Wrinkles are one of the best indicators that your skin shows age. As you add more candles to your birthday cake, it’s normal to see the lines on the face increase. The breakdown of collagen and elastic fibers is the cause of wrinkles, says Patrick J. Byrne, MD of the Head and Neck Institute of Cleveland Clinic, Ohio. He says that genetics and skin types are factors beyond your control which can increase the likelihood of wrinkles. Lifestyle habits such as sun exposure, pollution, and smoking can also accelerate wrinkle formation. According to a report published in Aesthetic Surgery Journal, sleeping on the face can cause wrinkles.
How Botox and other wrinkle reducers work to smooth wrinkles
Botox, or an injectable similar to it, can stop wrinkles dead in their tracks. Botox is a trademarked term dermatologists use to describe injectables made with a toxin derived from Clostridium Botulinum bacteria. According to Mayo Clinic, this bacteria can also cause botulism – a condition that attacks the body’s nerves – but this is a rare side effect.
Byrne says that this is the most potent neurotoxin ever discovered. The toxin enters the synapses and prevents the transmission of impulses to the muscle. The muscle will be wholly or partially paralyzed. This results in the smoothing of the expression lines. Treatments are temporary, lasting between two and six months.
Stopping expression lines also stops existing wrinkles from becoming more profound and permanent. Some doctors do not believe in neurotoxins being used to prevent wrinkles. Suppose a patient does not have a frown and wants Botox to prevent wrinkles. I won’t treat him in that case, says Phillip R. Langsdon, MD, a facial surgeon in Germantown, Tennessee, and past president of the American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS).
If you notice that the crease left by a facial expression does not disappear when you rest your face, you are at a point where a wrinkle is forming. Then consider a neurotoxin.
Consider Your Options – Beyond Botox
You are not restricted to Botox. Dr. Langsdon says that most people ask for Botox because it is the most well-known brand. You can also ask your dermatologist about similar products: Jeuveau, Xeomin, Dysport, and Daxxify. The U.S. FDA has approved Daxxify as the latest option. The Food and Drug Administration will approve the injectable in September 2020 to treat facial wrinkles among adults.
You may be surprised to learn that the active agent in all three is similar and identical. They all contain unique carrier protein that diffracts through tissue slightly differently, says Byrne. He is also a former board member of AAFPRS.
What you need to know about injectables
Botox
What Is It OnabotulinumtoxinA According to the Botox Cosmetic Website, FDA-approved Botox injections are FDA-approved for temporarily treating moderate to severe frowns, crow’s feet, and forehead wrinkles.
Who It’s Best for Langsdon says that Botox is effective in the bunny line on the side of the nose and the forehead lines. The review, published in Clinical Cosmetic and Investigational Dermatology in 2019, adds that Botox is effective for marionette wrinkles, which run from the corners to the chin, the wrinkles around the lips, and the vertical bands on the neck.
Langsdon claims that Botox is effective anywhere it is approved to be used. However, he warns that people with low eyebrows treated with neurotoxins may see their eyebrows fall lower. He says that sometimes you need to leave the lines alone. Your dermatologist or plastic surgeon can guide you.
Disadvantages Results show up after some time. Remember this if you are preparing for an important event or want to plan your treatment correctly. Langsdon says that although the company claims the results will appear within 24 to 48 hours, they should wait a few weeks to see the full effects. According to the Clinical Cosmetic and Investigational Dermatology Review, men need more Botox because they have greater muscle mass. The dose is often twice as high for them.
Dysport
What is it AbobotulinumtoxinA (Dysport) is an injectable that can smooth frown lines between the eyebrows. This information was taken from the Dysport website. The results are visible within two to three business days but may take up to one week.
It’s also cheaper: It will cost less if you need fewer appointments. Shah says this can lead to better results, as patients are more likely to come in regularly.
Byrne says that Dysport can travel slightly further through tissue. He says this gives an advantage when treating crow’s foot, which has a more extensive treatment area.
Another benefit? According to a report published in 2021 by Toxins, these neurotoxin injectables can reduce facial oiliness and acne. This review suggests that Dysport may be a good option for treating acne. The FDA has not approved these injectables to treat acne. So, consider this a bonus and not a guarantee. In 2021, a randomized, double-blind study published in Dermatologic Surgery with 50 participants showed that Dysport injections on the forehead reduced oiliness for six months. Participants in the study who received Dysport treatment were delighted with the results.
Disadvantages Botox may be better suited to target specific muscles (such as frown lines between eyebrows), according to Byrne. Dysport can still give you the results you want. “These differences, which are so subtle that I don’t believe it matters,” says Byrne.
Xeomin
IsIncobotulinumtoxinA (Xeomin) is an injection that targets moderate to severe frown lines between the eyebrows. This information can be found on the Xeomin Website.
Who’s It Best For? Over time, some people develop a tolerance for these injectables. This makes the treatment less effective. Shah says Xeomin differs because “the protein coating on the toxin molecule has a much thinner density than the other neurotoxins.” Your doctor may prescribe Xeomin if other injectables are not working.
