Daily Skin Fix

Holiday Sale: 20% Off Botox, Juvederm and Skin Care

Join Dr Elaine Cook and staff at Advanced Skin Treatment Center, 2609 Wolflin Village, Amarillo to celebrate the start of the Holiday Season with an Open House on Thursday, November 17 from 8am to 8pm in conjunction with the annual Wolflin Village celebration. This is a sale you won’t want to miss!

In addition to offering 20% off on all Dr. Elaine’s® Advanced Skin Treatment Skin Care, we have reserved the entire day for patients wanting Botox® and Juvederm® treatments at 20% off! It doesn’t get much better than that. Most people want to look their best around friends and relatives during the holidays especially for holiday photos. With this special, you can ‘Lose Ten Years in Ten Minutes’ and save 20%!

Relax the wrinkles between your eye brows, across your forehead and the crows feet outside the eye area with Botox. With Juvedermyou can plump up the ‘parenthesis’ wrinkles between your nose and the outside corners of your mouth, plump up your lips and fill in the areas below the outside edges of your mouth to give your face a more youthful look. Whether you’re a veteran to these procedures or want to try them for the first time, you should call today to schedule your appointment because we expect the slots to fill up quickly!

Botox and Juvederm first come, first serve, by appointment only. Call 806-358-1117  or email us at skincare@skintreatment.com today to schedule your appointment.

Now that Dysport has been released, and Xeomin has been approved by the FDA for medical usage, many people ask about the differences between them and which is the best. Short answer–they are all good products with some differences between them. Long answer (according to my nurses and my daughters I never give anything but the long answer)–see below.

So here is the final post about Botox and Dysport used for step #2 in a dermatologist’s anti-aging plan–Relax muscle action to reduce lines.

Q. How is Dysport different from Botox Cosmetic?

A. Both are carefully controlled pharmaceutical preparations of botulinum toxin used cosmetically for the treatment of muscle related lines on the face. The FDA has recently approved Dysport (abobotulinumtoxinA, Medicis), originally called Reloxin to join the established Botox (onabotulinumtoxinA; Allergan) for these treatments.

Dysport® diffuses over a larger surface area and it requires on average 3 times as many units as Botox® for equivalent effect but this will vary depending on the site injected. The onset of action is a few days quicker. It appears the length of effect will be similar. The technique, dosage and areas injected will differ.

Because of this the two are not interchangeable. Since Dysport affects a larger area, care must be taken not to inject at the same sites as Botox or there is a risk of affecting surrounding muscles. The dosage units are registered differently and it takes more units of Dysport to treat an area. Dysport  is a little cheaper for the physician to buy but usually those savings are not passed along to the patient. Therefore price per unit will be lower but the price to treat a specific area in an individual patient remains very similar to that of Botox.

Both Botox and Dysport  have a proven track record of years of safety and effectiveness. Each physician will usually have a preference for one or the other and stick with the one they prefer.

A red car is not a red truck, even though both are red and move.

Who should I see to get Botox or Dysport?

It is common to see walk-in Botox clinics, Botox parties, Botox injections on cruise ships as well as nurses, dentists and physicians who are not trained in one of the “core” aesthetic specialties of dermatology, plastic surgery and oculo-plastics injecting Botox and Dysport. Because it is a cash basis medical service not restricted to insurance based reimbursement the incentive by many medical providers to provide treatment is great. If it was an insurance reimbursed procedure, and reimbursed at the typically low rates that insurance companies pay for medically necessary treatments, there would be much less interest in providing it.

I think that Botox and Dysport should be injected by an experienced physician in one of the core aesthetic specialties. Of course I am an experienced physician in one of the core aesthetic specialties so I am biased in that direction. But it is more complicated than it looks, especially to achieve a natural, symmetric look in each individual patient. Even after treating many thousands of patients over the years, and doing it all day long, I still learn on every patient and treat each just a little differently based on their particular anatomy, muscle function, symmetry, condition of skin and degree of aging.

Even though I have wonderful nurses, I perform all of the Botox injections in our office. I do not consider it a nursing procedure.

Would you want your plumber doing your electrical work? Do you really want someone trained in kidney disease taking care of your face?

Why is there a difference in price quoted to me from one office to another?

Botox and Dysport are diluted in the physician’s office before treatment. Sometimes to encourage patients to try it or to win price shoppers, it is diluted more or a smaller dose is given. This decreases cost but often gives a less complete response and shorter duration of effect. Unfortunately since you are not the one diluting the medication you have to rely on the professionalism and honesty of your physician. Some unscrupulous practitioners  dilute Botox or Dysport more than they tell you they are and in reality you are receiving a lower dose than the unit dose for which you have paid. Although there is some legitimate variation one sign of this is a price that is much lower than the community norm. That’s why you need to be able to trust your physician.

