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Which wrinkle-reducing option is best for you?

December 4, 2022
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Your skin is a window to your age, and wrinkles are one of the biggest signs.

As you add more birthday candles to the cake, it’s completely normal for your facial lines to grow.

The end result of the breakdown of collagen and elastin fibers is wrinkled, says facial plastic and reconstructive surgeon Patrick J. Byrne, MD, chair of the Head and Neck Institute at the Cleveland Clinic in Ohio.

Genetics and skin type are two factors beyond your control that can make you prone to wrinkles. While lifestyle habits, such as sun and pollution exposure or smoking, can speed up wrinkle formation, she says.

According to a study published in the Journal of Aesthetic Surgery, sleeping positions such as sleeping on your face can also etch into lines.

How Botox and Other Wrinkle Reducers Work to Smooth Wrinkles To stop wrinkles in their tracks, you might consider Botox or similar injections. Botox is a catchall word trademarked name used by dermatologists for botulinum toxin type A, an injectable made from a toxin from the bacterium Clostridium botulinum.

Yes, that bacteria also causes botulism, a condition that attacks the body’s nerves, according to the Mayo Clinic but this side effect is rare with Botox injections.

It’s the most powerful neurotoxin known to man, says Dr. Byrne.

The toxin travels to the muscle synapses and blocks the transmission of impulses to the muscle.

When toxins are present in a muscle, that muscle cannot contract around the synapse the small gap between two nerve cells.

This means that the muscles are partially or completely paralyzed, and the result is that expression lines are smoothed out.

Treatments are temporary and can last two to six months. By closing expression lines, you prevent existing wrinkles from carving deeper and more permanently.

The time of onset depends on the patient, but some doctors do not believe in using neurotoxins prophylactically.

If a patient has no eyebrows and they tell me they want Botox so they never get wrinkles, I don’t treat them, says Philip R. Langsdon, MD, a facial plastic surgeon in Germantown, Tennessee. and past president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). But if you notice that a crease doesn’t go away from the facial expression when your face is at rest, you’re at a point where a wrinkle has formed. Then you might consider a neurotoxin.

Beyond Botox: A Look at Your Options Still, you’re not limited to Botox. Most people ask for Botox because it has the most brand recognition, says Dr. Langdon. But there are four other brands that work similarly and you can ask your dermatologist about Dysport, Xeomin, Juneau, and Taxify. Taxify is the newest of these options; The US Food and Drug Administration approved the injection for the treatment of facial wrinkles in adults in September 2020. This may surprise you: The active agents for these are not exactly the same but completely identical. Yet they each have unique carrier proteins that diffuse through the tissue a little differently, said Byrne, who is also a board member of the AAFPRS. Here’s what to know about each injectable.

Botox – What is it? OnabotulinumtoxinA injections, aka Botox, are FDA-approved to temporarily treat moderate to severe frown lines, crow’s feet, and forehead lines, according to the Botox Cosmetic website. Who it’s best for Botox works very well on browbones, crow’s feet, rabbit lines on the sides of the nose, and forehead lines, says Langsdon. A 2019 review published in Clinical, Cosmetic, and Investigational Dermatology adds that Botox may be effective for marionette lines, which run vertically from the corners of the mouth to the chin; wrinkles around the lips; and vertical bands on the neck and reviews note that results last three to six months. Although Langsdon says Botox works well anywhere it’s approved for use, he cautions that some people with low brows may experience drooping of their brows if horizontal forehead lines are treated with a neurotoxin. “Sometimes you have to leave these lines alone, he says. Your dermatologist or facial plastic surgeon will help guide you. Disadvantages Results don’t appear right away, which is important to remember to help manage your expectations (and properly plan treatment if you’re preparing for a big event.

Although the company says results can appear within 24 to 48 hours, we tell patients to give it a week or two for the full effect, Langdon says. Also, because men have more muscle mass, they need higher doses of Botox to effectively reduce wrinkles, often double the effective dose used for women, according to Clinical, Cosmetic, and Investigational Dermatology Reviews.

