Can Botox Be Injected?

Areas of the face that can be injected with Botox

Botox is still one of the most widely used and effective treatments for smoothing wrinkles. Unfortunately, it can’t treat all wrinkles, but you may be surprised to learn it can help much more than frown lines.

FDA Approved Areas for Botox

Botox first received approval from the Food and Drug Administration for treating frown lines. These are the “11’s” in between the eyebrows. More recently, it received approval to treat horizontal forehead lines and crow’s feet around the eyes too.

It’s no wonder Allergan, the maker of Botox, sought approval for these areas since these are the most commonly treated ones. Having FDA approval means that Botox was rigorously studied in these areas and showed that it works without a doubt.

You may be interested to know that FDA approval also allows the company to advertise treatment in those areas. Botox was used all the time to treat forehead lines before its FDA approval to treat them in October 2017, but the company could not run ads or promote this use to treating physicians before this time.

Other Facial Areas Where Botox is Used

As I mentioned, physicians injected Botox into forehead lines long before it was officially approved. Similarly, many other “off-label” areas of the face can be injected with great results.

Working from the top down, injecting Botox into the tail ends of the eyebrows lifts and arches them. While this is technically part of the crow’s feet area, it is a specialized approach.

When injected under the eyes, Botox opens and widens them.

A few drops on the sides of the nose softens bunny lines (the lines on the sides of your nose that appear when you scrunch), and when injected at the base of the nose, Botox actually raises the tip.

Botox around the mouth softens vertical lip lines and creates the lip flip.

We can even turn the corners of the mouth up with Botox using it to release downward muscle tension.

One of my favorite uses for Botox is to inject it in the chin to reduce the pebbled appearance that can develop with time.

Botox helps define the jawline in a procedure called the Nefertiti lift.

Botox is also great for reshaping the jawline in those who have a square face due to enlarged chewing muscles. Treatment changes the shape from square to oval. It may also help relieve symptoms of TMJ disorders.

Lastly, Botox can also lessen vertical bands and horizontal lines on the neck. While this is not technically the face, I think it counts ūüôā

How Can Botox Help So Many Areas?

To understand why Botox benefits so many areas, we have to briefly review how Botox works. Botox blocks muscle activation and reduces the intensity of contraction of small facial muscles.

All of the areas listed above benefit from Botox because the wrinkles in those areas are due to underlying muscle contraction. For example, the “11 lines” in the frown form when the three muscles in that area contract. Similarly, the crow’s feet appear when the eye muscles are squeezed.

Areas Where Botox Cannot Be Injected

With all these areas that benefit from Botox, you may wonder if there is anything Botox can’t do!

Unfortunately, Botox cannot improve the “parentheses” or “marionette lines” (the nasolabial folds and melomental folds). These are the wrinkles that go from the corner of the nose and the corner of the mouth.

Areas approved to treat with Juvederm XC

Sometimes, too, Botox is not enough to reduce a line all by itself. For example, if a frown line is really deep and etched into the skin, a filler like Juvederm may need to be used in combination with Botox.

Lastly, if placed incorrectly, Botox can lead to an odd appearance. If not injected carefully in treating the crow’s feet, for example, an eyebrow may arch quizzically or the smile may become asymmetrical. Smiles can also be affected when turning up the corners of the mouth.

For these reasons, start conservatively, especially if you’re getting these areas treated for the first time. You can always add more.

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Cheek fillers are an essential tool for rejuvenation and enhancement. However, how do you take of yourself after having them? In this post, I will answer common questions from patients regarding cheek filler aftercare and share my recommendations.

Bruising, swelling and cheek filler aftercare

Any time a filler is injected, bruising and swelling may ensue. However, the degree depends on the individual, the technique, and whether or not a blood vessel is pierced.

Some patients simply bruise and swell more easily than others. It’s just the way their body is built. Regardless of whether you bruise easily or not, you can consider taking arnica or bromelain both before and after treatment to reduce it. Of course, ice helps too.