Remember, it is priced by the unit not by the site treated.  The actual price by unit varies very little among physicians. There may be a slight differential for expertise, numbing and additional complimentary treatments. Ask how many units are used and compare price by the unit and the degree and duration of improvement to the cost.

Often in life, you get what you pay for.

Many of the questions I get about Botox and Dysport are related to safety concerns and possible side effects. It seems every couple of years something comes up that causes patients concern and I get more questions than usual.

Once again, this is what I tell my patients. If you are not my patient you should listen to what your doctor tells you.

Will I have any side effects?

• Very minor bruising is the most common side effect. Occasionally temporary eyelid droop, headache, nausea, and rarely temporary double vision occur.
• Usually the only side effect is that you will like it.

Is it safe?

• The FDA has recently changed safety labeling pertains to all of the botulinum neurotoxins (Botox, Dysport and Myobloc) in response to rare reports of distant spread after injection for medical — not aesthetic — purposes, resulting in heart problems, breathing/swallowing problems and allergic reactions. Most of these reports involved children who were being treated for spasticity. Since many occurred months after injection and many patients had other risk factors the relationship, if any, to the injection is unclear.  There have been no confirmed reports of distant spread after the aesthetic use of botulinum neurotoxin. The cosmetic use of Botox and Dysport is typically at doses that are significantly lower than the doses for therapeutic use of botulinum neurotoxin.
• Some patients have suffered serious health problems after receiving substances which were fraudulently represented as Botox.  Neither Botox nor Botox Cosmetic were in any way involved with these unfortunate events.
• Patients who are pregnant or breastfeeding, have ALS, Myasthenia Gravis or Lambert-Eaton syndrome, should not be treated.
• The majority of physicians who administer Botox and Dysport have treatments themselves. Believe me they wouldn’t do it if they weren’t comfortable with its safety record.

I heard that I can order Botox online, watch a YouTube video and learn how to inject myself and save money. Is that OK?

• Believe it or not there are online stores selling “do it yourself Botox and Dysport” or their “special” toxins. They sell it to anyone with a credit card. You are supposed to trust them to sell you authentic Botox or Dysport, or trust that their “special” brand is safe. They promote their stores on YouTube with videos on how to inject yourself. There is a group of “do it yourselfers” who vehemently insist on their right to inject themselves to save money, and to get better results than “those greedy doctors.”
• Counterfeit Botox is commonly produced in China, Russia, Chechnya and other countries. The counterfeits are part of a booming trade in fake pharmaceuticals ranging from cancer-treating medicines to knockoff Viagra. Terrorist groups are known to both sell counterfeit drugs to raise money and to be seeking botulinum toxin to weaponize. You do the math.
• Although I am quite comfortable with the safety, purity, and authenticity of the medication when purchased from Allergan or Medicis and injected by an experienced physician, I would never consider buying Botox or Dysport anywhere but directly from the manufacturer. There is not enough money in the world to pay me to inject myself with a “toxin” bought online. You shouldn’t either.
• If you think it is a good idea to buy one of the world’s most potent toxins online, with the significant risk of purchasing a counterfeit, adulterated, impure, and dangerously dosed “toxin” and try to inject it into yourself in your bathroom, you need more help than I can give you in this column.

Next: Botox vs. Dysport and cost of Botox and Dysport

I am asked many questions about Botox and Dysport, when we use then as step # 2 in our anti-aging plan–relax muscle action to reduce lines. This is what I tell my patients. If you are not my patient you should listen to what your doctor tells you.

The following information pertains to both Botox Cosmetic and Dysport but for readability I will just discuss in relation to Botox. Later I will give information on the differences between Botox and Dysport and pros and cons of each.

So here goes Ask Dr. Elaine:

What is Botox Cosmetic?

• Botox is a botulinum toxin medication for injection approved by the FDA to temporarily reduce muscle contractions causing facial expression lines. It reduces frown lines between the brows, crow’s feet, forehead lines, lipstick lines, lines at the bridge of the nose, some lines around the mouth, neck, under the eyes, and lifts the eyebrows in a “Botox Brow Lift”.
• After numbing with an anesthetic cream a few tiny injections are given. Results are seen within a week and last 4 months. There is no recovery time. Forehead lines are softened, the angry look is gone, eyebrows are raised opening the eyelids and crow’s feet are smoothed. Corners of the mouth are not as turned down. You look more rested and less stressed.
• So hyperbole aside—it’s a breakthrough in non-surgical anti-aging treatment.

Why do I read about it everywhere?

• Last year there were over 3 million Botox Cosmetic treatments in the U.S. making it the most popular physician-administered aesthetic procedure for the sixth year in a row.
• You read about it everywhere because it is everywhere.

Will I look frozen or weird?

• Although it can be overdone, when injected by an experienced physician you will have a naturally relaxed look. You can still frown or look surprised but without the wrinkles and creases.
• Frozen or weird–not from Botox.

