Botox Cosmetic & Neuromodulators (Dysport & Xeomin) in Palo Alto

Also Serving San Jose and the San Francisco Bay Area

Minimally Invasive Treatments


Botox is a medication that has revolutionized the cosmetic market. It is a medication that is injected into the muscles that create facial expressions and cause unwanted wrinkles and lines. Botox is FDA approved for treatment of moderate to severe wrinkles between the eyebrows (glabellar rhytids). It is also frequently used to eliminate crow’s feet and horizontal forehead lines. Bay Area facial plastic surgeon Dr. Hessler, uses many advanced techniques for Botox in her Palo Alto office, including treatment of neck bands, bunny lines or wrinkles on the nose, lip lines and wrinkles, axillary sweating, and to soften or reduce a full jaw line.

How does it work?

Botox is injected into the tissue and temporarily weakens the muscles that create facial wrinkles or lines. Expert knowledge of facial anatomy is required to assure the injection is delivered into the proper muscle to avoid complications such as asymmetries on the face. It takes the Botox molecule approximately three to five days to fully start working, and it may require two weeks to reach its full effect. Because of this, Dr. Hessler recommends a two-week follow-up appointment to assess if the treatment is working as expected.

How long does it last?

As with all cosmetic treatments, results will vary among individuals. Most San Jose Botox patients can expect the effects of their Botox injection to last three or four months.

Is Botox for everyone?

Botox works best on faces in which the wrinkle is not deeply inset into the skin. This can vary with age, sun exposure, and genetic factors. You can also think of Botox Cosmetic as a preventative treatment to help protect the skin from forming signs of aging. Many people begin their treatments in their early 30’s and 40’s, but treatment can begin at any age. People with neuromuscular disorders such as Myasthenia Graves Disease or Eaton Lambert Syndrome cannot receive Botox. Discuss with Dr. Hessler if you have any of these disorders, and she can recommend safe alternative treatments for you.

Is there anything I should do before my treatment with Dr. Hessler?

It is best to avoid any aspirin containing products or other medications that can affect the blood for one week prior to your treatment. These medications include: Motrin, Aleve, Ibuprofen, Naprosyn, Naproxin, and Vitamin E supplements. See also our office documents link that includes a more extensive list of medications to avoid before cosmetic surgery and injections. The main concern with taking these medications is that they can lead to bruising following the injection. Dr. Hessler’s patients are unlikely to experience bruising from Botox, as Dr. Hessler uses the smallest possible needles for her Botox injections, but taking any of these medications can increase this chance. If you have Botox questions or wish to receive any additional information, contact Dr. Hessler’s Palo Alto plastic surgery office. Some patients have found a benefit from taking Arnica Montana, an over-the-counter herbal supplement, before their injections. Arnica Montana can be helpful for Restylane and Juvederm filler treatments as well, because there is a slightly higher risk of bruising with those products than with Botox.

What should I do following my treatment?

It is important to stay sitting upright for four hours following your Botox injections. Dr. Hessler also advises patients to avoid facials and massaging the injection site for four days. All Bay Area patients who received BOTOX should also refrain from strenuous exercise, as this can increase the chance of bruising. Yoga and inversions must be avoided for 24 hours following treatment.

What is the Botox browlift?

Dr. Hessler frequently uses Botox injections to lift the brow. This is often referred to as the Botox Browlift or chemical browlift, meaning the brow can be lifted with Botox instead of surgery. To do this, Dr. Hessler will study your face and determine the precise location to place the injections to create the effect of a facelift without any recovery time. Dr. Hessler also performs traditional browlift surgery for patients who require more extensive enhancement.


Dysport is an FDA-approved alternative to Botox. Dysport was developed in the United Kingdom in the 1990s and has been used in many countries around the world.

Is Dysport the same as Botox?
Dysport and Botox are both Botulinum toxins, but they are not the exact same product. They are made by different companies, have different packaging and processing but both contain the same active ingredient: Botulinum. Dysport and Botox have very similar treatment effects, but both are used in the treatment of dynamic- or movement-related lines on the face and neck.