In terms of technique, we can inject fillers using cannulas or needles. Cannulas are blunt tipped needles that glide under the skin. They are less traumatic and have a lower risk of bruising. Their downside is that they may not offer as much precision as needles.

Although cannulas are blunt and reduce the risk of piercing a vein, sometimes it is inevitable. There is a robust network of veins under the skin and sometimes one is pierced. For this reason, it may be best to avoid cheek fillers immediately before a major event where having a bruise would be unacceptable. Fortunately, bruises on the cheek are often deep and not always prominent.

Can I exercise after cheek fillers?

This may be the most common question I hear in regard to cheek filler aftercare. My answer is yes, as long as the exercise does not put pressure on the recently injected areas. Also, keep in mind that you will have recent needle punctures and to be extra careful not to contaminate these areas.

Can I drink alcohol after my fillers?

Ideally, you should abstain from drinking for 24 hours after getting a filler. Alcohol thins blood and increases the likelihood and extent of bruising. Further, alcohol may increase inflammation which would slow healing.

However, we live in the real world, and I am certain that many patients have had a drink later that evening without any significant problem.

My cheek filler aftercare tips

  1. Apply ice. Icing for 5-10 minutes helps reduce bruising and swelling. Remember that your cheeks may be numb after getting fillers, so you should move your ice pack regularly to avoid an “ice burn”.
  2. Sleep slightly elevated and on your back for the next 2 nights. I think sleeping with your head above your heart also reduces swelling, and staying on your back avoids pressure which could theoretically move the filler. I tell patients that if they wake up in the the middle of the night and find themselves on their side, not to worry excessively.
  3. Wait 2 weeks in order to fully assess your results. I think it takes about 2 weeks for swelling to fully resolve and final results to be apparent. It’s especially important not to worry about asymmetry before 2 weeks because this can result from differences in swelling and bruising between the sides. Overt bruising is not common; however, even a subtle bruise can be enough to create an asymmetry until it resolves.
  4. Call immediately if there is pain or a dusky discoloration to the skin. These could be signs that the filler is blocking blood flow to the skin and needs immediate attention.
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Can you exercise after Botox?

A very common question I get from patients is how soon they can exercise after Botox. They are understandably concerned that doing so will negatively impact their treatment. Unfortunately, there is no scientific study to answer this question directly, so we have to review our understanding of Botox to come to a conclusion.

Woman exercising after Botox

Why Would Exercise Affect Botox

The concern about exercising after Botox is that it will somehow affect Botox results. This concern probably stems from initial worries about the spread of Botox after injection

In the initial clinical trials, about 3% of patients got drooping of their eyelid. One guess as to why this occurred was that Botox diffused away from the initial injection site and affected surrounding muscles.

When injected into the frown muscles, it could have traveled to impact the small muscles that raise the upper eyelid.

To take it a step further, dermatologists have been concerned that the Botox alternatives Dysport and Xeomin may have different diffusion profiles. These could lead to a wider area of spread and a greater risk of unwanted effects.

To limit the risk of spread, injectors commonly recommend that patients avoid lying flat for 4 hours after injection. The worry is that a change in head position may influence the spread of Botox.

Since head position could change with exercise (especially yoga or pilates), if would make sense to avoid these activities. However, there is no evidence that lowering or changing head position after injection influences spread or increases that chance of eyelid droop.

For a shift in head position to really affect Botox distribution, Botox would have to flow easily under the skin similar to how melted wax would run down the side of a candle if it was tilted a little.

To my knowledge, no studies have looked specifically at this. However, we can get an idea of whether or not this could happen by looking at how Botox works.

How Botox Works

Botox is a purified toxin that gets absorbed by nerve endings upon injection. Once in the nerve endings, it blocks the release of chemicals that cause the associated muscles to contract. Thus, it stops wrinkling by blocking signals that trigger muscle contraction and folding of the overlying skin.

We know from scientific study that Botox moves into the nerve endings within 5-10 minutes of contact with them.

Given the facts that changing head position does not influence the spread of Botox and that Botox moves into nerve endings quickly after injection, it would seem unlikely that exercising after Botox would affect results.

