Q. Sometimes I get Botox^® at my dermatologist’s office.  I recently visited a plastic surgeon’s office and they use Dysport^® for forehead lines.  What is the difference and how do I know which one is best for me? 

A. At Barber Center for Plastic Surgery, we offer both of these neuromuscular blockers for the treatment of forehead lines, crow’s feet, and frown lines between the eyebrows.  Dysport^® and Botox Cosmetic^® are very similar from a molecular standpoint and also quite similar when it comes to efficacy and longevity.  These two products are made by competing companies, and as such, there are frequently special offers that are promoted by the company in order to sell their neuromuscular blocker.  My opinion is that these two neuromuscular blockers are similar enough to each other that I will advise a patient to choose the one where a promotion is available.  I have been prescribing these two products for many years and find they both perform very well and have a similar safety profile.  I believe in brand loyalty for some things, but I feel that Dysport^® and Botox^® are both great wrinkle reducers, therefore you can feel safe in using either one of them.

Q. I have been reading about a new drug to shrink the fat in the chin area without the use of surgery.  Can you tell me a little about this drug? 

A. The drug that you are referring to is a recently FDA approved drug designed to reduce the volume of fat in the chin area.  The drug is call Kybella^® and the chemical name is deoxycholic acid.  Deoxycholic acid is actually not a new drug at all and has been used in mesotherapy for a long time.  The purpose of the deoxycholic acid in mesotherapy was to reduce the number of fat cells in a targeted area.  In the past, the use of this drug for fat reduction was not well studied and therefore was not FDA approved.  The drug has now gone through FDA studies and is felt to be efficacious in its ability to safely reduce fat cells, thus receiving FDA approval.  It is slowly being brought to market and being introduced to the medical community.  The doctors and their staff will complete required training from the company before offering it to patients.  It is only approved for use in the fat pad under the chin, but I have little doubt that its indications will soon expand to other areas of the body as the doctors get more comfortable with the drug’s capabilities.  Kybella^® is injected directly into the chin fat pad, causing destruction of the fat cells that it comes in contact with.  Kybella^® is a cytolytic drug, meaning it causes the cell membrane to break open which causes it to die.  The treatments can be repeated monthly until the desired effect has been realized.  Side effects include bruising, swelling, pain in the injection area, numbness, redness, temporary thickening of the fat pad, nerve damage, and difficulty swallowing.  The complications such as nerve damage and swallowing problems are rare according to the initial studies.  As for when Kybella^® will be available in the Greensboro area, I believe it will be soon.  The company is rapidly gearing up its sales force and is arranging for the doctors and their nursing staff to be trained in safe administration of the drug.  I anticipate it will be available sometime in the fall of this year.  I have no information as yet regarding the cost of the treatment, but I do not expect it to be inexpensive.

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William Byron Barber II, M.D. has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com