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It looks like Botox just smoothed the largest wrinkle it has ever seen. Calling it a wrinkle might be an understatement, a better description would be a very deep furrow. News from today reports that Allergan, the manufacturer of Botox the world’s number one wrinkle reducer, has agreed to pay $600 million to settle a years-long federal investigation into how it marketed its top-selling drug.
The company says it will plead guilty to a misdemeanor charge known as misbranding. This charge is based on claims that the company deliberately marketed to doctors on the use of Botox for non-FDA approved uses starting in 2000. Such unapproved uses included the treatment of headache, muscle pain, spasticity and cerebral palsy. It will cost the company $375 million in connection with that plea and an additional $225 million in civil fines related to the investigation, although the company denies any liability in that regard.
While this is a whopping fine for sure, it is well in line with such plea agreements that have been metered out against other major drug manufacturers in recent years. There is some supposition, probably for good reason, that the company agreed to settle as it is awaiting FDA approval for the treatment of migraines which is reported to be worth $1 billion in sales annually.
As a plastic surgeon and provider of Botox treatments, do I think the company did anything wrong? At the patient care level, I would have had no indication that these alleged practices were ongoing as there were never apparent to me. I suspect that the company got overenthusiastic and even greedy as a monopolistic provider of this type of drug. It has never had any competition until just last year. The FDA has rules for marketing and the company obviously transgressed them.
But the reality is Botox is one of the most used drugs when it comes to off-label or unapproved uses. While it is not magic pixie dust, it has been shown to be useful for a wide variety of neuromuscular uses. I regularly use it in the treatment of migraines, masseteric hypertrophy and myofascial facial pain, all with significant relief and results. The ‘problem’ is that Botox appears to be good for a lot of difficult medical conditions. Because it works it becomes highly used for non-FDA approved indications. As a physician that is within my province to make that judgment. The company, however, does not have that leeway as it is not in the business of practicing medicine.
Some patients will undoubtably wonder if this massive fine means the product is tainted or unsafe. There is nothing wrong with Botox as a drug. It remains safe and effective and freely available for clinical use. This fine is in response to the legalities of marketing, not as a response to how it works or is manufactured.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
Any drug that can change facial expressions can certainly influence how other people see and interpret you. But can they also change how you feel as well?
In the June issue of Emotions, researchers out of New York published a paper which reported that people who were treated Botox treatments not only change their appearance but may also had a weakened ability to experience emotions.
The facial feedback hypothesis (FFH) in psychology has long purported that if an emotion can not be expressed physically then it really doesn’t exist. It has remained largely an unproven theory as it is difficult to isolate an emotion as a physical loci. But the widespread use of Botox, a muscle weakening agent used for cosmetic wrinkle reduction, can suppress emotion by its effect on facial muscle units. This now makes it possible to work with people who have a chemically-induced expressive muscle weakness.
As a result, the theory of FFH can be tested for the first time. A person who has received treatment with Botox can still respond to an emotional event (something that makes them angry) but their facial muscles will be less active. Less muscle stimulation to the brain results with less feedback to the brain about what the face is expressing. This allows for a test of whether facial expressions and the feedback to the brain that it creates can influence our emotions.
The reported study used two groups of patients, one who got Botox injections and a control group which received a cosmetic filler (Restylane) which does not affect the facial muscles. Such a study design allows one to isolate the effects of facial expression and the subsequent sensory feedback to the brain that would follow from other factors, such as intentions relating to one’s expressions and motor commands to make an expression. In the study, the subjects filled out questionnaires about how they felt after watching positive and negative video clips before and after treatment.
The findings of the study shows that those who received Botox had no changes between the pre- and post-treatment emotional responses to the most positive and negative video clips. But, compared to the control filler group, Botox patients had much lower strengths of emotional responses. Their conclusions were that feedback from facial expressions is not necessary to have an emotional experience, but it may modify the intensity of that emotional experience.
Considering the number one reason people have Botox is to decrease the frowning or scowling between their eyebrows, this may also help people feel less angry and irritated. So maybe Botox, and its cousins Dysport and Xeomin, really are tranquility drugs as well.