Let’s see, though, what happens in the real world.

Botox After Exercise: Real World Observations

I don’t track closely track exactly what patients do after they have had a treatment and left my office, but I am certain that many of them exercise at some point that day. I am willing to bet that a good number have gone to the gym or for a run within a few hours of treatment. Some may even go right away.

If exercise really affected Botox results, I am sure my colleagues and I would have seen a suggestion by now. The truth is, I cannot recall anyone in my practice ever coming back with any concern after a Botox treatment with a history of having exercised shortly after injection.

Given my personal observations and the scientific facts we know about Botox, I think it is very unlikely that any form of exercise would significantly affect the results of a recent Botox treatment.

Right now, I still often recommend that patients avoid lying flat or avoid exercise with significant changes in head position such as yoga immediately after treatment. As we’ve learned, there’s no good evidence for these recommendations, but will I change what I say in regards to exercise after Botox? I probably will over time, but I don’t know yet. Most providers still recommend avoiding exercise after Botox for at least a little while after injection.

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One of the most youthful and attractive features of lips is the that little flip at the top edge of the upper lip. Some of us aren’t born with much of one, and it disappears with age in all of us. Now we can restore or enhance it using a technique called the Botox Lip Flip.

Botox Lip Flip enhances the flip of the top lip
The Botox Lip Flip enhances the flip at the top edge of the upper lip.

How is the Botox Lip Flip performed?

For the Botox Lip Flip, Botox is injected into the muscle that goes around the mouth (called the orbicularis oculi muscle). This is the muscle we use to purse our lips or whistle.

By relaxing it though, our lips roll up a little bit and enhance the natural flip.

How much Botox is used?

Generally, only 2-4 units are required. To put that into perspective, we usually use 12-24 to treat the frown.

What are the downsides?

Aside from the minimal risks of getting a bruise or an infection with any needle stick, the main risk associated with the Botox Lip Flip is overdoing it. Too much Botox weakens the muscle so much that it is difficult to pronounce the letter “p” or hold soup in your mouth.

How long does the Botox Lip Flip last?

Results wear off a little sooner than other areas. This is due to the relatively low number of units used and the dynamic nature of this area.

Most patients need to repeat treatment every 2 months. The more Botox used, the longer the results will last. Unfortunately, though, we can’t use very much Botox in this area.

Can it be combined with fillers?

The Botox Lip Flip and lip filler injections can definitely be combined at the same visit. This is a great way to fully enhance lips as they work in different ways and complement each other.

Who is a bad candidate for the Botox Lip Flip?

Most patients do well with this procedure. However, we are cautious in older patients with very thin lips. Sometimes, these patients do not have enough elasticity in their upper lip skin and injecting Botox can actually make the lip thinner by relaxing the muscle.

Can neurotoxins other than Botox be used?

Yes. The other currently available muscle relaxers including Dysport and Xeomin work just as well.

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Lifting corners of mouth with fillers

Lifting the corners of the mouth with fillers treats one of the signs of aging.

As we age, the corners of our mouth droop. This happens as our upper cheeks descend, and we lose support in our lower face.

Fortunately, fillers can restore the lost volume and rejuvenate this sign of aging.

How they work

Fillers add volume to the area injected. When lifting the corners of the mouth, we use fillers in two ways. The first is by directly injecting the drooping corners. This specifically lifts the corners.

The second way we use fillers to lift the corners of mouth is by adding volume to the cheeks. Replacing cheek volume elevates the corners of the mouth by pulling them up.

Filling each of these areas is a simple office based procedure. They can be treated independently of each other or together. I often recommend starting with directly filling the corners of the mouth and then adding volume to the cheeks if additional lift is needed.

Having said that, most people who need fillers to lift drooping mouth corners, often need volume replacement of the cheeks too.

Which filler is best?

The two main factors that affect the choice of filler are how much we need to lift the corners of the mouth and how deep the marionette lines are. The marionette lines are the folds that run from the corners of the mouth down toward the side of the chin.

