Top Botox® Mistakes to Avoid: What New Injectors Need to Know
New to injecting Botox®? This guide walks you through the most common mistakes—and how to avoid them—so you can deliver safe, natural-looking results your patients will love.
Listen to Neurotoxins in Your Aesthetic Practice
Medicine, cosmetic or otherwise, is constantly evolving.
New methods and developments are being researched and implemented all the time to help people improve their health and quality of life.
Many treatments that are developed today aim at not only improving an individual’s appearance but also several clinical conditions.
For example, consider the implications of neurotoxins, in the form of Botox®, Dysport® and Xeomin®, which treat fine lines and wrinkles, among other conditions. Studies have found great benefit in these products and their effectiveness.
In the current market, there are three different brands of neurotoxins that are available that are licensed for use in cosmetic practice – Botox®, Dysport® and Xeomin®.
These are all different forms of the same toxin – botulinum toxin A, released from the Clostridium botulinum bacteria. It is poisonous in large amounts but is extremely useful as a cosmetic agent when used in small doses.
When Botulinum toxin A is injected under the skin, it works on the neuromuscular junction, causing paralysis of the muscles in that area and smoothing of the overlying skin, resulting in a reduced appearance of the wrinkles. It also is used to treat cervical dystonia, migraines and blepharospasms (uncontrolled twitching of the eyelid).
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Since Botox®, in comparison to Dysport® and Xeomin®, is the more commonly used neurotoxin in aesthetic medicine, this article will discuss how Botox® compares to the latter, including similarities and differences.
Botox®, scientifically known as onabotulinumtoxin A, works by causing temporary paralysis of muscles in the area where it is injected.
It is used mainly to manage fine lines and wrinkles, as well as treatment of migraines.
Dysport®, which is scientifically known as abobotulinumtoxin A, is similar to Botox®, except that currently it is used mainly in the treatment of cervical dystonia.
Finally, Xeomin®- or scientifically known as icobotulinumtoxin A, has very similar uses and protocols as Botox®.
As mentioned above, both Dysport® and Botox® cause paralysis in the neuromuscular junction.
They are both used for treating fine lines and wrinkles. However, their differences are more extensive.
Dysport® is usually used to manage cervical dystonia, or spasmodic torticollis, which is an abnormal tone in the muscles of the neck, resulting in an abnormal head position.
Botox® is not usually used to treat this condition.
Further, Dysport® has the ability to take effects on the injection site a lot faster than Botox®.
For example, it is estimated that the results of Dysport® are seen around 48 hours after injection while Botox® can take up to 7 days to show any results.
The duration of action between the two is also quite different. For example, it is estimated that Dysport® can last up to 4 months.
Typically, it only lasts around 3 months. This ultimately has an effect on how many injections will have to be administered to patients who need long-term treatment.
However, one needs to consider the dosages of the drugs, as larger doses of Dysport® need to be given – 3 units – compared to Botox®, which only needs one unit, to see results.
Finally, Dysport® is cheaper than Botox®, and the storage of the two products differs. Botox® is freeze-dried and needs to be stored frozen at -5°C. Once opened and reconstituted it should be stored in a refrigerator (2° to 8°C) and used within 24 hours. Discard any remaining solution.
Dysport® only needs to be stored between 2 to 8°C once it is re-formed for use.
For more information from the IAPAM’s faculty of dermatologists, please read our expert discussion on Botox® vs Dysport®.
Again, both of these neurotoxins consist of Botulinum toxin A, a neurotoxin that acts by blocking the neuromuscular junction.
Similarly, they both take effect after approximately 7 days after injections, with the effects usually wearing off after 3 months (although they can last up to 6 months).
They are also measured in the same units, making it easy for the treating physician to measure up the required dose.
Finally, the cost of Xeomin® and Botox® are comparable.
The main difference between Xeomin® and Botox® lies in the biological structure. Botox® is encased within a protein, while Xeomin® lacks this protein, which can sometimes cause an immune reaction.
This can block the action Xeomin® by prompting the body to create an antibody to the substance, thus, in turn, making it completely ineffective.
Botox® bears an advantage over Xeomin® in that it results in no antibody formation upon injection.
As mentioned, Botox® needs to be stored in a freezer or at temperatures between 2 to 8°C, whereas Xeomin® does not, making transport and storage of the product easier and cheaper.
Typical side effects of each of these neurotoxins can include pain, itching and rash at the injection site, dry mouth, and occasional blurred vision.
Rarely, patients may develop swelling around the eyes or an allergic reaction.
These three different preparations of the botulinum toxin that are used in cosmetic practice have unique properties, giving them certain pros and cons.
Consult your doctor or aesthetic specialist to discover which treatment would be most suitable for you.
New to injecting Botox®? This guide walks you through the most common mistakes—and how to avoid them—so you can deliver safe, natural-looking results your patients will love.
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Botox is a trademark of Allergan Inc.; Dysport is a trademark of Galderma; Xeomin is a trademark of Merz Aesthetics
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