”I wanted to get to a couple of our more recent questions that have come in, and more importantly I want to talk specifically about the new products that are coming on board because there’s a lot of confusion.

There are three now, neuromodulators or “toxins” we don’t particularly like to use the term toxin because all medicines on those are toxins, but the neuromodulators on my mind include all of the botulinum toxin A. They are all serotype A’s that we use in aesthetic medicine and plastic surgery. Botox Cosmetic is the most commonly known one.

Many of you have heard me talk about Dysport, and I’ve placed some information about some studies that we’ve done comparing the two of those and I encourage you to visit those sites if you want to learn more.

As a result of that a lot of people are asking well “Can we use more than one product and take advantage of some of these subtle differences between the products?” Botox may behave a little differently than Dysport.

What we showed in a split face trial where we did Botox on one side and Dysport on the other in the crows feet region, was that there was a slightly better smoothing effect with Dysport.

In fact, one point or 20% on a 5 point scale when you were measuring this thin very small muscle that’s located around the eyes, its small but in square area it’s large and it’s a very fine muscle, and it did a better job on doing smoothing.

So I think a lot of people are thinking well it does a better job of smoothing here and Botox works more locally, can we do Botox or Xeomin in the glabella and Dysport in other areas? There have been some strategies and surgeons talking about mixing these products, in fact, in targeted ways doing Botox or Xeomin or Botox and Dysport on the same patient.

There haven’t been any controlled trials looking at mixing the products. There’s no theoretical disadvantage, physiologically other than the proteins are slightly different and like a lot of vaccines that are proteins, there would be slightly higher theoretical chance that people could develop blocking anti-bodies.

What does blocking antibodies mean? Blocking antibodies means that your body is recognizing these proteins as being foreign invaders, a lot like they would a virus and thus creating the antibody that would attach to the protein and ultimately destroy it. What we know from the cosmetic surgery literature over the, now 15 or more years that we’ve been using Botox is that the incidents of these blocking antibodies, we call it tachyphylaxis, another fancy term for it, where they don’t, there are as active is that it’s quite rare. Its quiet rare in cosmetic surgery because we don’t use very big doses and they’re very limited in their frequency.

In the neurology literature where they’ll be using 3, 4, 500 units of Botox in one setting for large muscles spasticity, there is a measurable incidents of this, of this tachyphylaxis or partial responders or antibody formation blocking, antibody formation.

So the short answer to your question about mixing and matching Xeomin, Botox and Dysport in the same patient is that, I’m not doing it as a part of our practice, the theoretical disadvantage of course is this, is your blocking antibodies or tachyphylaxis.

For most patients we’ll let them choose. They’re very good features of each of them. I think I’ve got a good idea right dozing ranges so we certainly offer it, and as we move forward I think we’ll see Xeomin become a much more important player, just like we’ve seen Dysport rise in its importance relative to the 800 pound gorilla in the room, which is still Botox Cosmetic.

So, if you have any other questions or thoughts on the treatment with these injectable and read a lot of papers on them. I encourage you to visit our website at DrMaas.com where those are reference you can see those papers. Certainly you’re welcome to send in a video to my DrMaas.com blog and/or photographs. I’m happy to answer or just questions and as always I’m happy to respond. This is Corey S. Maas MDTM on Looking your Best.

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