A cosmetic neurotoxin is a chemical protein (Botulinum toxin A) that is injected into the skin to soften or eliminate wrinkles. Wrinkle correction with Botulinum type A injection is the most commonly performed cosmetic procedure in the US and worldwide. In 2019 there were 7.4 million treatments performed in the US. At the present time there are 5 commercially available products – Botox, Dysport, Xeomin, Jeuveau and most recently Daxxify. All of these contain Botulinum type A as the active ingredient.
When Botulinum toxin is injected into muscle it creates a temporary paralysis. When muscle loses its ability to contract, wrinkles cannot form in the overlying skin. The skin appears more smooth. The degree of wrinkle correction depends on the dose of toxin that is injected. Complete elimination of wrinkles was the trend several years ago, but it often resulted in a rigid, expressionless appearance. The trend now is softer, less visible wrinkles with preservation of normal facial expression.
There are differences in the onset of action between these products, but all last between 3 and 4 months. For patients that like to maintain their results I recommend followup treatments every 4 months. Remember that results are much more dependent on dosing and injection technique rather than the product.
The conditions I treat in my practice include;
Horizontal Forehead Creases
Vertical Furrow Lines "11s"
Corner of Mouth Lift
Lip "Flip"
Brow Lift
Crow's Feet
Bunny Lines
Chin Dimples
Smokers Lines
How often do I need to be treated with Neurotoxin?
I tell patients that if they want to maintain their appearance, they should plan on being retreated when the wrinkles start to reappear. I don't tell my patients that they need to return every 4 months because this interval may vary from person to person. Most of my patients start to see recurrence around 3 1/2 to 4 months, but I have patients that feel that they look pretty good for 5 - 6 months. I also have patients that just want to look refreshed for an upcoming event. They might see me once or twice a year, and that is fine too.
Fillers soften wrinkles by plumping up the tissue beneath the crease or fold. They have no effect on the underlying muscle. (Refer to Fillers and Volumizers for more information.)
Whether to use a neurotoxin or a filler depends on what type of wrinkle you are trying to treat, and where they are located.
In the forehead and outer portions of the eyes, weakening of the underlying muscles has a positive effect on facial expression. In addition to softening the wrinkles, it allows the brows to raise up slightly, creating a more rested and youthful appearance, similar to a forehead lift.
Some wrinkles or folds respond best to plumping, and are best treated with fillers. These include the grooves that form along the inner corner of the eyes and cheeks (tear trough), the folds between the upper lip and cheek (nasolabial), the folds between the lower lip and cheek (marionette lines) and the indentations between the chin and cheek (jowels).
Neurotoxins can also be used in combination with fillers to achieve the desired effect.