Everything You Need to Know About "Relaxers" and Skin Quality with Dr. Elizabeth Adams
Hey friends! Today, we are talking about a word that sounds a little scary but is actually a total game-changer for aging gracefully: Neurotoxins. (I know, I know, can we please find a prettier name for it? Dr. Adams suggests "relaxers," and I am totally on board with that!)
I brought my dear friend and the amazing Dr. Elizabeth Adams back onto the show to clear up the confusion. We’re diving into the world of Botox, Dysport, and all those other names you’ve heard floating around. Plus, I’m finally answering the question I’ve been getting constantly since my surgery: “Deanna, now that you’ve had a facelift, are you done with the needles?”
The answer might surprise you!
In this episode, we chat about:
The "Six Sisters" of Toxins: Did you know there are actually six different types of neurotoxins on the market? Elizabeth breaks down the "personalities" of each one - from the "Gold Standard" to the one that gives you that famous red-carpet glow.
The Mystery of Price: We talk about her brand-new concept, STILL, and how she’s fixing the sticker shock and complicated math we usually face at the med-spa.
Life After the Lift: Why a facelift isn't a "one and done" for your skin’s movement and volume.
Biohacking Your Beauty: Why your body might stop responding to certain products over time and how to keep your neurotoxin career going strong.
The 5 Layers of Aging: We get into the nitty-gritty of what a facelift actually fixes versus what you still need to address with things like fillers, lasers, and (my favorite!) collagen.
Skincare Must-Haves: From the SPF we all should have worn in our 20s to the peptide-based products Elizabeth and I are currently obsessed with.
This episode is packed with so much wisdom to help you feel confident in your own skin. I'm taking a little summer break to love on my new grandson after this episode, so soak this one up!
Connect with Dr Elizabeth: Follow along on Instagram: @bestillwrinkles
Check out the STILL Studio in Birmingham, AL
Discussed on the episode: Deanna's Instagram reel of her visit to STILL
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Deanna: Welcome back to the Well and Worthy Life Podcast. I'm so excited to have my friend and doctor, Dr. Elizabeth Adams, on here with me today to talk about neurotoxins. Okay, just wait, that's a scary word, but we're going to get into that.
We'll talk about that after my facelift because that's one of the questions I get a lot. After my facelift, do you still have to do—as some people call it Botox, some people call it Daxxify, there are so many different names—so, Elizabeth, let's start off describing or defining what we're talking about today, specifically with neurotoxins.
Dr. Elizabeth Adams: Neurotoxins—it's a very scary word. It also goes by toxin or Botox. They are all synonymous, but neurotoxins are basically botulism toxin products. There are six on the market right now. Botox was the first on the market, but it is not the only one, despite people saying "Botox" when they mean any of them. Botox was the first on the market, and then came Dysport, then Merz had Xeomin, and then Daxi, Jeaveau, and there's a new one on the market, Latibo, as well. So those are the six that are on the market right now in the United States. Botox is just one of them. You can call them toxins, neurotoxins, or Botox.
Deanna: You know what's so funny? Toxin is really not a good, healthy word anyway. It automatically sounds bad. We need to come up with some other name for this.
Dr. Elizabeth Adams: Like a relaxer. I like that a lot.
Deanna: I like that a lot, which brings me to your new place that you've just opened up, which you have named appropriately: STILL. I love that. Let's talk about that for a minute before we go into what I do. Tell us a little bit about your new concept that you've just opened.
Dr. Elizabeth Adams: STILL is a new business in Hoover that is in Brocks Gap. It is two weeks old, so we are brand spanking new. It's a new concept, not in what we do—we do all of the neurotoxins—but it's how it's delivered. Typically in the industry today, the process is very confusing. You go into a physician's office or a medical spa, you discuss what your intentions and goals are, and then there's the unit discussion that leads into complicated math. Then there are unit conversions and product discussions, and it just turns into a very overwhelming experience in general. People ultimately walk out pretty much unsure of why they paid what they paid and what results they are about to get. There is no consistency in the industry.