Dr. Barry Eppley
Indianapolis, Indiana
Case Study: Adjunctive Treatment of Deep Glabellar Wrinkles with Dermnal Grafts
Author: barryeppley
Background: Frown lines are a major concern for many people as they make them look like they are scowling and angry. The frown lines are one of the major undesired facial features that have accounted for the meteoric rise in Botox sales and for making it a household name. Unknown to most, frown lines are actually the only FDA-approved cosmetic indication for Botox, even though it is widely off-label for other facial areas.
Despite the success of Botox in reducing the undesired actions on the skin between the eyebrows (aka glabella) of the corrugator and procerus muscles, one’s frown lines may not go completely away. Once the long-term actions of the muscles have permanently etched lines or grooves into the skin, muscle weakening along will reduce but not eliminate them. Botox is successful for the treatment of dynamic wrinkling (lines that appear when the face moves), static wrinkling (even when one is not moving muscles) requires a different or companion approach.
This is a case of a 50 year-old female who was bothered by her scowling and the unhappy expression that the lines into between her eyebrows gave. She has received Botox injections and, while it was better, still had some obvious vertical furrows in the glabellar area. She desired further efforts on reduction of these lines.
Adding some form of soft tissue filling is the next treatment strategy. Most commonly this is done with injectable fillers which are widely used. She did undergo Radiesse filler injections and was pleased with the results but wanted something that would last longer.
Other forms of soft tissue filling of facial lines and furrows are non-injectable and require a more invasive approach. (although not that much more invasive) Graft or filling options include one’s own fat, allograft dermal grafts (off-the-shelf) and a synthetic implant. (Advanta, also known as PTFE or Gore-Tex)
She desired a collagen-based implant over that of a synthetic one. Through two small nick incisions, above and below the vertical glabellar lines, the soft rehydrated dermal grafts were cut and threaded underneath. This was done as a simple in-office procedure under local anesthesia that took about 15 minutes to do. This provided her with a result that was equal to that of injectable fillers but which would last much longer. She remains with good results one year after procedure.
Adding an injectable filler or a dermal graft to glabellar furrows does not mean that one no longer needs muscle-reducing Botox injections. Deep glabellar furrows requires a double approach in some cases to get the best result, treating both the muscular hyperactivity and the skin etching.
Case Highlights:
1) Deep glabellar furrows or wrinkles may be reduced by controlling the muscle action with Botox but will not be completely gone. In long-established frowning, the skin becomes permanently indented which is not responsive to reducing muscle action alone.
2) Soft tissue filling is a companion treatment to Botox for deep glabellar lines. Treatment options include temporary injectable fillers or longer-lasting implants.
3) While Botox and soft tissue fillers can be done at the same time, it is usually best to do Botox first and see what the results are. Management of the grooved skin can always be done later if further improvement is desired.
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
Scars remain a common patient concern for which numerous treatments are available. One frequently used approach is that of injection therapy. This historically has been done through the use of steroids and, more recently, with a chemotherapy agent such as 5-fluorouracil. These injectional approaches are designed to disrupt how collagen bundles are formed or to disrupt or unbundled those that have formed. There has been usually reserved for the most problematic of scars such as keloids and more severe forms of hypertrophic scars.
Very recently, Botox (botulinum type A) injections have been added to the injectional agent list for scar therapy. Not only have I seen patients who have had their scars injected locally but a few clinical papers in plastic surgery journals have been reported. The logical question is…what is the connection between wrinkles treatments and scar therapy? Does the use of Botox for scar therapy make sense?
As most of the general public is aware, Botox is an anti-wrinkle injection treatment for certain facial areas particularly in the forehead and around the eyes. It works because of its local muscle paralyzing effect, decreasing the presence of dynamic wrinkling. But what does that have to do with what makes scars look bad…or prevent them from ever getting to that point? While Botox has been given some ‘magical properties’ by some, it is not a injection cure-all for anything (and it is being used for a lot of diverse medical problems) and any potential effect must have a biologic basis for its use.
