Getting comfortable in your skin: A guide to botox

Are you your own worst critic?

It’s an old saying, but it’s pretty accurate…

We tend to notice what we think are faults in ourselves that others hardly notice. And where do most of us tend to find these faults? In the mirror.

Although it’s a natural part of aging, wrinkles, sagging skin or scarring can have a negative impact on the way you feel about yourself.

And if you’re just not comfortable in your own skin, there’s no reason to be miserable.

The mainstream medicine types have tried to condition us into thinking surgery is something to be done at the drop of a hat. I disagree.

Though tons of people go under the knife every day for facelifts, eyelifts and more, none of these procedures are without high risk, including nerve damage, infection, scarring, complications from anesthesia, brain damage — and even death.

Thankfully, the signs of aging can be safely, effectively and affordably reversed — without going under the knife…

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Non-surgical cosmetics procedures

Botulinum toxin A (Xeomin®, Botox®, Dysport®) to relax wrinkles: Collectively referred to as “botox,” this is the most well-known and commonly used nonsurgical cosmetic treatment, with 4,597,886 performed in the U.S. in 2016.

This naturally-produced neuromodulator is injected into the face muscles responsible for wrinkles, temporarily paralyzing them so they cannot create wrinkles. It works great in the forehead creases, crow’s feet (quint lines at the corner of the eyes), scowl lines (between the eyebrows), and many more face wrinkle areas, shown below. This is the quickest and easiest anti-aging facial skin treatment for both men and women. When done correctly, it should still allow you to make facial expressions, but static lines (all face muscles relaxed) should be gone.

Expect to pay $300 to $500 for a full treatment of all these areas. Results are seen in 3-5 days and last 3-5 months per treatment. Side effects are not serious, such as localized redness, irritation or swelling.

Safety of botox for cosmetic uses is proven over the past 20+ years and is approved in approximately 80 countries. A 2014 review of 35 clinical trials with 8,787 participants receiving botulinum toxin showed a minor side effects rate of only three percent.

Long-term wrinkle reversal and prevention: Botulinum toxin is now being used not just to temporarily reverse facial wrinkles, but for long-term reversal. In fact, just two years of consistent use in the same facial area is thought to cause deeper wrinkles to continue to soften as the dermis layer of the skin heals and remodels its shape.

The latest discovery is that younger patients can prevent wrinkles from even forming! I recommend my patients avoid creases from developing by starting botox treatments when they notice static wrinkles (at rest) where they have the most facial animation. It could possibly fit into a budget even at the age of 25 to 30 years of age (younger wrinkles need almost half the full treatment).

Botulinum toxin can work even after age 60, but larger amounts are needed in deeper wrinkles.  When larger amounts won’t work, then dermal fillers are used to smooth and fill deeper crevices.

Xeomin is as good (if not better) than Botox. Xeomin (by Merz) is botulinum toxin type A, similar to Botox (by Allergan).  Xeomin has been safely and effectively used in Europe since 2008 and is currently FDA approved in the U.S. for facial skin wrinkle treatment just as Botox.

Xeomin has been well proven to be equally effective as Botox, with one unit of Xeomin equal to one unit of Botox.  Xeomin and Botox have identical side effects (minor swelling, bruising, headache, and soreness). However, Xeomin has a few benefits over Botox:

  1. Xeomin is a pure botulinum toxin A without additives. One benefit of a pure botulinum toxin A is that the human body is less likely to become resistant to it. Some patients have developed antibodies to Botox.
  2. Xeomin is the only one of the three botulinum toxin A products that does not need to be refrigerated before being reconstituted in normal saline for use. Whereas, Botox must be manufactured and then shipped on dry ice and kept in a freezer until reconstituted.
  3. With Allergan’s market dominance and aggressive advertising, they have significantly raised the purchase price for Botox, which gets translated to higher prices for healthcare providers and, therefore, patients.

For these reasons, Xeomin is becoming the preferred botulinum toxin A by doctors and patients.

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Botulinum toxin A injection sites

Where are the usual places to have botulinum toxin A injected? These include the following locations:

  • eyebrow lift (lateral brow)
  • lower eyelid wrinkles
  • smoker’s lines (above lips)
  • bunny lines (mid nose)
  • smile lift (corners of mouth)
  • chin dimples
  • platysmal bands (neck strands)
  • …and more.

Just a word of caution… You may have seen or heard a nightmare story of someone using a substitute botox. Under no circumstances should you receive a cosmetic procedure from anyone except a licensed and qualified practitioner. If a friend tells you she’s having a botox party at her house with super cheap prices, remember, you could be getting substandard botox or worse, end up disfigured for a few months.

In my next article, I’ll discuss my next two favorites — dermal fillers and platelet-rich plasma (PRP).

To feeling better in your own skin,

Michael Cutler, M.D.


  1. Xeomin — The American Academy of Facial Esthetics
  2. Cavallini M, Cirillo P, Fundarò SP, Quartucci S, Sciuto C, Sito G, Tonini D, Trocchi G, Signorini M. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. — Dermatol Surg. 2014 May;40(5):525-36. PubMed PMID: 24575858.
  3. Dressler D, Tacik P, Adib Saberi F. Botulinum toxin therapy of cervical dystonia: comparing onabotulinumtoxinA (Botox(®)) and incobotulinumtoxinA (Xeomin (®)). — J Neural Transm (Vienna). 2014 Jan;121(1):29-31. PubMed PMID: 23913131.
  4. Frevert J. Xeomin is free from complexing proteins. — Toxicon. 2009 Oct;54(5):697-701. PubMed PMID: 19292989.
  5. Dressler D. Five-year experience with incobotulinumtoxinA (Xeomin(®) ): the first botulinum toxin drug free of complexing proteins. — Eur J Neurol. 2012 Mar;19(3):385-9. PubMed PMID: 22035051.
  6. Botox vs Xeomin — Botox Forum


Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.