If I stop treatment will I look worse?

• No, you will look the same as before treatment.
• Except you will be older.

When should I start Botox?

• Right before your lines with expression become lines when your face is at rest.
• Or when you look in the mirror and see your mother.

Is it vain to do Botox?

• I have seen a real change in attitude in the past several years. My patients used to worry that it was indulgent to do cosmetic procedures. Now they don’t
• They treat it like having hair or nails done, it’s just part of their routine.

Men don’t do Botox do they?

• Actually, many do.  A man with pronounced lines between his brows looks stressed and angry. Personally and professionally men want to look confident and relaxed.
• Even if they aren’t.

Am I too young to start Botox?

• How young are you? For cosmetic treatments, I do patients as young as 18, and actually have a reasonable number of patients who start that young.  They are people who are already starting to get etched lines, and can look at their parents and see the future. Early treatment prevents the lines from becoming etched.
• You can love and respect your parents, without having to become them.

Next–possible side effects and safety issues with Botox and Dysport.

So now we move on to the next step of a cosmetic dermatologist’s anti-aging skin rejuvenation plan of Repair, Relax, Restore, Resurface, Re-drape.

Relax Muscle Action–Reduce Lines

We all have characteristic facial expressions which often run in families. Many patients tell me “my mom (or dad or grandmother) have horrible frown lines.  I am starting to get them too and I am afraid mine will be just as bad–help!” Characteristic facial expressions are set early in life, usually by 5 or 6 years old and sometimes even earlier. Once set in childhood they are very difficult if not impossible to change.

Frowns are often not due to anger as is commonly supposed but rather concentration. Unfortunately others subconsciously perceive the frowner as being angry. Patients say “I am so tired of people asking me why am I mad–it makes me mad”. Many people have what are called “hyperexpressive faces” and have a lot of frown activity, forehead expression and even crunch their noses up during animation (called bunny crunch or wolf lines). This gives horizontal forehead lines, frown lines and lines leading down from the bridge of the nose onto the cheeks.  Smiling or squinting leads to crow’s feet at the corners of the eyes. At first these lines appear only during expression. Over the years they become permanent, occur at rest and get deeper and deeper.

Now we are able to relax the muscles that cause these lines and reduce the angry, stressed or tired appearance. Injections of pharmaceutically prepared  botulinum toxin (Botox or Dysport) are used to treat the specific lines on the upper face that muscle related such as frown lines, forehead lines, and crow’s feet.  A “Botox brow lift” will lift the eyebows opening up the upper eyelid and reduce hooding. Some lines under the eyes can be improved. You look more rested and less stressed or angry.

In the lower face and neck Botox or Dysport are also used for anti-aging. Injections in the chin reduce muscle activity that leads to dimpling and to reduce the turn down of the corners of the mouth that occurs with age. They are also used to treat a “gummy smile” where the upper lip rises up too far with smiling showing more of the upper gum than is desirable. The muscles at the outside of the jaw which enlarge with teeth grinding can be slimmed. Bands of muscle in the neck can be softened reducing “cords” and improving the jowls.

• All in all Botox and Dysport have been great additions to our anti-aging treatments, allowing both reversal of signs of aging and prevention of progression. And contrary to the ads, nothings “better than Botox”.

Next–questions and answers about Botox and Dysport.

Elaine Cook MD

Welcome to the SkinTreatment.com blog, opinions and observations of board certified cosmetic dermatologist and creator of  Dr Elaine’s Advanced Skin Treatment skin care line, Elaine Cook M.D.  I’ve been specializing in Dermatology for 27 years, the last 15 of which have been devoted to the practice of cosmetic dermatology, the development of my own skin care  line, and running SkinTreatment.com. This blog represents the summation of the knowledge and experience I have gathered over the years seeing countless patients and developing multiple prototypes for our skin care products. Some of the medical stories happen over and over again, some are more unusual. Some are purely cosmetic. Some are symptoms of underlying medical disease. All are important. All affect peoples lives.

I plan on discussing a variety of topics. Among them: the so-called “cosmetic” skin problems–acne, melasma, rosacea, aging skin, wrinkles, spider veins, cellulite, stretch marks, hair loss, age spots, sun spots, discoloration and more. I will also discuss the cosmetic procedures used to remedy these problems: Botox, Juvederm, Restylane, Sculptra, Laser, Fraxel  Laser, Intense Pulse Light Photorejuvenation (IPL), Thermage, Therma-Frax (also called Fraxage), Sclerotherapy, Chemical
Peels and the various other light-based treatments such as LED and blue light. Finally, I will be using my understanding of the skin in health and disease and my experience developing my own skin care line as a basis to discuss anything and everything about skin care products.

Basically, I will be discussing whatever I want on any given day.