STILL was developed to address all those pain points. It was intended to address the pricing, so we have transparent pricing. It is a flat fee per area, unlimited units. You know going into STILL that you're not going to pay anything else; there's no up-charge. It is what it is. Taking that out of the equation, we work backwards. We always have a consultation to discuss what outcomes you are looking for. Are you looking for more stillness? Are you looking for a more natural look? Depending on what your goals are, then we work backwards to select the products. It is a lot different than your typical experience because it is just meant to be simplified. The entire experience is supposed to be simplified. Just tell me what you want, and we can make it happen.
Deanna: I love that, and it's a beautiful spa. I love that because so many times I go in and I have no idea what I'm getting myself into price-wise. I've been having this done since I was in my 30s, so I used to hide it from my husband, especially if I went in and got a whole lot of units. I would get sticker shock when it was done. So I love this. You know ahead of time before you have it done what it's going to be. Another great thing is that you have drop-ins, meaning you can just show up, which is nice too.
Dr. Elizabeth Adams: Yes, walk-ins are welcome. Appointments are available, but definitely walk-ins are welcome. One of the things I personally love about STILL is being able to discuss the personalities of each of the toxins. All toxins are not equal. They are all wonderful and, in different ways, really amazing products, but they're not all equal. I think one of the confusions in this industry today is that everything is compared to Botox. Botox gives you a particular look and a particular feel. It is beautiful, but there are other options out there as well. Being in a space that is not aligned with one particular company or product gives us the opportunity to truly discuss what you are wanting and what your desired outcome is. Then, again, we work backwards.
Deanna: Let's talk about that. Tell us the differences in all the different toxins.
Dr. Elizabeth Adams: Botox was the first on the market and it is our gold standard for a lot of reasons. That's what is compared in all the studies for the products that have come after it. It's a great product, but it's a tighter product. It gives you a tighter feel and just a more intense process, which is the best way I can explain it. They are all FDA-approved for the same amount of time, which is three to four months, because we compared everything to Botox when it came on the market. Botox definitely doesn't last longer than any of the others, but it just gives a little bit more intense feeling.
After that came Dysport. Dysport is a little bit more relaxed; it just feels a little bit looser. It doesn't necessarily look looser, it just feels looser. Sometimes people describe Botox as feeling like you're almost stuck in your face. That's not a bad thing if you want that look, but Dysport really alleviated that. It's just a softer, smoother product that diffuses really beautifully. It just kind of paints, if you will.
Then after that came Xeomin. Xeomin is a beautiful product. What it did differently for the market is that while all products have stabilizers and side protein chains, Xeomin minimized both the additives and the size of the protein side chain. By doing that, your body does not recognize the product as much, so it doesn't make the antibodies that it might make with some of the other neurotoxins. It is a more natural product, if you will—it's still a neurotoxin, but it's a more natural product. It also feels looser and softer, and the end result is softer as well. There's a softening of your wrinkles, but it's not frozen or completely still. There's a natural look to it.
After that came Jeuveau, which is another version of a softer product. Jeuveau really shines, in my opinion, in a younger population—like people in their 20s and 30s who are just now getting into the toxin world. Again, it is just a softer, more manageable product.
Then came Daxi (Daxxify). Daxi revolutionized neurotoxins because instead of having that protein side chain, they substituted it with a peptide. That peptide acts as a stabilizer molecule to induce longevity. Daxi can last longer than some of the other neurotoxins. All of them will last three to four months at the baseline, but Daxi, if dosed appropriately, can last a little bit longer, which is nice. Not for everybody, but for a lot of people. There is also a skin glow associated with it—called the "Daxi glow"—because of that peptide getting integrated into your skin.
They all have really pretty things about them, and again, it comes down to what you are looking for. If you are trying to get pregnant, maybe you want to try Daxi because it might last through your pregnancy if you get that longevity effect. If you have dull skin, maybe Daxi is a good choice. But if you're more worried about long-term biohacking, Xeomin might be your choice. All of them are chosen for different reasons, and by being at STILL where I have access to all of them and am not aligned with a particular company, it allows me to ask, "What are your desires? What are your outcomes?" and work back from there.
