You live your life to the fullest. Smiles and laughter are a regular part of your schedule. Being outdoors, whether in the form of a backyard picnic, an adventurous hike, or a walk to work, is a frequent occurrence. These experiences enrich our lives; however, as we age, repetitive facial expressions and chronic sun exposure can lead to the formation of deep wrinkles and fine lines. Fortunately, advances in cosmetic medicine can help erase these unwanted signs of aging so that your face appears as youthful and vibrant as your day-to-day life.
To find out if BOTOX, Dysport, Xeomin, or Jeuveau can undo the aging effects of chronic sun exposure and constant utilization, visit Dr. Hooman Khorasani at our New York City practice. To request a consultation, text message us securely, or contact us at our Manhattan office by phone at 212-230-3378.
BOTOX®, Dysport®, Xeomin®, and Jeuveau® are called neuromodulators as they have the ability to modulate the tone of facial musculature. When precisely injected into the skin of the forehead, around the eye, or around the mouth, these drugs limit the movement of hyperactive muscles. This in turn prevents the overlying skin from repetitive folding and creasing. Consequently, the benefits of this treatment are two-fold: existing fine lines and wrinkles are effectively smoothed and their forward progression is temporarily halted.
Deeper, more complex furrows like those that frame the chin (marionette lines) or extend from the sides of the nose to the mouth corners (nasolabial folds) may not respond to neuromodulator treatments. Patients seeking to correct these heavy-set lines are more likely to benefit from volumization with dermal fillers or a fat transfer. Please visit our Facial Rejuvenation and Fat Transfer pages to determine if these minimally-invasive treatments can best help you achieve your aesthetic goals.
Dr. Hooman Khorasani is a triple board-certified cosmetic surgeon who has spent over ten years helping patients eliminate bothersome wrinkles and lines so that their outside appearance reflects their youthful spirit. This extensive experience coupled with Dr. Khorasani’s commitment to procedural perfection directly benefits each patient, as your individual treatment plan is carefully customized to provide you with optimal cosmetic results.
The smoothness of your skin is largely attributable to the health and quantity of structural collagen. This important compound is responsible for the elastic properties of the skin and its ability to closely adhere to the underlying structures. Unfortunately, this vital collagen is gradually injured and under-produced with the passage of time. This robs the skin of its firmness and tone, leading to the formation of wrinkles and lines that increase in number and depth with age.
Sun exposure from your daily activities inflicts the most damage, with recent studies suggesting that 80% of the signs of aging are caused by UV energy. Constant creasing when smiling, laughing, frowning, or even talking is another culprit responsible for the depletion of collagen and its associated wrinkling. Aside from its substantial negative impact on your overall health, smoking dramatically accelerates the loss of collagen and can cause your skin to appear ten years older than your true age. Finally, your genetic makeup highly influences the timing, location, and overall appearance of fine lines and deep wrinkles.
BOTOX, Dysport, Xeomin, and Jeuveau all contain variations of a specialized neuromodulator compound. When injected by a highly skilled medical professional like Dr. Khorasani, this product has an impressive track record of safety and efficacy. Neuromodulators selectively target the nerves that control muscle movements and inhibit their ability to initiate contractions. Consequently, targeted administration of this medication can immobilize the strong muscles responsible for the wrinkles formed when smiling, laughing, frowning, talking, or eating. These paralyzing properties can also be used to elevate the brow or reduce the amount of gum that is revealed when smiling.
BOTOX, Dysport, Xeomin, and Jeuveau are all highly potent medications. When administered incorrectly, these drugs can lead to an overly frozen expression, asymmetry, or more serious adverse effects like impaired vision, difficulty swallowing, or breathing abnormalities. As such, it is critical that only certified and experienced health care providers inject BOTOX, Dysport, Xeomin, or Jeuveau. Dr. Khorasani has dedicated his dermatologic career to cultivating an expertise in all types of neuromodulators to facilitate safe and effective skin restoration for his patients. Rest assured that a wrinkle and line reduction treatment with Dr. Khorasani adheres to the highest standards of medical care and is optimized to produce the greatest results possible.