The deeper the folds and the more lift that is needed, the more lifting capacity the filler must possess. Each filler has unique properties including lifting capacity. Fillers with the greatest lifting capacity includeRestylane Lyft and Voluma.

I tend to prefer original Restylane most of the time for its combination of lifting capacity and versatility. Some of the newer fillers also offer flexibility which can be valuable in this highly mobile area.

For the cheeks, either Restylane Lyft or Voluma are best for their strong lifting capacity.

Complimentary treatments

In addition to lifting the corners of the mouth with fillers, I often use Botox to release the downward pull on the corners.

Botox works by decreasing muscle tension and limiting the intensity of muscle movement. The corners of our mouths have muscles that lift them when smiling and opposing ones that pull them down when frowning.

Crippling the frown muscles with Botox, leaves the lifting muscles unopposed.

Risks and recovery

There are no unique risks associated with using fillers as described. With any filler treatment, there is a chance of bruising and temporary swelling. More serious but rare risks include infection and injecting into blood vessels.

Swelling is usually not significant, so there is minimal recovery.

Botox has one unique risk in this area. If overdone, it can affect the smile making it asymmetrical.

Additional resources:
Galderma
Allergan

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Tear Trough Filler: Which is best?

Tear troughTear troughs are the grooves some people have under their eyes. Unfortunately for most of us, they become more prominent as we age leading to under eye hollows. Filling them, though, is often an excellent way to reduce or eliminate them.

Because under eye skin is thin, there isn’t much room for error, and getting the right tear trough filler is key to success.

Tear Trough Filler Choices

Most injectors use hyaluronic acid fillers. This category of fillers include Juvederm, Restylane, and others. While these dermal fillers share the same active ingredient, they differ from each other in their lifting capacity, water retention, and how they integrate with the skin.

Restylane and Belotero are my preferred fillers.

Out of the two, Restylane is the heavier product and lifts the skin more than Belotero. If the under eye needs lifting, I place Restylane deep and on top of the bone in order to push up the overlying skin. One of the limitations of Restylane is that it cannot be placed too superficially because it can create a blue discoloration.

Belotero is unique in that it integrates seamlessly into surrounding skin. It can be placed high in the skin without creating bumps or discoloration.

I use Belotero when there is more of a need to fill rather than lift. Often times, I use both Restylane and Belotero since many people need both lifting and filling.

Fillers to Avoid

Some fillers are flat out not suitable for the tear troughs. Sculptra is one. The risk of nodule formation is high with this product. I also avoid using Radiesse for the same reason.

I don’t use Juvederm as a tear trough filler either. Juvederm pulls water onto itself. This is great for plumping lips and folds, but creates an unnatural swollen look in the tear trough.

Risks

As I mentioned earlier, the skin under the eye is thin. This increases the risk of visible bumps if filler is not injected skillfully.

Also, the under eye area is rich in blood supply, so the risk of bruising is higher than normal. Using cannulas reduces this risk.

Cannulas vs. Needles

Cannulas are blunt tipped needles. They are inserted through the skin via a small needle poke opening and slid under the skin to inject the filler. Surprisingly, the process is actually quite painless.

The main advantages of using cannulas are the decreased risk of bruising and increased level of comfort.

Needles are more precise, and sometimes I choose to use a needle, so I can more precisely place the filler.

Recovery and Results

As with most fillers, swelling may appear and last for a few days. However, it is usually not dramatic, and if there is no bruising, very few people would notice anything unusual.

Under eye fillers last longer than when the same filler is used in other areas, often lasting up to a year.

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Restylane vs Juvederm

Both Restylane and Juvederm are hyaluronic acid based fillers, and choosing between them depends on several factors.

Firstly, let’s quickly review where we commonly use these fillers. Both fill nasolabial folds, marionette lines, and the corners of the mouth. In addition, they each plump under eye hollows, lip lines, and cheek and frown lines. Both can also fill temples and raise the brows.

