Neurotoxins

Facial lines develop overtime due to the effects of sun exposure, aging, muscle activation, and baseline skin quality and genetics. These lines can contribute to looking older and more tired than you may feel. Some patient also comment that they feel like their facial lines make them look angry. Fortunately, some of the effects of aging can be slowed and reversed. Neurotoxin treatment is a great option to address facial lines and wrinkles, as a safe, non-surgical treatment. This is a very popular non-surgical facial rejuvenation procedure, with the goal to refresh, and re-energize your look and feel. While there are many different neurotoxins on the market, we commonly use Botox® or Dysport®. Neurotoxins are derived from an organism called Clostridium botulinum, that temporarily blocks the nerve signals that cause muscles to activate or move. Relaxing contracted muscles allows the overlying skin tissues to smooth out and remove the wrinkles that result from this tension.

The most important consideration is to determine what areas bother the patient. Evaluation of these areas when the muscles of facial expression are at rest and activated is needed to determine areas to treat and how much neurotoxin to inject.  The amount of neurotoxin, measure in units, depends on several factors. Treatment must be individualized to address severity of wrinkles, muscle bulk, choice of neurotoxin, and response to any previous treatments. The goal is to achieve a natural and rejuvenated result.

Common areas treated include:

• Frown lines between the eyebrows
• Creases across the forehead
• Crow’s feet at the corners of the eyes.
• Fine lines around the mouth
• Horizontal lines on the forehead (frontalis)
• Vertical lines in the glabellar complex (procerus, corrugator)
• Wrinkles around the lateral portion of the eye known as Crow’s feet (orbicularis oculi)

Other treatment areas, considered off-label include:

• Bunny lines on the nose (nasalis)
• Wrinkles under the eyes (orbicularis oculi)
• Wrinkles around the mouth (orbicularis oris)
• Dimpled chin (mentalis)
• Marionette groove (depressor anguli oris)
• Jawline slimming and cleaning (Masseter hypertrophy or over-activity)
• Platysmal bands (platysma)
• Gummy smile caused by hyperactive lip muscles (levator labii superioris alaeque nasi, levator labii superioris, zygomaticus minor)

Neurotoxin injections are performed in the office with either no required anaesthetic, ice, topical anesthetic, or vibration stimuli to provide distraction. The procedure is fast with minimal discomfort, and you will be able to go home after the procedure or return to work and regular activities. There may some mild swelling at the injection sites that will subside after 1 hour. Small localized bruising can occur the needle injection sites, which will fade after 1 week. The refreshed results usually appear as early as 4-5 days and should reach their full effect at 2- 3 weeks.  A follow up after 2 weeks can be made if touch ups are needed for any asymmetry. The results can last 3-6 months and can be maintained with subsequent injections. We find that the results are longer for those who get injected at regular intervals over time, since the muscles start to atrophy over time when they are immobilized.

Neurotoxins have a great safety record, for both therapeutic and cosmetic use. There have been many studies that demonstrate the long-term safety of Botox® used for aesthetic indications. Treatment-related adverse events were blepharoptosis (2.5%), brow ptosis (3.1%), and eye sensory disorders (3%) in the upper face and lip asymmetries and imbalances in the lower face (6.9%).