Dr. Philip Schoenfeld of RENU Artful Medicine is a top Washington D.C. facial plastic surgeon who specializes in BOTOX injections for both cosmetic and medical purposes. BOTOX® is best known as a wrinkle treatment, temporarily relaxing “dynamic” wrinkles caused by repetitive facial movements over time.
- What are BOTOX® Injections?
- How Wrinkles Form
- What’s the Difference Between BOTOX and Dysport?
- How Do These Injections Differ from Other Fillers?
- Why Choose BOTOX Cosmetic?
- Before BOTOX®: The Preparation
- What to Expect During Your Visit
- Is there a Recovery Period After BOTOX?
- Potential Risks and Side Effects of BOTOX
- Frequently Asked Questions About BOTOX® and Dysport
What are BOTOX® Injections?
The bacteria Clostridium botulinum produces a neurotoxin, which is then purified to create BOTOX injections. The neurotoxin is known as botulinum toxin, which is how “BOTOX®” got its name. Research dates back to the 1920s, though medical injections were first discovered decades later as a treatment for crossed eyes and uncontrollable eye twitching. Some patients noticed aesthetic benefits following the treatment, which led to the development of BOTOX Cosmetic.
These neurotoxin injections were FDA-approved in 2002 for the cosmetic treatment of the glabellar lines (frown lines) that form between the eyebrows, and in 2013 for crow’s feet at the outer corners of the eyes. Throughout the years, there have been additional approvals for various medical uses, including involuntary contraction of the neck muscles (cervical dystonia), excessive sweating, migraines, lip twitching, and urinary incontinence.
How it Works
When expertly injected into specific muscles, BOTOX prevents nerve signals from reaching muscles that cause contractions. Without these contractions, the muscle movements that form wrinkles do not occur. The effects typically last about 4 months.
How Wrinkles Form
Try as we might, the progression of facial aging is unavoidable due to a number of factors including genetic tendencies, sun exposure, and lifestyle habits like drinking and smoking. Repetitive movements like smiling and frowning, along with aging skin, cause lines and wrinkles to form on areas like the face, neck, hands, and other parts of the body.
Patients often tell Dr. Schoenfeld that they look much older than they feel and want their appearance to reflect their energy level. Wrinkles form when structural components of the skin, including collagen and elastin, are damaged or produced at a slower rate.
What’s the Difference Between BOTOX and Dysport?
BOTOX brand injections are manufactured from botulinum toxin type A by Allergan. This short-term treatment is aimed at smoothing out dynamic wrinkles, those that are caused by facial expressions and regular movements.
The treatment begins to work within about 1 week, with full effects visible within 2 weeks. BOTOX keeps wrinkles at bay for about 3-4 months. The product is received by Dr. Schoenfeld’s office as a powder in a vial which can then be diluted for injected use. BOTOX® injections have been FDA-approved for specific areas of the face and body, though off-label uses exist as well.
Like BOTOX®, Dysport is an FDA-approved injectable that is produced from botulinum toxin type A but is manufactured by Medicis. Dysport is intended to treat dynamic wrinkles and will begin working within 5 days, displaying maximum benefits around the 10-day mark. In most cases, Dysport injections last about 4 months.
Doctors have treated their patients with this brand of injectable in Europe for years, and extensive studies have shown excellent cosmetic results as well as the assurance of safety. If diluted at a different ratio, the benefits of Dysport might not last as long as BOTOX treatments.
Because it is composed of a smaller molecule, Dysport has a greater tendency to diffuse slightly in surrounding tissues, which can be used to the patient’s advantage when treating certain areas of the face. It may also be more advantageous for men, who tend to have larger facial muscles.
Dysport is excellent for improving frown lines, glabellar lines (on the forehead between the eyebrows), and crow’s feet. It is also approved for several medical uses. Some patients who develop an immunity to BOTOX over time may find that Dysport is a good alternative.
A Third Option: Xeomin
Made by Merz Pharmaceuticals, Xeomin, too is created from botulinum toxin type A. There are no additives in the formula, which makes the treatment ideal for those with certain sensitivities. The formula does not require refrigeration, so injections may be more comfortable. Xeomin is FDA-approved for blepharospasm, cervical dystonia, and glabellar lines.
Usually, the effects and costs of each of the three options are similar. Patients can undergo a different type of injection at different times during their treatment plan to determine their preference.
How Do These Injections Differ from Other Fillers?
Both BOTOX® and Dysport are brand names for the safe and effective neurotoxin that creates a mild muscle paralysis for either cosmetic or medical purposes. Following treatment, patients can expect a smoother, younger-looking face. BOTOX® and Dysport are not effective for issues treating issues like skin laxity or areas of diminished fat, however.
