We get this question a lot.
Botox®, much like the other neuromodulator products on the market, such as Dysport®, Xeomin®, and the new Jeuveau® product, are all incredibly effective at reducing dynamic wrinkles on the face. Dynamic wrinkles are those that we create by the repetitive facial expressions we make on a regular basis. The most common areas for treatment include the glabellar ‘frown lines’ seen in the mid-brow area, the horizontal forehead lines, and the crow’s feet. Other areas can also be safely treated ‘off label’ such as the DAO muscles on either side of the mouth, which ‘turns a frown upside down’, as well as vertical lip lines over the top and bottom lips. As a doctor who routinely performs Botox in Phoenix, I feel that all of the currently available products are comparable in their effects.
The onset of action varies slightly between the different products, but it is safe to say that they will all be fully functioning by 2 weeks post-injection. The results we see typically last anywhere from 3-4 months. Duration of action is comparable between the four, currently available, products however, variability is seen and is dependent not only on the dosage used but also on patient characteristics. Long distance runners and fitness buffs, for example, seem to ‘burn’ through their treatments faster than more sedentary patients. A few years ago, there were some reports that zinc deficiency could lead to shorter duration times, though this has been disputed and is no longer believed to play a role.
There are two new products slated to hit the market within the next year or two. Both are currently in the final clinical trial stage. The first one is a shorter-acting botulinum toxin product currently going under the name, ET-001, which is composed of a different serotype of the botulinum toxin called BoNT-E (as opposed to Botox® which is BoNT-A). This product kicks in quickly with results seen after 24 hours but lasts only 2-4 weeks in duration. Allergan has acquired this product and it is unclear how it will be positioned in the neuromodulator market. That said, ET-001 may be a good choice for touch-ups mid-way through an injection cycle, for patients with an upcoming event, or for patients who are wanting to try neuromodulators for the first time.
The second, and more exciting product, in my opinion, goes by the name of RT002 and is made by Revance Therapeutics. This product has a longer duration of action, reportedly lasting up to 6 months post-injection. Depending upon price-point, I suspect that this will be an excellent option for most patients who are looking for a longer treatment effect, or for those that typically experience a shorter duration of action with standard neuromodulators – the long-distance runners, for example. Another benefit for the 6-month duration of action, aside from the obvious (no one loves getting needles poked into their face), is that we often perform dermal filler injections at the same time as neuromodulator treatments. Dermal filler injections typically occur on a 6-month maintenance cycle, so combining these two treatments would mean fewer visits to the doctor – an added convenience for busy patients.
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