Monday, November 23, 2009

The "New Botox"

Today I am excited to welcome the first post by Michelle Boone, ARNP-BC. Michelle is a Nurse Practitioner, and one of the most experienced and skilled injectors of Botox, Dysport, Juvederm and Restylane in Central Florida. She is also widely recognized as an expert in the use of lasers in aesthetic surgery, and is often asked to speak at national meetings on the topic. We are very happy to have Michelle on the Aesthetic Enhancements Plastic Surgery team and hope you enjoy her contributions to the blog.


THE NEW “BOTOX” ?

You’ve probably heard about Dysport, the new botulinum toxin for use in reducing facial wrinkles, a la Botox… and you are trying to decide whether to try it.  The advertising says it is better and lasts longer, so maybe….

Both Botox and Dysport are made from fermented bacteria and both have the final result of reducing muscle movement- and so, both are very effective at reducing the movement that causes facial wrinkles.

Let’s start with some basic anatomy and see how both products work.

In order for a muscle to produce movement, a nerve must send a message from the brain that ultimately causes muscle stimulation and movement.  Botox and Dysport temporarily de-activate the nerve, preventing the movement that produces the wrinkle in question (hence the term neurotoxin). Over the ensuing months, the nerve slowly regenerates, and the muscle starts moving again. For most people, this process takes somewhere between 3-4months.

Chemo denervation with Botox or Dysport (chemical deactivation of the nerve) helps to soften facial wrinkles and sometimes eliminate them—if they are not too deep. If injections are repeated at routine intervals—before the muscle returns to full strength—then sometimes the person can begin to use smaller amts or have a little longer effect. But not all will see this benefit.  When either product is stopped, no matter how long it has been used, the muscle will return to normal function, and most often the wrinkle will return in short order. So both Botox and Dysport do their job very well, but to maintain the benefit, regular re-dosing is necessary.

Now let’s quickly talk about the bad stuff….for one, the possibility of eyelid drooping. Muscles don’t work by themselves. When you mess with one, another responds. That is why it so important to know who your injector is, and choose only the most experienced and skilled injector.  With seemingly every spa and medical practice offering these procedures, poor outcomes are occurring and even making the evening news. The bottom line is that experience, and the skill obtained through it matters more than the letters after the name, whether it is a nurse or a doctor.

So, back to the droop. This can happen because the injector does not understand why the precise placement of those injections matters so much and a muscle that wasn’t treated reacted to one that was. Or it can happen because of spreading.

Spreading may be a significant difference between Botox and the new product, Dysport.  Both products come to us in a powder form and have to be diluted with sterile saline. (sterile salt water)  This solution spreads a little with each injection.  This might be great, for example, in the forehead where the area is bigger. We may get to have fewer pokes and get good coverage, but--- here is where knowledge and experience come in---around the eyes and scowl lines of the brows, adjustments may need to be made in placing  those injections to prevent that ‘spread effect’ to muscles we don’t want treated.

Another difference between the two products, Botox and Dysport, is in the way they are made.  We speak in “units” when talking about how much you will need.  How strong and big the muscle to be treated is determines the amount or number of units you will need. These “units” are totally different in the two products. For example, you may need 15 units of Botox but 37 units of Dysport to obtain the same result in the same area.  No, you don’t have to pay more than double for the same result.  For most offices, the prices of both are based on a unit charge and the unit charge is usually comparable.  The biggest difference that can sometimes occur is the time it takes to stop that muscle from moving.  Botox can begin to work in 3days, but for many people it can be a week.  Dysport has been known to kick in within a day or two. So, if you have a big event and you didn’t think far enough ahead to get your Botox, Dysport may be a better choice.

So what are the real differences to you, the consumer?  Probably not much.  Because Dysport is new and the company is trying to launch it, there have been price reductions, making it less expensive to try. Does it work faster? Sometimes. Does it last longer? Not significantly. But it is a reasonable, safe, and effective alternative that costs a bit less than Botox.


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