BOTOX is the original botulinum toxin-based drug that entered the market in 2002 and, due to patenting laws, was the only neuromodulator therapy available for multiple years. Following the expiration of the BOTOX patent, Dysport and Xeomin quickly entered the market in 2009 and 2010, respectively. Jeuveau is the latest player in the neuromodulator industry, having just received its FDA approval in February of 2019.
The differences between each of these medications can be summarized as follows:
Tried and true, this drug offers four to six months of reliable improvement in facial wrinkling. Additionally, BOTOX remains localized to the injection site, allowing for highly specific muscle immobilization.
As a faster-acting version of BOTOX, the Dysport-induced reduction in lines is seen several days earlier. The efficacy of Dysport is similar to Botox. This medication also tends to spread more widely than BOTOX, which is beneficial for covering larger-sized areas and larger muscle groups such as the jaw or neck muscles.
This formulation is the most pure form of botulinum toxin, which reduces the body's ability to become resistant to its paralyzing effects. Unfortunately, this also means that this medication is less durable than others, as it is not packaged with proteins to prolong its half-life. Xeomin is favored by patients who have lost efficacy to Dysport and BOTOX. It is also favored by professional actors or on-screen personalities who are dependent on facial expression and would prefer a lighter treatment on the forehead. In patients with these requests, Dr. Khorasani may use Dysport for the frown lines between the eyes and Xeomin on the forehead, as more forehead movement may be desired.
Jeuveau is the newest member of the neuromodulator family. The FDA clinical studies have documented both a fast onset of action and prolonged efficacy. As a relatively new therapy, Jeuveau is less studied than veteran products such as BOTOX or Dysport. Consequently, its clinical track record is still somewhat uncertain at the time of this writing. Depending on your specific health profile, pre-existing skin condition, and overall cosmetic goals, Dr. Khorasani will suggest the most appropriate neuromodulator therapy. Each individual recommendation capitalizes on Dr. Khorasani’s extensive dermatologic experience and has been hand-picked to maximize your aesthetic outcome.
Relaxation of the specific muscles responsible for facial expression inhibits creasing and folding of the overlying skin. This helps restore youthful smoothness to the forehead, the area between the eyebrows, the top region of the nose, the eye circumference, the borders of the lips, and across the neck. Dr. Khorasani precisely monitors the amount of neuromodulator injected into each muscle such that its ability to move is limited, but not absent. This prevents the dreaded “frozen” look that is associated with improper administration of neuromodulators. In addition to enhancing the evenness of the skin, paralysis of the muscles alters the natural progression of fine lines and deep wrinkles. This helps limit the increase in number, depth, and width of these unwanted signs of aging. As such, this neuromodulator treatment provides both instantaneous and preventative benefits.
Please note that this injectable medication does not address discoloration, textural abnormalities, or scarring. Patients seeking to eliminate wrinkles and target these other physical markers of time may consider adding a skin resurfacing treatment to their therapy plan. Please visit our Laser Skin Resurfacing page to determine if our array of innovative laser devices can help comprehensively rejuvenate your complexion. Additionally, neuromodulators do not correct age-induced skin laxity. Check out our Skin Tightening page to ascertain if these minimally-invasive treatments can improve your skin’s elasticity and reveal your youthful facial contours.
Patients with dynamic wrinkles, such as those created when smiling, laughing, frowning, or grimacing, are most likely to benefit from BOTOX, Dysport, Xeomin, or Jeuveau injections. Static lines that are visible regardless of your expression are less likely to respond to neuromodulator therapy. Additionally, this medication is best suited for the correction of mildly to moderately deep-set dynamic wrinkles. Heavy furrows are better addressed with volumizing treatments such as dermal fillers or a fat transfer. Please visit our Facial Rejuvenation and Fat Transfer pages to determine if these alternative anti-aging treatments can help erase your deeper lines.
