Botox®, Dysport®, and Xeomin® are all different injectables called neurotoxins that are placed under the skin. They work as wrinkle removers by selectively weakening squeezing muscles, allowing the skin to relax and regain its former, wrinkle-free state.
“More people know about Botox® than know about Viagra®. It went from being something no one in their right mind would think about—a poison—to the most popular cosmetic procedure in the United States in a decade. Actors, presidential candidates, and vice presidential candidates use it, though, not all of them admit it.”
– Allan Wulc, MD
What is Botox?
Botox®, originally known as Oculinum, was initially used in FDA studies of patients that had facial eye muscle squeezing disorders. Dr. Allan Wulc took part in conducting the original clinical trials in the 1980s. It was at that time he noticed the effect of Oculinum on wrinkles and spoke about it at an international meeting in the early 90s. Now Botox is a household word. The other neurotoxins that were more recently approved and are also used in our office. Dr. Wulc is a consultant to Allergan, Medicis, and Merz and has trained physicians on his groundbreaking techniques.
Dr. Wulc, the lead surgeon at W Cosmetic Surgery® of Philadelphia, has a unique injection technique, perfected during his 25 years using neuromodulators (such as Botox). This technique is employed by fewer than 1% of aesthetic physicians. Because of his expertise, Dr. Wulc has taught these methods to other physicians and has published his research and findings. Called the “nanodroplet” technique, small doses (much smaller doses than those used by other providers) are placed in multiple locations to selectively elevate certain facial muscles, lessen wrinkles and lift areas that are sagging.
We often see patients who are unhappy with their previous Botox® injections, whether it be at a medical spa, during a “Botox party”, or from another provider. Dr. Wulc can usually make a significant difference through attention to detail and our unique treatment approach.
How Botox Works
Botox®, Dysport®, and Xeomin® are all administered in the office. Before treatment, your facial expressions are observed along with areas of wrinkling.
Dr. Wulc uses a technique that he has developed and refined over the past 25 years. Most of our patients don’t require topical anesthesia (numbing cream) on the injection sites prior to the procedure because Dr. Wulc has several ways of making the injections minimally bothersome.
Patients undergo injections at several sites using a very fine needle. Bruising from Botox® injections is rare and any bruising is usually easily concealed.
The onset of effect varies from person to person, but usually, results of Botox®, Dysport®, or Xeomin® are seen within 5-7 days. If you’re ready to reduce wrinkles, contact us today!
Botox in the neck
We initially reported Botox in treatments to the neck in a paper published in 1994.
Sagging in the neck is often caused by the spasm of the platysma muscle. The platysma muscle, if treated with small doses of Botox, relaxes and improves the sagging in the neck and allows other parts of the muscle to pull upwards—restoring the jawline and recreating a more youthful face and neck contour. With a very small amount of Botox, we have been able to improve the neck by 30% to 50% in select patients.
If a neck is heavy with fat or very very loose muscles, other treatments such as liposuction, Kybella or face and neck lift may be better options.
The “Nefertiti lift” is described because of the beautiful neck that this Egyptian queen is depicted to have had. It is an injection of multiple small doses of Botox into the neck and can improve wrinkles. This is a different indication than for neck sagging and does work. The procedure needs to be repeated every three months.
Some doctors advocate huge doses of Botox to improve the changes in the neck, but there are concerns that these large doses could cause weakness, inability to hold the head up and cause difficulty with swallowing. We do not advocate these large doses nor are they necessary to achieve aesthetic benefit.
Botox for turkey neck
Sometimes neck sagging is caused by what appears to be visible platysmal bands in the neck. These bands of “loose muscle” are actually muscle in spasm and can respond to treatments with Botox. A crepey looking neck can not be treated with Botox but requires other modalities such as Intracel, radiofrequency tightening, Renuvion, or laser resurfacing.
How long does Botox last
Botox weakens muscles for about 2 and a half months. The effect on wrinkles depends on the age of the patient, lasting only three months or so in the expressive and over 40 crowd, and potentially for a longer period of time in those that are either younger or have been getting injected for a longer period of time. In general, patients with sagging necks require Botox every three to four months.
Frequently Asked Questions About Botox
Can Botox be administered around the mouth?
We initially published our results with Botox around the mouth in 1994. Botox can improve jowling, improve some of the marionettes and reduce wrinkles around the mouth. It needs to be repeated every three months.
*Each patient is unique and individual results may vary.
The Botox lip flip in our hands makes the lips pout slightly. It is more effective for the lower lip than the upper lip. This technique has not been published. Descriptions of it are vague, but that’s how it can be used to enhance the benefits of fillers.
This depends on the injector. Juvederm, Restylane, Lyft, Refyne, Defyne, Voluma, Vollure, Volbella and Revanesse, Belotero, all have particular benefits and can be used symbiotically to reshape, sculpture and fill lines, hollows and enhance the appearance of the cheeks, jawline, lips, nose, chin and profile. For patients where “sculpture” and feature enhancement, we like to use these stiffer fillers. For patients who wish more kissable and larger lips, a more liquid-type filler produces those softer lips. For cracks, we will dilute an already thin filler to actually plump up or “spackle” the line.
Intracel
Radiofrequency micro-needling is an exciting new technology that allows direct delivery of multiple growth factors into the skin and produces collagen deposition even if absent growth factors aren’t used. An array of charged needles are inserted superficially into the skin on its surface. RF micro-needling can be used anywhere in the body and is useful for scars, acne scars, wrinkles, stretch marks and dark circles, and sometimes, for removing lower eyelid bags. Some of the other RF technologies hurt more than the Intracel and some of the other technologies also produce unwanted areas of volume loss and irregularity. The Intracel may hurt less because the needles in the array are insulated. The intracel provides both bipolar and monopolar energy which allows the skin and underlying tissues to be treated in two ways. The Intracel works beautifully, well for scarring, wrinkles, crepey skin especially in the neck, wrinkles around the mouth, wrinkles in the cheeks and under eye wrinkles. We also use it to improve the appearance of scars and festoons and postoperatively as well to reduce bruising and swelling, and enhance and speed healing.
Intracel Before and After Photos
*Each patient is unique and individual results may vary.
We have tried Infini and Intracel, and these devices are comparable. However, our patients report that the Infini in our experience is much more painful. Other practices that have had both have also noted this, but Infini is nonetheless also a good product, but in the hands of other users may be effective and less painful. The cost of the Intracel treatment depends on the areas treated and the number of treatments. We generally recommend four treatments. Treatments can be combined with growth factors to enhance the results.
Botox Before and After Photos
*Each patient is unique and individual results may vary.
Microneedling Before and After Photos
*Each patient is unique and individual results may vary.