What is Botox?

Botox (Dysport) is:

Botox and Dysport (neurotoxins) are the number one cosmetic procedure in the United States today with millions of injections performed yearly. Despite this, many patients like you remain confused or misinformed about what it is and what it does. We’ve put together this at-a-glance page to help you better understand this popular and effective treatment.

Botox (Dysport) is:

  • A drug that has been used safely for several decades. It was first used to treat painful muscle spasms of the neck and back. From there, it became an effective way to treat twitching of the muscle around the eye. Botox was first approved for use in muscle spasms in 1985 and has been used for cosmetic purposes since the mid 1990’s (Dysport was approved in Europe in 1988) .
  • los angeles botox is botox safe after pictureslos angeles botox is botox safe before picturesA highly-purified protein that is reconstituted (or mixed) in saline prior to use for injection. When purchased directly from the manufacturer, Allergan, (the only legal way to do it in the U.S.) an injector can meticulously control the amount of Botox that is given to each patient.
  • An FDA-approved drug that has a better safety record than over-the-counter aspirin.
  • A treatment that can smooth and erase existing lines and wrinkles as well as work preventatively to stop their formation.

Botox is not:

  • A paralytic. Instead, it relaxes the muscle by blocking the neurochemical activity that triggers muscle contraction.
  • An injection procedure that any type of practitioner or facility can or should do. To ensure that you receive the best results that help you look more naturally relaxed, awake and youthful, see an injector who has plenty of knowledge and experience in aesthetic medicine and regularly participates in ongoing training on the latest and safest uses for Botox Cosmetic.
  • A treatment that causes you to look frozen or fake. As you can see from the photos on this page, a patient injected with Botox was able to smooth away a deep line across the forehead effectively while maintaining a natural and pleasing look to the area.

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What’s the difference between Botox and fillers?

Patients ask us often about the difference between Botox Cosmetic and dermal fillers. Consumers hear these names all the time but aren’t sure how the types of products are used or related. Botox Cosmetic and Restylane are brand names of injection products. Botox is in a class of products called neurotoxins and Restylane belongs to another class called dermal fillers. Neurotoxins work to smooth wrinkles by relaxing the muscles that cause them. Dermal fillers help smooth lines and folds by adding volume.

Dermal Fillers

Besides Restylane, there are many other dermal fillers such as Juvederm, Restylane Lyft (Perlane), Voluma, Belotero, Sculptra and more. Although all of these products can provide volume to replace collagen and fatty tissue, they are made of different materials. Hyaluronic acid, which occurs naturally in the body, is the main ingredient in most fillers, while calcium microspheres are the primary ingredient in Radiesse. Dermal fillers made of hyaluronic acid work by attracting water to the injected area. Hyaluronic acid has the ability to absorb 1,000 times it’s weight in water. This water attracting action plumps the skin adding volume where fat and collagen have been lost to the aging process. Dermal fillers add volume and definition to the mouth, cheeks, tear trough area (under the eyes), the laugh lines around the mouth (nasolabial folds), and even to the area around the chin and corners of the mouth.

Botox, Dysport & Xeomin

Botox Cosmetic is a product designed to temporarily relax specific muscles of the face to prevent and resolve lines and wrinkles. Dysport and Xeomin are similar to Botox in that they are also made of Botulinum Toxin Type A. Both are competitors to Botox. All of these products work well to relax the muscle that causes frown lines between the eyebrows (glabella area), the crow’s feet lines at the sides of the eyes and the horizontal wrinkles present above the eyebrows.

Combining Botox and Dermal Fillers

By combining both types of products (Botox or Dysport and Restylane, Juvederm, Perlane, etc.) patients are able to achieve a very natural, appealing outcome. Although Botox, Dysport and Xeomin help to resolve and prevent fine lines and wrinkles, they do not add volume like dermal fillers. Thus the products are complimentary and used in different areas of the face.

Restylane injections for dark circles under the eyes.

