It's the number one cosmetic procedure in the country: Botox to lift the eyebrows,get rid of wrinkles in the forehead and frown lines between the eyes.More thanfive million procedures are done yearly because it works. But nowBotox Cosmetic has competition.

Board certified dermatologic surgeon Dr.WilliamColeman, IIIin Metairie was among the first to test a new product called Xeomin.LikeBotox and Dysport, thesebotulinum toxins are neuromodulators. They temporarily block the chemical signal from the nerve to move the muscle. When used in the right amount by a trained doctor, the muscle should be relaxed,never frozen,keeping it from pulling too hard on skin that has lost elasticity from sun orultraviolettanning bed exposure.

'We found withXeomin, the forehead smoothes out exceptionally well with this a little different than we've seen with the other two toxins. It may be that it defuses a little differently so that means it moves out from the sites that we put it in,' explained Dr. Coleman, who istheEditor In Chief of Dermatologic Surgery and on the faculty of dermatology and plastic surgery atTulane University Health Sciences Center.

One of Dr.Coleman's office workers usedBotox but triedXeomin a month ago.

'TheXeomin,I found, it made my forehead a lot smoother looking in terms of the visible lines that you can see and it works much (more) quickly,' said Barbara Tregre, 48.

Metairie board certified plastic surgeon Dr.CynthiaMizgala also tried Xeomin. One patient wanted a touch up on her creases before her daughter's wedding and believes the effect ofXeominon her, lasts longer thanBotox or Dysport.

'Iwould feel silly trying to get rid of all of them (wrinkles).I didn't want to do that.I was just trying to have a little bit smoother look,' said Pam West of Metairie.

But the doctors agree, Botox,Dysport andXeomin can't be directly compared.

'Ithink there's a lot of individual variation andI don't think you can predict it before hand. SoI always encourage everyone to try all the products available and see what works best for them,' explained Dr.Mizgala who is on the faculty of both Tulane and LSUHSC.

Board certified dermatologist Dr.MaryLupo is an international speaker and teacher of Botox. Her New Orleans clinic is currently one of the sites for twoFDA studies usingBotox in the crow's feet, those lines on the outside corner of the eyes caused by sun damage.

'I noticed that the area in the skin here (pointing to her crow's feet)is much smoother andI had deep crinkles on the side and they're practically disappeared,' said studyparticipant Kathy Gauchet, 59.

Doctors have been injecting the crow's feet for years with excellent results,but it has been off label, not officiallyFDA approved to be marketed for that area. Dr.Lupo says the board certified dermatologist or plastic surgeon who has a lot of experience with all three products will know that there are different amounts needed with each product and they spread under the skin differently. The trained doctor will know which one is best for you and who should use a combination of them all.

'Ithink for the happyBotox patient or the happyDysport patient,I do not see as of yet any compelling reason to change.'In my opinion, the good thing aboutXeomin is anytime there's competition in the market place it holds the price down and that is always a good thing for the consumer,' said Dr. Lupo, who is on the faculty at Tulane Medical School.

Her youngerpatients do especially well withBotox because it keeps the deep lines from forming in the first place. And when usedconsistently, it may have a more permanent effect.

'Within a few days after theBotox treatment, the crow's feet actually, for me becauseI'm a youngerpatient, they almost disappear,' said board certified dermatologist Dr.Christin Hurt,30.

And while patients say the needle stick, especially when you use numbing cream beforehand, is just a quick pinch, threecompanies are going after people who are scared of needles. One company,Revance Therapeutics, Inc., says market research finds that two-thirds of people usinginjectableBotox, would use itsbotulinum toxin gel that is in development called, for now,RT001 topicalbotulinum toxin type A gel.

Thenew topical or rub onBotox type creams are notFDA approved yet but here's what doctors are telling us. In studies they seem to work best right here around the crows feet.That's because the skin there is thinner and they'll absorb better. But here's the catch, they're not a cream that you can take home and just rub on, they'll have to be done in a doctor's office and somedoctors say they may need to be on as long as 30 to 45 minutes before they absorb and are effective.

But until those topical versions hit the market,remember these products are just a tool.

'It's not only the tool that is in the artist's hands, it's knowing all the otherdifferent things that are needed (for the rest of the face to get the best overall result),' said Dr. Coleman.

'It's all in the artistry and thejudgment of who's injecting,' explained Dr. Lupo.

These medications have been used safely for years in doctors' offices.
Health problems have been caused by look-a-like, fake products brought in from other countries with people promising the same results at a reduced cost.

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