Treatment with a neuromodulator is also appropriate for patients wishing to prevent the onset of deep wrinkles and fine lines. Early relaxation of the muscles responsible for facial expression limits skin creasing and folding, delaying the progression to permanently wrinkled skin.
Individuals with heavy, sagging brows are also candidates for treatment with BOTOX, Dysport, Xeomin, or Jeuveau. This versatile therapy elevates the skin in this area without surgery, allowing your eyes to steal the show.
Neuromodulator-based masseter and parotid gland slimming helps convert the shape of the jaw from square to oval or heart shaped and enhance overall facial symmetry. Read more about this treatment on our Cheek Reduction page.
Finally, those seeking to improve the appearance of a gummy smile may also consider neuromodulator therapy, as the relaxation of the lip muscle will elongate the upper lip and reduce the appearance of “gummy smiles”.
Prior to treatment, Dr. Khorasani will thoroughly examine your face and neck to determine the most beneficial sites for immobilization and the most appropriate neuromodulator. The target areas will then be marked with a specialized surgical pen to ensure precise application of the medication. After thoroughly cleaning the face and/or neck, the neuromodulator will be meticulously administered in small quantities using a thin, short needle. This process is not painful; however, you may feel brief pin-prick like sensations as the medication is injected. For patients that are highly sensitive to skin stimuli, we will numb the area with a topical numbing cream prior to treatment to ensure maximal comfort.
The longest part of the procedure is the identification of the optimal treatment sites and the precise marking process, as these components require fifteen to twenty minutes to complete. Injecting the medication can be completed in less than fifteen minutes. In total, expect to be with us for approximately thirty-five minutes on the day of treatment.
Aside from its efficacy, patients love neuromodulator treatments because they are associated with zero downtime. You are free to resume normal activities immediately after treatment, as dictated by your own comfort level. We do, however, recommend that you avoid exposure to extreme heat such as hot yoga, steam rooms, saunas and hot tubs for 48 hours after your treatment. Additionally, you should avoid any rubbing of the treatment area for 48 hours after your treatment. Mild swelling at the injection site may be noticed immediately after the procedure but will resolve within a few hours. Bruising is extremely uncommon unless patients are taking aspirin or certain supplements that thin the blood. If bruising does occur, it is easily covered with makeup, and typically resolves within five to seven days after treatment.
The onset of wrinkle reduction varies according to the medication used. Jeuveau and Dysport boast the earliest visible changes, appearing within two to three days of treatment. Xeomin requires more time to assert its effects and may not be visible for five to six days. BOTOX, the original neuromodulator therapy, needs seven to ten days before the results may be appreciated.
The effects of neuromodulators in the muscles of facial expression last approximately four to six months. Most of our patients return to the clinic every 4 months for maintenance treatments. The effects of neuromodulators on the masseter and the parotid gland is more prolonged. Most of our patients complete two treatments, eight weeks apart and return for maintenance therapy every 12-18 months.
Dr. Hooman Khorasani is quadruple board-certified in Dermatology, Cosmetic Surgery, Facial Cosmetic Surgery and Mohs micrographic surgery. Additionally he led the Division of Dermatologic and Cosmetic Surgery at Mount Sinai for over ten years. His dedication to clinical excellence and constant innovation has led to numerous accolades, publications in premier medical journals, and authorship of a widely-used cosmetic surgery manual. He is considered an international expert in skin rejuvenation and has spent a majority of his career training the next generation of dermatologists and cosmetic surgeons.
Armed with this advanced clinical and academic competency, Dr. Khorasani carefully crafts a wrinkle reduction plan that is individually tailored and comprehensively addresses your needs. Personalization is infused into every aspect of our practice, from the treatment itself to our highly-skilled office personnel that are available 24/7 to answer any questions or concerns. Together as a team, we can erase deep wrinkles and fine lines so that your skin looks as young as you feel!
Dr. Khorasani and his highly-specialized team look forward to working with you to transform your medical or aesthetic goals into reality. To expedite a request for a consultation, message us securely, or contact Dr. Khorasani’s Manhattan office by phone at 212-230-3378. For more information about how to get in touch:
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