Deanna: I love that. I think that is so important. Before, I've gone in and someone just asked, "Do you want Botox or Dysport?" Those are really the only two I've ever been offered, so I think this is very interesting. Does it happen to some people where they start doing Botox and then after a while it doesn't work as well?
Dr. Elizabeth Adams: Yes, that goes back to the antibody response. Botox was the first on the market and it has the largest side protein chain as well as the additives. Your body recognizes that. It doesn't recognize the neurotoxin itself to the same degree, but it really starts to look out for those additives. Over time, some people make an antibody response that reduces the effectiveness of the product. This is the art of medicine; it's not a linear line.
The STILL model is actually based heavily on Xeomin primarily because of this reason. If you're going to continue to do it over and over again, having less of an antibody response is going to give you a longer lifespan for your neurotoxin career.
Deanna: How often do you recommend people getting neurotoxins? Does it go back to which one you use and the individual?
Dr. Elizabeth Adams: Yes, if you're doing Daxi, you might not have to do it as often. But assuming all things are equal, it follows a three- to four-month cycle depending on where you are in your own life cycle. If you're 20 years old, unless you're going for a specific look, a preventative-type treatment rotation doesn't require a strict three-month cycle; it might be every six months or longer. If you're 50 years old and you have a stagnant wrinkle right there, you're going to need to come in every single time you start seeing that wrinkle again because it's creating an etched line. At that point, I would say probably about every three months—as soon as you start moving, come back in.
Deanna: I always know when I need it because my husband always says something about how I furrow my brow. I'm like, "That's my mom face!" Exactly. Okay, let's go back and talk about neurotoxins after a facelift. That was one of the questions I got a lot afterward. Honestly, I wasn't really thinking I would need neurotoxins after a facelift, but we still do because we still move our face, right?
Dr. Elizabeth Adams: Exactly, it's that dynamic movement. With a facelift, you're not addressing the dynamic movement that neurotoxins address. The intention of a facelift is to address saggy skin and laxity, and to reposition some of the tissues, like fat pad deflation. Those are the primary goals of a facelift. What it does not do is volumize—that is a filler discussion, unless you add in fat transfers. It does not address skin quality or texture unless you are doing lasers in addition to the facelift. And it also doesn't take away your muscle movement—that dynamic movement is where the neurotoxins step in because you can create wrinkles even post-facelift.
Deanna: I've always had a lot of movement in my face because I'm very expressive. My ex-husband said to me when I was in my early-to-mid-30s—and remember, I'm 60 now, so this was years and years ago—he asked, "Have you ever thought about getting Botox?" Because at that time, there probably was just Botox. I was like, "What is Botox?" I appreciated that, honey! Well, he was very perfectionistic. So I started getting it then because once somebody points it out to you, you notice it. Now, I know the minute I need it.
A lot of people actually talk about the headaches, too. Botox has the most therapeutic and medical indications, one of which is migraines. Even if you do aesthetic injections, those tension-type headaches right in the brow area are addressed. You don't always have to do the true medical migraine injections because aesthetic injections can handle them.
Dr. Elizabeth Adams: That's nice, yes.
Deanna: Thank goodness I've never suffered from migraines. But before we get into filler, I want to ask you a question: What's your favorite neurotoxin?
Deanna: Oh, Daxxify. I really do like it. I don't know if I've ever had Xeomin—maybe we try Xeomin next time—but I know I've had Botox and Dysport. I love the Daxi glow, and I do think it lasted longer on me this time. That's really nice because if I can prolong those appointments, it saves a little bit of money, and more than anything, it saves time.
Dr. Elizabeth Adams: It's all about time.
Deanna: It's so true. Just having to go somewhere and get something else done is a lot. It's bad enough I have to get my hair done every four weeks and get my nails done. I need my hair done right now, too! I'm a high-maintenance girl, come on.