Disadvantages According to the company, results appear within three to four days, with the maximum outcome after 30 days. Xeomin is not for you if you want the results to show up faster (whether it’s because you prefer this or you have an upcoming event).
Shah and other doctors say patients often only notice the effects after two months. He says that when you have a certain tolerance for the other products, two months is a reasonable amount of time.
Jeuveau
What it is PrabotulinumtoxinA (Jeuveau) is the second most recent neurotoxin injection on the market. It was approved by the FDA in 2019 for moderate to severe glabellar wrinkles. Shah says the particle size is the same as Botox, which is 900 kDa (kilodaltons). This is the gold standard of efficacy. A double-blind placebo-controlled trial published in 2019 by Aesthetic Surgery Journal showed that Jeuveau is just as effective at treating forehead lines as Botox.
Who It’s Best forJeuveau is a good option for patients interested in trying out a new injectable. Byrne says that some patients strongly believe in one neurotoxin over another. Some patients think that one neurotoxin works faster, is more efficient, or lasts for longer than the other. We let the patients decide.
Disadvantages Although Jeuveau is a relatively new product, Langsdon says that “the data are limited and we don’t possess the years of experience we have with Botox Dysport or Xeomin.”
Daxxify
What It Is Daxxify, or daxibotulinumtoxinA-land, is the newest wrinkle reducer on the market. It is approved for treating moderate to severe wrinkles or lines between the eyebrows. StatPearls states that the muscles in this area are the procerus and corrugators. This muscle makes you “squint” by pulling your eyebrows downward. Joshua Zeichner MD is an associate professor at Mount Sinai Hospital, New York City, and director of cosmetic research and clinical trials.
Who’s It Best ForThe results of Daxxify are more likely to last longer than those of other wrinkle reducers. Daxxify producer Revance Therapeutics submitted to the FDA trials, which led to Daxxify being approved. Compared to placebo, 80% of participants showed improvements in facial wrinkles four months after treatment. About half of the participants experienced improvements within six months. Some people even maintained their results after nine months.
This may seem desirable. Before opting for Daxxify, you should be an experienced injectable neuromodulator user, says Dr. Zeichner.
Zeichner says that for first-time users, he would recommend using a longer-acting agent (than Daxxify) to ensure you are happy with your results. He added that Daxxify is a good choice for experienced users who know what they’re doing, like the results, and are familiar with their expectations.
Disadvantages In studies, Daxxify caused only mild side effects in a few participants. These included drooping eyes, headaches, and facial asymmetry. Revance reported. Zeichner says that the main disadvantage is the long-lasting effects of Daxxify.
How Much You’ll Spend for Younger-Looking, Smoother Skin
According to the American Society of Plastic Surgeons, their 2020 data, Dysport, Xeomin Jeuveau, and Botox cost $466 on average. Prices may be higher in certain places. This is the latest number. The price points vary widely depending on what area is being treated, the desired wrinkle reduction, and the number of units of product injected. Prices can also differ depending on city, region, and individual doctor’s offices. Daxxify’s price is yet to be determined as the injectable has not yet been available in dermatologists’ offices. It’s expected that it will be in 2023.
They’re popular, so they get a lot of satisfaction. Byrne says that all of these agents are effective when used correctly.
Working with a professional when getting Botox or similar injectables is essential.
It doesn’t matter what injectable wrinkle reducer you choose; seeing a doctor with the necessary knowledge is essential. This means that your doctor should be a dermatologist or a plastic surgeon. Langsdon says that you need to find an experienced, trustworthy doctor with whom you have a good relationship. You may be able to get a lower price from someone, but consider the cost of a provider who lacks experience.
In an alarming report cited in a paper published in 2018 by Plastic Surgery, it is reported that some people have turned to DIY botulinum treatments. They self-inject these agents using tutorials and maps of facial muscles found on YouTube or elsewhere on the Internet. The authors warn that this is not safe. You could also be using a counterfeit product. These DIY treatments may have permanent side effects like muscle paralysis, Bell’s palsy, and eye damage. According to the American Academy of Dermatology Association, these include permanent eye damage, Bell’s palsy, and muscle paralysis.
How To Know If Your Dermatologist Or Plastic Surgeon
Check that the dermatologist you see is certified by the American Board of Dermatology. You can find a facial plastic surgeon certified by the American Board of Facial Plastic and Reconstructive Surgery in your area using AAFPRS.org. The American Board of Medical Specialties has a tool that allows you to search by doctor name, city, and state.
Alternatively, using the free “Is My Doctor Board Certified?” tool from CertificationMatters.org, you can check whether your provider is board-certified.
What you should do before you undergo the procedure
AAD notes that your dermatologist will consult with you before recommending a treatment. Be prepared to share your medical history with your doctor during the consultation. This will help them to identify any potential complications. Disclosure of all medications, including non-prescription drugs, supplements, pregnancy or plans to become pregnant and surgical history is essential.
You can also ask any questions to your dermatologist during this consultation. Ask the provider about the number of procedures they have performed, who administers the injections, the costs, and the results. You can also ask your provider about other treatment options that might be better for you. They may even suggest combining treatments to get better results.