Botulinum therapy with Xeomin in neurology and cosmetology. Procedures and prices

Botox and other drugs based on botulinum toxin are widely used in medicine and cosmetology, as a means of promoting relaxation of the subcutaneous muscles.

However, until recently, their use has raised certain concerns associated with a high risk of complications. Everything changed with the advent of Xeomin – an analog of Botox, devoid of its shortcomings and preserving all the advantages of botulinum therapy.

Operating principle

The principle of action of Xeomin is based on the ability of its main component (botulinum toxin type A) to slow down the production of acetylcholine – an organic compound that makes muscles contract.

Injections of the drug lead to their partial relaxation, which makes it possible to treat diseases associated with excessive activity of the subcutaneous muscles and use Xeomin for cosmetic purposes to combat facial wrinkles.

Composition and form of release

Xeomin was first synthesized in 2001 by the German pharmaceutical company Merz. In USA, it began to be used since 2011. The product is available in the form of a white powder, packaged in hermetically sealed bottles of 50 and 100 PIECES (1ED = 0 fluid ounce).

It contains 3 components:

Title	amount
Botulinum Toxin Type A	100 units
Sucrose	4.7 mg
Human Serum Albumin	1 mg

Act

The main component of Xeomin belongs to the group of protein neurotoxins and in large quantities is the strongest poison that causes paralysis of all vital systems of the body. In medicine and cosmetology, it is used in micro-doses that are not harmful to health, causing only a partial blockade of the centers responsible for the production of acetylcholine.

Botulinum therapy with Xeomin acts as follows:

• overly tense muscles relax;
• pain caused by spasm disappears;
• wrinkles are smoothed out.

The effect of the drug is limited to several months, after which the subcutaneous muscle tone is restored.

A second injection course is possible. Compared to other medications based on botulinum toxin, Xeomin has several advantages associated with its small molecular weight and the complete absence of the foreign protein previously used for preserving drugs.

Namely:

• low probability of developing allergies;
• lack of addiction to the drug;
• high accuracy of administration, excluding the effect of the drug on areas that are not subject to correction. Due to this, the probability of such negative consequences of botulinum therapy as sagging muscles (ptosis) and facial asymmetry is minimized;
• the ability to eliminate the smallest flaws in appearance;
• preservation of natural facial expressions after the procedure and the absence of the effect of a “stone” face;
• long shelf life and ease of transportation.

However, it should be remembered about the shortcomings of the drug Xeomin:

• a shorter duration than Botox: it is limited to 3-5 months;
• the long time required for the appearance of the effect (about a week);
• limited applicability due to low diffusion ability: ability to disperse, penetrate into tissues.

Indications

Due to their ability to relax muscles and the relative safety of use, Xeomin injections have become an inexpensive, easy to use and painless means of combating pathological conditions caused by hyperactivity of the subcutaneous muscles.

Botulinum therapy with Xeomin is carried out with the following diseases:

• blepharospasm (nerve tic) – spontaneous closure of the eyelids or eyelids, difficulties in maintaining them in the open state, accompanied by dry eyes and high sensitivity to light;
• spastic torticollis – incorrect (with an inclination to the left or right shoulder) head position caused by excessive tension of the neck muscles on one side and their gradual atrophy on the other;
• immobility of the muscles of the arm (post-stroke spasticity).

In addition, Xeomin can be applied:

• as a rehabilitation tool after a stroke;
• in the treatment of migraines, strabismus;
• to alleviate the symptoms of cerebral palsy;
• with various pains caused by spasm.

In cosmetology, Xeolin is widely used in anti-aging procedures as a means of combating facial wrinkles caused by excessive activity of facial muscles.

With its help, the following cosmetic disadvantages can be eliminated:

• nasolabial folds of small and medium depth;
• vertical wrinkles in the area between the eyebrows;
• longitudinal forehead wrinkles;
• small periorbital wrinkles near the eyes (the so-called “crow’s feet”);
• cords on the neck;
• wrinkles around the lips.

