Cosmetic Uses of Botulinum Toxin (Botox, Dysport, Xeomin)

Austin dermatologist Steven Zimmet

By Steven Zimmet, MD

Austin, Texas 78703

Physician (MD, DO), Dermatology


Facial lines caused by facial expression are called “hyperfunctional facial lines”. Contractions of facial muscles scrunch the skin and can, over time, damage the collagen and cause prominent lines, such as frown lines, forehead lines and crows feet. Frown lines are often interpreted as anger, anxiety, fatigue, fear or sadness. Relaxing those muscles with Botox®, Dysport® or Xeomin® are generally very well tolerated.

Botox®, Dysport® and Xeomin® are all proteins produced by a bacteria called “clostridium botulinum”. Botox® was first used in the early 1980?s in the treatment of a number of eye disorders, such as strabismus (crossed eyes). Now it is widely used to treat hyperfunctional facial lines. It is also very useful to reduce overactive sweating of the underarms, palms and soles. An emerging use is in the treatment of migraine headaches. Dysport® and Xeomin® are newer forms of botulinum toxin that provide clinical effects similar to Botox®.

These different forms of botulinum toxin all block nerve impulses. If they are injected into a muscle, they prevent the muscle from being activated and stop muscle contractions. Botox® usually takes a week or so to reach full effect. The effects of treatment with Dysport® and Xeomin® may appear a little sooner. Because the effects tend to wear off after a few months, repeat injections are often performed 2-3 times a year.

Botox® has been used in thousands of individuals over many years and has an excellent safety record. However, as with any medical treatment, side effects can occur. Reported side effects include bruising and swelling at the injection site and a transient headache. Ptosis, a drooping of the eyelid and/or eyebrow, occurs in 1-2% of patients and generally resolves within 2 weeks of treatment. Strabismus, a weakening of the eye muscles, is a temporary side effect that has been reported. Although this is a temporary reaction, it could make driving unsafe. This is rare in the doses used for wrinkle treatment.  More serious side effects are rare and usually occur when botulinum toxin is used to treat conditions that require large doses, such as muscle spasticity due to stroke or cerebral palsy.

I do not use Botox®, Dysport or Xeomin in patients who are pregnant or breastfeeding.

Some patients develop resistance to a particular type of botulinum toxin. In such cases, they may benefit from changing to a different type.