Which Wrinkle-Reducing Option is for You?

Your skin is a window into your age. Most telling: wrinkles. It’s entirely normal for the lines on your face to increase as you add more birthday candles to your cake. “Wrinkles are the end result of collagen and elastin fiber breakdown,” says Patrick J. Byrne, MD, MBA, a professor and the director in the division of facial plastic and reconstructive surgery at the Johns Hopkins University School of Medicine in Baltimore. Genetics and skin type are two factors out of your control that can make you more prone to them, while lifestyle habits, like sun and pollution exposure or smoking, can speed up wrinkle formation, he says. Sleep position — namely sleeping on your face — can also etch in lines, according to a study published in theAesthetic Surgery Journal in June 2016.

How Botox Works to Smooth Wrinkles

To stop wrinkles in their tracks, you might consider Botox. That’s the catchall name dermatologists tend to use for botulinum toxin type A, injectables that are made from a toxin that comes from the Clostridium botulinum bacteria. (Yes, that bacteria also causes botulism.)

By stopping these expression lines, you also prevent wrinkles from carving in deeper and more permanently. The start time is up to the patient, but some doctors don’t believe in using neurotoxins preventively. “If a patient doesn’t have a frown line and they tell me they want Botox so they’ll never get a wrinkle, I don’t treat them,” says Phillip R. Langsdon, MD, a facial plastic surgeon in Germantown, Tennessee, and the president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). But if you see that a crease from a facial expression doesn’t go away when your face is at rest, you’re at a point where wrinkles have formed. It’s then that you may consider a neurotoxin.

Beyond Botox: A Look at Your Options

Nevertheless, you’re not limited to Botox. “Most people come in asking for Botox, as it has the most brand recognition,” says Dr. Langsdon. But there are three other neurotoxins that work in similar ways to ask your dermatologist about: Dysport, Xeomin, and Jeuveau, the last being the newest in the category.

What may surprise you: “The active agent for all four of these isn’t just similar but is totally identical. Yet they each contain unique carrier proteins that diffuse through the tissue slightly differently,” says Byrne, who’s also a board member of the AAFPRS.

What You'll Pay for Smoother, Younger-Looking Skin

The American Society of Plastic Surgeons reports that the average cost among all these injectables is $397, per their 2018 data. Price points differ widely depending on the area treated and how much of a wrinkle reduction is preferred. Prices also vary depending on the city or region and among individual doctors’ offices.

Overall, “patient satisfaction is so high because they’re so popular. All of these agents will be effective when used in the right way,” says Byrne. If you’re considering one of these noninvasive injectables, here’s what dermatologists tell their patients about the different brands:


What it is

OnabotulinumtoxinA injections are FDA-approved to temporarily treat moderate to severe frown lines, crow’s-feet, and forehead lines, according to the Botox Cosmetic website.

Whom it’s best for

“Botox works very well in the crease between eyebrows, in crow’s-feet, in the bunny lines on the sides of the nose, and forehead lines,” says Langsdon. While Langsdon says Botox works well in any place it’s approved for use, he cautions that some people with low eyebrows can see their eyebrows drop lower if horizontal forehead lines are treated with any neurotoxin. “Sometimes you have to leave these lines alone,” he says. Your dermatologist or facial plastic surgeon will help guide you.


Results do not appear right away — and that’s important to keep in mind to manage your expectations (and properly plan treatment if you’re preparing for a big event). Though the company says that results may appear in 24 to 48 hours, “we tell patients to give it a week or two for the full effect,” he says.


$550 is the average, according to more than 14,000 member reviews on RealSelf.


What it is

AbobotulinumtoxinA is an injectable to smooth the frown lines between the eyebrows, according to Dysport’s website. Results show up within two to three days but can similarly take up to a week.

Whom it’s best for

Some doctors, like Manish Shah, MD, a board-certified dermatologist in Denver, have moved away from using Botox. “I prefer to use Dysport,” he says. Dr. Shah points out that it lasts four months, allowing patients to visit the office three times per year.

There’s a financial advantage, too: If fewer appointments throughout the year are needed, the end result is that it costs less. That can actually yield better results because “patients are more comfortable reliably coming in on a routine basis,” he says.

In addition, says Byrne, Dysport may travel through tissues a slightly greater distance. “That gives you an advantage in certain situations like crow’s-feet, where there’s a broader treatment area,” he says.


Other injectables, such as Botox, may perform better when you’re looking to target a precise muscle (like addressing the frown lines between the eyebrows), says Byrne. But that doesn’t mean you can’t get the results you’re looking for with Dysport. “These differences are so subtle, I don’t think it matters much,” he says.




What it is

Learn more

IncobotulinumtoxinA is an injection that targets moderate to severe frown lines between the eyebrows, notes the Xeomin website.

Whom it’s best for

Some people develop a tolerance for one of these injectables and they become less effective over time. What makes Xeomin stand out is that “the protein coat on the toxin molecule is much less dense than on the other neurotoxins,” says Shah. If other injectables stop working for you, your doctor may turn to Xeomin.


Results appear in three to four days, according to the company, with maximum outcomes after 30 days. If you’re looking for effects to appear faster (whether because of personal preference or an upcoming event), Xeomin may not be for you.

Also, though the company says that benefits persist for three months, some doctors, including Shah, say that their patients note it often lasts just two. “But when you’ve built up a tolerance to the others, two months seems like a good amount of time,” he says.

Price $425


What it is

PrabotulinumtoxinA is the new neurotoxin injectable on the market, having been given FDA-approval for the treatment of glabellar lines (the vertical “frown” lines between the brows) earlier in 2019. “It’s the same particle size as Botox (900kDa), which is considered the gold standard for efficacy,” says Shah.


“The data is limited, and we don’t have the years of experience that we do with Botox, Dysport, or Xeomin,” says Langsdon. While he’s optimistic about the product, patient satisfaction — and whether they’re willing to jump over to something new — remains to be seen.



The Importance of Working With a Professional When Getting Botox

The most important thing to do is to go to a knowledgeable doctor, which means a board-certified plastic surgeon or dermatologist. “You need a provider who knows what they’re doing, whom you trust and have a relationship with,” says Langsdon. Someone may offer a cheaper price, but you have to consider at what cost this may be to you if they don’t have a depth of experience.

How to Know if Your Dermatologist or Plastic Surgeon Is Legit

If you’re seeing a dermatologist, check that they’re board-certified with the American Board of Dermatology. The certification for facial plastic surgeons is through the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). Fortunately, the American Board of Medical Specialties has a handy search tool on its website where you can search for any doctor’s board credentials by first and last name, and city and state.

What to Do Before You Undergo the Procedure

Before receiving treatment, the AAFPRS also recommends having a complete medical evaluation to talk about your medical history (this will tip off your physician to potential complications).

When at an evaluation, ask the provider how many procedures he or she has done, who is administering the injections, the cost, and the expected results, adds the American Academy of Dermatology (AAD). Always ask: “Is there another treatment that would be right for me?” adds the AAD.

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