However, it should be remembered that Xeomin, for all its merits, is not omnipotent: in particular, the drug:

• cannot cope with deep nasolabial folds, the cause of which is not only muscle hypertonicity, but also a downward shift of the soft tissue of the cheeks;
• powerless against age-related skin changes associated with a decrease in collagen production, since it does not affect this process;
• ineffective in the fight against hyperhidrosis and deep wrinkles due to low diffusion (ability to penetrate into tissues).

Instructions and dosage of the drug in neuralgia and cosmetology

Before use, Xeomin powder is diluted with saline. The concentration of the drug depends on the purpose of the procedure and on the stage of therapy.

In medicine and cosmetology, the following ratios are accepted:

Xeomin amount (fluid ounce)	The amount of saline (fluid ounce)
2	0.5
1	1
0.5	2
0.25	4
0.13	8

The technique of the procedure, the number of injections, the dose, the area of influence are determined by the purpose of botulinum therapy using Xeomin and the patient’s condition.

Therapy for blepharospasm

The injections are performed in the lottery and medial ligaments (for the upper eyelid), only in the lateral (for the lower). The initial dose does not exceed 2.5 PIECES ( 0,01 fluid ounce), the result becomes noticeable on the fifth day. With a short-term effect (less than 60 days), the dose is doubled.

The maximum total dose for one eye (if the botulinum therapy schedule is designed for a period of less than 12 weeks) is 25 units, the maximum volume of a single injection is 5 units. If the procedure time exceeds 12 weeks, the total dose can be increased to 100 units. For the treatment of the eyelid zone, needles with a marking of 27-30 G are used (that is, with an outer diameter of 0/32 – 1/32 inch).

Arm muscle immobility

The choice of needles depends on the depth of the location of the problem muscles: for surface injections 26 G needles are required (length – 47/32 inch, outer diameter – 1/32 inch). When processing muscles located deeper, thicker and longer needles are used (length – 94/32 inch, diameter – 1/32 inch).

The number of injections and the time required for a full course depends on the size of the affected area and the severity of the disease. The total dose should not exceed 170-400 units. A clearly visible positive effect is achieved after 4 weeks of therapy and lasts 12 weeks.

Spasmodic torticollis

The dose and area of treatment depends on several factors:

• head position;
• intensity of pain;
• level of neck muscle development;
• patient weight.

The amount of Xeomin, which can be administered in one injection, is limited to 50 units; in total, no more than 200-300 units can be administered per procedure.

25-30 G needles are used to relax the superficial muscles, 22 G needles are used for deeper layers. The patient notices lasting improvement a week after the start of the course, the effect lasts up to 4 months, after which the course can be repeated.

Eyebrow area (glabellar wrinkles)

To smooth out glabellar wrinkles (that is, located vertically between the eyebrows), 5 injections are performed in the following areas:

• the medial and central areas of the muscle wrinkling the eyebrow – 2 injections each. The injection site should be located at least 0’4 inch above the edge of the eye socket bone;
• the proud man’s muscle – 1 injection.

For each injection, 4 PIECES of the drug is needed, the total dose for one procedure is 20 PIECES. After 2-3 days, the depth of wrinkles decreases, a stable result is achieved after 4 weeks, the effect lasts 4 months.

Lateral periorbital wrinkles (crow’s feet)

According to the doctor’s decision, various schemes can be used to select injection sites in order to correct the zone of the outer corner of the eye.

3 points pattern

The first point is 0’4 inch further than the outer edge of the bone orbit, the 2nd and 3rd points are 0’4 inch higher and lower than the first puncture site. For one injection, 4 UNITS of the drug are required, in total for the procedure – 24 UNITS.

4 points pattern

First, a point is noted which is 0’4 inch from the outer edge of the eye orbit, then 0. 2 inch up (1st puncture) and down (2nd puncture). The 3rd and 4th punctures are located, respectively, 0’4 inch above the 1st and below the 2nd puncture.