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We spend a lot of time talking every day, but have you ever wondered what your mouth says about you? We’re not taking about actual words of course, but rather the appearance of your mouth and lips. The lower third of the face often gets overlooked in terms of age-related changes. The truth is though that it says a whole lot more than you might like about your age!

The reverse of this is also true; many woman simply plump their lips with fillers such as Restylane or Juvederm, creating an uneven, disproportional and unnatural looking mouth. The real truth is that balance and symmetry are essential when treating this area with Botox and fillers. It can be a very fine line to walk, and the insight and skill necessary can take years for an injector to hone in on and develop. This is why who treats you can be just as important if not more than what they treat you with.

los angeles restylane for lips before photolos angeles restylane for lips after photoLet’s use the woman in the photos on this page to demonstrate some of the very common age-related changes that can occur around the mouth and the effective, yet subtle impact that cosmetic injections can have in this area of the face.

Notice in her pretreatment picture that the area between her nose and upper lip appears flat and elongated. This happens because the muscle that encircles the mouth (like a purse-string) repeatedly contracts, pulling the upper lip down and curling it inward, toward the teeth. You don’t see them as much on this patient, but tiny, vertical lines (smoker’s lines) that appear above the upper lip also form in response to this muscle’s repeated contractions as we age. Notice how her mouth is almost turned down at the corners and how her upper lip appears much thinner, smaller and out of proportion with her lower lip.

Now, take a look at her photo after injections of Botox and dermal fillers. Wow! Big difference, huh? A very small amount of Botox was injected into the muscle around the mouth, softening its downward and inward pull on her upper lip. Hyaluronic acid based dermal fillers such as Restylane and Juvederm were also used to reshape her mouth by careful injections into the border of the lips (vermillion border). Combined with the Botox, this has the effect of rolling the upper lip out and upward (lip eversion), effectively shortening the distance between the nose and upper lip.

She also had a bit of filler placed in the red part (mucosa) of the lip, restoring the balance between her upper and lower lip as well as the proper proportion. Last but not least, a small amount of filler was added under the corners of her mouth. By replacing this small amount of natural volume that she’d lost with age, the corners turned up slightly. The overall appearance of her lips and mouth area is much more pleasing to the eye and looks totally natural, youthful and beautiful!

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We know that red stretch marks can cause much distress for patients like you. Red stretch marks often occur at the beginning, when new stretch marks are first being formed. They also occur more often in light or medium skin types.

Red stretch marks are caused when new blood vessels are created by the body to heal the area in and around the stretch mark. These small blood vessels are very near the surface and can appear as red streaks on the abdomen, love handles and even legs.

Red Stretch Marks Before PhotoRed Stretch Marks After Photo

Although these marks can be embarrassing and frustrating, they are easily treated with lasers. Pulsed dye laser treatments are the gold standard for the removal of red stretch marks. These lasers are highly absorbed by the blood in the small capillaries in the red stretch marks. When these small blood vessels absorb laser light, heat is generated, thereby closing them and removing the red color.

To learn more about removal of red stretch marks with lasers, give us a call today to schedule a free consultation.

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grinding teether migraines 2When I meet an injection (Dysport, Botox, filler) patient for the first time, I take note of any signs of muscle tension.  We all recognize how this looks on the upper face with a furrowed brow.

grinding teether migrainesHowever, it’s more common to observe chronic stress of the lower face muscles.  This appears as a dimpled chin, downward turn of the corners of the mouth, a puckered look to the sides of the chin, and…the most problematic area – the Masseter (jaw muscle).

The Masseter muscles are the large chewing muscles often referred to as the jaw muscles.  They are located in front of the ear and extend down to the jaw bone.  For people that grind or clench their teeth, they often will exhibit an overly large, bulky, or square jaw line or Masseter muscle.

