Dr. Horton here and for this installment of  Skin Care Tips for 2021, I want to discuss botulinum toxins- the wrinkle management injections. Although many people know the name Botox, as the name Kleenex, Botox is a brand name. There are currently 4 approved botulinum toxins available here in the United States- Jeuveau, Xeomin, Dysport, and Botox Cosmetic. Botox Cosmetic was approved by the FDA in 2002 with Dysport approved in 2009, Xeomin in 2018, and Jeuveau in 2019. All of these products work by blocking the nerve impulses that trigger muscle contraction. Although some of the botulinum toxins have FDA approval for use in the glabellar area (the frown lines between the eyes), all of them are used by aesthetic providers to relax other muscles of the face and neck. Botox brand has expanded indications for migraine, overactive bladder, excessive armpit sweating, and cervical dystonia after being proven effective in clinical trials.

So you may have heard someone say- ” Oh, those treatments didn’t work for me” or ” they didn’t last long for me”. It is really important to understand how these treatments are studied. Frown lines are actually graded I-IV and the clinical trial looks to see how many participants get 1 or 2 level improvement at particular time points compared to Botox Cosmetic. Patients who get these treatments sometimes expect full paralysis of the treated muscle for the duration of the treatment interval but in reality, the return of muscle contraction is gradual. Remember the desired outcome is not facial muscle freezing, it is the prevention of wrinkles. All these products have been found to yield comparable results to each other. If one could market themselves as superior to another product, that would be a great differentiator. The truth is they are all similar in efficacy when mixed and injected properly by a trained injector with a good understanding of facial anatomy who has educated you on the appropriate expectations of treatment.

A key point is when to start these treatments. Think of these treatments as preventative. You want to start treatment for lines before they go from dynamic ( visible with movement) to static ( present even at rest). For some people with very active muscles of facial expression, this could be in their 20’s. For others, they may be able to wait until the mid to late 30s but when treatment is started, the best results are seen when treatments are every 3-4 months on a regular basis. You can’t go to the gym once and look great you have to be consistent.

There seems to be an ever-increasing number of places to get treated with botulinum toxins- from Botox parties to dentist offices. My recommendation is to go to a well-educated provider with a good reputation for injection skills. Here at MD Age Management I personally perform all injection therapies. We have a membership club that provides you with botulinum treatments every 4 months at very competitive prices. Don’t be tempted to bargain shop or look for groupons for botulinum toxin therapy- you are paying for the skill and knowledge of the injector as well as the cost of the product.

When compared to all aesthetic procedures, botulinum treatments are a great value and a cornerstone of helping you “Manage How You Age”.

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