What are they?
Denevervating agents (onabotulinumtoxina), available as Botox and Xeomin work by temporarily reducing muscle activity to inhibit wrinkle formation, specifically between-brow lines that resemble the number 11. By decreasing forehead furrowing, they eliminate wrinkles and fine lines that currently exist and also prevent new ones from forming, making them favorites of patients of all ages.
In addition to cosmetic applications, many of which are considered off-label (see below), Botox is also FDA-approved for hyperhidrosis (excessive sweating). Xeomin is approved to treat abnormal spasms of the eyelids (blepharospasm) in adults who have had prior treatment with Botox. Xeomin is considered a more purified version of botulinum toxin type A than Botox because it does not have any protein additives. Some say this may help lower the risk of allergy to the product, as they believe the allergy risk is associated with these proteins. Xeomin is also the first denervating agent that does not need to be refrigerated before use.
Denervating agents have played a major part in the age of injectables, and doctors continue to find new and novel uses for them, as well as innovative ways to use them in conjunction with fillers.

  • Eliminating wrinkles and lines caused by movement
  • Excessive sweating (hyperhidrosis)
  • Creating wider-looking eyes *
  • Fixing scars *
  • Reducing pore size *
  • Lifting the top of the nose *
  • Lessening a gummy smile *
  • Treating migraines and TMJ *
  • Eliminating neck bands and cleavage wrinkles *
  • Temporarily improving the appearance of frown lines and crow’s-feet
  • Treating chronic migraines, defined as 15 or more headache days a month, each lasting 4 or more hours
(*indicates an off-label use)
Treatments and ResultsJust like injectable fillers, a topical anesthetic may be applied to make treatment more comfortable. Then, over roughly 10 minutes (depending on how many areas are being treated), your doctor will strategically place several injections. 
Although the overall experience is the same as with Botox and Xeomin, the main difference is that Dysport kicks in quicker—the results can usually be seen in a day or two, whereas Botox and Xeomin typically take three to five days. The results of both are believed to last about the same amount of time: on average, three months. However, after a series of injections, Dysport may last up to six months.
Side Effects and RisksYou may be red or bruised at the injection site for up to a few days, and in rare instances, patients have reported mild flu-like symptoms after treatment. 
Please call The Paragon Plastic Surgery and Med Spa for more information on Botox and Xeomin at (817) 473-2120



What is Juvederm Ultra Plus?
Juvederm Ultra Plus is hyaluronic acid which is a complex sugar that is identical to the hyaluronic acid your body makes. Because the Juvederm Ultra Plus is identical to the hyaluronic acid in your own body, it breaks down naturally.
How does Juvederm Ultra Plus work?
When Juvederm Ultra Plus is injected into or below the skin it lifts wrinkles, depressions, or scars, so that they are level to the surrounding skin.
Where is Juvederm Ultra Plus used?
Juvederm Ultra Plus can be used anywhere in the face (except for the hollows under the eyes (tear troughs), but it is best suited for deep wrinkles and to replace the facial volume lost due to the aging process. The ideal locations for Juvederm Ultra Plus are the smile lines or parentheses lines (nasolabial or melolabial folds), the marionette lines, to hide the jowls by replacing the volume lost just in front of the jowl (prejowl depression) and for lip augmentation (plumper lips).
Are there different types of hyaluronic acid?
Currently, there are two companies that make injectable hyaluronic acid. Medicis makes Restylane and Perlane, and Allergan makes Juvederm Ultra, Juvederm Ultra Plus and Juvederm Voluma XC.
Does Juvederm Ultra Plus work instantly?
Juvederm Ultra Plus works instantly to lift wrinkles, depressions, scars, and to restore the volume lost during the aging process.
How long does Juvederm Ultra Plus last?
The duration of Juvederm Ultra Plus varies from person to person, from injection site to injection site, and from visit to visit. There are three general rules with Juvederm Ultra Plus: 1. The closer you inject Juvederm Ultra Plus to the mouth, the faster the Juvederm Ultra Plus breaks down. 2. The more superficial you inject Juvederm Ultra Plus the longer it lasts. 3. There are no guarantees of duration when it comes to Juvederm Ultra Plus.
How many visits are there for a Juvederm Ultra Plus injection?
Unless you have had injectable fillers before, and know exactly what you want, there is usually a consultation to discuss your concerns and to educate you about your treatment options. Once the appropriate injectable filler has been determined for your concern we can do treatment at the time of the consultation.
Dr. Bishara provides a wide range of cosmetic procedures to help patients look and feel their best, including Botox and Juvederm. Many of these procedures can be combined in order to achieve your desired appearance. Please call our office at (817) 473-2120 to schedule your Juvederm appointment and ask about our weekly Botox specials.  Please also visit our website at and “LIKE” us on our Facebook Page- Paragon Plastic Surgery and Med Spa.