One of the many factors that influences scar outcomes is tension, pulling forces placed on the wound or incisional edges. There are two main factors that cause wound tension. The first factor is how tight is the wound closure, a force that comes primarily from the skin edges themselves. That is a wound influence that the plastic surgeon has some, but not much, control over. Wound suturing techniques help but when tissue as been lost or moved, the closure is going to be under some tension. The body relaxes this tension over time through scar widening and redness. The other tension factor, probably less significant, is the pulling of the tissues from the underlying muscle. This is primarily a potential issue in facial wounds and it has to have the right combination of scar orientation to the direction of the expressive muscle movement action. (scar must be oblique or perpendicular to how the muscle moves) Herein lies the theoretical benefit of Botox scar therapy. If the muscle action is lessened during the early phases of healing, scar widening could theoretically be reduced.
While the use of Botox in scar treatments makes some theoretical sense, its clinical use at this time is far more hopeful than proven. There are numerous factors that influence how a scar will eventually look and limited muscle action around a scar is but just one of them. Such Botox use would have to be done early (within the first few months) and would not have any chance of being effective in more mature scars. But the magical perception of Botox and the understandable anxiety of having a visible scar will likely lead to a lot of useless injection treatments. But hope is eternal and, for the sake of a few hundred dollars, there is no real downside to throwing this injection approach into the alchemy of scar therapies.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Indianapolis, Indiana
Botox is most well known for reducing facial expression activity and the wrinkles that they cause. Less known, but no less appreciated, is its use for excessive sweating or hyperhidrosis. This is another FDA-approved indication for Botox use. For those afflicted with excessive armpit or axillary hyperhidrosis, the relief from the constant wetting and staining of shorts and the embarrassment that it can cause is significant. For reasons not completely understood, the duration of action of Botox for hyperhidrosis is considerably longer than its effect on diminishing facial muscle movement.
Like its use in the axilla, Botox can be very effective for excessive scalp and forehead sweating. Injection technique is critical and should not be confused with how it is placed for forehead and glabellar wrinkles. The injection should be placed just under the skin and not deeper into the muscle or galea. If Botox is injected deeper in the muscle or too close to it, diffusion may occur causing some forehead asymmetry. This is a very minor problem and can easily be balanced out with additional Botox injections. If the injections are well placed and symmetric, however, any effect on the frontalis muscle will be balanced and not problematic.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
One of the typical features of an aging upper face are a variety of skin lines that develop between the eyebrows. The action of specific muscles combined with the effects of gravity create an abnormal skin pattern of vertical, oblique, and horizontal lines. These dynamic and eventual static wrinkles are bothersome for many patients as they create the emotional impressions of anger, grief, and age.
The non-surgical use of Botox injections and the surgical approach of browlifting or foreheadplasty are proven methods of modifying these muscles. By changing the degree or amount that these muscles move, the upper face becomes more relaxed and more youthful.
The corrugator muscle is the main culprit in this indesireable set of glabellar facial expressions. The horizontal portion of this muscle is responsible for pulling the eyebrows inward. When done enough over time, an evident pair of vertical skin creases develop. Known as the ‘11s’, they may also infrequently appear as a single large vertical crease. These vertical lines always extend significantly above the height of the eyebrows.
The oblique glabellar skin lines occur just at the level of the eyebrows, are oriented obliquely, and careful inspection will reveal they are not part of the vertical skin lines. They are caused by the medial eyebrow depressors which consist of the oblique head of the corrugators, the depressor supercilii, and the medial fibers of the orbicularis oculi muscles.
The skin crease that sits below the eyebrows is horizontal and is often called the ‘bunny line’. It is caused by the procerus muscle which pulls down the inner eyebrows. It creates this crease as it pushes down against the more fixed skin of the nose.
The combination of these six muscles flexing over time etches this pattern of glabellar lines between the eyebrows. In essence, dynamic wrinkles eventually become static lines if unchecked. This makes a good argument as to the benefit of early use of Botox or Dysport when one first begins to see this skin pattern appears. Such chemical prophylaxis is effective and many younger women today are embarking on this approach.
In established and deeper glabellar wrinkles, Botox and Dysport injections will make them more shallow but will not make them go completely away. In some cases, injectable fillers must be combined with muscle relaxation injections to make for a nearly complete smooth and wrinkle-free area between the eyebrows.
