Hit Me With Your Best Tox

There are at least four major brands of cosmetic neurotoxins available (in America) right now. It seems everyone wants to make a “better” version, or at least a “cheaper” version.

So the major brands are:

1) Botox—made by Allergan. The first and most well-known version. FDA approval for other indications in 1989, first approved for cosmetics in 2001.

2) Dysport—made by Galderma. Parent company is Mckesson, which has been in the medical business a long time. Probably the second best known. FDA approval in 2009.

3) Xeomin—made by Merz. Another large medical supply company. FDA approval in 2012.

4) Jeuveau—the newest contender, made by a company called Evolus. FDA approval in 2019.

This article isn’t about who’s better, or which one works better, so although I’ll give a little on my opinions, I’ll keep it  mostly neutral. I just want to give an overview of the different brands available, their claims, and what’s really important about all these.

So first, a neurotoxin is a chemical that produces a toxic effect to the normal conduction of the nervous system. Examples include alcohol, tetanus, and clostridium botulinum. The last is a bacteria that is very common in the soil and foods. The toxin it produces is the botulinum toxin—which is the one used for all of the cosmetic neurotoxins.

That bacteria produces a chemical that is highly toxic. Its mechanism of action is, in layman’s terms, a disruption of the normal nervous impulse to a muscle. A muscle only knows to contract by a nerve telling it to do so. If a chemical interferes with that conduction, the muscle relaxes. In larger doses it causes paralysis and even death. For medical purposes, that toxin has been purified, weakened and administered into muscles for spasticity, or in our case, for reducing or eliminating unwanted lines and wrinkles caused by muscle contractions. 

That is important, because not all lines and wrinkles are caused by muscle contractions. The most common are the lines of the forehead, between the brows, or around the eyes. But there are other areas we can treat on the face, depending on what we are trying to achieve.

Other lines are often caused by volume loss, and correcting these areas is accomplished with dermal fillers. That is a full discussion different that what we are talking about here, so we’ll save that for another article. But important to say—it is usually a combination of both Botox and fillers that leads to the best results.

The differences between all these brands is basically the size of the molecules and proteins used to deliver the toxin. There is a lot of controversy over whether the proteins, etc., help protect other systems or whether they can cause the immune system to respond to the medication, potentially rendering it less effective. That discussion will probably continue for a while before we know for sure.

The toxins all come in a powder form that are reconstituted ( made into liquid) by adding saline. The amount of saline used is a “dilution” factor. We do not actually “dilute” toxin, although different amounts of saline can be used to achieve different results. However, too much saline can make the response weaker and risk the spread of toxin to a larger area than desired. The typical reconstitution amount is one mL per 100 units of toxin ( units are just a way of measuring a dose—like milligrams in pills). That isn’t always the manufacturer’s recommendation but seems to get the best results.

Differences in the products:

Everyone responds differently to each of these. I’ve had clients who love Xeomin, but most claim it doesn’t last as long. Therefore we don’t usually offer it.

A lot of clients report that Dysport “kicks in” quicker. I’m pretty certain that has to do with the reconstitution factor, but I’m not sure. I personally don’t think there’s a lot of difference between Dysport and Botox, but Botox just has a more recognizable name, so we tend to do more Botox.

Jeuveau—well it may be too early to tell. I personally had Jeuveau injected at a reasonable dose, and didn’t get anywhere near the result I get with Botox. However, several of the employees here at Willow also received their typical dose equivalent in Jeuveau and report a great result. So time will tell. But if their claim is less cost—I will say that by the time you factor in taxes, rewards back to the client and provider, and the cost of doing business, the savings are not that impressive.

So, the pertinent question here is — what’s most important?

We carry all four brands, and can offer any of these for facial rejuvenation. But it really doesn’t come down to which of the brand names are used—the most crucial factor is the provider’s training and experience. A poorly administered neurotoxin is a bad result—no matter which product you use. A well balanced neurotoxin administration will give great results every time, so then the brand name used doesn’t matter as much, except maybe in how long the results last, which may depend more on the variability of the client response, not so much on the product.

At willow, we are dedicated to providing the best administration of product. We focus more on the individual client’s needs and desires, rather than which product will make us the most money. Our goal is to get you to your goal in facial rejuvenation. What we offer is a result, rather than a product.

So let us help you get the results you want. If a certain brand name is what you’re seeking, we likely have that, but the brand isn’t what gives you the results—the proper administration is. And we stand behind the proper administration of all our treatments.

Come see the Willow difference! 

 

– Dr. James A. Ross, MD