Botox, Dysport, & Daxxify

Conveniently located to serve Providence, RI

Neuromodulator injections, (Botox®, Dysport®, Daxxify®, Xeomin®, and Jeuveau®) temporarily weaken muscles, diminish sweating, and many other functions. Our office offers three of these products: Botox, Daxxify, and Dysport. Each has some advantages over its competitors, but there are also individual preferences.

Cosmetically, neuromodulator injections are mainly used to reduce the appearance of wrinkles and fine lines, particularly on the face. By temporarily or weakening the targeted facial muscles, these injections can smooth out wrinkles and give the skin a more youthful appearance. The effects of neuromodulator injections typically last anywhere from 3 to 6+ months, depending on the individual’s response to the treatment and the specific area being treated. This non-invasive approach has made neuromodulator injections a favored option for those seeking to enhance their appearance without surgery.

How do these products work?

The way these substances work is by blocking the release of neurotransmitters, which are chemicals that transmit signals from nerve cells to muscles, glands, or other tissues. This blockade prevents the target from performing its usual function such as muscle contraction or sweating.

What is the difference between Botox®, Dysport®, Daxxify®, Xeomin®, and Jeuveau®?

These products all belong to a family of bioactive chemicals called botulinum toxins. Produced by bacteria, there are seven different types of botulinum toxins. Studies have shown that type A works best and therefore all these products are botulinum toxin type A. All are made by different companies, with Botox® being the oldest (FDA approved for facial spasms in 1989, cosmetic approval in 2002). This was followed by Dysport®, Xeomin®, Jeuveau®, and finally Daxxify®.

There are many manufacturing differences between all these products, in terms of associated proteins, molecular weight, and other attributes. Although Daxxify® is the only product manufactured in the United States, Enzer & Associates, P.C. only purchases these products directly from the manufacturer.

Some people find one product starts working faster, has better results, or lasts longer than the others. The pricing is different for each product, and the number of units is different as well. This makes comparisons between providers or products difficult. We recommend focusing on the results. When you get a great result, stick with that product, and stick with that provider.

What can be accomplished with neuromodulators to improve your appearance?

• Smooth or reduce forehead lines.
• Lift your eyebrow(s).
• Shape your eyebrows or improve brow symmetry.
• Open your eyes.
• Reduce lines on the sides of your eyes (“crow’s feet”).
• Smooth your lines between your eyebrows (“11’s”).
• Reduce your lines on the side of your nose (“bunny lines”).
• Increase your upper lip red show (“lip flip”).
• Reduce your lip creases (“smoker’s lines”).
• Turn up the corners of your mouth.
• Reduce your jaw muscle (masseter) prominence.
• Decrease tooth grinding (Bruxism).
• Soften vertical neck bands (platysmal bands).
• Non-invasive face lift (“Néfertiti Lift”)

Who is a good candidate?

Virtually everyone is a candidate for treatment. There are a few contra-indications, mainly for people with neuromuscular weakness conditions, and some antibiotics. You should not receive these products if you are pregnant, trying to get pregnant, or breast-feeding. If you have had a previous problem with these products, please discuss it with one of our providers. It doesn’t necessarily mean you cannot have a treatment.

What is a good age to get my first treatment, or start my treatments?

Typically, any adult from age 21 to even people in their 90’s are candidates for treatment. Starting young has many advantages in terms of preventing or delaying the onset of permanent expression lines.

What should I do to prepare for my treatment?

A bruise is probably the most common side effect of neuromodulator treatment. By avoiding medications, pills, or supplements that interfere with blood clotting for two weeks before your treatment, you will help avoid bruising. If these are prescribed medications, you will need to check with your medical provider before stopping them.

You can come to the office with makeup, and we usually do not need to remove it.

We always recommend having a light meal before your treatment.

If you tend to get lightheaded when you get a blood test or other procedure, please tell us beforehand. We can take special precautions to make sure you are safe and comfortable.

What can I expect during the treatment?

We will take photographs of you at rest and with certain facial expressions. This allows us to create a treatment plan customized for your goals and to give you the most natural aesthetic result possible.

You will be seated in a comfortable chair with soothing music in a semi-reclining position. We usually pretreat the area with ice to minimize discomfort, although the needles used to inject the product are some of the smallest manufactured today. There are some sites that sting more than others, and everyone has different sensitivity levels. But most find the treatment much easier than they imagined.

The fact that people do these treatments every three months year after year should tell you they are very tolerable, safe, and effective.

How long is the procedure?

Most treatment sessions take about 15 minutes but may be more or less depending on the person and number of sites treated.

What can I expect after the treatment?

There might be some bruising at one or more treatment sites, especially if you take any blood thinning products. Sometimes we see a bruise immediately, while other times it may take 1-2 days to emerge.

The first few minutes after your treatment some people describe a feeling like you are aware something was done in the area, although these products do not actually change the sensation of touch.

