Think about the first image that crosses your mind when you hear the word Botox or facial filler. It is likely one of a plastic, frozen faced woman with evidence of one too many facial plastic surgery procedures, unnatural facial proportions, oversized lips and unnaturally tight skin.  These are the extremes that websites and the media have convinced us are common place.  For this reason, many of my patients are hesitant or scared about using these products as they don’t want that unnatural look.  But they are still in my office asking about what can be done.  So where is the happy medium?  Reverse aging changes in a way that doesn’t appear artificial.  Herein lies the art of facial plastic surgery.  Artfully using these medications can yield great improvements in facial appearance.  Misuse or overuse can do the opposite at great cost to you.

The key to Botox/Dysport is putting the right amount in the right place.  That seems intuitive, but results can vary greatly by the technique used and experience of the injector.  Botox is popular because it works and most people who are happy with their Botox treatment get a nice flattening of the lines between the brows, on the forehead and in the crow’s feet.  When improperly placed, brows drop or have a “Spock” appearance, lower eyelids can sag, and the face may look too inanimate to be real.  To get a natural effect, first start with an experienced injector, one that will study your facial expression and target the problem muscles, rather than just injecting in a standard pattern.  Then, expect to be invited back after the first week to ensure the proper result was attained.  Sometimes, I feel I’ve given my patients enough to relax the forehead evenly, but after a week I need to add a few more units to the outer forehead muscles.  This allows me to better map out the face and subsequent injections will be on target.  Where a few get into trouble is wanting to eliminate every facial wrinkle with Botox and convincing someone to inject them.  Your face needs expression, which is an underappreciated part of facial beauty.  An appropriate dose of Botox will allow for this movement and still soften the telltale signs of aging.  If your doctor takes his/her time and follows up, your results should end up exceeding your expectations.

In like fashion, the key to good filler is the right filler, in the right amount, in the right place.  Again, that seems intuitive, but many people get into trouble when they want either the wrong type of filler or too much filler placed.  An experienced injector will have a preference for certain brands and types of fillers in different areas of the face.  This is usually based on their experience and results. It is in your best interest to let the injector direct you on what filler they want to use.  If you have a strong preference, seek out a person who specifically advertises using that brand.  With regard to the amount of filler placed, many people think more is better.  This is where the unnatural appearance is most likely to enter the picture.  Overinflated lips, cheeks and tear troughs are dead giveaways that work has been done.  My advice is start slow and add as necessary. Fillers all come by the vial.  An injector can inject part or all of the vial and save the rest for a few days until the initial swelling has resolved.  This allows a metered approach and can give you a maximum improvement without overdoing it.  The flip side to this comes when patients expect a maximum improvement at a minimal cost.  Often two to three (or more) vials are necessary to get a significant improvement, especially in the smile lines and cheeks.  With one vial retailing for around $500-600, many people aren’t willing to spend that much on a non-permanent procedure.  This is where you need to have a frank discussion with your injector about what result you can expect and whether you’d be better off saving for a surgical procedure or maximizing other less invasive treatments.  Having appropriate expectations is key to your satisfaction.


We now have 2 good products on the market for smoothing out dynamic wrinkles: Botox and Dysport. Both are forms of botulinum toxin, a potent chemical that blocks signals at the junction between nerves and muscles. Botox (onabotulinum A), has been around for about 30 years and was initially developed to treat disorders of muscle spasm, such as frequent uncontrolled blinking (blepharospasm). Doctors noted that their patients who received Botox around the eyes had decreased wrinkles, an unexpected benefit of the treatment. An enterprising pharmaceutical company, Allergan, sought a cosmetic indication from the FDA. Botox Cosmetic was introduced to the market, approved for treatment of glabellar wrinkles (those vertical lines between your eyebrows). As is often the case, doctors experimented with injecting Botox in many areas of the face and today it is administered all around the eyes, face and lips.

In 2009, a second product came on the market called Dysport (abobotulinum A), which is very similar chemically to Botox. Many doctors have now gained experience with both medications, but which one is better? Patients who have tried both often prefer one over the other stating that one has a faster onset or lasts longer. A double blind randomized trial (the gold standard for research) was conducted in which patients were injected at the crow’s feet on one side of their face with Botox and the other side with Dysport. They were photographed at the time of injection and at 30 days after. They were also asked to rate which side they liked better. Among the 90 patients studied, they rated Dysport better 2/3 of the time and the researchers also rated Dysport as better for smoothing crow’s feet than Botox. The difference was mainly noted when patients were smiling very vigorously. At rest no difference was noted. In other studies, the risks and side effect profiles were equivalent.

In my experience, Botox and Dysport both work well.  Patients who have used both comment that Dysport seems to have a quicker onset (1-3 days vs. 3-7 days), but that hasn’t been universal.  Dysport can be slightly cheaper as the company that distributes it in the US often offers rebates to the patients. If you have been using Botox and it is working well for you, I’d continue with it.  Occasionally people develop a tolerance to one drug and then you could switch over to the other and likely still get good results again. If you have never tried either, the choice is yours. They both work well and are safe.

If you are interested in trying Botox or Dysport, call our office for a consultation at 801-264-4420.