For one injection, 3 units of the drug are taken, for the whole procedure – 24 units. The effect will be noticeable in a week, by the end of the second week the skin is completely leveled, the result lasts for 4 months.

Longitudinal forehead wrinkles

To determine the location of future punctures as accurately as possible, the patient is asked to wrinkle his forehead by raising his eyebrows. The number of injections depends on the depth of wrinkles, on average, the consumption of the drug per session is 10-20 units. Injections are done at a distance of at least 0’8 inch from the eyebrow line. The result becomes noticeable already for 2-3 days , the effect lasts about 3 months, after which the course must be repeated.

Training

The success of the procedure depends on how correctly the preparation was performed.

The preparatory period includes several stages:

1. Consultation with a specialist in order to discuss existing problems and choose the best ways to solve them, taking into account the wishes of the client and the possibilities of medicine.
2. A thorough history taking, which will give a complete picture of the state of health and will be able to identify the presence of contraindications.
3. Repeated conversation with the patient, during which he is given recommendations that are binding.

It may be required 7-10 days before the procedure to refuse to take drugs that can cause an undesirable effect when interacting with Xeomin: antibiotics, painkillers, blood thinners.

Prohibited:

• aspirin;
• ibuprofen;
• escadrine;
• Vitamin E
• medicines used for Alzheimer’s disease.

The day before the procedure, it is necessary to exclude the use of alcohol: expanding blood vessels and increasing blood circulation, it can lead to an increase in the area of influence, cause asymmetry of the face, ptosis, tumors and bruising.

On the day of the procedure, you should try not to perform any heavy physical work, accompanied by frequent inclines, heavy lifting, high stress on the respiratory system.

Procedure

Botulinum therapy with injections of the drug Xeomin is performed on an outpatient basis, anesthesia is usually not required.

The procedure time does not exceed half an hour, during which:

1. A protective cap is removed from the vial containing the drug, and the cork is disinfected with an alcohol solution.
2. Saline is added to the powder contained in the vial in order to obtain an injection solution of the desired concentration.
3. The skin is cleansed of cosmetics, sebum, impurities.
4. The points of future punctures are marked.
5. In some cases (during cosmetic procedures), a cream is applied to the face that has a weak anesthetic effect.
6. Injections are carried out at selected points.

Rehabilitation

Strict observance of certain restrictions in the first time after botulinum therapy will make it
possible to reduce the risk of negative consequences.

In particular, you cannot:

• the first 4 hours to lie and bend;
• immediately after the procedure, touch the face or usd the puncture site;
• during the first day to do makeup;
• drink a lot of fluid (with the correction of the area around the eyes, it can cause swelling);
• in the first week to refuse to visit the pool, sauna, steam room;
• for the next 3-4 days, reduce to a minimum the time spent in the sun and refuse tanning services;
• within the next 20 days, do not take medicines from the “forbidden” list and alcohol;
• the first week to limit sports and physical activity;
• for the whole time, until Xeomin’s action ends, manual massages, myostimulation, microcurrent therapy are prohibited.

For the first time after the procedure, it is recommended to perform simple exercises that make the muscles located in the injection area with a goal of more even distribution of Xeomin: smile, move eyebrows, frown. After the end of the rehabilitation period, gentle peeling and light masks are allowed.

Undesirable consequences

The cause of side effects when using Xeomin may be:

• inexperience of the doctor;
• low quality of the drug;
• non-compliance by the patient with the rules of conduct before and after the botulinum therapy session described above.

The type and intensity of side effects depends on the area and purpose of the treatment.

With blepharospasm

Extremely rarely possible severe swelling of the eyelids and the development of angle-closure glaucoma.

More commonly observed:

• weakness of the eye muscles;
• inability to open one or both eyes (omission of the upper eyelid);
• lacrimation
• dry mucous membranes;
• headaches.

With spastic crank

Patients complain of difficulty swallowing, a lump in the throat, and pain in the neck.