Okay, so I haven't had to have filler since my facelift, though I did do filler before it. What might be something that somebody would still need filler for after a facelift?
Dr. Elizabeth Adams: Again, the facelift repositions tissues, but it doesn't always address fat pad deflation and bone reabsorption. Bone reabsorption is another thing that filler is used for, essentially mimicking bone. During facelifts, sometimes surgeons will perform fat transfers, or some plastic surgeons might use filler during the operation. But a facelift alone doesn't address the aging process of fat pad deflation. Once you reposition those tissues and muscles, there are still layers of aging that a facelift does not address, and two of those are the fat pads.
That is where filler goes in. Each person is different genetically as far as how their fat pads are aging, but in general, the big post-facelift needs for filler would be the temples—because our temples hollow out and that's not touched at all by a facelift—and then usually the mid-face and sometimes the jawline. A mid-face augmentation gives you back that volume, which represents a younger, more youthful look.
Deanna: It really is a youthful look. I have had filler put in my cheeks years ago, and it was amazing. It's funny because I look back at younger pictures of me and my face was fuller, which is such a youthful look. As we get older, unfortunately, we don't lose the weight in our tummies; we lose it in our face and our cheeks! How does that happen? Can I take the fat from my tummy and put it in my cheeks? That's what I'd like. I lose it in my butt and my cheeks. I'm like, "Where did it go?" Really, exactly.
Is there anything else you can think of that we need to talk to everybody about regarding neurotoxins, filler, or just your general thoughts?
Dr. Elizabeth Adams: The next big thing that facelifts don't necessarily address through the surgical process is collagen. We age on five different layers. The top layer of skin is tucked during surgery, but that doesn't change the quality of the skin itself. The quality of the skin is significantly affected by collagen. There are other skin qualities we look at, such as dyschromia—the reds and the browns and the general evenness of the skin tone—which is usually addressed with lasers.
But specifically with collagen, we start losing it in our 30s. It drops more in that perimenopausal 40s phase, and then it's off to the races after that. Collagen stimulation and enhancement is a huge part of aging gracefully that facelifts do not address.
Deanna: What do you suggest for that?
Dr. Elizabeth Adams: There are several ways that you can at least enhance the loss, even if we can't always replace it one-to-one because we lose it at such a significant rate. I am a huge believer in collagen supplementation, like Vital Proteins. Put it in your coffee and drink it every morning. You can also do microneedling, which helps with collagen stimulation, and you can do lasers. There are all sorts of collagen lasers.
Deanna: What lasers do you like?
Dr. Elizabeth Adams: I think the best bang for your buck in this entire industry is an IPL (Intense Pulsed Light). I think IPLs are fabulous. There are a lot of different kinds—BBL (BroadBand Light) is a specific brand, but IPL is the general category, just like neurotoxins. An IPL or BBL works on the reds and browns we just talked about, and it acts as a collagen stimulator over time. Now, "over time" means doing it once or twice a year for five to ten years. It takes time, but if you're treating your reds and browns while getting that collagen stimulation in the background, that's a win for me.
Finally, the last—and probably the most effective, though it's the most expensive—is Sculptra. Sculptra is poly-L-lactic acid. It is not a filler; it stimulates your body to make its own collagen. It's best done in a series, typically anywhere between four to six vials over about a three-month period to get your body up to where it is producing that collagen. Then, once or twice a year depending on what your collagen looks like, you come back in for a maintenance vial. It's a really beautiful collagen stimulator.
Deanna: Where do you put that? Do you inject it?
Dr. Elizabeth Adams: Yes, it is injected like a filler, but it is delivered mostly with water. When you get it injected, you're likely going to bruise—everybody bruises with Sculptra. You bruise, and then all the water absorbs and goes away, and you go back to your normal face. At first, you're like, "What in the world did I just spend that much money on?" But over three to six months, you're going to start seeing that collagen stimulation. It really shines back toward the hairline and the mid-face area. The areas that Sculptra is not ideal for are around the mouth and around the eyes. One of the things you worry about with Sculptra is that if it gets between the sphincter muscles that move constantly, it can create a reservoir of the product and form a tiny ball of collagen that feels like a BB. So, you avoid those moving muscles.
