Botox Alternatives: Finding the Right Injectable for You

An Introduction to Botox

Botox is one of the most popular cosmetic procedures in the world. The botulinum toxin used in Botox injections works by temporarily paralyzing muscles, reducing the appearance of fine lines and wrinkles. While traditional Botox is by far the most common, there are actually several different types of botox on the market.

In this comprehensive guide, we'll explore the different types of botox, examining their uses, safety profiles, and effectiveness for cosmetic and therapeutic purposes. We'll also look at emerging botox alternatives and the future of wrinkle relaxers.

What is Botox?

Botox is the brand name for botulinum toxin type A, produced by the biotechnology company Allergan. Botulinum toxins are neurotoxic proteins produced by the bacteria Clostridium botulinum.

While botulinum toxin is extremely dangerous in large quantities, Botox utilizes small, diluted amounts that are carefully injected into specific muscles. This temporarily blocks nerve signals to those muscles, reducing contractions and relaxing the area where it's injected.

When injected into facial muscles, Botox can smooth lines and wrinkles by limiting muscle movement in the treated area. Effects last about 3-6 months as the body slowly metabolizes and eliminates the toxin.

Medical Uses of Botox

While best known for cosmetic purposes, Botox was originally approved by the FDA in 1989 for two medical applications:

• Treatment of strabismus and blepharospasm (involuntary eye muscle spasms)
• Treatment of cervical dystonia (spasms and contractions in the neck)

Since then, Botox has been approved for several other therapeutic uses including:

• Chronic migraine headaches
• Overactive bladder
• Hyperhidrosis (excessive sweating)
• Muscle spasms in the arms or legs

Research is ongoing into using Botox injections to help treat conditions like depression, premature ejaculation, restless leg syndrome, and more.

Types of Botox

There are currently three types of botulinum toxin approved for various uses in the United States and around the world:

OnabotulinumtoxinA (Botox)

Botox is the original brand-name botulinum toxin treatment. Manufactured by pharmaceutical company Allergan, Botox has over 30 years of clinical data supporting its safety and efficacy.

Botox gained FDA approval for cosmetic use in 2002. It's authorized for temporary improvement of:

• Forehead lines
• Frown lines
• Crow's feet

Botox is the most popular wrinkle reducer in the world, with millions of treatments performed every year. Many cosmetic surgeons and dermatologists prefer Botox because of its reliable results and impressive safety profile.

AbobotulinumtoxinA (Dysport)

Dysport is another brand of botulinum toxin type A, produced by pharmaceutical company Ipsen. It contains the same active ingredient as Botox but may have slight differences in inactive ingredients.

Dysport was approved by the FDA for cosmetic use in 2009. It can temporarily reduce moderate to severe frown lines between the eyebrows.

While Dysport and Botox are very similar, some key differences include:

• Dysport may spread to a slightly wider area and have a faster onset of action.
• Dysport may not last quite as long, with effects wearing off after 2-3 months rather than 3-4 months.
• The dosing isn't interchangeable with Botox, as a smaller amount of Dysport is needed to achieve similar results.

Dysport is considered a safe alternative for those who have used Botox before. But for first-time users, Botox is typically recommended due to the more extensive clinical data.

IncobotulinumtoxinA (Xeomin)

Xeomin is the brand name for incobotulinumtoxinA, manufactured by Merz Pharmaceuticals. Like Botox and Dysport, it contains botulinum toxin type A.

Xeomin was approved by the FDA for cosmetic use in 2011, for the temporary improvement of moderate to severe glabellar lines (frown lines between the eyebrows).

A few things that make Xeomin unique include:

• Xeomin doesn't contain accessory proteins sometimes linked with resistance to the effects of botulinum toxin.
• Studies show patients are very unlikely to develop resistance to Xeomin, even with repeated use.
• The onset of action may be slightly faster.
• It may result in less diffusion and less side effects in nearby muscles.

Overall, Xeomin is considered as safe and effective as Botox but provides the advantage of decreased allergenic potential and resistance with long-term use.

