Neuromodulators (also know as Neurotoxins)
Since its FDA approval for cosmetic use in 2002, Botox® (Botulinum toxin [Allergan, Inc.]) has become a household name and was reintroduced as Botox Cosmetic ®. Botulinum toxin is a prescription medication that temporarily improves the appearance of moderate to severe frown lines between the eyebrows, sometimes referred to as the “11’s”. It does so by blocking signals from nerves to muscles, reducing muscular contraction, causing lines and wrinkles to soften. In 2009. Dysport® (Galderma) another botulinum toxin, became FDA approved, followed in 2011, by Xeomin® (Merz Aesthetics), both of which are approved for treating glabella lines.
The number of Botox® treatments per year has increased exponentially. According to the procedural statistics of the American Society For Aesthetic Plastic Surgery there were over 4.5 million Botulinum toxin (Botox®, Xeomin®, Dysport®) procedures in 2016. In 2013, Botulinum toxin was FDA approved to treat crow’s feet, lines at the corner of the eyes. Botulinum toxin is also FDA approved for treatment of excessive underarm sweating (axillary hyperhidrosis).
While all three products can be equally effective in softening lines, wrinkles and muscle activity, they are not interchangeable. These products differ from one another in dose, duration and other factors, and therefore treatment guidelines for each product must be followed. While each of these neurotoxins has FDA approval for specific indications, they have been used “off-label” to treat a variety of other cosmetic concerns. These include treatment of the following areas:
- Forehead lines
- Drooping eyebrows
- Uneven brow position
- Bunny Lines – lines on the sides of the nose
- Lip lines
- Drooping corners of the mouth
- Gummy smile
- Prominent neck bands (Platysma bands)
- Sweaty palms
- Sweaty feet
- Lines in the décolletage
What types of physicians treat patients with neuromodulators?
Physicians from a variety of specialties who are trained and experienced in the use of Botox®, Xeomin® or Dysport®. These usually include plastic surgeons, dermatologists, facial plastic surgeons, and ophthalmic plastic surgeons. It’s important to be treated by a physician who is knowledgeable about the anatomy and function and interrelationship of the muscles being treated. He or she must have complete understanding of the dosing of each product for both effective treatment and safety.
How long do the effects from a treatment last?
For most patients the effects usually lasts three to four months. Many patients do not wait for the effects to completely dissipate before their next treatment. They enjoy and appreciate the benefits of looking their best.
Do men get treated with either Botox®, Xeomin®, Dypsort®?
ABSOLUTELY!! According to the American Society for Plastic Surgeons, the 2014 Plastic Surgery Statistics report that treatment with with Botox®, Xeomin® or Dysport® is the #1 cosmetic minimally invasive procedure performed on men. There was a 7% increase in the number of treatments administered to men in 2014 compared to 2013.
Is there a difference in how men are treated with Botox®, Dysport® or Xeomin® compared to how women are treated?
There are some differences in how men are treated compared to how women are treated. Dosage may be different. In treating the muscles that tend to pull the forehead (brow area) down men usually require more botulinum toxin because their muscles are bigger and stronger.
The goals of treatment may also differ. While it is natural for most men to have a relatively low-set brow compared to women, the goal of treatment for a man may be look less angry, while the goal for women may be not only to raise the brow but to shape it as well.
Are there any pre-existing conditions in which Botox® Dysport ®or Xeomin® is contraindicated?
Yes. When these conditions are present neuromodulators are contraindicated. These preexisting conditions include but are not limited to:
- Preexisting neuromuscular disorders (ex. Myasthenia gravis)
- Ptosis (drooping) of the upper eyelids
- Weakness of forehead muscles/difficulty raising brows
- Planning forehead or eyelid surgery within several months
- Preexisting blurred or double vision
- Infection at the injection site
- Certain autoimmune diseases
Will insurance cover treatment of excessive underarm sweating?
Some insurance carriers will cover treatment of excessive underarm sweating. However, often times conventional treatments must be tried first, such as using drysol, and these efforts must be documented in the medical record.
Can Botox®, Xeomin®, or Dysport® be used to treat excessive sweating elsewhere besides the underarm?
Yes. Botox is the only one of the neurotoxins that is FDA approved for excessive sweating.
If I stop treatment will the treated areas look worse?
On the contrary, if you have been treated on a regular basis over a significant period of time, the underlying muscles may have atrophied and weakened. Therefore, they may not be able to contract as forcefully as they could prior to treatment, producing less lines and wrinkles.
What age is the best age to start using neuromodulators?
As with many cosmetic procedures, there is no specific age when to begin treatment. While we would generally not prescribe neuromodulators for cosmetic reasons to teenagers, there are some individuals in their twenties who may perform certain expressions so often and so forcefully that lines and wrinkles are readily apparent and are out of sync with the rest of their facial appearance. During a consultation the doctor can, based on her/his assessment of the patient, not only in terms of anatomy but also level of maturity and understanding, advise the patient whether it is indicated and appropriate for the patient to begin treatment.