Botox, Dysport, and Xeomin Injections for Wrinkles and Excessive Sweating

The advent of Botox®, Dysport®, and Xeomin® injections has revolutionized the approach to wrinkle treatment.  Botox®, Dysport®, and Xeomin®, injections are quick, relatively straightforward outpatient procedures, with minimal risk, that has now replaced many of the more traditional surgical approaches to facial aging.  A more youthful appearance can be achieved in a single 15-minute session.

Botox®, Dysport®, and Xeomin®, are trade names for purified proteins that are used in extremely small doses for certain cosmetic procedures and medical conditions. These products are particularly useful for eliminating unwanted lines of facial expression, such as the frown lines between the eyebrows that may persist through repeated, often subconscious action of a muscle called the “corrugator”. They are also superb treatments for horizontal forehead creases, crow’s feet around the eyes, lines on the upper lip caused by pursing the lips, and down turned corners of the mouth.

Additional uses of these medications include the non-surgical brow lift, where they are used to elevate the eyebrows, as well as treatment of neck wrinkles and muscular bands.  These are remarkable advances in the treatment of the aging face, as traditional approaches to eyebrow depression and neck aging have previously only been invasive surgical procedures.

Botox® and Dysport® are also highly effective in the treatment of hyperhidrosis, or excess sweating.  Many people suffer from overactive sweat glands of the hands, underarms, feet, and face.  These medications are great options when traditional topical or surgical approaches to this embarrassing and uncomfortable problem have not been very effective.  Now Botox® and Dysport® can be injected directly into the areas of sweating, producing a sweat-free environment for up to six months at a time.  This is truly a revolutionary approach to sweating.  It is also helpful in many patients with tension or migraine headaches, and can provide months of relief with one simple treatment session.

Frequently asked questions:

What Is Botox®, Dysport®, Xeomin® and How Do They Work?

Botox® (Onabotulinumtoxin A), Dysport® (abobotulinumtoxin A), Xeomin® (Incobotulinumtoxin A) are purified proteins derived from the bacteria Clostridium Botulinum.  They are produced by different bacterial strains of Clostridium botulinum type A and purified from culture in different ways, but their effect on muscle is similar.  Xeomin® is different than Botox® and Dysport ®as it does not have complexing proteins.  The clinical relevance of this is still unknown.

Wrinkles of facial expression (frown lines, crow’s feet, forehead lines, lip lines), are present in part because of the muscle repetitively contracting and pulling the skin into a crease.  When these FDA approved neuromodulators are injected into the intended muscle group, the muscle temporarily loses its ability to contract.  This in turn helps to smooth wrinkles.  The medications have the same clinical indications and are injected in the same general locations.  Botox® and Xeomin® have similar treatment units, however Dysport’s treatment units are measured differently, and therefore it is important for your provider to understand the dosing protocols of the three products.  The onset of wrinkle erasing effects of Dysport® are seen faster (on average 2-3 days) than those of Botox® and Xeomin® (on average 4-7 days).  In addition, there is data to suggest that the effects of Dysport® last longer than Botox. Overall, they are very similar products and all are reproducibly effective at improving wrinkles and smoothing the skin.

Where Do You Put the Botox®, Dysport®, or Xeomin®?

When you purposefully make a frown, you can feel the corrugator muscle just above the inner part of your eyebrows as a thickening.  Injecting Botox®, Dysport®, or Xeomin® into a facial muscle weakens the muscle and its associated contractions.  By inhibiting this movement, the muscle can no longer pull the skin creating the wrinkles.  Gradually these lines improve dramatically and often disappear completely.   Forehead lines are caused by contraction of the frontalis muscle, which can be seen when the eyebrows are raised. Squinting produces a gathering of the skin next to the eyes in the crow’s feet area, and is caused by a portion of the orbicularis oculi muscles. Neck wrinkles and bands are caused by protruding fibers of the platysma muscle.  Each of these muscles is readily visible to the skilled physician, and can be safely injected in a single session.

Are the Effects Lasting?  

Treatments with Botox®, Dysport®, Xeomin® take only a few minutes.  The results are noticeable in three to seven days (depending on which product you choose) and peak in two weeks. Gradually, over a period of three to five months, the effects of the medication will wear off and the muscles will again be functional. Repeat injections are done as muscle function returns.