Emerging Forms of Botulinum Toxin

With the success of Botox, pharmaceutical companies continue researching and developing new forms of botulinum toxins.

Here are some of the up-and-coming botox competitors to watch:

PrabotulinumtoxinA (Jeuveau)

Jeuveau is the first new form of botulinum toxin approved by the FDA in over 10 years. Manufactured by Evolus, Jeuveau contains prabotulinumtoxinA as the active ingredient.

Jeuveau was approved in 2019 based on clinical studies showing it was a safe and effective alternative for temporarily improving frown lines. Early experience suggests it provides comparable results to Botox at a more competitive price point.

DaxbotulinumtoxinA (DAXI)

DAXI by Revance Therapeutics contains daxbotulinumtoxinA, which utilizes a unique stabilizing excipient peptide to potentially lengthen the duration of effect. Currently in phase III trials, DAXI may eventually provide an advantage of longer-lasting wrinkle reduction between doses.

Botulinum Toxin Type B

Myobloc in the U.S. (also sold under the names Neurobloc or RimabotulinumtoxinB) contains botulinum toxin type B. While type A toxins act on nerve terminals, type B targets the cell body of the nerve.

Myobloc is FDA approved for cervical dystonia treatment but not yet for cosmetic use. Research is ongoing into applications for facial rejuvenation, with the potential advantages of a faster onset of action and decreased skin resistance.

"Baby Botox" and Similar Techniques

"Baby Botox" has become a popular term for using very low doses of Botox for subtle, natural-looking results. However, the term is misleading since actual Botox is not being used in smaller doses.

Rather, "baby Botox" relies on injection techniques like:

• Microdoses of standard-strength Botox placed into more superficial muscle layers.
• Strategic placement of standard Botox doses into select small muscles only.
• Lower volume of dilution used during injection.

This preserves some natural facial movement while still smoothing lines. Areas like the forehead and crow's feet are treated more delicately. When done properly, "baby Botox" can look extremely natural.

Benefits of "Baby Botox"

• Results appear more subtle and gradual.
• Less chance of an overly "frozen" or artificial look.
• May require less product, reducing costs.
• Preserves some natural expressions.

However, it still requires an experienced injector to properly target the right muscles and insert Botox into the appropriate tissue planes. When performed by a skilled injector, "baby Botox" allows patients to maintain a youthful, relaxed appearance.

Are Different Types of Botox Safer or More Effective?

All FDA-approved forms of botulinum toxin have undergone rigorous clinical testing and demonstrated safety and efficacy for their approved applications. However, there are some differences between Botox and newer products:

• Botox - The longest track record of safe cosmetic use, with decades of clinical data.
• Dysport - Similar safety profile to Botox. May provide quicker results but shorter duration.
• Xeomin - Appears safe for those who develop resistance to Botox effects with repeated use.
• Jeuveau - Early safety data comparable to Botox, but less long-term evidence available so far.

While alternative forms of botulinum toxin provide advantages like faster action, less resistance with repeated use, and no accessory proteins, comprehensive safety data over many years is still strongest with Botox Cosmetic.

Off-Label Botox

Some providers offer "off-label" Botox in areas like the neck, chest, and buttocks. Since these are unapproved areas, injection techniques are variable and the long-term safety is less clear.

Patients who choose off-label Botox injections should ensure they're receiving treatment from an experienced provider who follows safe clinical practices.