Injectable fillers are used to add volume to areas that have experienced collagen loss and fat migration. Fillers are composed of different materials, including those which occur naturally in the human body, such as fat, hyaluronic acid, or calcium hydroxylapatite, or biocompatible synthetics like polyalkylimide, poly-l-lactic acid, or Polymethyl-methacrylate microspheres. Dr. Schoenfeld offers the following injectable fillers at his Washington DC clinic:
- Facial fat injections
- Restylane Lyft
- Juvederm Voluma
Why Choose BOTOX Cosmetic?
BOTOX Cosmetic is one of the most popular non-invasive wrinkle treatments on the market. It has a decades-long track record of safety and effectiveness and helps patients look and feel younger by smoothing away dynamic wrinkles for months at a time.
Botulinum toxin injections can also be used to treat vertical bands of the neck (platysmal bands) that become more prominent with age, as well as excessive sweating, medically known as hyperhidrosis. The appeal of this treatment is the wide array of conditions it can correct.
Since BOTOX® and Dysport are administered during a simple injection session, patients can get back to their normal schedules right away. A recovery period is not necessary following an appointment, making the treatment ideal for busy individuals who do not wish to undergo plastic surgery. BOTOX® Cosmetic injections are also less expensive than many other anti-aging medical treatments and can be maintained for as long as the patient wishes to continue treatment.
Both injections can successfully treat dynamic wrinkles caused by repetitive muscle movement in both men and women. Patients in overall good health who are seeking to improve early to moderate signs of aging may be good candidates for the injections.
Injectables are safe for all skin types and ethnicities. Ideally, patients will have a good understanding of the treatment process and have reasonable expectations for their results. The best results typically occur when fine to moderate wrinkles are treated.
BOTOX® is generally the more popular treatment option, but Dysport may be better for larger areas of the face or for those with stronger muscles. Male patients might prefer Dysport injections for these reasons. The smaller molecules can diffuse to a larger area than BOTOX, and fewer injections or a less potent concentration of the product may be used.
Dr. Schoenfeld can recommend BOTOX® or Dysport based on the patient’s goals and his knowledge of the different products.
Before Dr. Schoenfeld sees a patient for BOTOX® treatments, he will first meet with them for a doctor-patient consultation at RENU Artful Medicine. He will perform an examination of the areas to be treated, including both the skin and surrounding features. He will also review the prospective patient’s medical history and ensure that he is aware of any allergies the patient may have. The doctor will explain the treatment in-depth, including any inherent risks, and answer any questions that may arise during this time.
In addition to BOTOX, Dr. Schoenfeld may suggest medical-grade skincare or discuss a regimen that consists of at-home skincare as well as non-surgical and surgical procedures at his Chevy Chase, MD practice. Each treatment plan is customized to meet the patient’s unique needs.
Before BOTOX®: The Preparation
It is recommended that patients follow the timeline below for best results.
7 days prior:
Discontinue over-the-counter medications that thin the blood and can cause more post-injection bruising – aspirin, ibuprofen, naproxen, and St. John’s wort. Some doctors also recommend eliminating oil supplements like vitamin E and fish oil.
3 days prior:
Avoid smoking and drinking in the days leading up to the appointment.
2 days prior:
Patients can take arnica supplements sublingually (under the tongue) or apply it topically if instructed by Dr. Schoenfeld to reduce bruising.
The day of injection:
Patients should cleanse their skin as instructed and remove any makeup.
What to Expect During Your Visit
BOTOX® treatment sessions typically take less than half an hour to perform, depending on the patient’s needs. Because the needle used is very small, the trained practitioner does not typically need to prep the skin with ice or a topical numbing solution. Pressure or a slight pinch may accompany each injection but should not create long-term discomfort.
The treatment plan may be sketched on the face with a special marker to ensure each requested area is treated. Next, the practitioner may ask the patient to smile or frown to see how the face moves with each expression. These measures create the most precise target-treatment of facial lines. The effects of BOTOX® injections typically last up to six months (3-4 months on average), so injections must be repeated regularly to maintain the results.
Additional Procedures to Optimize Results
BOTOX® injections can rejuvenate the face as a standalone procedure, but they may also be combined with other facial cosmetic treatments for enhanced results. The treatments are often combined with dermal fillers like Radiesse, Juvederm, or Restylane to treat static wrinkles (which are caused by collagen and volume loss).
While BOTOX Cosmetic injections provide a more conservative treatment option than facial plastic surgery, some patients opt to undergo a surgical procedure such as blepharoplasty (eyelid lift) or neck lift to address more extensive signs of aging. Other areas of the face can then be treated with these injections to provide enhanced results.
