Botox & Dysport are neuromodulators used as muscle relaxants that indirectly alleviate or improve the appearance of animation wrinkles
One of the disadvantages or Botox & Dysport may that the effect is not permanent (advantages if your brow drooped after the injection) with the effect lasting 3-4 months.
The most important issues to achieve the Best Cosmetic Outcomes with Botox & Dysport, in my opinion, is the following:
- you and your provider agree to the anatomical sites for injection to optimize your beauty
- you and your injector use both your history of the amount of units injected relating to the response your body produced (to wrinkles) as well as any adverse effects (droopy brow or asymmetry).
- once the anatomical sites (forehead, crows feet, glabellar area, nose- Bunnie lines) and the amount (units) are determined, the injection technique can provide an excellent cosmetic outcome or a unwanted effect. Truly observing the shape, position and symmetry of your brows is essential to creating the optimal aesthetic result.
If one has the entire brow lower than the optimal position, a filler (I prefer the permanent Bellafill) placed immediately at the superior aspects the brow hair lifts the brow. If this is not successful, a brow surgical procedure is indicated for the desired lifting appearance.
If only the tail of the brow or the peek of the brow needs more lifting, then this often can be achieved with Botox & Dysport. Unfortunately, the result will be temporary lasting 3-4 months.
Some of the Techniques Used to Improve the Longevity of Botox & Dysport:
- Optimal units of the muscle relaxant is essential. When the animation wrinkle is deeper or the muscle hypertrophied (larger), then more Botox & Dysport is needed to achieve the desired aesthetic softening of the wrinkle. However, one must avoid over-injection of the forehead, which can result in brow drooping.
- If over time, the response of one neruomodulator is lessen in effect regarding the duration, then changing to a different muscle relaxant is indicated (Botox to Dysport for instance). The minor difference in the chemical structure makes a difference in the bodies ability to recognize the foreign body and metabolize the protein more rapidly.
- For those patients that the above two methods are unsuccessful or the duration of muscle relaxant effect is so short (4-8 weeks), then one should consider adding Zytaze. A clinical study from University of Texas Southwestern revealed that combining ZINC with an enzyme PHYTASE known as ZYTAZE taken each day for 5-10 days prior to the injection of the neuromodulator will extend the cosmetic effect duration from 2 to 6 weeks longer (30% longer). One can also take zinc supplement alone and may observe an extended effect, although the clinical studies used Zytaze. However, the Zytaze effect was noted in the patients who’s duration of effect was less than the typical response.
- Adding lidocaine with epinephrine and bicarbonate (as a buffer) to the sterile saline increased the duration of effect of both Botox & Dysport. I recently completed a three year clinical study showing that Botox longevity improved by ten days while Dysport longevity improved by a mean of 13 days. This scientific study was presented at the annual meeting o the American Academy of Cosmetic Surgery and at the Aesthetic Show. The hypothesis is that during the initial injection, the epinephrine constricts the blood vessels in the target facial muscles. This vasoconstriction isolates the muscle relaxant longer at the synaptic cleft (where the nerve stimulates the muscle fibers). The more neuromodulator is present, the more binds to the cleft, and the more profound effect or longer duration of effect. I did not observe a more profound effect, however, when the injection completely alleviates a wrinkle, it is impossible to document more muscle relaxation.
Neuromodulators (Botox & Dysport) are the most common cosmetic procedures performed in the United States. Facial volume replacement with dermal fillers are second. The procedure is simple, reproducible, low risk, with excellent alleviation of animation wrinkles with few alternatives.
Keep looking your best.