How do Neurotoxins work
Botulinum toxin is used to reduce the appearance of fine lines and wrinkles caused by facial expressions (think: frowning, squinting, smiling, and the like) by injecting it into the muscles underlying the affected area. In turn, the lack of muscle contraction prevents the face from forming lines and wrinkles and the result is smoother skin for three to four months (or until it wears off). While the active ingredient in each brand is botulinum toxin type A, some also feature protein blends that may affect the diffusion and efficacy of the injection. However for the average patient all of the products last a similar amount of time, and they all provide similar result. Individual results may vary depending on the degree of skin damage, depth of lines, size of muscles, the amount used, metabolism, and presence of antibodies and/or other medications known to interfere with the effectiveness. Some patients will not have the same pronounced effect as others.
Botulinum Toxin injection can be administered in as little as 10–15 minutes. Weakening of the injected muscles begins to be apparent after 3-7 days with the peak effect being reached after 14 days. The results can last up to 3 months. The procedure is temporary and will have to be repeated on a regular basis (every 3 months) to remain effective. Injections given at less than 3-month intervals may not produce a noticeable effect.
Ready for a modern-made tox? Carrying the self-designated hashtag #newtox, FDA approved Jeuveau® has positioned itself as an affordable alternative to Botox for younger patients wishing to treat early signs of aging. The botulinum in Jeuveau® is prepared using a unique purification process, which makes for a unique formula. This means that Jeaveau® may get better results than Botox for some patients, and vice-versa.
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FDA Approved in July 2011 (and it has also been medically approved to correct muscle spasticity and, most recently, excessive drooling). Xeomin® is unique in that it does not blend BoNT-A with complexing proteins (though inactive ingredients include human albumin and sucrose). Xeomin® costs the same as Botox® and Dysport® — but fewer units may be needed to achieve the desired result. Patients who show signs of resistance to Botox® and Dysport® may find success with Xeomin® due to the purified state of BoNT-A. Results from Xeomin® injections take 5-7 days to become visible and last a similar amount of time to Botox®, Dysport®.
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FDA approved in April 2009 and like Botox®, also has therapeutic uses to calm muscle spasticity. While Dysport® and Botox® have the same proteins at their core, the weight of the protective proteins in Dysport® are not uniform like those in Botox®. As a result, Dysport® has a higher rate of diffusion, which makes it ideal for treating larger areas (think: foreheads). Like Botox®, it is formulated with human albumin, however Dysport® also contains lactose and cow’s milk protein — making it unsuitable for patients with milk allergies. While the effects of Dysport® may show up sooner (within 24 hours) than Botox®, some studies have shown that they may not last as long. The shorter lifespan could make it a good choice for patients who are unsure about whether they will like the results of Neurotoxins injections.
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FDA approved as a temporary aesthetic treatment to improve the appearance of frown lines between the eyebrows, forehead lines and crow’s feet. Botox® is formulated with protective proteins that a subset of patients may develop an antibody against over time, lessening the effectiveness of the treatment. The inactive ingredients in Botox® include human albumin (i.e. plasma proteins) and sodium chloride. There is also a therapeutic version of product that can be used to treat medical conditions like migraines, excessive sweating, and eye spasms to name a few. Botox® is effective but not permanent. It takes about 3-5 days post-treatment for the results to appear (though it can take up to two weeks for the final effect to be visible), and it lasts about three to four months in most patients. The longevity depends on everything from the way a patient’s body metabolizes the product to the area being treated.
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At the consultation:
During the initial consultation, your practitioner will discuss with you exactly what your concerns are and manage your expectations to ensure you get the best result. They will make treatment recommendations to align with what you want to achieve and your budget.
On your appointment date:
At your first neurotoxin appointment, you’ll complete a medical consent form and pre-treatment photos are taken to track your results. This initial appointment is about 30 minutes, which is longer than follow up appointments which are only around 15 minutes. Our philosophy is that it is better to err on the side of using less products (especially on your 1st visit) because you can always give more, but you cannot remove it. This follow up visit allows us time to assess your response to the neurotoxin and to make adjustment to the dosage if necessarily and make a note it in your records for future appointments.
Immediately after the treatment
Right after the treatment, you may have a small amount of redness and swelling – this will usually resolve within ten minutes. Most people experience no pain or side effects, a small number get a mild headache after the treatment which can be eased with mild pain relief.
The biggest concern when having this procedure is a droopy eyelid. This happens when product migrates down into the muscles above the eye, but having a skilled practitioner along with your compliance with proper post care instructions will essentially make this a rare occurrence.
1 day after the treatment
Most people will not experience any symptoms that show they’ve had the treatment done, however it is possible to have some minor bruising. Noticeable results are not usually visible the next day, as it take a bit of time for Neurotoxin to kick in.
1 week after the treatment
After 5-7 days, you are likely to start to see results of your treatment, with the full effect seen at 10-14 days. The treated area will appear smoother and look more refreshed.
1 month after the treatment
A month down the track, your treatment will still be very effective. Some people will have a very small amount of movement return, although this differs for everyone and also depends on the area treated.
3 months after the treatment
After about 3 to 6 months, the effects of neurotoxin starts to wear off and you will start to see a gradual return of movement. If you want the fresh and smooth look to return, you will have to repeat the injections. Most people get injections every 3 to 4 months.
Will my face look overdone or unnatural?
