What Is It?

The creases between our eyes, around our eyes and across our forehead come from using certain facial muscles repetitively. Such creases make us look worried, unapproachable and older. The muscles from these creases are involuntary, so we cannot consciously relax them to make the creases disappear. As dermatologists have become better acquainted with products like botulinum toxin and dermal fillers, they have discovered that these treatments are ideal for combined use. Pre-treating with a muscle relaxing agent and following up with dermal fillers, the result is further enhanced without looking “overdone”.

Botulinum Toxin

Botox® Cosmetic, Dysport® and Xeomin® may also be used in conjunction with laser or light-based therapies for beautifully rejuvenated skin. We are fortunate to have a treatment, botulinum toxin, which can relax these busy muscles by inhibiting muscle activity. Botulinum toxin can also lift our eyebrows and make our eyes appear more open, resulting in a more relaxed, fresh and youthful appearance. Three FDA-cleared brands of botulinum toxin are available at the Skin Specialist Centre – Botox® Cosmetic, Dysport® and Xeomin®. These products have exactly the same ingredient (botulinum toxin) and differ only in the proteins that surround that ingredient. All are effective, although some seem to work better than others in different individuals. All botulinum toxin injections are performed by Dr McKerrow, who has years of experience to know how and where to place injections safely and for the best result.

Areas of treatment using muscle relaxing injections include:

  • Frown lines between the eyebrows

  • Forehead lines

  • Crows feet

  • Eye area

  • Bunny lines on the sides of the nose

  • A drooping nose

  • Gummy smile (excessive show of gum above the teeth on smiling)

  • Excessive squareness of the face in association with large muscles (masseter muscle) at the angle of the jaw

  • Upper lip wrinkles

  • Downturned mouth

  • Popply chin – softening the pebbled-like chin contractions

  • Poor jaw line definition

Non-cosmetic uses for Botulinum toxin:

Botulinum toxin procedures are quick, with no anaesthesia required. Injections are administered with an ultra-fine needle directly into the muscle being treated. Discomfort is minimal and brief. Once complete, there is usually no discomfort. You will be able to return directly to work or normal activity immediately. Most people are surprised for the first time to see just how quickly and comfortably botulinum toxin can be injected. If you have had botulinum toxin in the past at another practice and had any unexpected side-effects, please let us know so that Dr McKerrow can make the necessary adjustments to your dosage and/or injection placement.

The effects of botulinum toxin appear within a few days and generally last for four to six months. As with all medicines, muscle relaxing injections may cause some minor side-effects, but these are temporary.

Muscle relaxing injections are a prescription medicine that should only be administered by medical professionals who have received appropriate training and completely understand the facial anatomy of the muscles to be injected. At the Skin Specialist Centre we realise that most patients prefer a more natural look, rather than the frozen appearance of “Hollywood celebrities”. We will assess and treat you with the optimal dosage to create a fresh, natural, relaxed look.

To prevent bruising after treatment, do not take Aspirin-containing products or homeopathic treatments such as Omega 3 or flaxseed oil for two weeks before the procedure. The injected areas may look like a mosquito bite for 20 – 60 minutes following the injection and be swollen for a few hours. Little red areas may appear but they resolve in a few days. Bruising is uncommon, but if it occurs it may require 7 – 10 days to clear. In the meantime, the bruising can be camouflaged with make-up which may be applied immediately after treatment. You may speed up botulinum toxin absorption by making frowns, raising your eyebrows, smiling and squinting. Do this several times for a few hours after the injections. Try not to lay back or fall asleep during this time because the injected botulinum toxin may spread to nearby areas and cause unwanted relaxation of muscles. Feel free to resume your regular skincare immediately after treatment.

Botox® Cosmetic

Botox® Cosmetic (onabotulinumtoxin A) injections have been used for many years to treat a number of medical conditions, such as eye and neck muscle spasms. Botox® Cosmetic is commonly used as a minimally invasive, anti-ageing treatment to eliminate or reduce as a muscle relaxing injection all the areas described above. Botox is a purified protein made up of botulinum toxin. It is a safe, FDA-approved procedure for relaxing muscles, thereby slightly restricting the muscle movement that causes wrinkles and lines. Dysport® and Xeomin® are other types of injections that work in a similar way to Botox® Cosmetic. Find out more about Dysport® injections and Xeomin® injections.

Some lines, wrinkles or folds may respond better to what are called dermal fillers or injectables (Restylane®, Juvederm®), or to laser resurfacing devices which can reduce the appearance of some lines and wrinkles. Dr McKerrow can advise you as to the best procedure to achieve the results you want.

Botulinum toxin for jaw reduction

The masseter muscle is one of the more powerful muscles in the body and is wrapped around the jaw bone. The masseter’s role is to open and close the jaw in speech and eating. When this muscle enlarges, the shape of your face can change, sometimes quite dramatically. For women, this represents the issue of appearing somewhat masculine. Botulinum toxin injection into the masseter muscle can be successfully used to reduce the ability of the masseter muscle to exert heavy force and this reduced force allows the muscle to return to a normal size and shape. The treatment of botulinum toxin is simple, with results lasting four to eight months.