Other complementary improvements are plump lips, which can be obtained through Juvederm Volbella injections, or a more defined chin and jawline, achieved with chin augmentation. These can be combined with your cosmetic injections.
Is there a Recovery Period After BOTOX?
There is no downtime necessary following BOTOX injections. Patients can return to their normal activities, including work, without having to take any special precautions. While some minor redness or bumps may occur at the injection site, these side effects should resolve within a few hours.
Patients will begin to see results from the treatment in five to seven days, though the maximum benefits may take up to two weeks to become visible. Results are not permanent but tend to last between three and six months. After this time, if a patient notices that the skin once again displays signs of aging, a quick repeat treatment can extend the results.
Potential Risks and Side Effects of BOTOX
BOTOX® cosmetic injections are safe and FDA-approved. Side effects of the treatment will typically dissipate quickly and may include:
- Mild swelling
- Light bruising
More serious complications from this treatment are extremely rare but could include:
- Nerve damage
Hi again, Well... I was at a concert in Dewey last Sunday night (Patty Smith and Scandal... yes, very 80s but I really love their music). Anyway, after the concert, I got to actually meet the band members, which was this huge thrill for me. The fact that the concert and the trip to Dewey were my birthday gifts to myself came up, and I said something about turning 41. The bass guitarist, who was not one second over 30, said to me, "You're kidding! I would have thought you were 31." And I was SO about to blurt out, "WOW, we can really thank my doctor, who just shot me up with Botox the other day!!!" But I managed to just laugh and say thank you and not give up the ghost about the Botox. It was worth every cent of the $375!!! And, no, he was absolutely not hitting on me. So, thank you for your excellent work. I consider this to be a true Botox success story :). Take care,
- I have those little lines above my lips.
- What should I know about the facility?
- How would a forehead lift help my severe brow line?
- Are there any complications associated with Dysport?
- How do I find out if this is the right approach?
Frequently Asked Questions About BOTOX® and Dysport
In cosmetic medicine, this cosmetic injection is a great solution for improving lines that appear as a result of repeated facial movements. In many cases, patients in their 30s to 50s are good candidates for BOTOX® injections and don’t require more extensive surgical corrections. BOTOX® can sometimes even hold off the need for a facelift.
The natural aging process creates other changes to one’s appearance, however, including deep creases in the skin, skin laxity (causing sagging and drooping), and the movement of underlying fat which can simultaneously create bulky and hollow areas of the face.
While this, Dysport, or Xeomin injections can address muscle contractions that cause wrinkles, the injections do not reduce other signs of aging. For the remaining issues, facelift surgery might be more beneficial.
While these treatments may be the best solution for some patients, the injections are not suited for those with advanced signs of aging such as skin laxity, including those with jowls and “turkey wattle,” and displaced fat.
BOTOX® can smooth lines and wrinkles, but it cannot lift or tighten soft tissue like a surgical procedure can. Those with more advanced aging concerns may not see the dramatic results they desire from these injections alone. Dr. Schoenfeld will suggest an appropriate treatment plan for each patient.
BOTOX® is a non-surgical treatment that is ideal for treating mild to moderate dynamic wrinkles. It is best suited for those who cannot undergo surgery or patients who seek quick results with little downtime.
The treatment has few side effects and is very low risk compared to more invasive surgical procedures. The results are temporary and wear off after about 4 months, allowing patients to try different aesthetic approach if they would like.
This treatment safely disrupts muscle-nerve connections and can successfully control or treat a number of medical conditions. BOTOX® Cosmetic has been used to address the following conditions:
• Crossed eyes
• Eye spasms
• Cervical dystonia (a neurological disorder affecting the neck)
• Muscle stiffness
• Limb spasticity
• Urinary incontinence
• Excessive sweating
Visit Dr. Schoenfeld at RENU Artful Medicine of Washington DC to learn more about the ways BOTOX® can enhance your life.
The vertical platysma bands can become prominent during the aging process due to movement of the platysma muscle. The appearance of these bands can be addressed with a non-surgical neck lift involving a series of strategically-targeted injections in the neck muscles. Patients will notice a smoother, younger-looking neck. Most patients choose to address areas of aging on the face and neck simultaneously for a complete makeover.
BOTOX® and Dysport remain effective for about 4 months and should not require additional treatments before this time. Sometimes, the doctor may treat new patients conservatively and offer free touch-ups if more of the product is needed for the intended result. Some patients may need maintenance in other areas of the face and body at different times, depending on when they were treated and for which concern.
Why choose Dr. Schoenfeld
- Double board-certified in Otolaryngology
- Double board-certified in Head and Neck Surgery
- Double board-certified in Facial Plastic and Reconstructive Surgery
- Medical degree from New York Medical College
- MINDBODY Visionary Award