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Botox FAQ Los Angeles

Below you will find the answers to common questions that people like you have about Botox® Cosmetic, Dysport®, and Xeomin® injections. For a description of the treatments provided by Nu Vela Vein Center, click to conditions treated with Botox® , or click Botox® overview for the description of the products. If you have any more queries or concerns that you don’t see answered in our website, please don’t hesitate to contact us to arrange a consultation with Dr. R. Dishakjian, the cosmetic surgeon of the Center.

What is the difference between Botox® Cosmetic and facial fillers?
While Botox® Cosmetic temporarily corrects or eliminates dynamic wrinkles by blocking the chemicals that cause the underlying muscles to contract; dermal fillers smooth out wrinkles that exist in the absence of any facial expression; that is, “static” wrinkles. Moreover, dermal fillers can plump up hollows and depressions, such as under eye hollows and sunken cheeks, caused by aging and dieting. There are several available fillers. They include Restylane, Sculptra, Radiesse, Juvederm, and Perlane.

Can Botox® injections be combined with dermal fillers?
In cases where untreated wrinkles have become etched in and appear even at rest, or when wrinkles are caused by the looseness of the skin, Botox® injections can be administered in conjunction with other treatments, such as dermal fillers, or fractional laser resurfacing.

Which product is the best – Botox®, Dysport® or Xeomin®?
While the active ingredient in Botox®, Dysport®, and Xeomin® is the same Botulinum toxin, the preparations differ in the way they are manufactured and purified. As a consequence, concentrations and units of administration doses are different. Dysport® diffuses better than Botox®, and unlike Botox® and Dysport®.

As to the effectiveness of the three products in cosmetic surgery, some researchers have reported that clinical results with Dysport® last longer than Botox® (4-7 months as compared with 3-6 months) and that results with Dysport® are often noticed a day or two earlier than with its competitor Botox® (2-4 days as compared with 3–8 days). There are also reports documenting that Dysport® improves the appearance of crow’s feet significantly better than Botox®®Cosmetic. This is ascribed to the property of Dysport® to diffuse better. Xeomin® seems to act more like Botox® Cosmetic than Dysport®. It is observed that it takes about one week for the full effects of Xeomin® injections to be realized, and once this occurs, the results seem to last from 3-6 months.

In practice, the vast majority of clients at Nu Vela have experienced similar results in terms of effectiveness of the three products and their clinical duration. The differences likely mean more to the physician than the consumer (longer shelf life and no need for refrigeration), except of course, for more aggressive rebates and patient friendly promotions as things heat up in the wrinkle-relaxing world due to increased competition.

When are results seen and how long do they last?
Patients usually notice the clinical effect 1-3 days following botulinum toxin injections, and the effect is maximal by 1-2 weeks. The clinical results can vary depending on the skill of the practitioner, the nature, dose and concentration of the product, the frequency of the injections, the nature of the injected muscle, as well as the quality of the skin. For instance, a higher dose for a particular area might be needed if the interval between treatments is much longer than recommended.

The benefits of Botox® Cosmetic, Dysport®, and Xeomin® treatments typically last 3-6 months, except when used for jaw reduction. Surprisingly, jaw line reduction results are slow to show, but usually last more than a year (see below). Younger patients may also experience longer lasting benefits due to the better quality of their skin. Treatments can be repeated as the effects of botulinum toxin wear off. Deeper wrinkles may require 1 to 2 additional sequential sessions before the best results are seen. In select cases, it may be necessary for the patient to have additional procedures, such filler injections, for optimal results.

Who can administer Botox® injections?
The manufacturers of Botox® Cosmetic recommend physicians to inject the medication themselves. Accordingly, it is very important to have the treatment at a Center where a physician performs the procedure, rather than a nurse or a physician’s assistant (PA), as is sometimes the case. Dr. Dishakjian, the cosmetic surgeon at Nu Vela, always personally performs all cosmetic procedures, including Botox® injections.

