Tag Archives: Botox and Dysport

Treatments with injectable fillers, such as Juvederm, Restylane, Radiesse, and Sculptra, not to mention others, can restore a youthful appearance to the lips, nasolabial folds, marionette lines, midface, jowls and lower eyelids, with minimal to no downtime. Many patients avoid these treatments, though, because they have heard horror stories from friends or colleagues about the pain associated with these treatments. Suffice it to say, this needn’t be the case – there are steps your plastic surgeon can take to make these treatments more comfortable.

Recently, BioForm Medical, Inc., makers of Radiesse, received approval from the Food and Drug Administration to mix the filler with lidocaine, an injectable local anesthetic, prior to injection into the skin. This approval was based on a large study of patients, in which 100% of patients reported feeling less pain when Radiesse was pre-mixed with lidocaine. Many plastic surgeons, including me, have begun to pre-mix lidocaine with all fillers, including Juvederm, Restylane, and Evolence, not to mention Radiesse, prior to injecting into patients. The results of treatment are still great, but patients are significantly more comfortable during treatment.

Others things your plastic surgeon can do to make your treatment with injectable fillers more comfortable include:
•    Using topical anesthetic gel for at least 30 minutes prior to commencing any injections.
•    Augmenting treatment with topical anesthetic gel with injections of local anesthetic into nerves above and below the lips.
•    Using small gauge needles and slow injection techniques

Combining all of these treatments can ensure that you’ll not only look great after your treatment with injectable fillers, but you’ll feel pretty great during the treatment too!

The world of dermal fillers has evolved significantly over the past two decades. Once a leading option for non-surgical facial rejuvenation, collagen fillers have largely been replaced by hyaluronic acid (HA) fillers as the go-to choice for patients and providers alike. But why have collagen fillers fallen out of favor, and what makes HA fillers the superior option today? Let’s explore the key differences, benefits, and limitations that have shaped this shift in aesthetic medicine.

What Are Collagen Fillers?

Collagen fillers were among the first widely used dermal fillers, offering a way to restore volume and smooth wrinkles. Derived from bovine (cow) or human sources, collagen fillers work by supplementing the skin’s natural collagen levels, which decrease with age.

Popular collagen-based fillers in the past included Evolence, Zyderm and Cosmoderm. These products provided temporary results, typically lasting around 2-4 months, before requiring re-treatment.

What Are Hyaluronic Acid Fillers?

Hyaluronic acid fillers, introduced in the early 2000s, have become the gold standard in non-surgical facial rejuvenation. Hyaluronic acid is a naturally occurring substance in the skin that helps retain moisture, provide hydration, and add volume. HA fillers like Juvederm, Restylane, and Belotero offer immediate, customizable results that can last from 6 months to 2 years, depending on the product and treatment area.

Why Collagen Fillers Lost Popularity

Collagen fillers were groundbreaking in their time, but several limitations led to their decline:

Shorter Duration:
- Collagen fillers typically last only 2-4 months, requiring frequent re-treatments.
- HA fillers offer significantly longer-lasting results, reducing patient downtime and expense over time.
Allergy Testing Requirement:
- Bovine-derived collagen fillers required allergy testing weeks before treatment, adding inconvenience for patients.
- HA fillers are biocompatible, meaning they rarely cause allergic reactions and do not require pre-treatment testing.
Less Versatility:
- Collagen fillers were primarily used for fine lines and wrinkles.
- HA fillers are much more versatile, effectively addressing wrinkles, folds, volume loss, and even contouring areas like the cheeks, jawline, and lips.
Advancements in Technology:
- HA fillers incorporate advanced technology, such as cross-linking, to improve their durability and effectiveness.
- Collagen fillers lacked these advancements, making them less competitive as newer options emerged.
Safety and Reversibility:
- HA fillers can be dissolved with an enzyme called hyaluronidase, offering a safety net if patients are unhappy with results or experience complications.
- Collagen fillers do not have this reversibility feature, making corrections more difficult.

Why Hyaluronic Acid Fillers Dominate Today

Hyaluronic acid fillers have set the standard for non-surgical facial rejuvenation thanks to their many advantages:

Natural-Looking Results:
HA fillers integrate seamlessly into the skin, providing a soft, natural appearance.
Hydration Benefits:
Unlike collagen fillers, HA fillers attract and retain water, enhancing skin hydration and improving texture.
Customizable Treatments:
HA fillers come in a variety of consistencies, allowing providers to customize treatments for different areas of the face, from delicate lines around the mouth to deeper folds and volume restoration.
Improved Patient Experience:
With no allergy testing required, minimal downtime, and long-lasting results, HA fillers offer a more convenient and patient-friendly experience.
Ongoing Innovation:
Manufacturers continue to improve HA fillers, introducing products with more natural integration, longer-lasting effects, and targeted uses (e.g., Juvederm Volux for jawline contouring).

Are There Any Benefits to Collagen Fillers?

While collagen fillers have become less popular, they still have a place in aesthetic medicine. For patients who are specifically looking for subtle, temporary enhancements, collagen fillers may be an option. Additionally, advancements in bioengineered collagen products, such as Sculptra (a poly-L-lactic acid injectable that stimulates collagen production), have renewed some interest in collagen-stimulating treatments rather than collagen as a filler material.

