Xeomodulation at different levels of administration - maximum effect in one procedure

Dermatologist, cosmetologist, trichologist - Komarova Elena Stanislavovna Make an appointment

Cosmetology does not stand still and is constantly improving in search of new solutions for its clients. Relatively recently, the drug Xeomin, a highly purified botulinum toxin type A, appeared on the Russian market, smoothing out wrinkles without the effect of a fixed mask on the face. Due to its low molecular weight, it can be used for injection into the area around the eyes, neck, chin, forehead and nasolabial folds.

Xeomin has established itself as a hypoallergenic drug that practically does not cause swelling and other side effects. A big advantage is its storage conditions: at room temperature (but not more than 22-25 degrees) for up to three years, thanks to which you can remain confident in its quality in the absence of violations in operation.

which means you can remain confident in its quality in the absence of violations in operation.

When using Xeomin, emotionality and active facial expressions are preserved, and the “frozen mask” effect is eliminated. This is an excellent remedy for toning and tightening the skin of the face. The duration of action of the drug is about 3-4 months.

What is Xeomin (Xeomin)

Xeomin is a drug used in botulinum therapy, based on botulinum toxin type A. Injections with Xeomin are used to eliminate age-related changes, primarily to smooth out dynamic wrinkles in various areas of the face. The drug was developed in Germany by Merz Aesthetics; today it is successfully used in almost all countries, including Russia. Xeomin is one of the most modern and newest drugs; it has appeared on the German market since 2005. Almost all drugs used in botulinum therapy are demanding regarding the conditions of their maintenance, because retain their effective properties only when stored in refrigerators at low temperatures. The advantage of Xeomin is obvious here - this drug can be stored at room temperature for 48 months, without requiring special refrigerators and freezers. Xeomin’s advertising slogan is: “Xeomin gets rid of wrinkles, but not facial expressions.” And this is true - the active substance of xeomin, compared to other botulinum drugs, has the lowest molecular weight, thanks to this, the muscles are blocked as selectively as possible, facial expressions are completely preserved.

Introduction

The purpose of the study is to determine the effectiveness of Xeomin® at various levels of administration (intramuscular, subcutaneous, intradermal) in one aesthetic botulinum therapy procedure. In this case, different volumes of saline solution were used to reconstitute the lyophilized drug. The resulting concentrations of Xeomin® were specifically injected into different segments of the face and to different depths.

tasks were set :

1. Receive maximum correction of the patient’s aesthetic problems in one procedure.
2. To determine effective options for restoring Xeomin® for different areas of the face.
3. Determine the effective minimum doses of Xeomin® for intradermal administration.
4. Evaluate the effectiveness of the procedure through medical photography and research using the Antera 3D device.

Secondary objective of the study: minimizing possible risks of side effects.

The study involved two healthy female volunteers aged 35–45 years who signed informed consent to participate in the study, understood the purpose of the procedure, and were willing to comply with the recommendations during the study period.

Patients were included in the study according to approved standard inclusion and exclusion criteria for injection procedures. Patients who had received correction with any absorbable fillers or hyaluronic acid, botulinum toxin type A in the treatment area within 12 months before the start of the study were also excluded.

Patients meeting the inclusion criteria received an injection of Xeomin® at a dose of 100 units in various dilutions depending on the location of the injection.

The second phase of the study involved observation and evaluation. Observation lasted for 14 days from the beginning to the end of the study. The assessment was based on data obtained through medical photography and the results of research using the Antera 3D device.

Contraindications

Botulinum therapy is a serious trend in cosmetology, which involves the injection of botulinum toxin into muscle tissue.
Remember that such procedures must be carried out by highly qualified specialists with higher medical education! Xeomin or any other neuroprotein in inexperienced hands can harm not only the appearance, but also the health of the patient. Before carrying out the injection procedure, a responsible, experienced doctor will definitely collect an anamnesis, carry out the necessary procedures, make prescriptions, if any, and eliminate all risks. Injections are indicated for absolutely healthy patients; if there are signs of acute respiratory viral infection or any other cold, the procedure is not performed. Also, the procedure is impossible during the period of exacerbation of any chronic diseases. It is imperative that the skin at the injection sites be free of any inflammatory processes or wounds.

One hundred percent contraindications include the following factors: - the patient’s age is under 16 years; — pregnancy and lactation; — allergies to medications, individual intolerance; - fever, ARVI and any other infectious diseases; — chronic diseases of the nervous system; — chronic diseases of the circulatory system; - oncological diseases; - diabetes; - the presence of inflammatory processes on the skin (ulcers, wounds and other injuries) - taking antibiotics and other potent drugs; - various lung diseases.

Xeomin effect

It is important to know that xeomin is not an anti-aging agent; xeomin does not produce collagen, which is responsible for the strength of the body’s connective tissue. Xeomin is a drug that relaxes the muscles that cause facial wrinkles and allows them to rest. But externally, the effect of xeomin injection looks exactly like rejuvenation. Thanks to the relaxation of facial muscles, we get an amazing effect - wrinkles in the eyes, lips, forehead and other areas of the face are smoothed out. In addition to smoothing existing ones, the formation of new wrinkles also stops. The skin is transformed and restored, while all functions of facial mobility are completely preserved. Thanks to injections with Xeomin, the contours of the face and its oval are improved. Wrinkles are smoothed out, cheekbones and jawline become more pronounced. The corners of the mouth rise, due to this the sad, mourning expression on the face disappears. The look becomes more expressive and open, wrinkles around the eyes disappear.

Botulinum neurotoxin administration levels

Administration of botulinum neurotoxin (BoNT) is possible at various levels where there are receptors for it:

1. Intramuscular
   (fairly standard)
   administration
   . The targets are the facial and masticatory muscles.
2. Subcutaneous administration
   . The target will be the distal sections of the muscle fibers of the facial muscles that are woven into the skin, as well as the retinaculae cutis. There are also reports and studies that botulinum neuroprotein may also have an effect on adipose tissue.
3. Intradermal administration
   . Targets include fibroblasts, sebaceous glands, the levator pili muscle, primary afferent terminals of nerve fibers that release neuropeptides, and the vascular wall.

Xeomin, Botox or Dysport?

All three drugs are neuroproteins used in botulinum therapy, the active component of which is botulinum toxin type A, which blocks neuromuscular transmission.
Similarities of drugs

— active component – ​​botulinum toxin type A; — all three drugs are officially registered, approved for use in Russia and have all the relevant supporting certificates; — correction of facial wrinkles is the main task of these drugs in cosmetology; — all drugs are safe, but to carry out an injection procedure using any of the listed drugs, an experienced certified cosmetologist is required.

Differences between Xeomin and other botulinum-containing drugs

— xeomin has a low molecular weight; — Xeomin is produced in Germany, Botox is produced in America, Dysport is a French drug; — all preparations contain different concentrations of botulinum toxin, which affects the number of units required for the correction and smoothing of wrinkles. Thus, the cost of one unit of the drug may be more expensive, but less quantity will be needed to obtain the desired result. And vice versa - the cost of a unit of the drug may be much cheaper, but more units will be needed for the procedure. As a result, the final cost of the procedure with any of the possible botulinum toxins is approximately the same. Therefore, when choosing the type of botulinum toxin, it is better to be guided by your doctor’s advice, and not by its cost. — the drug Xeomin does not contain complexing proteins, therefore it is most suitable for correcting age-related changes and smoothing wrinkles for patients who often experience allergic reactions to medications; — xeomin is purified from complexing proteins, it has a low molecular weight, and therefore the risk of addiction to the drug and the reaction of the immune system to it is minimal; — xeomin has the lowest molecular weight, thanks to which natural facial expressions are preserved; - xeomin, unlike other botulinum toxins, is stored at room temperature up to 25 degrees, the shelf life is longer - 48 months;

Drug concentrations depending on areas of administration

Rice.
1. Dividing the face into five segments To get the most natural result from BTA injections, you need to take into account the specific anatomical and morphological structure of a particular area of ​​the face. For convenience, the face can be divided by vertical lines into 5 main segments:

1. The central (unpaired) segment is located between parallel lines drawn through the commissures of the mouth;
2. Paracentral (paired, left and right) segments are located between parallel lines drawn through the commissure of the mouth and the lateral protruding point of the brow ridge;
3. The lateral (paired, left and right) segments are located between parallel lines drawn through the lateral protruding point of the brow ridge and the tragus (Fig. 1)
   .

To ensure the expected effect of aesthetic botulinum therapy and minimize the risk of unwanted side effects, injections must be made taking into account facial segmentation and the dose-dependent effect of BTA.

The accuracy of botulinum neurotoxin administration is increased by using different concentrations, which are achieved by reconstitution with different volumes of saline (Fig. 2)

.

Highly concentrated dilution - 100 units. Xeomina® 1 ml

Standard - 100 units. Xeomina® 2 ml

Low concentrated (Mesotoxin) - 100 units. Xeomin® per 2 ml is diluted 1:1 = 100 units. Xeomina® 4 ml

Low concentrated (Mesotoxin)

Rice. 2. Drug concentration depending on the zone and segment of administration.

For use in the central segment of the face, we recommend using botulinum neurotoxin in a smaller volume of recovery with saline solution - highly concentrated (100 units of Xeomin per 1 ml of saline solution). A high concentration of solution is necessary in this area to minimize the risk of drug diffusion. Since the muscles in this zone have a small area and volume and are located very close to each other, precise administration of the drug is important to prevent its spread to the non-target muscle.

The target muscles in this segment are:

• glabella muscles ( m. Corugator supercilli, m. Procerus, m. Depressor supercilli
  );
• muscles of the nose ( m. LLSAN, m. Nasalis pars transversa, pars alaris, m. Depressor septi nasi
  );
• muscles of the lower third of the face, where there is a very narrow therapeutic window, and the muscles have important articulatory and other functions ( m. Orbicularis oris, m. mentalis
  ).

For use in the paracentral segments of the face, we recommend using botulinum neurotoxin in a standard recovery volume (100 units of Xeomin® per 2 ml of saline solution). There are fewer risks here, and the muscles are of sufficient size in area. Target muscles in these segments: m. Frontooccipitalis

,
m.
Orbicularis oculi ,
m.
Platizma . We can work with these muscles and simulate the lifting effect by changing the muscle balance between muscle bundles, portions within one muscle. Such effects include the effect of modeling the shape of the eyebrow, the effect of an open eye, and the effect of lifting the oval of the face.

For use in the lateral segments of the face, we recommend using botulinum neurotoxin in high volume recovery with saline. Procedures using a low-concentrated solution of the drug are also called “mesotox”. To work in these areas, we restore a bottle of the drug Xeomin® 100 units. per 4 ml, using a sufficiently large volume of solvent (saline). We use this concentration to administer the drug intradermally to form a papule with a volume of 0.01 ml (Xeomin® concentration 0.25 units). A larger volume of solution is injected, but the number of botulinum neuroprotein molecules in this volume is less than in the standard volume. BTA molecules are uniformly distributed due to physical distribution in the solvent and in the injection zone. We inject the drug into the lateral part of the face in such a way as to correct small superficial “smile echo” wrinkles that appear during active emotional expression. This correction can be carried out in the “crow’s feet” area, sometimes extending to the cheek. The main goal of correction in this area is to relax the distal facial fibers that are woven into the skin and to relax the skin tension that creates the appearance of fine wrinkles. In addition, using this technique, using intradermal injection of a low-concentrated solution, you can work over the entire area of ​​the face.

Xeomin: how long does its effect last and how quickly will the result come?

The main and frequently asked question of many patients is: how long will the effect of the procedure last?
The exact duration of action of botulinum toxin xeomin cannot be determined. Usually this is 3-6 months, in some cases there is a longer lasting effect. The duration of the drug's effect on the muscles depends on various factors - the amount of the drug administered, the depth of the wrinkles, the age of the patient, and the characteristics of the body's metabolism. The body’s immune system also has an effect – it can provoke a rapid weakening of the drug’s effect on facial muscles.

The effect of the drug Xeomin occurs gradually and intensifies over time. The first results after Xeomin injections are visible already on days 2-3, and the final result will be obvious on days 12-14, when the muscles that cause facial wrinkles are completely relaxed.

As a rule, the results after injections with Xeomin last 3-4 months, then the effect of the drug begins to weaken, because the relaxing effect of xeomin on the facial muscles ends. The residual effect of the drug Xeomin can persist for up to two months, and after six months the procedure is recommended to be repeated.

Effect of BTA at different levels of administration

Intradermal administration of botulinum neurotoxin significantly improves skin quality. In this case, you can look at an administration regimen in which the drug Xeomin® was administered at a dosage of 0.25 units. to one point. The points were located at intervals of 1–1.5 cm relative to each other. What results were obtained with intradermal administration? First of all, reducing sebum production, reducing pore size, skin graininess, and the severity of redness. There is also a general brightening of skin tone and, of course, a general face lifting effect.

A very important point is the correct administration of the drug. The drug is administered at an angle of literally 10 degrees, the bevel of the needle is directed downward. We inject the drug with the formation of a white papule - this is a clear criterion for intradermal administration.

In the photograph (Fig. 3)

we see the results of administering the drug at different levels of the face, that is, in one visit and one procedure we worked with all muscle groups (in the upper third of the face, middle third of the face and lower third of the face). The drug was administered both into the facial muscles, subcutaneously and intradermally. We have seen that by combining work at different levels using different concentrations we can achieve excellent results. Firstly, we achieved beautiful face lifting, skin brightening, reducing diffuse redness, and improving overall skin tone. Secondly, we see the effect of rejuvenation, while maintaining naturalness.

Before

After

Rice. 3. Results of botulinum therapy using Xeomin® administration at different levels. The result may differ from that shown in the photographs and depends on the individual characteristics of the patients.

Using the Antera 3D device, we can look at the results in more detail. Macro photography allows you to see the skin texture both before and after the procedure. The image is converted into digital values ​​that were obtained as a result of the study. Thus, it was recorded that after intradermal administration of Xeomin®, the severity of static wrinkles decreased significantly, as well as the digital values ​​of skin roughness and graininess (Fig. 4)

.

Rice. 4. Results of the study using the Antera 3D device

There is a decrease in the digital values ​​of redness. Also, given that any redness is accompanied by pro-inflammatory reactions in the skin, which subsequently contribute to the deposition of melanin, an improvement in this indicator is noted. After intradermal administration of BTA, a lightening effect is observed, leveling the overall skin tone (Fig. 5)

.

Rice. 5. Results of the study using the Antera 3D device.

Below are the results of another patient (Fig. 6)

, which is the owner of dense, thick, oily skin with wide pores. As a result of intradermal administration of the drug, there is a decrease in the severity of roughness, or graininess, of the skin, as well as the severity of enlarged pores. This gives an overall effect of smoother, more even, velvety skin, which the patient really liked.

Rice. 6. Results of the study using the Antera 3D device.

Cost of the procedure

Elimination of expression wrinkles with the drug Xeomin: 1 unit – 300 rubles 50 units – 13,000 rubles
Before carrying out the procedure, a consultation with a cosmetologist is necessary. More detailed information about visiting a cosmetologist and the cost of services can be obtained by calling: +7 (3452) 65-94-32. Or leave a request for a call back, we will call you back within a day.

The professionalism and experience of the doctor, correctly selected doses, the correct method of administering injections, strict adherence to sterility and many other important factors are the key to an excellent result.

Carry out injection cosmetic procedures only in specialized clinics with experienced cosmetologists, take care of yourself, love yourself and be irresistible!

The article was checked by: Deputy General Director of the Nanoesthetic Clinic, Candidate of Medical Sciences, cosmetologist, trichologist, Elena Andreevna Makhneva.