Is There Any Danger of Botulism from Botox®, Dysport®, or Xeomin®?

No, botulinum toxin is not harmful at the appropriate doses. Botulism occurs when large amounts of the toxin are ingested into the system, usually from eating contaminated food. Doses of about 3,000 units are considered highly toxic. For the procedure you have elected, you will be receiving between 10-250 units (the number of units vary depending on which product you chose).

How Has Botox®, Dysport®, and Xeomin® Been Tested?

Botox® has been used since 1980 for treatment of two facial conditions, strabismus (lazy eye) and blepharospasm (uncontrolled eye blinking). It was first used for forehead wrinkles in 1989.   Botox® has been studied in the US for the improvement of glabellar lines in two clinical trials involving 405 subjects.  It was FDA approved in the US in 2002.  Since that time millions of patients have been treated successfully.

Dysport® was developed in the United Kingdom in the early 1990s to treat several neurological and ophthalmic conditions.  There have been six clinical trials of Dysport® conducted in the US that have shown that Dysport® is the same as Botox® in key respects.  These include safety, efficacy, tolerability, batch-to-batch consistency, and placement of injection points.  Dysport has been used for aesthetic purposes in Europe, Asia, and South America for over a decade with outstanding results.  It was FDA approved in the US in 2009.  There is data to suggest that Dysport® has a faster onset of action amongst the neuromodulators and results may last longer.

Xeomin® was similarly developed for treatment of certain neurological and ophthalmologic disorders. It has been studied in 2 US clinical trials which included 547 patients.  Xeomin was shown to significantly improve the appearance of glabellar lines. It too is extremely safe, effective, and well tolerated.

Are There Side Effects?

Side effects from Botox®, Dysport®, and Xeomin® are minimal when it is properly administered by a physician trained in its use. There will be a little discomfort as the solution is injected at the treatment site and there is a small chance of bruising. Some patients describe a mild headache for up to 24 hours post treatment.  This is easily relieved with common pain relievers.  There have been no known reports of permanent side effects with cosmetic uses of Botox®, Dysport®, or Xeomin®.  In very rare cases, there is a temporary, slight lowering of the eyebrow or eyelid, which typically resolves in a few weeks.

How Will I Look After My Treatment? 

Immediately after the treatment, there may be a mild amount of redness and swelling at the injection site, but this resolves in a few hours. Bruising is possible, but subsides within days. Some patients ask if they will have a mask-like appearance or lose facial expression. The answer is no.  You should not observe any significant negative alterations in facial motion or expressions.  It takes two weeks for the results of the treatment to optimize.

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Can I Have Other Cosmetic Procedures Done If I Have Had Botox®, Dysport®, or Xeomin®?

Botox®, Dysport®, and Xeomin® are useful for improving frown lines, crow’s feet, forehead wrinkles, neckbands, and ridges, drooping eyebrows, furrows of the upper lip, turned down corners of the mouth and certain other wrinkles by relaxing the muscles so that they appear less noticeable. It can be used successfully and synergistically along with other cosmetic procedures such as chemical peels, filler treatments with Restylane/Juvederm/Radiesse/Sculptra, and Laser therapy.

Botox® and Dysport® for Treatment of Hyperhidrosis (Excessive Sweating)

Excess sweating of the palms, face, and underarms can be an embarrassing problem for patients.  Social interactions can be adversely affected, and many patients are eager to have their sweating eliminated. Botox® and Dysport® injections are performed in a simple 15-30 minute outpatient session.  Multiple injections with a tiny needle are carefully placed into the areas of sweating.  Local application of ice and topical numbing cream reduces most discomfort associated with procedure.

The effects of the Botox® or Dysport® injections begins to be apparent three to five days after the treatment, and lasts on average six months.  Repeat injections are performed as the effect begins to dissipate.  Side effects are minimal to non-existent, and include minor bruising and occasional short-term very mild hand weakness (when the palms are treated).  Driving and normal activities are generally not affected, and the weakness resolves within two to four weeks.

Botox® and Dysport® injections, for axillary (underarm), palmar (hand), and facial sweating are amazingly effective procedures that have changed the lives of thousands of patients.