Botox/Dysport or Dermal Fillers?

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You might have considered Botox or dermal fillers to address those fine lines and that tired appearance that may have crept in over the last few years.  There is a key difference between the two treatments in the way they are administered, and a very important consideration to take into account before getting one of them done.  Let’s take a little time to look at both types of treatment so you will know what it’s all about.

About Botox/Dysport

  • Botox or Dysport are actually brand names referring to the same medication – Botulinum Toxin A. Botulinum toxin A is a toxin that is produced by the bacteria Clostridium Botulinum in nature, although more precise and sophisticated methods of production are routinely utilized in this modern age.
  • Botox/Dysport are neurotoxins, differing only slightly in their amino acid sequence and structure, accounting for their slightly different actions and results. Botox contains onabotulinum toxin A and Dysport contains abobotulinum toxin A
  • Other brands of botulinum toxin A include Xeomin (incobotulinum toxin A), Lantox and Neuronox (made in China and Korea respectively).
  • In the dosages used for medical as well as cosmetic indications, it has an extremely high safety profile, with a 40 year track record of usage worldwide and over millions of injections safely administered. The LD50 (lethal dosage for 50% of individuals) for botulinum toxin A is around 5,000IU of Botox or 12,500IU of Dysport – a very expensive way to die.
  • As a neurotoxin, Botox/Dysport acts at the neuromuscular junction – the junction where the nerve ending meets the muscles. It effectively prevents the muscles from being able to contract fully, and hence it works very well when treating dynamic wrinkles associated with extremes of expressions (i.e. crow’s feet, frown lines, forehead wrinkles etc)
  • For some muscle groups, the prolonged relaxation and inactivity also results in wasting of the muscles. This allows Botox/Dysport to also be used to reduce the size of the masseter (jaw) muscles and helping to create a V-shaped face, as well as reducing the prominence of the neck muscles, alleviating neck lines and enhancing jawline definition. When used on the calves and shoulders, Botox/Dysport can help to reduce the size of undesired large calf or shoulder muscles, giving a slender appearance to these body parts.
  • Botox/Dysport injections will last anywhere from three to six months. It is not metabolized by the human body and undergoes spontaneous degradation over a six month period without fail. However, in habitual users, the neuromuscular junction probably has a means to compensate against the paralytic effect of the neurotoxin, and hence the effective duration shortens to between three to four months.
  • Side effects of Botox/Dysport are always limited to a maximum period of six months – the maximum lifespan of the neurotoxin in the human body.
  • The common side effects are related to the toxin diffusing to adjacent muscle. During the treatment of frown lines and forehead lines, one may experience depression of the eyebrows or alteration of the brow shape, and in the worst case scenario, drooping of the upper eyelids. Treatment of crow’s feet may at times result in a stiff smile (due to outward and downward diffusion of the toxin) or transient blurring of vision. Similarly treatment for jaw slimming may result in a stiff smile due to forward diffusion of the toxin.
  • The risk of all these common side effects can be greatly reduced with the administration of the appropriate dosage at the appropriate sites on the face, customized for the individual patient. This comes with experience and having performed many treatments.
  • Very rare side effects relate to the toxin entering the blood stream and causing botulism, whereby excess toxin results in generalized paralysis, inability to breath and death. There is a lag time of 12 hours to several days as Botox/Dysport requires time to take action. This has NEVER occurred in a clinical setting when the injecting physician adheres to recommended dosages and uses legitimate Botox/Dysport. Botulism is only seen in cases of Clostridium Botulinum infections.
  • Being a protein based toxin, there is always a theoretical risk of life threatening allergic reactions to Botox/Dysport (known as anaphylaxis). There are very few documented cases worldwide, and such life threatening anaphylactic reactions can also occur to any medication and to various naturally occurring allergens, bee venom and other types of venom. Hence it cannot be viewed as a Botox/Dysport specific risk. Any licensed medical facility carries the necessary emergency equipment and medications to manage such emergencies.


About Dermal Fillers

  • Dermal fillers, as the name implies, are injected into areas of volume loss or defects on the face usually. The commonest type of dermal filler are hyaluronic acid (HA) dermal fillers. Hyaluronic acid is a naturally occurring substance in the human body. When used in dermal fillers, the hyaluronic acid contains a little synthetic cross-linking to stabilize the hyaluronic acid (typically BDDE cross-links), allowing for an effective duration of six to twelve months commonly. Otherwise the hyaluronic acid will be completely degraded by the human body within a week or so.
  • Hyaluronic acid is also commonly found in various face masks and skin booster formulations, as it has the ability to absorb water and hence hydrate the skin and surrounding tissues.
  • Hyaluronic acid dermal fillers are administered via injection to the deep dermal layer or subcutaneous layer typically. There are two main effects of the hyaluronic acid dermal filler:
    • Reversing signs of ageing
  • By addressing the volume loss that comes with ageing, hyaluronic acid dermal fillers can correct sagging cheeks, sunken nasolabial folds, prominent eyebags and other age related facial changes
    • Correcting areas of congenital defects
  • Hyaluronic acid dermal fillers are commonly used to enhance areas of congenital defects, like a short chin, a flat nose bridge/fleshy nose tip, thin lips, sunken temples and other areas of the face. This offers a convenient alternative to plastic surgery with very little down-time.
  • Hyaluronic acid dermal fillers have few side effects. Common side effects are bruising and swelling, and very often minor asymmetry is the cause for patient dis-satisfaction – something which is frequently relating to the injector’s technique and experience.
  • On very rare occasions, dermal fillers of any kind may result in embolism. Embolism refers to the filler material being inadvertently injected into the blood vessels, migrating to another part of the body and obstructing the circulation there. This can result in skin necrosis and breakdown, or in unfortunate cases irreversible blindness. The risks of such complications may be reduced with various safety measures, and is in part related to the choice of filler material (hyaluronic acid being the safest) and the injector technique and experience.
  • As hyaluronic acid dermal fillers contain synthetic cross-links (commonly BDDE) there is the risk of a foreign body granuloma reaction mediated by the white blood cells against the synthetic cross-links. The quoted incidence in literature varies from 0.02% to 0.4% of cases receiving hyaluronic acid dermal fillers. This presents with late onset inflammation of the areas with prior filler injection, and is normally readily treatable with a combination of medications, injections and interventional procedures – no surgery is required.


Before Any Treatment…

When you are thinking about either Botox/Dysport or dermal fillers, you should do a little research first.  You have already learned about Botox/Dysport and dermal fillers, but it is also important to research your doctor. You should be confident in his or her skills and also feel safe in their care. Please note, it should be a medical professional who is administering these treatments. A beautician in a spa is not likely to have had the right amount of training, and she or he is not likely to have any medical training to help you if something does go wrong, nor will the spa have any sort of way to reverse the treatment if you have a reaction.

Don’t be shy about asking your doctor questions. These can include learning about how your doctor received his or her training, and also how long they have been administering Botox/Dysport or dermal fillers. You shouldn’t be made to feel like they are trying to make a sale. They should have your best interest at heart and find the right treatment for you.

You can do a little digging on the internet to see reviews about the brands of dermal fillers and botulinum toxin A as well to learn what other users have to say, and also what medical providers have found about them.

Now that you know the differences between dermal fillers and botulinum toxin A, you can ask your doctor which treatment best suits your needs.

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