Q. Can Botox be used around the mouth?A. Yes, but it is technically more difficult so an expert who is experienced in the techniques must be the one injecting the Botox. One of my favorite uses is for the “gummy smile”. This happens when the muscles pull the upper lip up so high, you can see the upper gums. A little Botox in just the right spot lowers the lip to cover the gums when the person smiles. It often results in the lips looking a bit larger as well.
Q. I am very confused about when I need Botox and when I need filler for my crow’s feet.
A. I was part of the FDA trial evaluating the safety and efficacy of Botox in moderate to severe lateral canthal lines (crow’s feet) over 4 years ago. I found that those with severe sun damage and resulting skin laxity needed more than just Botox. Adding filler to smooth the deeper lines, or resurfacing the area with laser will often be necessary for older patients and those with a history of tanning. The daily use of SPF and nightly retinoids (I like Renova best in this area) are very important to smooth the surface texture and prevent further damage. A good skin care program (Teoxane and Neocutis Lumierre Eye Cream on which I did the clinical trial over a decade ago, remain my go to cosmeceuticals to complement the sunscreen and Renova. Finally, I strongly recommend patients begin Botox for crow’s feet in their late 20’s. After 18 years of injecting Botox, I have seen firsthand its preventative benefits in smoothing crow’s feet before they get deeply etched into the skin.
Q. I love my Botox results, but I am hearing about a new product called Xeomin which is supposed to be more “pure”. Is Xeomin better than Botox?
A. Great question. We now have 3 neuromodulators on the market here in the US that are FDA approved for glabellar frown lines (and Botox is FDA approved for lateral canthal lines or “crow’s feet”). Botox has been around the longest for cosmetic use (since 2002) and then we had Mypbloc, but it was not nearly as good, so it is not available. Then came Dysport, which seems to have a larger area of effect than Botox. In my office, most of those who tried Dysport, went back to Botox. A few liked it more, so they have stuck with that product. Recently, Xeomin got FDA approval. It does not have the complexing proteins found in the other 2 products, thus they call it more “pure”. The fact is, no one knows if these complexing proteins are good, bad or make no difference. I have had a few people try Xeomin and a few like it better than Botox. So here is my recommendation: if you love Botox, why switch? If, however, you feel the Botox does not give you the result you like, or it doesn’t last more than 3 months, perhaps you should give the new product, Xeomin, a try.
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