Dr. Kenneth Beer

Botox is most commonly injected in the area it’s FDA approved for, frown lines. A close second, is a combination of injections into the forehead and outside the brow to give a brow lift.

There are studies that show that within 48 hours,patients notice an onset, but typically we see maximal onset in 5 to 7 days. Also studies using Dysport, Xeomin, show a very rapid onset, sometimes within 2 to 3 days.  How long it lasts depends on the dose.  If you go to discount place that waters it down, it might only last 4 to 6 weeks; but, in general, the duration is 3 to 4 months; and you get longer duration after several visits.  Patients who have been treated for 8 to 10 years break their habit of wrinkling, so they don’t need to use it again for 6 months or more.

It’s kind of like Coke and Pepsi. In a lot of respects, injectors have a different response depending on a patient’s anatomy and biology. They are all good products. Xeomin is a protein that doesn’t have additional molecules with it that bind the actual active molecule. Some physicians think this is better while others prefer the carrier molecules. Each is manufactured in a different way, and there are subtle differences between them. Each has its own advocates, but Botox still retains the lead in terms of number of injections. The arrival of the two new competitors has increased the amount of people getting injections; so they all are increasing their marketing because of competition.

The biggest difference is what they are made of. Restylane, Perlane, Juvéderm, and Belotero are hyaluronic acids or sugar-derived molecules. They are all clear and gel-based. Juvéderm tends to be smoother and great for thin skin and for filling superficial lines. Restylane and Perlane are more particulate and firmer so are better for injectable facelifts and sculpting. To lift up the mid-face, or if there are deeper lines, we use a thicker product like Radiesse. Radiesse is a calcium-based filler, that is white and thicker. Because of its color and thickness, it needs to be placed deeper in the skin. It’s not intended for use in the lips or under the eyes. Any of the hyaluronic acids can be digested, so that if you get a lump or a bump, it’s easy to fix. Radiesse is harder to get rid of, but the flip side is that it lasts longer and has a lot more lifting capability.

Prevelle lasts for a few weeks; it’s a low concentration, a low cross-linked, hyaluronic acid. Radiesse lasts six to nine months. Sculptra lasts 12 to 22 months. Juvéderm, Restylane and Perlane last six to 12 months (depending on whether an enhancement injection is done after the initial injection).

It’s a collagen-stimulating molecule. Whereas other products are used for lifting, sculpting or filling, Sculptra is used for volume replenishment. It causes the body to make collagen, and, unlike the other fillers, it requires a series of injections. It’s absolutely wonderful for sunken cheeks, fallen temples, filling out the jawline, and it can bridge the gap between filling lines and facial volume restoration. As we age,the face loses volume and everything goes south. Sculptra can reinflate the face and pull things north by creating collagen. You can combine Sculptra with other products. This really gives someone a renovation without surgical intervention.