BOTOX/DYSPORT
FREQUENTLY ASKED QUESTIONS

1. Where are Dysport and Botox injected?

Now, the main areas of injection for both Botox and Dysport are in the muscles of the forehead, the area between the eyebrows called the Glabella (where people can get etched lines which look like “11’s” or “111’s” which make them appear angry), and around the corner’s of the eyes to treat those fine lines called Crow’s Feet.  I also use Dysport and Botox to treat those “bands” in the front of the neck which become more prominent as we become older and in the chin to both lift the corners of the mouth as well as smooth out the chin when it gets that puckered ”orange peel” look.

As mentioned above I will also use Botox and Dysport to treat medical conditions such as migraines, tension headaches, and Bruxism (also called teeth grinding) and TMJ(Temporal Mandibular Joint inflammation).  Although these are medical conditions insurance typically does not cover them so patients have to pay out of pocket like they do with all cosmetic procedures.

As for using Botox and Dysport to treat conditions such as “Hyperhidrosis” or excessive sweating of the hands and armpits, I typically do not do that until all other options and medical treatments have been explored as these injections are expensive and last only a few months.

1. How long do Botox and Dysport last?

This is a question frequently arises.   Essentially, the average duration of Botox and Dysport are 3 months.  This depends on several factors:

1) How much is injected and where:  Some injectors dilute the mixture to get more out of the bottle or just plain inject less to save money.  The result is that your body breaks down the Dysport/Botox that much quicker.  I use the strongest concentration known as a 1:1 ratio.  That just means I don’t dilute my product to try and save money at the patient’s expense.  This ratio is the strongest, but does not have any danger of producing Botulism or long term effects.  Basically, it means I am an honest guy who puts his patients first and wants them to be happy.  I believe it is better to have a smaller number of patients who are happy than having a large number of minimally satisfied or even dissatisfied patients.

2) The patient’s metabolism:  Patients all have different metabolisms, meaning some people break the product down either faster or slower than the average.  Thus, someone with a fast metabolism may get 2-3 months and someone with a slower metabolism may get 5-6 months.  To be safe I tell patients that they should expect it to last about 3 months and as such, at the last part of the second month they can expect to start noticing some movement back in the muscles signaling its time for another treatment.

3) What product is used: Again with both Dysport and Botox, you can say the average time they can expect is 3 months.  I have noticed a trend is some “unbelievable savings” advertisements.  I tend to price my injections in the middle of the road so people of all financial backgrounds can be treated and have access to me.  I am a trained physician who has devloped his own technique, I use the strongest concentration, and I buy my products directly from the company to ensure it is FDA approved and quality control standards have been met.  There is a trend where physicians and med spas are getting “counterfeit” Botox, Dysport, Restylane, Perlane and Juvederm from other countries as it costs much less.  

The typical scenario is that nurses and doctor “injection factories” purchase the product from Canada at greatly reduced prices.  Canada buys them from India and China which do not have FDA approval.  Thus, I find this to unethical if you have no idea what is in the syringe.  Not all great deals you see in the paper mean that the company or physician is using counterfeit product, but I wanted you to be aware of the trend for safety reasons. I try to educate patients to protect them whether they go to me or not.   

To illustrate the dangers of counterfeit product I will tell you that recently a patient was injected with counterfeit Restylane from China and it caused skin necrosis (skin death).  When Medicis investigated the incident they found the product was counterfeit from China and contained cleaning solution (i.e. bleach/ammonia).  I need to mention that Restylane, Perlane and Dysport are manufactured in Sweden only, and go through a stringent inspection process by the FDA to ensure the products are safe before being released in America. 

You will have people ask “How is the counterfeit product legal?” Well, as with most laws created by politicians and lawyers there are loopholes.  It is not illegal to import the product from Canada but it is illegal to dispense and use on a patient.  The next question will be “How will a patient know?”  I show patients the bottle (which does not have Chinese or Arabic writing on it), the expiration date, and lot number.  When using filler I take a sticker off the syringe and place it in the chart with all that information. Thus, if a patient ever wanted to know if the product was real they could have a copy of the lot number and check it with the company.  Additionally they can check with a company via phone or website to see if the physician is registered.  If he or she is not registered and they are injecting, something may be amiss.  There is also a hologram on the box is similar in nature to the holograms on dollar bills which allow us to distinguish counterfeit money from real money.  Finally, if there is a Medicis rebate offer (which often happens once per quarter) the patient must mail in the box top to get the rebate.  If the product is not real, then they do not get the rebate (as the box top will not have the hologram).

4) How long does it take to kick in?

I always tell patients to wait up to 14 days to see the full effect of either Botox or Dysport.  However, because of the way I inject, some people will start to notice an effect within the first 2 days.  Some areas of the face kick in faster than others, so if a patient is concerned they look “crooked”, I tell them to wait no less than 14 days before coming back in.  The reason being is that if I inject a second time to correct an area that has not fully kicked in, the patient will most certainly end up crooked when everything does finally kick in.  The technique I have developed ensures smooth coverage of all muscles to create a natural, “unfrozen” look so I typically do not receive such phone calls.  It is also important to note that all of us have some asymmetry in our faces which makes us look natural and unique.  I maintain the balance of the asymmetrical face to avoid making people look like mannequins.

5)What are the side effects?

The good news is that patient cannot get botulism and there are no long term side effects.  The most common issue is if someone injects into one of the danger areas of the face (i.e. right in or under the eyebrow or under the eye itself), they can get a facial droop.  This is why it is important to have a quality injector who has years of experience in injections and who knows anatomy well.  I always stay far away from the danger areas and have not had any incidents where patients have a facial droop.  Some people also notice they get a headache from the injections.  It is a side effect that hits a minority of the patients and is rare considering I use the same injections  to treat headaches.  The headache usually does not last more than a day or so and I simply tell patients to take Tylenol, Aleve or Ibuprofen. Finally, with any injection there is the chance of infection, bleeding or bruising.  To avoid infection I use a sterile technique and clean the area vigorously multiple times throughout the procedure.  To avoid or minimize bleeding and bruising I use a very small needle and inject at such an angle as to minimize pain and tissue trauma.

6) How many times a year should I do this?

As mentioned above, the treatment lasts about 3 months. It wears off gradually and at the end of the second month and patients can expect to feel some motion of the muscles return.  I ask patients to do treatments 2-3 times per year as we are now finding that keeping up with injections basically keeps those muscles relaxed permanently.  As such, it trains the patient not to make those expressions which contract the muscles which :etch” the lines and this in turn can stop progression of and even begin to reverse some of the lines!  So is it worth the effort and cost?  Definitely!  They have done studies on twins where one received regular doses of Botox/Dysport and the other did not.  The twin who had the treatments looked 10 years younger than the one who did not when they reached their 50’s.