If one is seeking a more permanent or longer-term treatment, this is where the option of a surgical foreheadplasty comes in. Besides altering the shape and position of the eyebrows, this operation is intended to help lessen these unfavorable glabellar skin lines. This is done by weakening the actions of the aforementioned six muscles through removal or excision of some of these muscles. This is best done through an open incision (coronal or hairline browlift) but good and diligent endoscopic techniques can make a dent in their action also.
Most patients, regardless of their degree of glabellar skin lines, begins with injection therapy to see how much improvement they can achieve. In advanced cases associated with excess upper eyelid skin, the combination of a browlift and blepharoplasty can make for a satisfying forehead result.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Cankle Lipo
Liposuction can be performed almost anywhere there is some thickness of subcutaneous fat. The thick leg, between the knee and the ankle, represents differing thicknesses of subcutaneous fat which yield an amorphous lower leg that has a straight line shape. Creating an improved shape comes by creating a thinner profile, or inward indentation, from the lower end of the calf down to just above the ankle bone. (particularly above the inside of the ankle) Discrete small-cannula liposuction can be safely done to reduce the appearance of a chubby ankle.
The key is to not overdo the liposuction area and focus on a limited treatment area that will make the most difference. Because of the elevated venous and lymphatic pressures, the ankle swelling after surgery is more prolonged than liposuction does in almost any other area of the body. But the results can be very visible later and a modest shape improvement is definitely achievable.
Earlobe Lift
Even though the earlobe is small, it is extremely visible. Its appearance can definitely create an impression as to one’s age. (much like one’s hands) An abnormal earlobe, like the ‘pixie earlobe’ deformity after a facelift, is particularly unflattering and a well-known sign of a ‘bad facelift.’
As we age, the earlobe for some people actually deflates losing some of its fat volume. It may also get elongated, particularly in women, due to decades of ear ring wear. The deflated or stretched out earlobe can be rejuvenated. Injectable fillers are an easy and immediate fix to the wrinkled and delated earlobe. A few tenths of a cc of Juvaderm (or amost any filler) provides an instant plumping. Fillers in the earlobe seem to last longer than almost anywhere else in the face, perhaps due to its slow lymphatic clearance. This is a not uncommon request after someone has had a facelift. The floppy thin earlobe looks out of place after.
In the elongated earlobe, a simple earlobe lift can be done by removing a full-thickness wedge of tissue. Done under local anesthesia, a shorter and fuller earlobe is the result.
Dimpled Chin
Neuromuscular injections have found a low of uses but no matter where it is placed on the face it is for muscle weakening or paralysis of an area of hyperactivity. One of the uncommon but very effective uses for this treatment is in the softening of chin fasciculations. Some patients will experience excessive muscle activity of the mentalis muscle. This is a small but thick muscle that envelopes the bony chin with attachments into the overlying skin. When this muscle becomes stressed, through habit or from straining in a short chin, the chin skin will develop irregular dimples and assume an almost golfball shape. In the extreme, it can be quite noticeable and peculiar-looking.
Muscle weakening injections, like Botox and Dysport, can lessen these chin skin irregularities. While not permanent, repeat injections over time make allow for some expression re-education.
Knee Liposuction
When looking at the legs, it is important to look at the entire legline particularly its inner aspect. The inside of the knee is one small area that can stick out and breakup a smooth transition from the inner thigh down to the calf. It is one of the most bothersome leg areas for many women. It is an easy area in which to do liposuction from a small incision located in the backside of the knee. A surprising amount of fat can be quickly removed and it is important to blend the fat removal down into the upper calf and upward into the knee and lower inner thigh so a smooth flow of the inner leg line is obtained.
It is uncommon to just do knee liposuction alone. It is almost always done as part of inner and outer thigh reshaping. One important patient consideration is that the knee will be sore for some time, often longer than any other liposuction area. Because the knee is a moveable joint, there is a lot of continuous motion across the area leading to prolonged swelling and discomfort. I advise my patient to wear an elastic athletic knee strap afterwards for several weeks. Not only does it stay on but the contiunous support helps reduce discomfort.
Neckline Botox
Even after a good facelift, low neck lines (necklace lines) may still be present. No form of a necklift can produce as much improvement way down in the neck below the adam’s apple as it does above it. These low horizontal lines across your neck are a telltale sign of aging. One of the only methods to treat it are Botox or Dysport injections.