Comparing Botox and Botox Alternatives

Here is a brief overview comparing traditional Botox to some of the newer alternatives:

Botox

• Active ingredient: Botulinum toxin type A
• Brand name: OnabotulinumtoxinA
• Manufacturer: Allergan
• FDA approved: 2002 (cosmetic), 1989 (therapeutic)
• Treatment areas: Frown lines, forehead, crow's feet
• Use: Temporary wrinkle improvement
• Duration: Approximately 3-4 months
• Ideal for: First-time users, due to volume of long-term safety data

Dysport

• Active ingredient: Botulinum toxin type A
• Brand name: AbobotulinumtoxinA
• Manufacturer: Ipsen
• FDA approved: 2009
• Treatment areas: Frown lines
• Use: Temporary wrinkle improvement
• Duration: Approximately 2-3 months
• Ideal for: Experienced Botox users seeking quicker results or shorter duration

Xeomin

• Active ingredient: Botulinum toxin type A
• Brand name: IncobotulinumtoxinA
• Manufacturer: Merz Pharmaceuticals
• FDA approved: 2011
• Treatment areas: Frown lines
• Use: Temporary wrinkle reduction
• Duration: Approximately 3 months
• Ideal for: Those who develop resistance to Botox effects

Jeuveau

• Active ingredient: Botulinum toxin type A
• Brand name: PrabotulinumtoxinA
• Manufacturer: Evolus
• FDA approved: 2019
• Treatment areas: Frown lines
• Use: Temporary wrinkle improvement
• Duration: Approximately 3-4 months
• Ideal for: Those seeking a competitively priced alternative to Botox

Finding an Experienced Botox Provider

The skill and experience of the provider plays a critical role in achieving safe, aesthetically pleasing Botox results. Always look for an experienced injector like a board-certified plastic surgeon or dermatologist.

Be sure your provider:

• Has specialized training in facial anatomy.
• Regularly achieves natural looking results.
• Uses proper injection techniques to minimize risk of complications like ptosis (drooping eyelid).
• Offers newer forms of botulinum toxin FDA approved for cosmetic use.
• Has an aesthetic eye for facial balance and proportions.

View before and after photos to evaluate the provider's work. Schedule a consultation to make sure you feel comfortable with their approach and have a treatment plan customized for your facial rejuvenation goals.

Preparing for a Botox Treatment

Following these tips can help you get the most out of your Botox or Dysport treatment:

• Avoid blood thinners like aspirin, ibuprofen, fish oil, and vitamin E for 1-2 weeks pre-treatment, as this can increase bruising risk.
• Discontinue retinoids like tretinoin 3-5 days before injections to minimize skin irritation.
• Schedule just before a weekend or relaxed period to allow down time if any side effects like headache or bruising occur.
• Optimize your results by maintaining consistent follow-up appointments every 3-4 months once you begin treatment.

Be sure to communicate your treatment goals and expectations during your consultation. And don't hesitate to schedule a follow-up 2 weeks post-injection to refine results if needed by having additional product placed.

Caring for Skin After Botox

Following these tips can help reduce side effects and speed healing after your Botox or Dysport treatment:

• Avoid rubbing or massaging the treated areas for 24 hours to prevent the toxin from migrating.
• Sleep face-up and avoid pressure on treated areas overnight.
• Apply cool compresses as needed to decrease swelling, redness, and tenderness.
• Use a gentle cleanser and moisturizer that won't irritate skin.
• Avoid facials, chemical peels, microdermabrasion, and laser treatments for 1-2 weeks.
• Wear broad-spectrum SPF 30+ daily to protect skin.

Results become visible within 3-10 days as the neuromuscular blockade sets in. Maximum effect is seen at about 1 month. Schedule a follow up during this time to assess your response and whether touch-up doses are needed.

How Long Botox Results Last

Botox results last approximately 3-6 months, depending on the patient. With repeated treatments every 3-4 months, the effect can last longer before wearing off.

Factors affecting Botox duration include:

• Dose - Higher doses may produce longer-lasting results.
• Metabolism - Results may wear off sooner in those with faster metabolism.
• Gender - Some research shows shorter duration in men due to muscle size and activity.
• Age - Younger patients tend to have shorter response times.
• Muscle movement - Expressive "super-animators" may metabolize Botox more quickly.

With routine maintenance appointments, smoothing of lines and wrinkles can be sustained long-term without having to start over from baseline.

Risks and Side Effects

When performed correctly, Botox is a very safe procedure with few side effects. Possible temporary adverse reactions include:

• Mild pain

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.