Dysport – Is AbobotulinumtoxinA, or Dysport, an injectable that can smooth the lines between the eyebrows, according to Dysport’s website? Results are seen within two to three days but may take up to a week. Who it’s best for Some doctors, like Manish Shah, MD, a board-certified plastic surgeon at Shah Aesthetic Surgery in Denver, have steered clear of Botox.

I like using Dysport, says Dr. Shah. He notes that it lasts four months, allowing patients to visit the office only three times a year. Dysport itself says the results can last longer, up to five months in some patients.

There is also a financial benefit: if fewer appointments are needed throughout the year, the end result is that it costs less. It may actually produce better results because in that case, patients are reliably more comfortable on a regular basis, says Shah. In addition, Byrne says, Dysport can travel slightly longer distances through tissues.

It gives you an advantage in certain conditions like crow’s feet, where there is a wider treatment area, he says. Another potential benefit? Reduction of facial oiliness, pore size, and acne, since these neurotoxin injections can interfere with the function of sebaceous (oil) glands, according to a review published in 2021 in Toxins.

The review mentions that Dysport can be one of the better options specifically for this purpose.

These injections aren’t FDA-approved for acne treatment, though, so consider this a potential bonus, not a guarantee. A randomized, double-blind trial published in 2021 in Dermatologic Surgery involving 50 participants found that Dysport injections into the forehead significantly reduced oiliness in the area for six months. Study participants who received the treatment reported that they were very happy with the results.

Disadvantages Other injectables, such as Botox, may perform better when you want to target a specific muscle addressing frown lines between the eyebrows, for example, Byrne says. But that doesn’t mean you can’t get the results you’re looking for with Dysport: These differences are so subtle, I don’t think it matters too much, he says.

Xeomin -What It Is IncobotulinumtoxinA, or Xeomin, is an injection that targets moderate to severe frown lines between the eyebrows, notes the Xeomin website. It’s best for Some people to develop a tolerance to one of these injectables, which makes treatments less effective over time. What makes Xeomin different is that the protein coating of the toxin molecule is much less dense than other neurotoxins, says Shah.

If other injections stop working for you, your doctor may switch to Xeomin. Disadvantages Results appear within three to four days, according to the company, with maximum results after 30 days If you’re looking for effects to appear quickly due to personal preference or upcoming events, Xeomin may not be for you. Also, although the agency says the benefits last for three months, some doctors, including Shah, say their patients feel it often lasts only two. But when you build a tolerance for others, two months seems like a good time, he says.

Juneau -What It Is PrabotulinumtoxinA or Jeuveau, is the second most recent neurotoxin injectable on the market, receiving FDA approval in 2019 for the treatment of moderate to severe glabellar lines the vertical frown line between the eyebrows.

It’s the same particle size as Botox 900kDa, or kilodaltons, which is considered the gold standard for efficacy, says Shah. A double-blind, placebo-controlled study published in 2019 in the Journal of Aesthetic Surgery found Jeuveau to be as effective as Botox in addressing forehead lines. Who’s Best for Juve will interest patients who are interested in trying a new injectable. When it comes to either of these neurotoxins, we have patients who strongly believe that one or the other is better for them, says Byron. Some believe one works faster, is more effective or lasts longer than the other.

It’s a matter of personal preference, and we let patients choose. Disadvantages Although Jeuveau has been around for years at this point, the data is limited, and we don’t have the years of experience with Botox, Dysport, or Xeomin, Langdon says.

Daxxify – Is it Daxxify, or daxibotulinumtoxinA-lanm is the newest wrinkle reducer on the market? It is approved for the treatment of moderate to severe lines or wrinkles between the eyebrows.

This region, known as the glabella, includes the corrugator and procerus muscles. These muscles are what pull your brows down as you pluck them, says Joshua Zeichner, MD, associate professor of dermatology and director of cosmetic and clinical research at Mount Sinai Hospital in New York City.

