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What is it?

Neuromodulators/wrinkle relaxers (Botox, Jeuveau, Xeomin, Dysport) contain Botulinum toxin type A. This toxin is found naturally in the soil, household dust, and food. The rare disease “Botulism” can occur following ingestion of contaminated food which has been improperly prepared. Botulinum toxin is most lethal if ingested or inhaled in large quantities. However, injecting Botulinum toxin into small areas of the body is very safe, especially in the doses we use for aesthetic medicine. Botulinum toxin works by blocking the communication between the nerves and the muscles, hence “relaxing” the muscle temporarily. When the muscles are relaxed, it allows the skin to have a smoothed and improved appearance.

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What is it indicated for?

Botulinum toxin type A is indicated for the temporary improvement in the appearance of moderate to severe lines associated with muscle activity in adults less than 65 years of age. It is commonly used aesthetically for treatment in the glabellar, crow’s feet, forehead, gummy smile, chin, masseter, bunny lines, and vertical lip line regions. It can also be used medically for migraine treatments, trigger point pain in large muscles, treatment of contractures, jaw clenching, and armpits for excessive sweating.

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Will it hurt?

Everyone responds differently to pain, but you can expect it to hurt somewhat. We use a very small gauged needle, and certain areas will be more painful than others.

 

When will I see changes?

Typically, patients will notice softening of lines at the injected area 3-7 days post injection. Peak benefits are noticed at two weeks. You do not see benefits immediately, so make sure to schedule ahead if you have a specific event you are planning for. Some people report that exercising the muscles in the treated area help get the product in faster, but this has no effect on the overall efficacy of the treatment. Massaging the area is not recommended and will not make the effects quicker, and could lead to un wanted migration to other muscles. 

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How long does it last?

The duration is variable by the patient and their lifestyle. Clinical trials show the effects generally last 3-4 months. However, if you are very active or have a higher metabolism, you may notice it wearing off sooner. If you only get treated for small lines or  “prevention” of lines, you may be able to go as long as 6 months between treatments.

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Are there any side effects?

Side effects are very rare, and it is important to discuss your medical history and all medications prior to getting treatment to avoid any complications. Slight bruising, bleeding, or swelling are common at the injection site and usually resolve within hours to a couple of days. If you are fair skinned, you may have more redness or bruising than darker skin tones. Some people may experience a slight headache or flu like symptoms for a few days after treatment. Fever or severe symptoms are not typical. 

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Who cannot get neuromodulators?

People with known neurological disorders such as ALS, myasthenia gravis, and Lambert-Eaton syndrome. Multiple sclerosis patients may be candidates if cleared by their neurologist first. It is not recommended during pregnancy or for mothers who are breastfeeding. There are small amounts of additives such as albumin, sucrose, and milk protein, so if you have a known allergy or hypersensitivity to these ingredients, it is not recommended for you. Certain medications may interfere or cause increased bleeding/bruising, so please make sure to discuss all your medications with the injector prior to treatment. If you have any active infections or open sores on your face, we would need to wait for those to heal prior to treatment.

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How many units will I need?

It depends on the area you are concerned about and how deep the lines are. Starting with lower doses and being conservative is key. You can always add more units later, but you cannot take them away. We typically like to see our patients back after 2 weeks to re-assess the effectiveness and can add more units at that time if desired. We always encourage before photos so you can see the difference that was made at your 2 week follow up visit. 

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What happens when it wears off?

Hopefully you do not go long enough between treatments for it to completely wear off. If you are consistent with your treatments, the lines will not return. If you let too much time lapse between treatments, you can expect the lines to return, and the natural aging process to begin again.

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What else can I do for my lines?

A complete skincare routine is recommended for everybody. Starting off with a good cleanser, moisturizer, and daily SPF. To help soften deep lines, you can speed up cell turnover with procedures like retinol, microneedling, dermabrasion, or chemical peels. Staying adequately hydrated and eating a nourishing diet also helps with the skin appearance. It is also recommended to sleep on your back to avoid laying on the skin for extended amounts of time which can speed up collagen break down and increase wrinkle production on the face, neck, and chest.

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Why didn’t my wrinkles completely disappear?

If you have deep lines and are new to neuromodulators, it can take several treatments to get those stubborn lines to soften. Keep in mind, the lines start to soften because the muscles are no longer working as much. The skin then has to regenerate, and it can take 28-40+ days for new skin cells to appear. The goal is over time, as the muscle atrophies and the skin cells turnover, the lines will fade or disappear completely.

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What does my first visit look like?

Initial screening of past medical history, facial surgeries, and medications. We then proceed with a physical exam of your face and skin, and ask what your areas of concern are. We will look together at areas of concern and discuss realistic expectations. My goal is to achieve the appearance of a well-rested, youthful face and restore symmetry as much as able. Please keep in mind, we all have asymmetries in our face and cannot expect perfect symmetry. We can then proceed with the injections when a treatment plan is agreed upon. 

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What are post treatment instructions?

Please refer to your after care instructions for full details. We recommend that you keep your head upright for at least 4 hours. DO NOT massage the injected areas, as this may make the neuromodulators migrate to muscles outside of the intended injected area. Avoid rigorous exercise for 24 hours, normal activity and walking are OK. Avoid any activity that will require you to put pressure on the treated areas, ie: laying on your face for a massage, wearing a helmet, hat, headband, or anything constricting on your forehead. Some people may need to apply an ice pack for a short time after treatment if they have excess swelling at the injection sites.

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Will I become addicted?

There are no physically addictive properties to neuromodulators.