Masseter Before Dysport Injections Photo 11Masseter After Dysport Photo 11

Besides lower face muscle tension influencing one’s appearance, there are some common complaints that need to be explored.  For example, those that tend to exhibit a large Masseter muscle mass will confirm migraines, tension headaches, or even neck and shoulder pain upon questioning.  They may even describe being under the care of a physician that is providing prescription medications for migraines.  Or, a neurologist that is dosing with Botox to the upper face muscles, scalp, or even the back of the neck for relief.

grinding teether migraines beforegrinding teether migraines after

Oftentimes health professionals are not asking the patient if they grind or clench their teeth.  Better yet, they should be checking the Masseter muscle for evidence of over-use and tension.  The reason being, these muscles that are tight and over-worked may lend to symptoms of migraines with radiating pain along the neck (of the side they are using) and sometimes down the shoulder.

Although our focus is aesthetic outcomes, we have had several patients find relief by simply administering Dysport and/or Botox into their Masseter muscles.  Pain and tension is generally relieved within several days, and the appreciable changes to the appearance are realized in as little as a few weeks for most.

When we are able to help piece the puzzle together, it’s rewarding for both patient and practitioner alike.

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In 2009, the FDA issued a “Black Box” warning for Botox that has now carried over to all neuromodulators such as Dysport and Xeomin.

A Black Box warning is the most serious warning that the FDA may issue for drugs/medications that have potentially dangerous side effects. Because of the potential spread to distant areas after injection, Botox (and its sister products) was given this warning on its packaging.

Botox black box warningLet’s consider the following:

  • When Botox/Dysport are received directly from the manufacturer and used responsibly by a trained practitioner, treatments are extremely safe.
  • Botox has a higher safety rating than Aspirin.
  • Botox (neuromodulators) are the #1 cosmetic treatment in the world.
  • Reports of distant spread of Botox was associated with very large doses in patients already with compromised health wherein the risks of treatment were outweighed by potential benefits. (ex: cerebral palsy)
  • Cases wherein patients suffered great harm were associated with “bootleg” Botox that was not received directly from the manufacturer.
  • A more recent case of distant spread was related to the use of high doses in the neck for platysmal bands that resulted in compromised swallowing for more than a couple of months. We do NOT use Botox/Dysport in the neck as we believe this is far left of off-label wherein benefits are outweighed by potential risks.
  • Finally, there are many common drugs that carry a Black Box warning such as:

Cipro (common antibiotic), anti-depressants, anti-coagulants, anti-diabetics

Balanced and responsible information in all things…

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As patients, and even as injection practitioners, we sometimes overlook the importance of the “south” end of our faces. Specifically, that little muscle that works overtime but gets little attention…the chin. The chin muscle, also known as the mentalis, can become quite a challenge when exercised too much.

For those that tense up the chin area, or are prone to clenching of the jaw, the chin may take on a dimpling effect. Using Botox and Dysport to relax this area is an inexpensive way to tame this pesky muscle. Besides having a smoother tablecloth over the chin, when relaxed, we keep the chin from wanting to become knobby and curled upward over time.

Dysport to relax the chin

dysport to relax the chin

Using dermal fillers such as Restylane or Radiesse, we are able to create a much smoother canvas to better blend the peaks and valleys that are created from over-active muscle movement in the lower face.

Restylane filler for shaping the chin

restylane for shaping the chin

Lasers offer a sophisticated approach in resurfacing the topography of the skin by literally removing microscopic pieces of wrinkles and lines to produce new skin and collagen absent of the memory of those wrinkles. Deep fractionated technology has given us an entirely new and better approach to this endeavor.

Photo 1 – Deep fractionated laser resurfacing

deep fractionated laser resurfacing

In many cases, a combination of any of these 3 approaches may be the best recipe. As with all injection treatments, let us remember that the canvas of the face should be approach as a whole. Giving equal attention to all areas provides for synergy and balance.

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Botox Cosmetic and Dysport are both classified as botulinum type A products that are used for not only cosmetic purposes but medicinal as well. Botox is manufactured by Allergan, and Dysport is produced by Medicis. Both are well-known companies with an excellent reputation for products. Both products have FDA approval for the treatment of glabella (frown) lines for cosmetic indications.