Neurotoxin injection is a technique-sensitive treatment. You can trust Neurotoxin products to deliver subtle results when you are treated by someone who is licensed, trained, and a medical expert in facial anatomy. So you’ll look like yourself—only with less noticeable lines. No one should be able to tell you’ve had anything done.
Does treatment hurt?
Some patients report that being injected Neurotoxins feels like a pinch. Your specialist may use ice to numb the treatment area. If you are concerned about discomfort, your specialist can instead apply a topical numbing cream before administering your treatment.
How long is the recovery time after treatment?
Treatment requires minimal downtime. So you can return to your daily routine immediately after you leave your specialist’s office.
What were common side effects seen in clinical studies?
The most common side effects of any botulinum toxin injectable are bruising and pain at the injection site, flu-like symptoms, headache, nausea, redness, and temporary facial drooping. While rare, it is possible that the toxin may spread beyond the treatment area, which could lead to botulism-like symptoms including trouble breathing and swallowing, muscle weakness, and slurred speech. Please see the Important Safety Information including Boxed Warning and Medication Guide and talk to your specialist.
How long do results last?
Last 3 – 6 months depending on the area being treated and how patient’s body metabolizes the product. Athletes tend to metabolize Neurotoxins faster.
Contraindications include but are not limited to the following:
- Pregnancy or active breastfeeding
- Diseases that affect muscles and nerves
- Allergies and past side effects to any Botulinum Toxin product
- Allergies to cow’s milk products (Dysport only)
- Allergies to human albumin (Xeomin only)
- Pre-existing swallowing or breathing difficulties
- Weakness of forehead muscles
- Aminoglycoside Antibiotics: amikacin, gentamycin, streptomycin, or tobramycin
- Taking agents interfering w/ neuromuscular transmission: magnesium sulfate, guanidine, lincosamides, polymyxins, anticholinesterases, succinylcholine chloride, curare
- Had surgery on your face
- Patients with unrealistic expectations
Compliance with the recommended pre / post-care instructions as well as recommended follow-up visits by your practitioner are crucial in minimizing the risk of side effects and complications. It is your responsibility to inform your practitioner of your most recent sun exposure, new medications, or changes in medical history before each treatment is performed.
Before Your Treatment
- It is not recommended to have Botulinum Toxin injection procedure less than 90 days apart.
- It is not recommended to have Botulinum Toxin injection procedure less than 2 weeks before a big event.
- Inform your practitioner if you have a history of medication allergies, history of anaphylaxis, and any other medical conditions.
- Do not use Botulinum Toxin if you are pregnant, trying, or breastfeeding.
- Do not use Botulinum Toxin if you are allergic to any of its ingredients, or suffer from any neurological disorders.
- Schedule a follow-up appointment 2 weeks after your procedure.
- If you have a history of cold sores (Herpes simplex virus), start antiviral therapy 2 days before your procedure.
- To avoid bruising it is best not to take any blood-thinning or NSAIDs medications, vitamins, and supplements (unless otherwise prescribed by your doctor) approximately 3 days before your procedure.
- If you have a tendency to bruise easily, you may start taking over-the-counter Arnica Montana tablets 3 days before your procedure.
- Do not drink alcoholic beverages 24 hours before and after your procedure to avoid bruising.
- Do not apply potentially irritating products for 2 days before and after treatment (e.g. tretinoin, Retin-A, glycolic acid, benzoyl, hydroquinone)
- Arrive with a clean face. Please do not wear makeup (you may bring your own makeup to apply after your procedure).
Day of Treatment
- You may experience a mild amount of tenderness, stinging, and discomfort during your procedure.
- The number of units injected during your procedure is an estimate of the amount required to temporarily paralyze a targeted muscle. We ask that you wait at least 14 days after injection to assess whether or not additional units are needed to achieve the desired result. A regular charge applies to all subsequent treatments and/or dose adjustments.
After your treatment
- Stay in a vertical position for 4 hours following injection. Do not rest your head or lie down; sit upright.
- It is best to try to exercise your treated muscles for 1-2 hours after the procedure (e.g. practice frowning, raise your eyebrows, and squint). This helps to work the product into your muscles.
- Do not massage the treated area(s) after the procedure.
- Avoid wearing makeup until the following day.
- Temporary redness, swelling, bruising, tingling, numbness, and pressure right after the procedure are normal.
- You may take over-the-counter Arnica Montana tablets or apply Arnica Montana topical cream to help reduce bruising.
- You may take Acetaminophen/Tylenol if you experience any mild tenderness and discomfort.
- You may apply ice to the treated area with light pressure to reduce swelling. Ice should be applied in an on and off fashion for 10 minutes.
- Avoid extended UV exposure until any redness/swelling has subsided. Apply SPF.
- Avoid strenuous exercise for 24 hours after your procedure. You may resume other normal activities/routines immediately.
- Do not apply potentially irritating products for 2 days after treatment (e.g. tretinoin, Retin-A, glycolic acid, benzoyl, hydroquinone)
- Avoid laser or skin tightening procedures to the treated area(s) for a minimum of 48 hours (or as directed by your practitioner).
- You will not see an immediate improvement. Most patients start seeing the effect as early as 3 days and up to 14 days after the procedure.
- Schedule a follow-up appointment 14 days after your procedure for your practitioner to assess if additional units are needed to achieve desired results. A regular charge applies to all subsequent treatments and/or dose adjustments.
If you experience any side effects, such as prolonged redness or swelling, a histamine reaction, or infection, immediately contact your practitioner for proper assessment and care instructions.
Regularly scheduled treatments 3-4 months apart.