Rarely, a small percentage of people describe a headache after their treatment. This is a result of the fluid used to reconstitute the neuromodulator, not the medication. In our experience this is rare, mainly occurs with the first few treatments, and then goes away. More often, these products get rid of your headaches.

How long before I notice the treatment is working?

There is a considerable amount of variation between people’s response to these products, areas treated, which product is used, and even different batches of the same product over time. However, in our experience, and confirmed by multiple studies, Dysport almost always starts working the fastest, typically within 2-3 days. The other products typically start working at about day 5-7 after treatment, and all the products peak in their effect at about two weeks.

Do I have any limitations after the treatment?

There are so many different recommendations for what people should or should not do after neuromodulator treatment. None have been verified with randomized medical studies. Therefore, while we do not have specific recommendations, we tell our patients to use common sense, avoiding massage, inversion positions, or heavy exercise the rest of the day after their treatment.

What if I stop treatment?

If you stop treatment then the products wear off, and the muscles start working again. Soon afterwards the facial expression lines return.

How long do the results last?

The effect of your neuromodulator treatment lasts an average of three months. Of course, some people will have longer or shorter durations. Sometimes the effect of the product lasts longer in one part of the face than another.

The newest neuromodulator, Daxxify, contains a proprietary peptide that the company claims make the effect of the product last longer than all the others. In their FDA study the average duration of effect for frown lines between the eyebrows was six months (about twice that of all other products).

What are the risks?

While any medical or cosmetic treatment has risks, botulinum toxin type A has been time tested in humans for over forty years with no proof of any adverse long term side effects.

Short term, the most common side effect of treatment is a bruise. In our practice this happens in about 10% of the treatments and is most common around the outer eyelid area. You can help prevent this by avoiding all medications, over-the-counter pills, and herbal supplements that interfere with blood clotting for two weeks before your treatment. Do not stop any prescribed medication without your medical provider’s approval.

Other potential unwanted effects include headache after treatment, under-treatment, over-treatment, drooping eyes, drooping eyebrows or heavy lids, asymmetry, or spread to unwanted areas.

Tell us if you have a history of facial weakness, stroke, lightheadedness or loss of consciousness with lab tests or procedures, or if you are pregnant, trying to get pregnant, or breastfeeding.

Tell us if you have ever had any problems with previous neuromodulator treatments, or what you think was an allergic reaction.

Finally, and most rarely, there have been more serious side effects from neuromodulators such as double vision, trouble swallowing, trouble breathing, or generalized muscle weakness. There have even been some reported deaths due to overdosage of these products. Usually this is due to illegal use or purchase of the product when used for cosmetic purposes.

What is the cost?

There is a considerable variation in the cost of neuromodulator treatments in our community and across the country. Factors include the cost of the product (Xeomin ® is the least expensive), the amount of product you receive, urban vs. rural, reputation, degree of training (nurse, nurse practitioner, physician assistant, dentist or podiatrist, medical doctor, or a more specialty trained cosmetic physician). Pricing can be offered by the syringe, by units, by area(s), or in steps.

Enzer & Associates, P.C. and Dr. Yoash Enzer were among the first providers of Botox in New England and the United States. Dr. Enzer participated in studies for the first use of cosmetic Botox in 1992 while in training in Los Angeles, a full ten years before being FDA-approved for cosmetic use in the United States.

Now with over thirty years’ experience in use of cosmetic neuromodulators, Dr. Enzer has established Enzer & Associates, P.C. as the leading destination for these treatments in our region and has many patients who fly or drive in from other states to experience his customized care. And under his training for over five years, Ashley Wright, N.P. has emerged as the most sought-after injectable provider in Rhode Island.

Our fees are commensurate with the most established and best reputation providers in the region. Because they are customized for each patient we provide this information after your first consultation. In general, you can expect Daxxify ® to cost about 25% more than the other products, but with about twice the duration, for most patients this amounts to a considerable cost savings each year.

Are there medical uses of neuromodulators that are covered by insurance?

From a therapeutic standpoint, neuromodulators have been used to treat various medical conditions including chronic migraine, involuntary facial spasms, muscle spasticity, excessive sweating (hyperhidrosis), crossed eyes, writer’s cramp, and many other conditions. The way these substances work is by blocking the release of neurotransmitters, which are chemicals that transmit signals from nerve cells to muscles, glands, or other tissues. This blockade prevents the target from performing its usual function such as muscle contraction or sweating. The mechanism for reducing migraine headaches is still not fully understood.

Medical insurance companies may provide coverage for some conditions. The product is expensive, and therefore these companies usually require a thorough preauthorization process. Often, even if covered, many patients incur high copays or other fees. While we have no control over these issues, we do our best to tell you beforehand and help navigate the difficult preauthorization process.

Schedule Your Consultation

Patients all over Rhode Island trust Enzer & Associates with their cosmetic needs. If you’d like to book a consultation, please contact us today! We look forward to meeting with you and helping to give you the rejuvenated look that you desire.