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Juvederm Nasolabial Fold - Before

Before Juvederm to Nasolabial Fold

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Juvederm Nasolabial Fold - After

After Juvederm to Nasolabial Fold

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Differences in Manufacturing

Competing companies manufacture these fillers using different techniques. Restylane is made by manufacturing a large block of hyaluronic acid that is cut into small cubes in its final stages. Juvederm, on the other hand, is composed of strands of hyaluronic acid that are chemically bonded together for stability.

As a result, Juvederm tends to be more silky consistency than Restylane which often makes it a better choice for the lips where softness is ideal. Compared with Juvederm, Restylane provides more support making it a great choice for lifting the corners of the mouth.

Bruising and Swelling

Bruising is equally likely to occur with either product. Bruises happen when the needle accidentally pierces a blood vessel. There are techniques and steps to minimize bruising, but that is another topic.

Regarding swelling, Juvederm has a greater tendency to hold onto water than Restylane. As a result, Juvederm swells more when comparing Restylane vs Juvederm. Thus, Restylane is a much better choice for injecting under eye hollows since swelling in this area accentuates under eye bags.

How Long Each Lasts

To my knowledge, there is no well designed study directly comparing Restylane and Juvederm to determine which one lasts longer. The company that developed Restylane initially studied it for 6 months.  Whereas the company that discovered Juvederm, studied it for a full year, so they are able to claim a longer time frame.

A subsequent study showed that Restylane could also last a long time.  It found two treatments with Restylane done 4 months apart provided results lasting 18 months in the nasolabial folds.

Personally, I think the results from each are fairly similar. Juvederm may last a little longer after a single injection. However, I have seen several patients over the years who achieved very long lasting results with Restylane for their nasolabial folds.

Restylane vs Juvederm: How to Choose

When it comes down to it, there are multiple factors when deciding which to use: Restylane vs Juvederm

One factor is the area the product will be injected. As mentioned earlier, Restylane is a far better choice for under eye hollows, and Juvederm is often a better choice for lips. I also prefer Juvederm when I use certain techniques to fill temples.

I prefer Restylane for lifting the corners of the mouth, but often choose Juvederm if the marionette lines are relatively shallow. For lip lines, cheek lines, frown lines, and nasolabial folds, either is fine.

Another factor I consider is prior response to the filler. If a patient had a very good result with one of the products, I will tend to stick with that product for follow-up treatments.

Finally, some patients simply prefer one over the other. If a patient prefers Restylane vs Juvederm, for example, I am happy to use Restylane unless there is a compelling reason to use the other.

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Thermage jowls beforeThermage jowls afterRadio-frequency to tighten skin remains a common and popular approach. Many devices exist that treat the skin with radio-frequency. This article will answer the question of whether or not radio-frequency skin tightening is really worth it.

Skin tightening options

When it comes to tightening skin, there are surgical and non-surgical options. Within the non-surgical space, many devices utilize radio-frequency. However, other technologies exist that use other forms of energy including laser and infrared.

The commonality between all non-invasive skin tightening devices is the generation of heat in tissue. I will explain more later why heat is so important.

First, however, surgery deserves mention.

Surgery, in general, tightens skin better than any non-surgical treatment. Procedures such as face lifts, neck lifts, and tummy tucks literally pull skin tighter by cutting out excess tissue and stretching the remaining skin tighter.

Of course, surgery is more invasive than non-surgical skin tightening, so it is not an option for everyone. Some people want to avoid an over-tight look, others find it too invasive, and some are just not candidates for surgery.

Radio-frequency skin tightening

Of the non-surgical treatment devices that exist, many use radio-frequency.

Radio-frequency works by heating the skin. The available devices differ in how they deliver radio-frequency to the skin, but they all strive to deliver enough energy to the skin to heat it to a certain temperature.

Heat is the key.

It turns out that if you heat collagen to a very specific temperature, two things happen. Firstly, the existing collagen fibers tighten. Secondly, the collagen producing cells within the area are triggered to produce more collagen.

The dermis, which is the second layer of skin, is full of collagen.  Collagen also exists deeper in the fat layer within strands that weave between fat providing support for this layer.

