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Injectibles Part 2: Botox Cosmetic & Dysport
Agents such as Botox Cosmetic and Dysport relax muscles and can reduce furrows in the brow and wrinkle lines that come from expression. Expression lines are the "memory of the skin". Over the years, muscles in our face have folded our skin thousands and thousands of times. The skin begins to remember these folds, eventually resulting in a structural change. Botox Cosmetic and Dysport injections reduce this effect when correctly applied to specific areas of the brow and around the eye.
In the forehead patients often want to reduce the downward pull between the eyebrows. The downward pull is responsible for most furrows and also brings the brow down. By weakening these muscles there is a slight brow "lift". Then I may relax the muscles that lift the brow a little bit, just to soften the effect. We like the forces to pull up; we want to minimize the forces pulling down. This is done with precise placement of the product in exact amounts and with the right combinations. Similarly, with the lateral part of the eyelid and around the eyes, I treat a portion of a muscle to get the desired effect, relaxing areas under those expression lines.
When using agents like Botox Cosmetic and Dysport, it's important to understand that the treatments need to be repeated. With only a single treatment, the patient will see a decreased level of activity in the muscles but it won't change the wrinkles. We will need to cultivate improvements over time, a maintenance routine that needs to be addressed every 3-4 months. After a patient has received treatments for a number of years, we can often reduce that frequency. Regular treatments over time deliver the improvement and also prevent the development of deeper wrinkles.
I'm often asked about the difference between Botox Cosmetic and Dysport, a new product on the market. Dysport has been approved by the FDA for injection. I have it, I've injected some of it, and I think there are some differences. Dysport originally positioned itself in the market as a more affordable alternative to Botox Cosmetic, but I'm not sure the cost savings are real once you take into account promotions and discounts. Companies offer certain specials on their products, making prices more competitive. It's a good way to get a discount on these products. Current specials being offered can be found on my website here.
These procedures require a lot of finesse and need to be done in a way so that you don't lose all expression. We've probably all seen an example of Botox Cosmetic gone wrong, and it can look very strange, or even a little stupid. We want to have expression -- we just don't want to have hard expression. So I carefully administer the treatments in a way that makes the expression softer but not expressionless. This is the primary reason I feel strongly that only expert plastic surgeons like myself, with our expert depth-of-knowledge and years of experience working with the anatomy of the face, can utilize these agents correctly and to their optimum potential. Usually the best results are often achieved by a combination of procedures, including surgery, injectables, and skin care.
No single solution works for everyone; many factors need to be understood: skin laxity, sun damage, smoking damage, medical history... as well as the typical changes of aging. We explore all of this during complimentary patient consultations. During these interviews we examine the patient's needs and disposition, and openly discuss a variety of options to find the best combination for each individual. That's the benefit of a consultation from a plastic surgeon -- they can tell a patient the full range of possibilities, how they vary, and if they should be applied.
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 James Green, MD | Plastic Surgery, Santa Fe | Phone (505) 988 2215
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