While claimed to produce a bit of a neck lift, some go as far as calling it a “Nefertiti lift.” While there are no other options to treat these neck lines, I have never been impressed that a true neck elongation actually occurs. But a slight softening effect can be seen and it is quick and easy to do. Whether injections into this neck area is beneficial is ultimately based on whether one feels that the cost is worth its temporary effect.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
1. How soon will I see the results of my Botox treatment? And how long will it last?
Unlike injectable fillers, the effects of Botox are not seen immediately. It takes several days for Botox to begin to ‘kick-in’and a full week for its maximal muscle-weakening effects to be seen. Clinical studies show that the average length of time that Botox works is between 100 to 130 days. (three to four months)
2. What is the difference between Botox and Dysport injections?
Botox was FDA approved for cosmetic use in 2002 and was the only injectable facial wrinkle reducer until recently. In the summer of 2009, Dysport became available as a competitive drug to Botox by a different manufacturer. It s a botulinum toxin with a slightly different molecular structure . While Dysport was released with much hype about its potential for lasting longer and being less expensive, my experience in my Indianapolis plastic surgery practice shows that much about it is comparable to Botox. If Dysport has any advantages over Botox, they are not yet apparent.
3. Will my face be frozen afterwards? Will I look unnatural?
A common patient concern and misconception about Botox is that one’s face will look unnatural afterwards…and be like some Hollywood faces. While this can certainly be achieved with Botox, it takes a lot of injections (high doses) and cost to create this unnatural look. And this is usually beyond the budget and desires of most patients. Judicious use of Botox in a few select facial areas produces a relaxed and natural facial look. Botox is primarily used to reduce furrowing betweens the eyebrows, lessen horizontal forehead wrinkles, and make wrinkles around the eyes less noticeable.
4. Does the regular use of Botox keep my wrinkles from getting deeper and keep me looking young?
Because Botox temporarily reduces wrinkling caused by continuous facial muscle activity, its regular use has long-term anti-aging facial benefits. Regular Botox use over years does result in less facial wrinkles because the cause of them has been reduced. I have seen this particularly illustrated in a set of identical twins where one has had Botox for over seven years and the other has not. The amount of facial wrinkles is significantly reduced in the Botox user.
5. Are Botox treatments the same no matter where I go?
In theory, the results of Botox injections should be the same no matter where you go. But there are a variety of factors that affect how well Botox works and what results are obtained. Injector experience, how Botox is prepared, where on the face injections are given, and how many units are administered all affect what results are seen.
6. Can one become immune to the effects of Botox?
Developing a resistance to a drug is always possible. Most patients never develop a tolerance or an immunity, but reported cases do exist. A minority of treated patients will develop a perception that Botox isn’t working as well as it used to. Whether this is because one has become accustomed to the results or whether it really is less effective is not clear. In these cases, one may try Dysport instead which has a slightly different formulation to which the body may be more susceptible.
7. What other cosmetic and medical conditions is Botox useful?
Botox has been around for over twenty years and has a variety of approved uses. Most of these are for muscular conditions such as spasms in cases of paralysis and for strabismus. (continuous eye muscle twitching) Botox has been approved during this past decade for hyperhidrosis (excessive sweating) of the armpits, hands, and feet. Encouraging results are being seen in off-label applications of the face such as in the treatment of certain migraine headaches and TMJ and jaw muscle disorders.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarain West Medical Center, Avon, Indiana
Indianapolis
Botox and Injectable Fillers on Indianapolis Doc Chat Radio Show
Author: barryeppley
On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 12:00 to 1:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon, the very popular topic of injectable anti-aging and facial rejuvenation treatments was presented. With guest facial plastic surgeon Dr. Steve Dayan from Chicago, the numerous injectable treatments of Botox and Injectable Fillers and their role in facial rejuvenation and enhancement was dicussed.
In the past, cosmetic plastic surgery was all about having surgery to reverse the effects of aging on the face. Time was, once you were scared enough by what you saw staring back at you in from the mirror every morning, facelifts, eye tucks and the like were routine procedures with all of the associated bandages, expense and gossiping tongues.