What makes Daxxify and the other wrinkle reducers on this list the best for one is that the results can last the longest. In trials submitted to the FDA by Daxxify manufacturer Revance Therapeutics (PDF) that led to Daxxify’s approval compared to placebo, 80 percent of participants saw improvement in facial lines four months after treatment.

Meanwhile, about half of the participants saw improvement after six months. Some individuals have even seen their results persist after nine months. This may sound desirable.

But before opting for Daxxify, you’ll want to be a more seasoned injectable neuromodulator user so you know what you’re in for, Dr. Zeichner says. For first-time users, I would recommend a short-acting agent rather than Daxify to make sure you’re happy with the results, says Zeichner. Taxify, he added, is a good option for those who are experienced, know what to expect and like their results.

Side effects In the study, Daxxify reported only minor side effects, such as drooping eyelids, headaches, and facial abnormalities, in a minority of participants, Revance reported. The main drawback is that because the results are so long-lasting, those who are dissatisfied with the treatment may have to wait longer than another injection for the effects to wear off, Zeichner notes.

What You’ll Pay for Smoother, Younger-Looking Skin The American Society of Plastic Surgeons reports that the average cost between Dysport, Xeomin, Juneau, and Botox is $466, according to their 2020 data.

This is the most recent number; prices are likely to be higher in some areas.

Price points vary widely depending on the area being treated, how much wrinkle reduction is desired, and how many units of product are injected. Prices also vary depending on the city or region and individual doctor’s offices. Pricing for Daxxify has yet to be determined, as injectables are not yet available in dermatologists’ offices; It is expected in 2023.

Overall, patient satisfaction is so high because they’re so popular. All of these agents will be effective if used in the right way, Byrne says. The Importance of Working With a Professional When Getting Botox and Similar Injections No matter which injectable wrinkle-reducer you choose, the most important thing is to see a knowledgeable doctor, which means a board-certified plastic surgeon or dermatologist. You need a provider who knows what they’re doing, who you trust, and who you have a relationship with, Langdon says. Someone may offer a lower price, but you need to consider what a provider’s lack of experience might cost you in terms of health and safety. Worryingly, reports cited in a 2018 study in Plastic Surgery suggest that some people are turning to DIY botulinum toxin treatments, self-injecting these agents through tutorials and facial muscle maps found on YouTube and elsewhere on the Internet. It’s not safe, the authors warn. Not only do you run the risk of injecting the muscles incorrectly – but there’s also a chance that the product you’re using could be fake. The American Academy of Dermatology Association (AAD) notes that the side effects of these DIY treatments, including muscle paralysis, Bell’s palsy, and eye damage, can be permanent so the procedure is definitely best left to a professional.

How to know if your dermatologist or plastic surgeon is legitimate If you see a dermatologist, check to see if they’re certified with the American Board of Dermatology. Certification of facial plastic surgeons is through the American Board of Facial Plastic and Reconstructive Surgery, and you can search for board-certified facial plastic surgeons in your area at AAFPRS.org.

And the American Board of Medical Specialties website has a handy search tool that lets you search for any doctor’s board certifications by first and last name and city and state. Free Is my doctor board certified? A tool from CertificationMatters.org.

What to do before you have the procedure Before you have the treatment, your dermatologist will schedule a consultation to discuss it, notes the AAD.

During this consultation, be prepared to discuss your medical history, which will alert your provider to potential complications. Be sure to disclose whether you are pregnant or planning to become pregnant, and your history of surgery, any medications including non-prescription drugs and supplements you take. This consultation is your chance to ask your dermatologist any questions you’d like answered.

The AAD recommends asking the provider how many procedures he or she has performed, who is administering the injections, and the cost, and expected results. Your provider can also talk to you about other treatments that may be a good option for you, as well as whether combining certain treatments will produce better results.