Paula S.Gould DDS
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  • Writer's pictureDr. Paula S. Gould, DDS

Does She or Doesn't She?

Updated: Mar 21, 2018

Understanding Botox, Xeomin, and Dysport.

Spoiler Alert! Some of the following are facts and some are my opinion based upon my observations over the past 10+ years.

1. Botox, Xeomin, and Dysport all are forms of botulinum toxins that when strategically placed, can block the nerve endings to muscles (i.e., facial muscles of expression), preventing them from contracting.

2. One is not better than the other.

3. Botox and Xeomin work and are used essentially in the same way. Consider them interchangeable. I use Xeomin most of the time. Dysport is a bit different, works slightly faster, I use it in different places than the others, and mostly on men.


It depends greatly on the SKILL AND UNDERSTANDING of the person injecting, HOW much is used, and WHERE the injections are placed.

5. Mishaps I See and Hear About: There is an art to placement, giving the most natural results. Star Trek Spock "raised eyebrows" are not necessarily a good result. But I see them and some people like them.

6. Drooping eyelids is a poor result I am asked about a lot. Placement too close to the outside eyebrow causes this. Too much in that area can cause almost eyelid closure. Mismatched eyes, meaning one looks slightly smaller than the other, or both are equally droopy looking is caused by poor placement, and/or too much, and/or the injector not really understanding that everyone's muscles and facial features ARE NOT THE SAME.

7. Twice last week I met younger women who had recently had "Botox" injections, and every single forehead wrinkle was gone. They asked me, "Should my forehead feel heavy"?  The answer is NO. They also appeared to have hooded droopy eyelids that they never had before, and now have difficulty putting on eyeliner! Maybe too much, and poor placement.

Women want to look bright and well rested, not droopy and heavy headed. Sometimes there has to be a trade-off between leaving a few eyebrow lines, and not getting droopy eyelids. I always point this out when it applies.

8. Beware of Groupons. I hear there are a lot of those going around. If it sounds too good to be true, IT IS. You should NOT compare THE # OF UNITS YOU HAD BEFORE. They may tell you you need less or you need more. It means NOTHING. Some of these places cut corners and their UNITS are not as strong as recommended by the manufacturer. They sometimes do sloppy and quick placement, where the results are not even-looking, one eye droops, or the results wear off faster than the usual 4 months. Most of these I've fixed are from Groupons.

9. All confusing, but no reason to stay away! Ask questions. Ask to see the bottle, don't ask how many units, because each place has their own measurement. Beware of the one appointment-fits-all where nothing is explained, and injections are 1-2-3 and you are done. Remember, placement and amounts for you are not the same as for your friend. It takes 2 weeks to see the full results. This is NORMAL.

After 2 weeks, you might want to send a photo to your doctor, or set up an "enhancement" visit, to "even" your results and add more if needed. Remember two things about the enhancement visit... 1. it is not free of charge, and 2. until we know you, and have an idea of your specific amounts, we don't know any exact magic amount for you. My style is TO NOT OVER-FREEZE. I'd rather get to know a patient, see them in two weeks, and assess their needs personally, each time. If more is needed to get the optimum result, that's better and less costly overall than injecting more than is needed. I prefer a more natural, well rested look.


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