What are the conditions that can be treated with Botox®, Dysport®, and Xeomin®?
Despite the fact that cosmetic injections of Botox®Cosmetic, Dysport®, or Xeomin® in any site other than the glabella constitute an off-label indication in the United States, the scope of botulinum toxin applications in cosmetic surgery is increasing every year. At Nu Vela, Dr. R. Dishakjian uses Botox® Cosmetic, Dysport, or Xeomin to correct the following:

  • frown lines
  • forehead lines
  • crow’s feet
  • bunny lines
  • corners of the mouth
  • brow lift or brow balance
  • smokers lines
  • wide jawline and square face
  • gummy smile
  • teeth grinding
  • wrinkled and dimpled chin
  • nasal flare
  • excessive sweating
  • chest rejuvenation

For more details about a particular procedure, click applications of Botox®, Dysport®, and Xeomin® in cosmetic surgery.

What are the contraindications and complications associated with Botox® Cosmetic, Dysport®, and Xeomin®?
Although Botulinum, the neuromuscular blocking toxin in Botox® is associated with botulism, there is no danger of botulism from Botox®, because botulism is caused by very large amounts of the toxin in the system, usually from eating contaminated food. Very high doses, often 100 times more than would normally be used, would have to be injected to cause harm and botulism.

In fact, risks are very minor when Botox® is used for cosmetic purposes. As of today, no serious issues have been reported among adults who have received botulinum products, such as Botox®, Dysport® or Xeomin®, for cosmetic uses. Adverse effects are usually mild and transient. The most common substantive complication is excessive weakness of the treated muscles, and this resolves as the action of the toxin wears off. Complications such as brow ptosis, eyelid ptosis (Eyelid sagging), neck weakness are usually due to injector error or lack of injector experience. All of these effects are reversible, and fade with time. If you have eyelid drooping after a Botox® procedure, it is a good idea to let the cosmetic surgeon know because there are medicines available that may alleviate this condition. Ptosis can be treated with apraclonidine 0.5% eyedrops. Phenylephrine (Neo-Synephrine) 2.5% can be used when apraclonidine is not available. Note that Neo-Synephrine is contraindicated in patients with narrow-angle glaucoma and in patients with aneurysms. Any other difficulties, such as difficulty breathing or rashes, should be reported to the doctor.

The most common side effects of botulinum toxin used in cosmetic surgery are temporary soreness or mild bruising around the injection sites. Bruising can occur, particularly if a small vein is lacerated or a patient has taken aspirin, vitamin E, or NSAIDs, or has consumed alcohol on the day of injections or the few days preceding the treatment. Ideally, patients should stop taking these products 1 week before the procedure. Applying ice to the injection sites before and after treatment may decrease the pain and the risk of swelling and bruising. Some people may experience a slight headache that lasts for several hours after treatment.

Contraindications include prior allergic reaction and injection into areas of infection or inflammation. Botox® injections are contraindicated for patients with allergic history to egg albumin. Botox® injections are not recommended in pregnant or breastfeeding women. However, many patients have been unknowingly injected during pregnancy and to date no fetal injury or birth defects have been reported in these cases. Nonetheless, to be on the safe side, delay of injections is recommended until pregnancy is complete and breastfeeding has ended.

Botulinum toxins should be used with caution by patients taking certain medications that decrease neuromuscular transmission, such as aminoglycosides, penicillamine, quinine, and calcium channel blockers. Ask your doctor about possible interaction with these medications before a treatment. Patients with certain neurological disorders, such as myasthenia gravis, ALS, or LAMBERT-EATON syndrome could be at an increased risk of side effects.

Questions about cost or a Botox® treatment?

You may reach our Los Angeles medical spa by clicking the “Contact” button at the top of the page, or by calling 818-832-4500. Our receptionist will be delighted to assist you with any enquiries regarding cost, additional information, or scheduling a consultation session with Dr. Dishakjian, the cosmetic surgeon of the center.