Deanna: Okay, so collagen stimulation would be the last piece. What do you do personally? Do you do all the above?
Dr. Elizabeth Adams: Literally everything that I just said, I have done it.
Deanna: I had the CO2 laser last year when I did my facelift, which was pretty brutal, but I will say it was good. I've had a BBL before, but just on my nose for some little vascular red spots. I've never thought about having it on my whole face.
Dr. Elizabeth Adams: Your face, your décolletage, your hands—it works really well there. The CO2 is the gold standard in the laser industry. It is amazing and it works. It is the only laser that truly gives rhytids (wrinkles) a run for their money. There's nothing else quite like a CO2, but there is significant downtime and a lot of pain, unless you are augmenting it with a facelift procedure where you are already numb or under.
Deanna: What about skincare? What do you use and suggest for skincare?
Dr. Elizabeth Adams: Skincare can be put into big buckets. Everybody needs an SPF. Everybody needs to wear an SPF, SPF, SPF!
Deanna: I agree! I wish somebody had told me that when I was in my 20s, to just lather in SPF.
Dr. Elizabeth Adams: Definitely SPF. I'm also a huge fan of Vitamin C. The retinols, retinoids, and tretinoins—that whole group is appropriate for certain people after a certain age, usually around the 40-year-old mark, if your skin tolerates it. Not everybody's skin can tolerate retinoids. One of the myths or busters in this industry is that while retinoids cause chemical disruption to trigger cellular turnover and recycle your skin, if you are one of those people who just turns red, flaky, and irritated, don't do it. Do it a different way. Do a CO2 laser instead; there are other ways to achieve skin resurfacing. There are over-the-counter products that are gentler than tretinoin, but some very fair-skinned people can't even tolerate those.
Truly, you would think with my brunette hair that I would not be a fair-skinned person, but I do not tolerate tretinoin very well at all. I just flake up and become really irritated. You can kind of work through some of that over a period of weeks to months to build tolerance, but sometimes it's like, what's the point?
The other product that I use every day and really love is called OneSkin.
Deanna: I knew you were gonna say that! You told me about that before. I have used some of their products and I really do like it.
Dr. Elizabeth Adams: Yes, I love OneSkin because it is a peptide-based product and it has a lot of great data behind it. Four female PhDs created it, so it's a really good product that helps with hydration and wrinkles over time. Those would be the main ones I would talk about.
Deanna: Well, thank you so much for joining us today on the podcast. I'm so happy to have you back on. Not too long ago, we talked about hormones, so thank you again.
Dr. Elizabeth Adams: Thank you for inviting me again!
Deanna: Let's tell everybody again where they can find you on Instagram.
Dr. Elizabeth Adams: Instagram is @bestillwrinkles.
Deanna: And don't forget, you can do a walk-in appointment or make an appointment. It's over in Brocks Gap in Hoover—a beautiful little shopping center and a gorgeous spot. You're going to love it. I shared an Instagram Reel this week—well, when you're listening to this, it's going to be a couple of weeks ago—showing how pretty it is, so you can check that out. We'll link that Instagram video in the notes. Thank you again, Elizabeth. I appreciate you being here with us.
Dr. Elizabeth Adams: Thank you for inviting me on again.
Deanna: Thanks, y'all! Listen, if you find this to be helpful, please share it and be sure to tag us on Instagram so that we'll know that you saw it. Thank you so much for being here.
I'm wrapping this season up. I'm going to take a little break and hopefully be back in the fall with you guys. I just need a breather from podcasting; it's been a lot. I just got a new grandson, so I'm going to go enjoy my summer with my grandchildren. I'll be back in the fall, but remember, I've got lots of past episodes that you guys can listen to in the meantime. Thanks again, y'all!
