The Florida Society of Plastic Surgeons
Neuromodulators are injectable medicines that are used to treat fine lines and wrinkles of the face. The first brand of neuromodulators FDA-approved for this was BOTOX® Cosmetic. Many others have been approved since then, including Dysport®, Xeomin®, Jeuveau®, and Daxxify®.
Andrew H. Rosenthal, MD, FACS
Botox is the brand name of the neuromodulator toxin made by the bacterium Clostridium botulinum. Botox was the first neuromodulator approved for cosmetic use by the FDA but there are other brands of similar neuromodulators available such as Dysport, Xeomin, Daxxify and Jeuveau.
Each of these neuromodulators have the same active toxin, botulinum toxin type A, but differ slightly in method of injection, strength and migration beyond each injection spot (“spread”). You should discuss the pros and cons of each with your surgeon to make an informed decision on which would be best for you.
Botulinum toxin type A works by blocking the neurotransmitter released by nerves that allow muscles to contract. When muscles aren’t able to contract for long periods of time the wrinkles on the face above them diminish over weeks and months creating a more smooth, youthful appearance. The effects of the toxin generally last from 3-6 months and commonly need to be repeated to achieve the best, long lasting results. Fun fact: while Botox appears to “wear off” over time. Actually, its action goes away because your body builds new nerve endings into the muscle where it was blocked. Different people grow nerves (like hair and nails) at different speeds. So that’s part of why your Botox may last longer or shorter than someone else. Botox does not destroy the muscle or the nerve, which is why it is safe to repeat.
The botulinum toxin is typically injected with a very small syringe and needle into the facial muscle just below the skin surface. To achieve the best results multiple injection sites are typically used. The most common areas of the face treated are forehead, glabella (area between the eyebrows), crows’ feet (area around the eyes), nasal/nasalis(bunny lines), lip lines, chin (cobblestone appearance), neck bands, botulinum toxin is also used to treat other conditions such as prominent jaw (masseter hypertrophy) and excessive sweating (hyperhydrosis).
Botulinum toxin injections are made with a very small needle so are relatively painless for most people. However, there are topical anesthetic creams or ice that may be applied ahead of time to reduce the discomfort further.
Most patients can return to work and most activities immediately. You may see some effect of the botulinum toxin within a few days but full effect generally takes two(2) weeks or more. This “onset” time differs slightly by the specific toxin and muscle location. Results should be expected to last three months. Again, this time can vary by toxin, amount of dose (how “frozen” the muscle was), and your individual body. Repeat injections will likely be required to achieve the best, long lasting results.
Botulinum toxin is an extremely safe product. Since 2002, Botox has become one of the most widely performed non-surgical cosmetic procedures globally. In 2023 alone, over 8.8 million Botox injections were administered worldwide– more than 7 million of those were in the US. Since then, it is estimated that Botox and other toxins like Dysport have been injected over 100,000,000 times!
However, there are some potential complications and side effects of which you should be aware.
Most common side effects are bruising, mild swelling and redness at the site of injection. Less common, but possible side effects include eyelid drooping and asymmetry leading to a crooked smile. These are temporary. Uncommon, but serious problems (notify your doctor immediately) are hoarseness, trouble swallowing, trouble breathing, and double vision.
The cost of Botox or any of the botulinum toxin type A treatments varies depending on areas of treatment and amount needed for each area as determined by your surgeon or injector.
What Should I Do Next?
Schedule a consultation with an FSPS member today and discover how Botox(Botulinum toxin) can reduce wrinkles, create a more youthful look and boost your confidence!