There is no denying that “Botox” is the king of aesthetic procedures. The king has been crowned since 1999; Botox has been the #1 aesthetic procedure ever since. In any game, peak success is normally an amalgamation of various factors, and oftentimes one or two of those factors is sheer luck or being in the right place at the right time. Less commonly, success is achieved purely because of one extremely powerful variable. This is why “Botox” reigns supreme.
That single variable is a neurotoxic protein called Botulinum toxin. Botox is by far the most popular form of this toxin, but not the only one. Just like Kleenex and Bandaid are brands that came to represent the product (tissue paper and a bandage for wounds), Botox is a brand that often represents other products, too. Currently, Botulinum toxin is available via four brands: Botox, Dysport, Xeomin, and, the newest, Jeauveau. Is there any differences between these products? Or is that one variable, the Botulinum toxin, simply the key no matter which you buy?
Board certified plastic surgeons Dr. Stafford Broumand of New York City and Dr. Peter B. Fodor of Beverley Hills and Aspen discuss the extreme success of Botulinum toxin and the differences between the products per their uses.
King Botox
The stats for Botulinum toxin are significant. As mentioned, the use of Botulinum toxin has been the #1 aesthetic procedure since 1999. In 2018 alone, there were 1.8 million procedures performed. This is nearly twice as many procedures as the top 5 surgical procedures combined. Clearly, something is working, and well.
What’s working is Botulinum toxin softening wrinkles and delaying facial aging. The toxin works by temporarily paralyzing facial muscles that causes wrinkles. For example, the muscles that raise the brows that cause forehead wrinkles and the muscles that frown, causing brow lines. If Botulinum toxin is injected into these muscles, they are temporarily paralyzed and cannot be fully used, meaning they cannot make the motion that caused the wrinkles. When they stop being used, the wrinkles significantly soften, and the patient now has a 3 month window where they’ve paused certain aspects of facial aging.
This all occurs from a few simple injections. Needless to say, this is incredibly powerful.
Variety vs. Ability
For Dr. Broumand, varieties in brands for Botulinum toxin isn’t nearly as important as who is injecting the product, and where. In other words, the difference between the available toxins is slight, while the difference between a bad injection and a great injection can be enormous. “I say, ‘It’s my way or the highway’,” he explains. “There are a lot of products that all work similarly, but it’s really in the hands of the practitioner. It’s the way you inject and how you inject, rather than the product you inject.”
Dr. Fodor agrees, although notes that emerging products do seek to achieve slightly differing results. For example, the latest brand into the toxin arena, Jeauveau, claims to last a bit longer than the established toxins, something that some practitioners and/or patients may find attractive. “The question is,” Dr. Fodor asks, “who is it good for? The plastic surgeons? The patients? Or the manufacturers?”
Ultimately for the surgeons, only one thing really matters: consistency of the product.
Product Consistency Means Great Results
While there are 4 toxins now to choose from, it’s more about consistency than it is about their differences. Imagine a great painter specializes in portrait painting. He found and has been using one brush specifically to paint the face, and he knows for every painting he can expect the same results if he uses that brush. Imagine then that there are three other brushes available that are basically the same, but with minor tweaks. For the painter, since his objective is successfully painting a face, being able to expect the same results from his same tool is more important than minute differences that may or may not improve on the way he paints. Even as far as painting goes, this is an analogy that represents the toxins.
“In the hands of a practitioners, I want something that’s consistent and reproduceable, and then translates the artistic vision we have between the patient and myself,” shares Dr. Broumand. “Is it Botox? Is it Jeauveau? Is it Xeomin? If you do something consistently and do it well, that’s what matters.”
On differences, Dr. Fodor notes that Dysport acts a bit quicker than Botox and Xeomin, and therefore might be applicable in a situation where someone needs the product to begin working faster. In his example, this may be for a wedding where someone quickly would like to achieve results with a toxin. While Dr. Broumand agrees with the idea that Dysport may be used in this circumstance, as a practitioner, he doesn’t want to be in that circumstance. “In our practice, we have an understanding with our patients. If they say, ‘You know, I have my daughter’s wedding coming up at the end of the month,’ then we’ll know to treat them at the beginning of the month!”
Practitioner Over Product
As relayed from the surgeons, Botulinum toxin varieties is exciting from a product perspective, but practically speaking sort of irrelevant when it comes to taking care of patients. Because the products are so similar, it highlights how critical selecting the right injector is over selecting the right product. For Drs. Broumand and Fodor, their results come from their knowledge and expertise, not from the product used.