Upon heating collagen, skin tightens because of immediate collagen fiber contraction and, also, from delayed new collagen formation.

Thermage and ThermiTight are two pioneering technologies that utilize radio-frequency to tighten skin.

Thermage

Thermage machineThermage was the first in the category of radio-frequency skin tightening. It works by delivering radio-frequency from the outside of the skin inward.

During treatment, a treatment tip is applied to the skin. When the trigger is fired, a calculated dose of radio-frequency is delivered. By using a sophisticated protocol, Thermage heats skin to a specific temperature and goes to a specific depth. This ultimately leads to collagen tightening and production.

There is no recovery after Thermage because the skin is not broken or damaged.

Further, Thermage is capable of treating many different areas including the face, neck, abdomen, and eyelids.

ThermiTight

ThermiTight delivers radiofrequency via a probe inserted below the skin’s surface, and is the first to do so. Placing a probe under the skin allows one to heat both the under-surface of the dermis as well as the deeper collagen fibers that exist between fat.

ThermiTight jawline

ThermiTight

Thus, ThermiTight may be more effective at tightening the deeper tissue layers as well as the dermis.

During treatment, both internal and external temperatures are monitored to ensure skin gets to the optimal temperature but is not over-heated.

Other skin tightening devices

There are many other devices that utilize radio-frequency to tighten skin and others that use other energy sources.

Unfortunately, very little data exists comparing one device to another.

Machines that do not use radio-frequency include Ulthera and various other devices that use light or infrared energy. Ulthera uses ultrasound energy. All of these devices use the same concept of generating heat to tighten collagen. What differs is the energy source they use to produce that heat.

Effectiveness

While the concept of tightening skin by heating it makes sense, how effective are these treatments?

Most devices have limited scientific data. Thermage is probably the most studied. Most clinical reports, and my own personal experience, find that the average patient sees a mild to modest improvement. One study that tried to quantify results recorded an approximately 20% improvement after one treatment with Thermage.

However, at the time of this study, it was common to only perform one treatment. Now, I often recommend a second treatment at 3 months.

Overall, I find that ThermiTight typically provides more improvement.

Hidden benefit

Whether results are minimal or modest, a major benefit of radio-frequency skin tightening is that treatment induces collagen. Even if not enough collagen is produced to tighten skin, healthy collagen is beneficial. At the very least, it may slow the signs of aging.

In other words, radio-frequency skin tightening treatments may be preventative.

Best candidates

Almost anyone who wants tighter skin, or who is interested in delaying further skin looseness, could benefit from radio-frequency skin tightening. Having said that, older patients who have very loose skin probably won’t see enough improvement to make a non-surgical treatment worthwhile. A face lift is usually the only option for them.

For everyone else, though, radio-frequency skin tightening may be very good option. It is critical, though, to have appropriate expectations about your results.

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Dysport vs Botox: The ultimate comparison

Dysport vs BotoxAs far as wrinkle treatments go, there is no denying that Botox is a household name.  However, there are alternatives to Botox that are available.  Dysport is one of them.  However, what are the differences?  In this post, we will explore Dysport vs Botox.

What is Dysport?

Like Botox, Dysport is an injection that softens frown lines and dynamic wrinkles.  As a neurotoxin, it limits muscle movement in the treated area, so it decreases the appearance of wrinkles that occur when muscles contract.

Wrinkles appearing from muscle movements are those in the frown, crows feet, and forehead.

Dysport can also be used to raise the eyebrows, lift the corners of the mouth, decrease dimpling in the chin, reduce neck lines, and slim the face by decreasing the bulk of the jaw muscles.

How long does Dysport last?

Clinical studies show that Dysport lasts up to 4 months.  This is similar to Botox.  In my experience, some patients find that Dysport lasts longer than Botox; whereas, others note the opposite or no difference between the two injectables.

On average, there is no difference in how long wrinkles stay away with either Dysport or Botox.  However, every individual is different, so one may find that one of these products lasts longer than the other for them.

How fast does Dysport start working?