For treatment purposes, the products are quite similar with the only difference being dosing requirements as well as the manufacturing process. Onset, effects, and duration for both are quite similar.

los angeles dysport before and after pictures los angeles dysport before and after pictures

Regardless of which product the patient and practitioner decide upon, healthy competition in this arena is a win-win situation for consumers. This is clearly demonstrated by first-time consumer rebates being offered by Allergan with promotional incentives as well by both companies.

Be sure to discuss your treatment goals and the available options with your practitioner.

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It’s not unusual for patients, both men, to voice concern about their motivation for seeking out aesthetic treatments.

Some curious men will ask, “Do many men get these treatments?” Women, on the other hand, will say, “No one knows that I do these treatments. I’m treating myself today.” A more recent question that I’m asked by patients when receiving their injection treatments is, “do you think I’m being vain?

being vain with botoxI always pause before answering that sincere question. I recognize that the average patient works hard to invest in these treatments, and I’m very aware that they are trusting me with this investment in themselves.
My answer remains the same. “No, I do not. Wanting to help your frown lines or freshen up your appearance is no different than getting your hair done or working out to maintain physical health.”

If we give attention to our physical health, maintaining our hair, nails, or wardrobe, then wanting to improve an important asset, our face, fits nicely into that routine.

I recognize that in this day of endless selfies, outrageous aesthetic treatments, and a society that is overwhelmingly promoting self-centeredness, it’s no wonder that a patient would pose that question.

I have often repeated a mantra over the years of, “crazy people do not wonder if they are crazy.” We can translate that to, “narcissists do not wonder if they are narcissistic” and finally….Vain people do not wonder if they are being vain.

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Us ladies generally know there are many options for our faces, we complain about our necks, but we seldom give attention to our hands beyond a manicure. If we do notice the increasing changes, we rely on expensive and ineffective hand creams. So, what’s changing?

As time marches on, the skin and padding of our hands begins to thin out, we lose volume, the skin becomes more crepy. It is these cascade of events that then allows structures that are usually tucked in tight to become more visible – crazy making visible. Examples: large, bulging veins, bony structures are more prominent, tendons and ligaments give a more ropy appearance.

hand rejuvenationThose that know me know that I am not a fan of my own hands. They work hard and are usually cutting wood and digging in dirt while on my little homestead in the mountains. Arthritis has now set in which makes me a little more self-conscious.

The last thing I want to do is have a manicure that will bring more attention to these paws besides being too lazy and frugal to want to rely on this service. I have been a patient unto myself to use the three treatment plans outlined below, and I want my female patients to know that options do exist.

Brown Spots

Whatever name we give them (ex: sun, liver, or age) brown spots have got to go! Using our Q-switched YAG lasers, we are able to effectively remove these with no downtime and with only 1-2 treatments. This is my favorite laser for several reasons, but for brown spots – it’s the gold standard.

hand rejuvenation before photohand rejuvenation after photo

Dermal Filler Injections

radiesse for hand rejuvenationLasers and moisturizers work to soften and improve the skin of the hands, but what are the options for the other issues? First and foremost, my favorite and direct approach is to use filler injected into the hands superficially under the skin. The reason for this is to restore volume AND camouflage the structures when the filler flows above and around the landscape of the hands. Most patients benefit from 2 syringes of Radiesse one to two times per year. Results are immediate and support a good duration.


A secondary approach is to use sclerotherapy to resolve/remove the larger veins that are not needed. This involves a chemical solution that is injected directly into the vessels. Results are achieved with treatments spaced six weeks apart and may require 2 to 3 (average) treatments for optimal results. Personally, I believe the use of filler offers the best financial investment with a more immediate effect. Using both treatment plans is also an option as well.

sclerotherapy asclera before photosclerotherapy asclera after photos
Sclerotherapy (Asclera) for the hands after 3 treatments

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