What is it FDA approved to treat?
Dysport received FDA approval for treatment of the same cosmetic issues that Botox is approved to treat. These include the glabellar lines, the vertically oriented lines between the eyebrows that are referred to as the “11’s.” As previously mentioned, Botox and Dysport are routinely used by plastic surgeons and dermatologists for ‘off-label’ usages on the face. This includes treatments to soften crow’s feet, eye wrinkles, horizontal forehead lines, neck bands, bunny lines, and chin dimpling.

How does Dysport differ from Botox?
Botox and Dysport are injected into the facial muscles in the same manner. Some patients notice that Dysport starts working within a day or two, whereas Botox can take up to a week to show results. Other patients do not notice a significant difference between the products and their time of onset.

Is the cost different?
No, Dr. Hessler charges the same price for Botox or Dysport in the same treatment area.

How do I decide between Botox and Dysport?
It is best come in to Dr. Hessler’s Palo Alto office for a Dysport consultation so that you can review your goals and expectations. Dr. Hessler will assess multiple factors for your treatment, including: the strength of your muscles, the quality of your skin, your desired amount of relaxation and other anatomic factors of the eyelid and brow position.

Are there any different side effects?
The side effect profile is very similar for Dysport and Botox. The most common side effects Dr. Hessler sees after Dysport injections are very slight soreness at the injection sites or a slight headache. While bruising can occur after your treatment, it is uncommon. Dr. Hessler uses the smallest needles available for her Dysport and Botox injection treatments. Occasionally, patients taking blood thinning medications will have a red dot appear on the skin right where the needle was injected.


Dr. Hessler has been selected by Mertz Aesthetic as one of the first plastic surgeons to use Xeomin in the northern California bay area. Prior to the official launch of Xeomin, a few select plastic surgeons were chosen to use this FDA-approved product before it became available to other physicians.

What is Xeomin?
Xeomin, also known as incobotulinumtoxin A, is the newest FDA-approved alternative product to Botox. Xeomin is really quite similar to Botox in many ways. It is a medicine injected into the face to soften wrinkles by relaxing the muscles underneath them.

How is it different?
Patients generally notice the effects in three to five days for Xeomin and Botox. Both products have the possibility of lasting three to four months. Most of Dr. Hessler’s San Jose and Palo Alto patients experience the effects for about four months. The main difference between the two products is only related to how they are stored. Xeomin does not need to be refrigerated, which can make it easier to ship from the company. Therefore, it is less prone to denaturation and damage than Botox.

Which treatment should I have?
Both products have similar safety profiles. Dr. Jill Hessler recommends trying each of the neuromodulators to see which product works best for you. For some patients Botox cosmetic may have a stronger result, while Dysort may be longer-lasting. As with all medications, each of the neuromodulator Botox-type products need to interact with your own body chemistry to see what is right for you.

Is there anything I need to do before my treatment?
When you come to our Palo Alto office for your Xeomin treatment you should keep in mind that the treatments are injections. To minimize any change of bruising it is best to avoid aspirin or aspirin containing products, ibuprofen, motrin, Aleve or any other anti-inflammatories. All of these products make your blood platelets less effective and your skin more prone to bruising.

What can I take for pain before my treatment?
In general, Tylenol or acetaminophen is best to take before or after any cosmetic injections, because it does not affect your chance of bleeding and bruising. If you have taken ibuprofen once during the week prior to your appointment, it should not be a problem because the needles Dr. Hessler uses are very small. However, any amount of anti-inflammatory medication can increase your chance of bruising or similar complications.

What can I expect after my treatment?
Immediately following your Xeomin treatment, you may notice some mild redness or very slight swelling. These side effects generally resolve within half an hour. It takes a few days for the Xeomin to fully relax the muscle, and Dr. Hessler encourages patients to use the muscles that have just been injected with the Xeomin to help the product start working faster.

What are the potential side effects?
Side effects from receiving Xeomin, Botox, or Dysport are quite unusual. The most common side effect is a small red dot or tiny bruise where the needle was inserted. This is best avoided by not taking any anti-inflammatory medication or blood thinners for one week before your treatment. Headaches and minor soreness can also occur. Tylenol is the best medicine to take for any pain after your treatment.

Is it Safe?
Xeomin is an FDA-approved product that has undergone extremely rigorous and extensive testing to show that the product is both safe and effective.

Which product lasts longer?
Xeomin and Botox last the same amount of time, which is about three to four months in most patients. Some patients, however, experience the effects of either for up to six months.