BOTOX®, Dysport, & Daxxify

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.

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.

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

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).

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.

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.

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.