The Bottom Line

The rise of hyaluronic acid fillers over collagen fillers is a testament to the progress and innovation in aesthetic medicine. While collagen fillers paved the way for modern injectables, HA fillers offer superior longevity, versatility, safety, and results, making them the clear choice for patients and providers today.

If you’re considering injectable treatments to rejuvenate your appearance, schedule a consultation with a board-certified plastic surgeon or experienced injector. They can guide you through your options and recommend the best product to help you achieve your aesthetic goals.

Neurotoxins, including Botox, Dysport, and others, are some of the most popular and effective treatments for reducing wrinkles, fine lines, and other signs of aging. These injectables work by temporarily relaxing targeted muscles, giving the skin a smoother, more youthful appearance. Let’s explore the key neurotoxins used in the U.S., their FDA-approved indications, off-label uses, and the pros and cons of each.

How Neurotoxins Work

Neurotoxins are derived from botulinum toxin, a purified protein that blocks nerve signals to muscles. By inhibiting muscle contractions, neurotoxins effectively reduce dynamic wrinkles—lines that form due to repetitive facial movements.

FDA-Approved Neurotoxins in the U.S.

1. Botox Cosmetic (OnabotulinumtoxinA)

FDA-Approved Indications:
- Glabellar lines (frown lines between the brows)
- Crow’s feet (lines around the eyes)
- Forehead lines
- Axillary hyperhidrosis (excessive underarm sweating)
- Chronic migraines
- Overactive bladder
- Cervical dystonia (neck muscle spasms)
Off-Label Uses:
- Lip flip (upper lip enhancement)
- Gummy smile correction
- Jaw slimming (masseter muscle relaxation)
- Bunny lines (nose wrinkles)
- Neck bands (platysmal bands)
- Perioral lines (smoker’s lines)
Pros:
- Most studied and widely used neurotoxin.
- Predictable, reliable results.
- Versatile with a broad range of applications.
Cons:
- Slightly higher cost compared to competitors.
- Results can take 5-7 days to become noticeable.

2. Dysport (AbobotulinumtoxinA)

FDA-Approved Indications:
- Glabellar lines (frown lines)
- Cervical dystonia
Off-Label Uses:
- Similar to Botox, including crow’s feet, forehead lines, and masseter reduction.
Pros:
- Diffuses more readily, making it ideal for treating larger areas.
- Results may appear faster (within 2-3 days for some patients).
Cons:
- Diffusion can be a disadvantage in small, precise areas, potentially causing unintended muscle relaxation.
- Requires slightly more units than Botox for equivalent results.

3. Xeomin (IncobotulinumtoxinA)

FDA-Approved Indications:
- Glabellar lines
- Cervical dystonia
- Blepharospasm (eyelid spasms)
Off-Label Uses:
- Crow’s feet, forehead lines, and masseter reduction.
Pros:
- Contains no additives, reducing the risk of developing resistance or immunity over time.
- Results are comparable to Botox.
Cons:
- Effects may take slightly longer to set in (5-7 days).
- Some providers find it less versatile than Botox or Dysport.

4. Jeuveau (PrabotulinumtoxinA-xvfs)

FDA-Approved Indications:
- Glabellar lines
Off-Label Uses:
- Crow’s feet, forehead lines, and other facial wrinkles.
Pros:
- Marketed as a “modern” alternative to Botox with similar efficacy.
- Competitive pricing compared to Botox.
Cons:
- Limited FDA-approved uses compared to other neurotoxins.
- Less long-term data compared to Botox and Dysport.

5. Daxxify (DaxxibotulinumtoxinA-lanm)

FDA-Approved Indications:
- Glabellar lines
Off-Label Uses:
- Similar to Botox but not as widely adopted yet.
Pros:
- Longer duration of results—lasting up to 6 months, which is twice as long as other neurotoxins for many patients.
- Ideal for patients seeking fewer treatments per year.
Cons:
- Limited availability and higher cost.
- Newer product with less widespread use and clinical data.

Comparing Neurotoxins: Choosing the Right Option

Neurotoxin	Onset	Duration	Best For	Price Point
Botox	5-7 days	3-4 months	Precision and versatility	$$
Dysport	2-3 days	3-4 months	Larger areas with faster onset	$$
Xeomin	5-7 days	3-4 months	Patients prone to resistance	$$
Jeuveau	5-7 days	3-4 months	Cost-conscious patients	$
Daxxify	5-7 days	4-6 months	Long-lasting results	$$$

Weighing the Pros and Cons of Neurotoxins

Pros:

Quick, Non-Surgical: Minimal downtime and immediate return to daily activities.
Customizable Results: Treatments are tailored to each patient’s needs.
Preventative Benefits: Early use can prevent deeper wrinkles over time.

Cons:

Temporary Results: Maintenance treatments are required every 3-6 months.
Potential Side Effects: Includes bruising, swelling, or asymmetry if improperly administered.
Cost: Ongoing treatments can add up over time.

Conclusion: The Right Neurotoxin for You

Each neurotoxin offers unique benefits, and the best choice depends on your specific goals, treatment area, and preferences. It’s essential to consult with an experienced provider to determine the ideal option for your needs.

If you’re ready to explore neurotoxin treatments, schedule a consultation with our office today to learn more about how Botox, Dysport, and other options can help you achieve your aesthetic goals!

Best Plastic Surgeon - Dr. Sam Jejurikar

Working Toward Painless Treatments with Injectable Fillers