Still on the Fence About Botox? Try These Alternatives


Hawaii Anti-Aging Cosmetic TreatmentLet’s face it: Botox has gotten a bad rap. Thanks to certain celebrities, some people associate Botox with a “frozen” or unnatural look. They believe that it will immobilize key areas of their faces so they can’t express themselves naturally, making them look emotionless. However, it isn’t the Botox that creates that effect: it’s a poor injector.

When Botox is administered by a board-certified dermatologist who is an expert injector, your face will retain its full range of expressions. The muscles that are specifically injected will relax and no longer press your skin into wrinkles and folds, however, they can still move and allow you to show your emotions.

But if you’re still doubtful about Botox, and would like to explore other options, Dysport and Xeomin are two alternative neuromodulators that can eliminate wrinkles without surgery. Each of them has its own advantages.

Understanding the range of benefits that Botox, Dysport and Xeomin offer will allow you to make an informed decision when you visit your board-certified dermatologist at Kitagawa Dermatology for wrinkle reduction.

What Is a Neuromodulator?

A neuromodulator works by reducing the signals from the nerves (neurons) to the muscles. All cosmetic neuromodulators are based on purified botulinum toxin that, when injected into a muscle, causes the muscle to relax its movements to prevent folding the skin into a crease or wrinkle.


Dysport, by Galderma, is made of purified abobotulinumtoxinA. As with the other neuromodulators, only a minute amount of the toxin is injected into the treated muscle. It comes in single-use, sterile 300-Unit vials that are diluted with saline.

Honolulu Skin Care DermatologistDysport is used to relax the glabellar muscles that cause frown lines, otherwise known as frown lines or “11s.” In a 10- to 20-minute treatment, your dermatologist will inject 50 Units of Dysport into each of 5 points: Two above each brow and one between the brows.

Dysport may work within 24 hours for some patients but by the second or third day following the injections, your brows will no longer push your skin into a severe and unpleasant frown. Yet, they will still be able to move and express your feelings normally.

Without the muscle continually pressing the skin into 11s, the skin smooths out and the wrinkles disappear. You’ll look younger and happier for 4 months or more. Some patients have seen their results last for up to a year. To maintain these results, touch up treatments are recommended.


Xeomin, by Merz, is made of highly purified incobotulinumtoxinA. It is indicated for moderate to severe frown lines between the brows (11s). The FDA approved Xeomin to resolve frown lines in 2011.

Hawaii Cosmetic Dermatology XeominDuring the manufacturing process, any proteins in the toxin that do not have clinical utility are removed. The only ingredient in Xeomin, besides the saline that’s used to reconstitute it, is the active neuromodulator. This may make it easier to tolerate for patients who have sensitivities. Unlike the other two neuromodulators, Xeomin does not need to be refrigerated.

Xeomin comes in 50- or 100-Unit vials, to which your dermatologist will add sterile saline. To treat frown lines, you will receive five injections of 4 Units each: about 1 cm above the middle of each brow, about 1/2 cm above the interior of each brow; and one between the brows just above the start of the nose.

Xeomin may take 2 to 4 days before its effects can be seen. Xeomin can control your frown for up to 4 months. Some patients report it has a “lighter” and more natural-feeling effect than Botox.

Botox Cosmetic

Botox Cosmetic, by Allergan, is made of onabotulinumtoxinA. It’s the only neuromodulator that’s FDA approved for moderate-to-severe frown lines, moderate-to-severe forehead lines, and for moderate-to-severe crow’s feet — those fine wrinkles at the corners of your eyes. It’s been part of the dermatologist’s resources since it was first approved in 1989.

Honolulu Xeomin Wrinkle ProcedureBotox comes in 50-Unit and 100-Unit single-use vials that are reconstituted with a sterile saline solution. Once reconstituted, each vial will contain 4.00 Units of active ingredient in every 0.1 mL.

The amount of Botox needed will depend on the area being treated. To help reduce and prevent crow’s feet wrinkles, your dermatologist will inject Botox into the muscle that curves around the outside of your eye. The injections are made in three places on each muscle, making a triangular pattern that frames the outer eye: under the tail of the brow, on the same horizontal line as the eye corner, and below the first point, equidistant from the middle point.

Forehead lines are treated along with glabellar lines to minimize the risk for a drooping brow. Botox will be injected horizontally in two lines that run across the forehead for a total of 20 Units.

The pattern for glabellar injections is the same as that for Xeomin and Dysport. Quieting frown lines takes 20 Units of Botox.

Botox results are seen within 3 to 4 days. It should keep the muscles quiet and the skin wrinkle-free for up to 3 to 4 months.

Other Uses

In addition to treating glabellar lines, crow’s feet, and forehead lines, there are many other ways that Botox, Xeomin, and Dysport can improve your looks and resolve unwanted wrinkles and creases. These neuromodulators can also be used to treat:

  • Mouth wrinkles
  • Nose wrinkles (bunny lines)
  • Jaw pain (TMJ, bruxism)
  • Square jaw shape (face slimming)
  • Orange-peel chin
  • Platysmal (neck) bands
  • Special conditions, such as excessive sweating, Bell’s Palsy, MS, muscular spasms, crossed eyes, urinary incontinence, and tennis elbow

Botox, Xeomin, and Dysport can also be administered with dermal fillers as part of a nonsurgical facelift to rejuvenate your entire face without surgery. Learn more about injectables at

The Choice Is Yours

All three FDA-approved neuromodulators are effective, fast-acting, and long-lasting. As with all medical or cosmetic dermatology procedures, the most important ingredient is the skill of the dermatologist. To get beautiful, natural results with Botox, Xeomin or Dysport, only trust your face to a board-certified dermatologist who’s been trained in the neural and muscular anatomy of the face.

If you’re ready to take care of your frown lines, crow’s feet, and/or forehead wrinkles, Kory Kitagawa, MD at Kitagawa Dermatology is an expert injector in Honolulu. Call Dr. Kitagawa today to set up an appointment or use our online contact form.