Since 2002, non-surgical injectable alternatives have burst onto the anti-aging scene in ways that never could have been predicted. The concepts of muscle paralysis, plumping fillers, and fat dissolving agents have made it possible to have smooth foreheads, fuller lips and softer laugh lines, and maybe some subtle tightening of the jowls and neck in a few simple visits to the doctor’s office. Unlike surgery, injectable facial treatments are as much about the prevention of the effects of aging as they are about reversing what has already taken place.
Along with this explosion of available injectable treatments have come the inevitable, unbelievable marketing claims, and so-called ‘expert’ injectors. But, like much of what you may read on the internet, in popular magazines, and hear in commercials , what can you really believe? How do you separate reality from marketing hype? How can you decide where-or if-injectable treatments fit into your needs and desires?
Minimally invasive aesthetic enhancement procedures like injectable facial treatments are safe and effective ways of rejuvenating the face and significantly reducing signs of age. Plus, injectable cosmetic procedures can also add volume and new contours to facial features: the lips can be fuller and more defined; a hollow appearance to the cheeks can be greatly improved; and, of course, fine lines, deep wrinkles, and crow’s feet can be smoothed out for a more refreshed, youthful aesthetic.
Injectable treatments, dermal fillers, and other non-surgical procedures offer patients a quick and safe method of achieving more subtle skin rejuvenation and revitalization. Some of the most popular cosmetic injection treatments include BOTOX® Cosmetic and JUVEDERM™, as well as the latest and most innovative options, including fat injections and Sculptra®.
Today’s programs discussed all of these issues to help the listener discern whether and which of the injectable facial treatments is right for them.
Plastic Surgery and Injectable Botox and Filler consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area facilities at Clarian North office at 317-814-4100 or his Clarian West office at 317-217-2200.
Dysport, with its recent FDA approval, offers a competitive product to Botox. Another neurotoxin for aesthetic use is highly welcomed by many as some are frustrated by the service and price that comes from a monopolistic manufacturer. As Dysport has become commercially available, rumors abound that it lasts longer than Botox and its price will be less.
To date, no large scale studies have been published that can support or refute these supposed properties that Dysport provides. In the November 2009 issue of Plastic and Reconstructive Surgery, Kane and colleagues have published results from the clinical trial that evaluated the effectiveness of Dysport for glabellar lines. I presume that this information is what made up most, if not all, of the manufacturer’s submitted clinical data to the FDA for consideration for approval.
This was a phase III, double-blind, placebo-controlled study that was conducted in 27 centers and involved 816 patients. Patients were stratified by race and received a single treatment with Dysport or a placebo based on a variable dose that differed for women and men. They were evaluated up to 150 days after treatment. In essence, this was a very well designed and conducted clinical study.
In reading the results, one can draw the following conclusions of clinical relevance. First, onset of the effects of Dysport were seen as early as 24 hours with a mean onset of 4 days. This does seem earlier than that of Botox and so the rumor that Dysport has an earlier onset of action does seem to be true. But it is not always within the first 24 hours but rather days. This means that it kicks in a few days earlier than Botox on average. The mean duration of effect for Dysport averaged slightly less than 110 days. When compared to Botox, this is a very comparable length of active time. The rumor that Dysport lasts longer than Botox appears to be just that…a rumor not fact. What is very interesting in the study is that the response and duration of action was slightly higher in African American patients. They do not speculate as to why.
A cost analysis was not done as part of this clinical study nor would it be appropriate for a clinical investigation. The study shows that there is not a dose comparison between Dysport and Botox as everyone knows. Given that the ‘average’ dose of Botox for the glabella is around 20 units, Dysport doses ranged from 50 to 80 units based on muscle mass and sex of the patient. That equals roughly 2.5 to 3 units of Dysport to 1 unit of Botox in dose administration. Knowing that ratio should help physicians and patients determine if they are getting a Dysport treatment that is equal to or less in cost than that of Botox.
The rumors that Dysport is ‘better’ than Botox are not substantiated in this large clinical study. It does show that it is just as effective and does offer a true competitive analogue. Whether it will cost less is determined completely by the pricing and incentives that your local provider may or may not give.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis