The Truth About Botox: Neurotoxins, Skin Boosters & Breaking the Frozen Face Myth

In this episode of The Cowboy and the Queen of Aesthetics, Wyatt celebrates being named Best Rep of the Year in Biologics before diving into one of the hottest topics in aesthetics: neurotoxins. From Botox and Dysport to Xeomin and Daxxify, the duo breaks down how these treatments work, the truth about “frozen faces,” dose creep, antibody resistance, and the growing trend of using neurotoxins as skin boosters for pores, texture, and oily skin. Packed with expert insight, myths vs. facts, and plenty of humor, this episode gives listeners a fresh look at the science behind modern aesthetics.

Transcript

unknown 0:00

All right.

SPEAKER_00 0:01

Why had I hear some congratulations are in order. Tell me what's going on with you.

SPEAKER_01 0:06

Oh, we had to bring it up, I see, huh, sis? But no, it wasn't very special. I actually was awarded uh Best Rep of the Year by Logics. Um, it was something that was you know, something truly special to me because it just, you know, like it all goes out to all my amazing partners that I have in this company. And, you know, with honestly, without them and our relationship, um, you know, it wouldn't have happened uh without them. So super grateful, super appreciated. Um, and I take it to heart.

SPEAKER_00 0:38

Well, congratulations. That really is no small feat. So you should be very, very proud. And gosh, that should just make more people want to listen to us because if you're number one in the country, I want to listen to us.

SPEAKER_01 0:48

There you go, right? Yeah, right. That's exactly right.

SPEAKER_00 0:52

All right, so let's get on into it. Welcome back to the Cowboy and the Queen of Aesthetics, where we talk beauty, science, real life, and everything in between.

SPEAKER_01 1:05

And where the queen tries to convince me that needles in your face are normal.

SPEAKER_00 1:11

Today we are going to be doing a deep dive into the most asked topics in aesthetics about neurotoxins.

SPEAKER_01 1:17

So basically poison for your face.

SPEAKER_00 1:21

Not exactly poison, but close enough to get your attention. And today we're going to be going deeper than usual, not just talking about Botox, but we're going to be talking about dose creep, antibody resistance, and something really new and cool using neurotoxins as skin boosters to help your pores and fine lines look better, not necessarily your muscles.

SPEAKER_01 1:41

Nice. So yeah, this really does sound like a little uh medical thriller here.

SPEAKER_00 1:46

So let's start simple. When people say Botox, they really mean neurotoxins. So Botox is like saying Kleenex versus the facial tissue. It's just the name brand. And so, you know, there are actually a couple of different neurotoxins that are FDA approved that are used in aesthetics. And so we're not going to be addressing all of them today, but just the most common ones that are typically used in the aesthetic space. So we have Botox, Desport, Xeomen, Juvo, and Daxapry. And these all work by blocking the signal between your nerve and your muscles. And so what this does is it blocks the acetylcholine. And when the acetylcholine is blocked, then your muscle cannot move. And so what this does is it softens dynamic wrinkles like frown lines, forehead lines, crow's feet, makes your frown from being too strong, your chin from dimpling. And also we're going to be talking about how it can be used just to improve things like pore size and also even control oil and sebaceous in the skin.

SPEAKER_01 2:51

Awesome. So you're basically, you know, turning off that angry face muscle, or if you will.

SPEAKER_00 2:57

Exactly. So we're not necessarily paralyzing your whole face, we're just dialing it down to specific muscles that cause those lines and wrinkles or those negative vectors that tend to pull down the face and neck. Awesome. So Botox is kind of the OG in aesthetics. It's the most studied neuromodulator. It was the first to market, and it's the most widely used neurotoxin in the world. And what we know that it's used for most greatly is for fine control, brow shaping, and simple, natural, subtle results. And typically it lasts about three to four months in most patients. And I will say it's not a complete three to four months of frozen. So the misconception when patients come into practices is that you're going to get this injectable, they're immediately going to go to sleep, and then they're not going to wake back up until that 90 to 120-day mark. And that's just absolutely not true. So we tend to tell patients in our practice you're more on this bell curve of relaxation. So you're going to get the neuromodulator, it's going to be at its peak efficacy in about two to three weeks. And then the minute after that peak efficacy starts wearing off, patients kind of start slowly waking back up and getting more facial expressions. And so, you know, it's a slow go-to-sleep and a slow wake up, but it's definitely on a bell curve. And so they, the misconception is that they're just totally asleep. And then at, you know, 90 to 120 days, they wake back up immediately. But that's definitely not true. But I will say, kind of got off on a tangent, but back to Botox Cosmetic, it has been around the longest in the marketplace. It was the first to market. And it typically does last about three to four months in most people.

SPEAKER_01 4:36

Okay. So yeah, this is basically like the, you know, the classic cowboy hat, reliable, timeless, and it gets the job done, right? For sure.

SPEAKER_00 4:46

So let's talk about dysport. Disport tends to be a little bit more of a spreading neuromodulator, more so than your Botox cosmetic, which can actually be a really good thing when we're trying to treat a larger area or a larger muscle. So patients that tend to have larger foreheads or when we're trying to treat muscles in the neck, sometimes dysport is something that we go to because it does tend to spread a little bit more than Botox does. And it lasts about also three to four months.

SPEAKER_01 5:13

Okay, perfect. Just round. So yeah, this would be like the wider rim hat because obviously you're just gonna cover more ground, correct?

SPEAKER_00 5:19

Absolutely. Yes. I I love that. So let's talk about zeomen. Zeomen is a newer player to the market, and it's often called the naked toxin or the pure neurotoxin because it does not have all the accessory proteins. And accessory proteins are typically measured in neurodaltons. And so what this does is they take all the neurotoxin products and they kind of line them up. And accessory proteins really add no value to how well the neurotoxin works. But they're, you know, some neurotoxins have as many as 900 uh kilodaltons of accessory proteins, and some have as low as 150 uh kilodaltons of accessory proteins. And so what we know over time is that the more accessory proteins a neuromodulator has, it's definitely not a good thing for the patient long term. And so zeomen is kind of that, you know, cleaner naked toxin. So it has a lower amount of accessory proteins in it. And so it's typically known as the cleaner toxin. People tend, it tends to last three to four months in most patients. And it's great for people that metabolize neurotoxins more quickly, or for patients that just want a cleaner option when it comes to a neuromodulator. And again, it lasts the same about three to four months. So Juveau is kind of a they call it the new TOX, and it's actually it was developed, it was developed specific to aesthetics and not for medical conditions like like Botox Cosmetic was, and orzeamin is used, and it behaves very similar to Botox, but is marketed more towards those aesthetic and cosmetic patients. And it's kind of best for patients that are new or first-time neurotoxin users for younger patients or just as a preventative treatment for stemline.

SPEAKER_01 7:14

Awesome. So this I'll go back to my my analogy by cowboy. So this is like the trendy new cowboy hat that's like everyone's wearing, like on TikTok or something.

SPEAKER_00 7:23

Exactly. Exactly. And that leads us to the newest, most commonly used neurotoxin on the market. And it's called Daxify. And this is kind of known as the game changer in aesthetics because it was really groundbreaking compared to the other neuromodulators on the market. And it's different from all the others because it's made from a peptide. So it's not made from your typical core neurotoxin. So instead of using human-derived serum albumin to stabilize it, Daxy uses a proprietary peptide. And because of that, it can last a little bit longer since some of the other neurotoxins. We see up to four to five months in some patients, and it also kicks in almost immediately. So patients like myself that are constantly going places and speaking and don't have a lot of time to really plan my aesthetic procedures, even though I do this for a living, I can do it on a Monday and by Friday, it's going to be completely kicked in. So it's really nice for those patients that want it to kick in super fast, busy patients or patients that just don't have a lot of time to constantly come in for neurotoxin treatments.

SPEAKER_01 8:27

So yeah, this would be like my good old heavy-duty like ranch truck of toxins, right? That's pretty much fun. I'm saying like that. And then obviously the question on that too. Are you you are seeing it last obviously longer, but we're not, you're not seeing it last a year or eight months, or maybe you are. I don't know. But I feel like that from what I've heard too, is that they're around that six-month time frame or five to six months, correct?

SPEAKER_00 8:53

So yeah, I mean, maybe not even that long because I really think it depends on someone's exposure to neurotoxin, how many times they've been treated, how many years they've been doing it. And typically, Wyatt, it's really good to change up your neurotoxin every couple of treatments. So instead of someone doing zeomen for five years, we may say, you know, do zeeomen for four treatments and then let's switch it. And so what tends to happen is if you kind of your body gets used to one neurotoxin, it's good to kind of switch it up. And so it does last longer. We're seeing maybe four to five months, but the fact that it kicks in within a couple of days right out of the gates makes it last a little bit longer anyway, because the other neuromodulators really take 14 to 21 days to really kick in and do their job 100%.

SPEAKER_01 9:39

And you said something a little bit wild earlier. Um, but those toxins are now being used as, you know, skin boosters. What does that even mean?

SPEAKER_00 9:47

So this is actually one of the coolest innovations that we're seeing right now in this space is that we know traditionally neurotoxins are used to relax muscles. And now we're seeing in microdoses of or a little bit more of a hyperdilution, these neurotoxins can be used to treat pore size. They can be used for um to treat oily skin. And so, you know, they call it what you'll hear often called in the market is microtox, baby botox, or skin boosters. And that's when you go into the skin intradermally versus into the muscle. So you're not trying to paralyze a muscle, but you're trying to change the integrity of the skin. We also see a lot of really nice results with patients that have scarring, whether it's acne scarring or surgery scarring, really using those neuromodulators to help boost the skin in that regard can help really soften scars and those raised ropey scars or even the depressed scars like acne scars.

SPEAKER_01 10:48

So you're not for you're not freezing anything, correct?

SPEAKER_00 10:51

No, exactly. We're not treating wrinkles in that space. We're simply treating skin quality. And, you know, here's what skin boosters can really do. Like we talked about pore size, improve the skin integrity, texture, oil control. They go far beyond just freezing the muscle or making the muscle go to sleep.

SPEAKER_01 11:08

And so, you know, this is like a uh skincare, but with Botox or Yeah, so we can really reduce the activity of sebaceous glands.

SPEAKER_00 11:18

And so patients with oily skin or enlarged pores or acne prone skin do really well when these products are injected intradermally because it really does help shut down those sebaceous glands and change the pore size, the appearance of the pore size. And so instead of paralyzing muscle, the microtox creates a subtle softening effect. So it's like a hybrid between Botox and a skin treatment. So it's best for you know patients that don't want traditional Botox, younger patients, oily or acne-prone skin, or anyone that just wants that glotox look. And so it's actually intradermally, it lasts two to three months. It's not going to last, you know, a longer time because we are just putting very finite amounts of product intradermally.

SPEAKER_01 12:04

Okay. So basically it's like coffee, you know, you have one cup, then you have two cups, and then you have three cups.

SPEAKER_00 12:11

Exactly. Exactly. Perfect.

SPEAKER_01 12:14

Okay, well, let's let's dive in now. Let's talk about antibodies. That sounds like a freaking sci-fi movie or something like that.

SPEAKER_00 12:21

I'll just you have so Wyatt, dose creep is real. And I'll tell you kind of what we see in our practice. What dose creep actually means is that over time patients slowly start needing more units of toxin than they did previously to get the same result. And so there are a few reasons that this actually happens. Muscle strength actually does change. So some people naturally come with very strong facial muscles. And over the years, treatment of those muscles can adapt and become harder to relax. And also aesthetic preference. So dose creep can also be caused by patients coming in too frequently, not waiting long enough in between their neurotoxin treatments. It is also kind of there is a buzz around, you know, the higher those um kilodons of accessory proteins can cause dose creep as well. And we also see this, you know, sometimes with patients just that just have really strong muscles over time. It kind of takes more units to to get the same aesthetic result than they did previously.

SPEAKER_01 13:29

And like I said, this is your this is last and recommended, but you want to, I'd say recommend what, at least every two months, 12 weeks, something you're around that time frame.

SPEAKER_00 13:38

Yeah, so you don't want someone coming in for Botox or neurotoxin treatments, you know, any sooner. I even think eight weeks is too close. And so what you're doing when you're constantly exposing a patient to those neurotoxins, that's when you're going to build that antibody resistance, or you're going to be using more frequent doses to get the same result. And so, you know, coming in every month is absolutely a problem.

SPEAKER_01 14:05

So someone comes in and tells you or me or whatever, said, I'm getting Botox once a month, that is a problem.