Also possible:

• migraine;
• feeling of dry mouth;
• omission of one or both eyelids;
• difficulty in pronouncing words;
• the appearance of symptoms characteristic of colds

With immobility of the arm muscles

After botulinum therapy, a rash and itching may occur, sometimes patients note impaired coordination of movements, lack of sensitivity of the fingers. Also in the list of negative effects are various disorders of the nervous system: headaches, unexplained anxiety, insomnia.

When smoothing facial wrinkles

Side effects occur during the first days after the procedure, then gradually weaken.

It can be:

• bruising at the injection site;
• loss of sensitivity in the injection area;
• swelling of the face;
• asymmetry;
• sagging tissues.

Rarely after the procedure is observed:

• blepharitis development;
• feeling of dry mouth;
• photophobia;
• the appearance of “colds” symptoms;
• bouts of nausea.

The manifestation of any side effects is limited by the time of presence of botulinum toxin in the tissues. As soon as it is removed from the body, the phenomena caused by it will also disappear. In order to accelerate this process, drugs, massages, microcurrent therapy are used.

Contraindications

In most cases, subject to all the rules of the procedure, botulinum therapy using Xeomin is well tolerated.

But, since the main active component of the drug is neurotoxin, there are a number of absolute and relative contraindications:

• allergy to the components of the drug;
• any diseases that cause muscle weakness;
• poor blood coagulability;
• oncological diseases;
• the need for antibiotics;
• the presence of skin diseases at injection sites;
• some eye pathologies.

In addition, the procedure is not performed if you feel unwell for any reason, during pregnancy and lactation, or if the patient is under the age of 18.

Interaction with other drugs

Botulinum therapy with Xeomin is incompatible with many drugs, so one of the main requirements of botulinum toxin therapy is the refusal to take them.

It is important to consider that:

• antibiotics can reduce (tetracycline drugs) or enhance (Xenomin) aminoglycosides. For this reason, the dose may be too small and ineffective or too large, and the composition introduced during injection migrates to neighboring areas of the skin, causing any of the side effects described above;
• medicines of the group of analgesics, in particular, aspirin, thin the blood, reducing its coagulability. This leads to bruising and bruising at the puncture sites;
• myolesants (drugs that affect the process of transmitting a nerve impulse to muscle fibers) in combination with Xeomin can cause any unpredictable effects and negative changes in facial features.

Overdose

If the dose of Xeomin is exceeded, muscle paralysis may develop in areas that have not been exposed.

Paralysis can cause:

• feeling of weakness;
• profuse sweating;
• difficulty speaking and swallowing;
• trouble breathing.

To restore the normal functions of the body, the patient is hospitalized with the aim of providing supportive treatment. In case of paralysis of the muscles responsible for breathing, intubation and mechanical ventilation are used until the symptoms disappear.

Terms of sale and storage

When buying a drug, make sure the package is tight and check the date of manufacture. Unopened pack can be stored until the expiration date (for Kseomin it is 3 years) at a temperature not exceeding 35,6 – 41°F.

Diluted in sterile conditions, the drug should be used immediately for its intended purpose , but its storage in the original packaging is allowed for a day at a temperature of 35,6 – 46,4°F.

Analogs

The analogues of Xeomin are Botox, Dysport, Relatox. With a similar mechanism of action, each of the drugs based on botulinum toxin has its own characteristics, advantages and disadvantages.

Their comparative assessment according to several of the most important criteria is as follows:

The cost of the drug in pharmacies

A bottle for 100 PIECES costs $ 140, for 50 PIECES – $ 84. Xeomin is considered the safest of the group of drugs based on bolulotoxin. Among the advantages – high accuracy of introduction, ease of storage, reasonable price.

At the same time, the drug is inferior to its analogues in terms of the appearance of the effect, duration of action, and ability to penetrate into tissues. Do not forget that this is a new and insufficiently studied botulinum treatment.

Video about
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