The normal action of the masseter muscle does not usually cause this type of muscle enlargement, although if you chew gum, eat a lot of nuts or chew on hard food, chewing alone may be the cause. However, the most frequent causes are teeth grinding and unconscious clenching of the jaw.

Anxiety and stress are common amongst many people and often it is not until one assesses the shape of their jaw and seeing it become more square that one realises that you are clenching or grinding. Your dentist can provide help with teeth grinding and once you are aware of the tenseness or clenching in your jaw, you can take steps to reduce the tension, or at least re-direct it.

If you are considering botulinum toxin for masseter treatment, it is essential that the procedure is undertaken by a dermatologist who has plenty of experience, as there are glands in this area that must be avoided. Also, the dilution of botulinum toxin for masseter treatment is not the same as standard botulinum toxin injections on the face.

Dysport®

Dysport® (abotulinumtoxin A) and is a muscle relaxant agent similar to Botox® Cosmetic. The desired effects are the same and Dysport® is used in the same way to relax frown and worry lines and smooth wrinkles. The difference is in dosing units. Dysport® unit numbers are higher, although this does not mean the product is less effective. It is simply the way the product is diluted and delivered. Depending on the individual, Dysport® and Botox® Cosmetic last for 3 – 6 months, requiring repeat treatments to maintain results. Clinically, however, the two offer some differences:

  • Time to effectiveness – Dysport® molecules are smaller, so the results appear faster, with an onset of 2 – 5 days, rather than 4 – 7 days for Botox® Cosmetic.

  • Longevity – Dsyport® can last longer than Botox® Cosmetic in some patients, decreasing the number of touch-up treatments required per year.

  • Botox® Cosmetic treats a more highly targeted area, as Dysport® diffuses through a wider area of muscle (forehead wrinkles). This can sometimes mean that a patient requires fewer Dysport® units versus Botox® Cosmetic units, but this varies from patient to patient.

The primary difference between Dysport® and Botox® Cosmetic is in their respective unit dilutions. An average conversion is 2.5 – 3 units of Dysport® to 1 unit of Botox® Cosmetic. Your treatment with Dysport® will use an equivalent amount of the neuroprotein. As with Botox® Cosmetic, individual requirements will vary, with men generally requiring more units for full effect than the units required by women.

For those who have developed antibodies to Botox® Cosmetic, which unfortunately makes it no longer effective or less effective, Dysport® is a welcome addition to the muscle relaxing injections.

Dysport® and Botox® Cosmetic are so closely matched in effect. There is no determination for one being better than the other. Sometimes, it will be a matter of choice and Dr McKerrow will suggest one or the other, dependent upon the area of use.

The effects of Dysport® last around 3 – 6 months, depending on the location of the injection, your muscle activity and your body’s individual response.

Xeomin®

Xeomin®, like Botox® Cosmetic and Dysport® is designed to treat brow wrinkles, crows feet, bunny lines and frown lines. The active ingredient (botulinum toxin) is exactly the same as in Botox® and Dysport®. If you have previously been injected with Botox® Cosmetic or Dysport® and found that your improvement is less than expected, did not last as long as it should or has decreased for a given dosage, you may respond better to Xeomin®. Our experience shows that patients who respond poorly to Botox® or Dysport®, often respond well to Xeomin®.

The difference in Xeomin® (incobotulinumtoxinA) is that it does not carry the proteins that are typical of the other products. The manufacturing process removes the proteins so that Xeomin® is referred to as the “naked” botulinum product. The potential advantage lies in the lessened likelihood of antibodies being formed to the protein which, for a very limited number of patients, can render the product ineffective (this is typically only seen in patients who have used botulinum toxin for an extended period of time).

Xeomin®, for some, begins taking effect within 2 – 3 days after injection and will generally remain effective for up to four months. Botox® Cosmetic is a little slower and Dysport® can sometimes begin acting the next day following injection.

What’s the next step?

If you already have an appointment booked at The Skin Specialist Centre, you can easily add an Botulinum Toxin treatment/consultation to your booking by calling our friendly team on (09) 524 5011. If you have never been to The Skin Specialist Centre, you can either give us a call on (09) 524 5011 or make an enquiry by clicking on the Enquire Now option below.

Botox and Dysport are Prescription Medicines containing 100 units of clostridium botulinum Type A toxin complex for injection. It is used for the treatment of severe frown lines of the face. It should be administered only by trained medical professionals. Arrange a consultation to discuss the benefits/risks of this procedure in appearance medicine. Cautions: people with defective neuromuscular transmission disorders, presence of infection at site of injection, glaucoma, pregnancy and lactation. Possible side effects include headaches, pain, burning or redness at injection site, local muscle weakness including drooping eyelids, lack of feeling and nausea. If you have side effects or concerns speak to a doctor. A charge applies. Note: Botox and Dysport treatment lasts about 4 months and after this time further courses of treatment could be necessary. Arrange a consultation to discuss your own situation.

1 Benedetto A. The Cosmetic Uses of Botulinum toxin type A. Int J Dermatol 1999, 38:6641.655