Both are produced from a toxin made by Clostridium bacteria. You may have heard of the medical condition called Botulism which is a form of food poisoning caused by this type of bacteria and the toxin it produces. Botulism was most often found in contaminated cans of various foods and when ingested, caused a rapid paralysis of the muscles in the body leading to either death, or a very prolonged stay in a hospital. Scientists isolated this toxin (known as Botulinum Toxin A)many years ago and as early as the 1950’s, started using it in controlled and small amounts to treat conditions characterized by muscle spasm. For example, in Cerebral Palsy, patients can have such muscle spasms that they become contorted and deformed. Scientists and physicians noted that using small amounts of this toxin in purified form could immediately relax the muscles and stop the spasm without the side effects of botulism.
Around the 1970’s and 80’s the toxin was used to treat strabismus, or “wandering eye” caused by excessive contractions of some of the muscles which control our eyeball movements. A pharmaceutical company named Allergan began research on using this mechanism of relaxing muscles to apply to the face. In other words, the constant contraction of certain muscles in the face leads to the development of lines in the overlying skin.
Allergan theorized that by relaxing those muscles with Botulinum toxin, a patient would be unable to make those expressions which caused fine lines, wrinkles and creases to appear. Thus, Botox was born and began its use in the field of cosmetics in addition to its use in muscle spasms, wandering eye, and even tension and migraine headaches.
HYALURONIC ACID Fillers
While Botox and Dysport act “superficially” meaning on the muscles near the surface of the skin to reduce and soften fine lines and wrinkles, fillers work deep and fill or “inflate” deep folds and wrinkles from the inside out. There are various types of fillers used at Eurolaser and they are from the Hyaluronic Acid class: Hyaluronic acid (HA) fillers include Restylane, Restylane Silk, Restylane Lift, Juvederm XC Ultra, and Juvederm XC Ultra Plus. Hyaluronic Acid (HA fillers) are made of up a large grouping of sugar molecules known as polysaccharides. These polysaccharides are made of a clear gel formulation which is completely biocompatible with the body and is broken down naturally via enzymes in our bodies called Hyaluronidases. Now each of the HA fillers on the market differs mainly in the thickness of the product. So essentially, Restylane is a bit “thinner” and thus more malleable (I can literally sculpt it like clay) and that is why I use it in sensitive areas such as right under the eyes in the tear trough. I also use it in the lips and to fill in lines in the forehead, glabella and crow’s feet which have become so etched and deep that they do not respond to Botox/Dysport adequately. Perlane is a bit thicker and thus is used in areas requiring deeper injections (cheeks, nasolabial folds, jaw bones and occasionally gently in the lips). I say it gives more “bang for the buck” in the sense that it is thicker, but it is important that the injection location is suitable. For example, I would not use it in the tear troughs as it would be too thick and lumpy. Instead I would use the thinner Restylane which I can sculpt and mold along the patient’s existing facial structure.
Juvederm XC Ultra is another nice HA filler which, like Restylane is a bit thinner. Juvederm XC Ultra Plus can be compared to Perlane which is thicker. I do like using these products in the lips and the cheeks, and, as with every patient, I will take a medical history and study their face to determine what I think will be the best product to use and the best locations to inject. Note: The “XC” in Juvederm and the “L” after Perlane or Restylane refer to the fact that there is lidocaine in the product itself. Thus, when I inject filler, I typically first place a topical numbing cream on for 15-20 minutes (and this is why patients should come 20 minutes beforehand). I will apply the topical ointment while the patient is in the waiting room or the treatment room. This numbs the skin somewhat and then, when I inject the product, the lidocaine in the product will make everything under the skin quite numb. Patients may feel the pinch of the first injection or two, but I use very small gauge needles and have a very slow, gentle injection technique so the patient will have a comfortable experience. Now if someone has an allergy to Lidocaine I would inject just regular Juvederm Ultra, Juvederm Ultra Plus, Perlane, and Restylane without Lidocaine.