SPEAKER_00 14:12

Yes, that is absolutely a big red flag. And, you know, some injectors believe that Xeomin may have a lower risk of that antibody resistance because it doesn't have the accessory proteins. And Daxy, I think, is still kind of too new to fully understand the long-term antibody risk, but the early data that we're seeing is absolutely promising. But honestly, the biggest factor is not the brand, it's how often you're being treated. And so, you know, most recommendations are wait 12 weeks before being retreated. So if you're getting toxin touch-ups or tweaks every six to eight weeks, your risk of antibody resistance is much higher than someone that wakes two to three months. So, you know, that's that's really how we see dose creep happen in our practices.

SPEAKER_01 14:59

So basically, you know, you want to, you want to trust your injector a thousand percent. Absolutely. So, Missy, what is the best neurotoxin out there?

SPEAKER_00 15:08

That's a tricky question, Wyatt. There is no single best toxin. There is really only the best toxin for the individual. So it really depends on muscle strength, skin thickness, your lifestyle, how fast your body metabolizes the toxin, your aesthetic goals, and your history of dosing and frequency. And so it really just depends on you. And some patients respond better to one neurotoxin and then others respond respond better to another neurotoxin. So you kind of have to find one that works best for you. And also be willing to switch it up because we do see that patients that do switch up their neurotoxins tend to get longer longevity when they do get treated with instead of just sticking with one for years and years.

SPEAKER_01 15:52

Well, and then I just I go back to this too as well because you know, we know this in aesthetics that trust is important. You just want to make sure that you are trusting, that you want to trust your injector.

SPEAKER_00 16:04

Absolutely, exactly. So then be like, let's do myth versus fact, and then you say the myth, and then I'll say the fact and just kind of expand on it a little bit.

SPEAKER_01 16:14

So you want me to say the myth?

SPEAKER_00 16:16

Okay, and then you go and then I'll just be like, okay, miss, so let's do myth versus facts.

SPEAKER_01 16:21

All right, sounds good. All right, all right, miss, let's do the myth versus the facts. So, number one, toxin will make you look frozen.

SPEAKER_00 16:32

Well, why it's facts bad neurotoxin will good neurotoxin will not make you look frozen.

SPEAKER_01 16:41

All right. Myth number two, once you start, you can't stop.

SPEAKER_00 16:46

You can absolutely stop. Your wrinkles are just going to return to their baseline over time. Sometimes we'll hear that, you know, like getting filler is gonna stretch your skin or getting neurotoxin is gonna make your wrinkles worse when you stop. And that's absolutely a myth.

SPEAKER_01 16:59

Awesome. Myth number three: more units equals better.

SPEAKER_00 17:04

Fact, technique matters more than dose. And too much can cause that dose creep. So being, you know, knowing anatomy and going to someone that can really be precise matters more than just loading a patient up with a lot of toxin units.

SPEAKER_01 17:21

Perfect. And when myth number four, you can't build resistance.

SPEAKER_00 17:26

You can build resistance. It is preventable with proper timing and proper dosing.

SPEAKER_01 17:32

I did not know that. That's pretty good, right there. And then myth number five Botox is only for wrinkles.

SPEAKER_00 17:39

No, it can be used for texture, pores, oil production, as skin boosters. We can use it for sebaceous glands, we can use it for sweating excessively, we can use it for muscle spasms, we can use it for TMJ in the jaw, we can use it for headaches. Neurotoxin can be used for so many other things, not just wrinkles.

SPEAKER_01 18:02

Awesome, awesome.

SPEAKER_00 18:03

So at the end of the day, neurotoxins are one of the most powerful and safest and most customizable, customizable tools and aesthetics, whether you're treating wrinkles or boosting skin.

SPEAKER_01 18:12

And Van, so like if you're like I said, if your injector knows what, you know, what knows what they're doing, you're gonna look, you know, you're gonna look rested, you're gonna look, you know, refreshed. And it's not gonna be like you got hit and by like a frozen lasso, if you will.

SPEAKER_00 18:27

That is correct, Wyatt. So thank you for joining Cowboy and the Queen of Aesthetics. Until next time, stay glowing.

SPEAKER_01 18:34

Stay glowing, y'all. Thank you. Information shared on this podcast is for educational and informational purposes only and is not intended as medical advice, right? The views expressed are based on personal experience, clinical insight, and you know, current research. But they do not replace medical evaluation, diagnosis, or treatment uh from like your own qualified healthcare provider. Always consult your physician or licensed medical professional before making any changes, whether it's your health, wellness, or medical care.