Which FDA Appoved “Botox” is the Right Choice For YOU?

According to the American Society of Plastic SurgeonsBotoxwas considered one of the top 5 minimally invasive cosmetic procedures with 7.4 million procedures done in 2018. This number went up 3 percent from 2017.

By no means am I saying you should get Botox but when I finally decided to get it (age 32) I looked better and consequently my confidence went up. It is an option for someone exploring the anti aging/beauty world. You can still be expressive with botox in a natural, beautiful way. Refreshed, “just went on vacay” is the look we are going for.

Looking better without actually going on vacation?! SIGN ME UP!!
BOTOX®Cosmetic falls into the category of neuromodulators or neurotoxins. I prefer the word neuromodulator. Think of it as being a brand name. There are a few FDA approved neuromodulators out in the market with BOTOX®being the most well known. I know not everyone is familiar with ALL the neuromodulators. That’s the normal for most people I’ve come across. This is why I’m here. All the neuromodulators come from purified protein derived from a bacteria called Clostridium Botulinum. There are 7 different subtypes but TYPE A is the most easily made and stable.

You might be wondering:

How does it work?
Neuromodulators Work on nerve endings and stop a molecule called acetylcholine from being released so a muscle cannot contract. They speak to the nerves and say “hey , slow down there “ so the muscles don’t contract as much.

BOTOX®Cosmetic by Allergan was approved for cosmetic use in 2002 for forehead wrinkles and in 2013 for wrinkles on the sides of the eyes usually seen when you smile.

Neuromodulators are best for dynamic wrinkles which are wrinkles that form only on expression. Static wrinkles (wrinkles etched in at rest) are harder to treat and may require more than one treatment to see results.

So its best to get it before the lines settle in and this is why many people are starting preventative care at a younger age for anti-aging. If you think about it over time the repeated expressions from the muscles will lead to wrinkles

How do you know if you would benefit from it?
If you already see wrinkles at rest then you should definitely go in for a consultation. But if you don\’t or you are not sure if neuromodulators are right for you the best way is to look in a mirror and make a few funny facial expressions.

STEP 1- Squeeze your brows together-do you see any lines right in between your eyebrows? This is usually called the “11 sign” and over time these lines on expression will get deeper.
Step 2-Raise your eyebrows. Do you see any lines on your forehead?
Step 3-Smile. Do you notice any lines around your eyes?

If you notice there are wrinkles to one or all questions above, I recommend you go in for a consultation to get more information and see if you would be a good candidate.
Besides wrinkles on the forehead and around the eyes there are other areas that can be treated on the face. They are off label ( not FDA approved) but common areas to treat in practice. Some of these areas include:

  • Marionette lines which are depressions at the corners of the mouth that make you appear sad
  • Cobblestoned chin( orange peel appearance of the chin skin)
  • Masseter muscle (muscle at the back of the jaw) for jawline slimming
  • Base of the nose for a lifting tip effect

The results from neuromodulators usually appear in 4-7 days , the maximum effect is 30 days and it lasts for usually 3-4 months . The number of units varies on each individual depending on the anatomy. Hence it is important to go to an experienced injector.

All of the neuromodulators on the market are made from Toxin A as stated above. They have different names. The most well known BOTOX®is actually named Botox (genius name !). It is derived from Onabotulinum Toxin A made by Allergan.

As practitioners we are usually trained with this neuromodulator first. BOTOX®is associated with a smaller accessory protein. This is important because ones immune system can develop antibodies to these proteins and botox may not work as effectively on future treatments.

XEOMIN® is made byMerzderived from Incobotulinum Toxin A. FDA approved for forehead wrinkles in 2011. According to research lasts just as long as BOTOX®. This Neuromodulator Is very pure due to how it’s made. The unnecessary proteins are removed.

What does this mean for you?
There is less risk of developing antibodies.

Dysport® is made byGalderma derived from Abobotulinum toxin A. FDA approved for forehead wrinkles in 2009. You cannot get this type of neuromodulator if you are allergic to the protein in Cows Milk. This is not to be confused with lactose intolerance ( deficiency in lactase enzyme) which is not a true allergy.

What makes this neuromodulator unique is it works quicker than the other two above usually in 2 days as opposed to 7 days. Also it spreads over a wider area when injected. There is a softer look due to this.

Pra Botulinum toxin A also known as Jeuveau™ was just recently launched by Evolus and recived FDA approval for forehead wrinkles in 2019 . According to studies the efficacy is equal to Allergan BOTOX®.The company uses High Pur technology.

Again what does this mean for you? This Botox May last longer although it is still too early for results to be published.

So now how do you know what is right for you?

Here’s the deal:

Personally I have tried Allergan BOTOX®and Merz XEOMIN® I liked the results of both equally. I couldn’t really tell a difference on me. Both lifted my eyebrows ever so slightly for a younger look and softened my lines on expression. If you love the results of one product then stick with it. If money is an issue ask the provider which one is cheaper? If you are not so keen on accessory proteins and want the purest botox try XEOMIN®. If you have an event in 2-3 days and need the botox to kick in quick try Dysport®.
Ask your provider which they prefer and have used? Isn’t that a fair question. I will also emphasize the injector matters.Injecting a neuromodulator requires knowledge of anatomy and an appreciation for facial aesthetics.

Know your options. It’s your beautiful face that is being injected!
One last point I want to bring up is the stigma associated with BOTOX®and any of the neuromodulators. We all age but how we deal with it is truly our own choice. There is no right age to start in my mind but if anti-aging and preserving your beauty is important consider this an OPTION.

The numbers speak for themselves on how many people get botox but why are we afraid to tell? Afraid to be judged? My friend told me the other day my skin looked great. I told her I recently didbotoxand also keep up with microneedling and just started laser resurfacing last year.

Why did I disclose this?

Simply because it’s the TRUTH. Truth is liberating and don’t ever be afraid to be your TRUE AUTHENTIC self.
Dr. Khiani MD

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