Both Dysport and Botox are absorbed by nerve endings near the treated areas soon after injection.  They work by blocking the release of transmitters from the nerves that signal muscles to contract.

The majority of people begin to see the effects of Dysport 2-3 days after injection.  This is a slightly faster onset of action than Botox which is typically about 3 days after injection.

For both Dysport and Botox, effects reach full result in 2-3 weeks.

In the case of time to onset in Dysport vs Botox, Dysport has the advantage.

Effectiveness and final appearance

Once they reach full effect, both Dysport and Botox are equally great at reducing wrinkles.

Treatment with Dysport does require more units than Botox to get the same result, but with appropriate dosing, each gives equally effective final results.

Potential risks

One unique feature about Dysport is that it has a feathering effect.  Meaning, the effects gradually taper off as you move away from the center of injection.

This can be both good and bad.

When injecting a muscle that we want to soften, Dysport could spread to affect a muscle that we don’t want to treat if the two are located near each other.

Dysport vs Botox lower crows feet areaAn area where this could occur is in the lower aspect of the crows feet.  The lower outer edge of the crows feet is relatively close to the upper end of one the muscles needed for smiling.

So if too much is injected in the lower portion of the crows feet, some Dysport could spread wide and impact the smile.  This would lead to a crooked smile.

Another area where the spread of medicine could be a problem is in the chin.

We aim to accomplish two things in treating the chin.  One is to reduce dimpling of the chin itself.  The other is to lift the corners of the mouth.

We have to be precise in treating both because any drift of medication could effect the muscles used to speak and smile.

Just to be clear, the spread of medicine to unwanted areas could also occur with Botox, but it may be a little more likely with Dysport because of its feathering effect.

Natural appearance

On the other hand, the main benefit of the feathering effect of Dysport is that it can create a more natural appearance.

By naturally feathering itself at it’s edges, there can be less of a demarcation between treated and untreated areas.

Two areas where this may be particularly helpful are the forehead and crows feet.

In some patients who get Botox in their forehead, there is an obvious and abrupt transition between treated and untreated areas which creates a “boxy” appearance.

When these patients lift their eyebrows to wrinkle their forehead, the center part of the forehead is smooth, but there area wrinkles around the edge.  The result is that the treated part of the forehead, which is in the center, looks like a rectangular box.

It is very obvious where treatment ended.

To create a smooth result with Botox, very small amounts of medicine have to be placed around the edges to blend them. ¬†Dysport naturally blends, so there is less of a chance to end up with a “boxy” result.

Similarly in the crows feet, it is critical to blend between the bottom of the crows feet and upper cheek.  Otherwise, there is an obvious transition especially visible when smiling.

Again, blending can be done using micro-drops of Botox, but Dysport often does it naturally.

Cost

To the consumer, the cost of both Dysport and Botox are usually about the same.  In our office, they are exactly the same.

You need more units of Dysport to get the same result as Botox, so the price per unit of Dysport is less.  Since you need more, however, the final price ends up being the same.

The companies that synthesize each of these products do occasionally run promotions which makes one product more attractive than the other from a cost perspective.

Dysport vs Botox: The final verdict

In the battle of Dysport vs Botox, there is no clear winner.  The choice of which product to use depends on many factors including the individual response of the patient, the familiarity of the injector with the nuances of the product being used, and the areas being treated.

A skilled injector can get excellent results with either product, and the only way to assess individual response is to try each one and compare for yourself.

One word of caution in doing a personal Dysport vs Botox challenge.

It may not be fair to draw a final conclusion after one treatment of each.  A little know fact is that the FDA allows a certain range of potency in the manufacture of each of these products.

Meaning, you could get one bottle of Botox that is super-potent and another that is on the weaker side.  If you ended up being treated with a super-potent bottle of Dysport and compared it to a treatment from a weaker bottle of Botox, you would probably think that Dysport was far superior.  However, it could have just been that the Botox was a weaker batch.

As injectors, we can’t tell which bottles are more or less potent. ¬†So, it’s safest to do several injections with each product¬†for a really good comparison.

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