Reducing the appearance of wrinkles with neurotoxins

January 16, 2018 by Shari Twigg, MD
Reducing the appearance of wrinkles with neurotoxins
Neurotoxins, like Botox or Xeomin, are used for the temporary improvement in the appearance of moderate to severe wrinkles.  The wrinkles most affected are ones that occur with movement, however, the longer one gets these treatments, the static wrinkles (wrinkles at rest) will often times improve as well.  Neurotoxins work by affecting a protein in the nerve ending, making it inactive until the body makes new proteins.  On average, neurotoxins last about 3-4 months, however it can be as short as 2 months or as long as 6 months.

There are only 3 absolute contraindications to this treatment at this time:  Pregnancy/breastfeeding, active infection in the treatment area, or a sensitivity/allergy to something in the medication used.  Other considerations for not doing treatment with a neurotoxin can be present as well, but those are reviewed individually, and most patients have minimal adverse reactions to neurotoxin injections.  The most common reactions are due to just general injectionsà pain, bruising, redness, swelling, tenderness, headache, infection, or numbness.

Neurotoxins can be injected into many areas:  between the brows, forehead, and crow’s feet area are the most common.  These are considered basic techniques.  More advanced techniques are used to treat a multitude of areas.  We can treat lower eyelid wrinkles, do an eyebrow lift for a more aesthetically pleasing brow and to open the eye space up, and improve “bunny lines” (the lines on the upper lateral nose when scrunching up the nose).  Other advanced techniques include lip lines (smoker’s lines), a gummy smile, marionette lines/downturned corners of the mouth, the pebbled chin, neck bands/platysmal bands, horizontal neck lines (“necklace lines”), nose reshaping, lines on the décolleté, and softening a square jawline.  Neurotoxins can even be used for excessive sweating with very good results.

Treatment begins with a consultation and photos.  The physician will evaluate lines and wrinkles at rest and with movement.  The areas of your concern are discussed and treatment options are discussed.  Once treatment has been done, the treatment results, although not guaranteed, start at 2 days and gradually become evident by 10-14 days.  The patient should not rub the areas injected for at least 2 hours and should remain upright for 4-6 hours after injection.  If additional treatment is needed for improvement in dynamic wrinkles (wrinkles that occur with movement), then this is done at 2 weeks.  It is not uncommon, particularly with new treatment areas or first treatments being done to need additional neurotoxin injected, as average starting doses are used.  Some patients need more to get the best results.  Once the dose is found for appropriate response, this dosage is then done all at once at the next treatment (usually 3-4 months for most areas).  Patients should return for additional treatment as soon as they begin to notice movement in the target muscle again.

Some wrinkles respond best by incorporating additional types of treatments in addition to neurotoxin injections.  These treatments could be:  dermal fillers to “fill” in an area that has lost structure, microdermabrasion to smooth the surface of the skin, microneedling to induce new collagen development in the skin, chemical peels for resurfacing and decreasing wrinkles, Skinfinity Radiofrequency fractional ablative skin resurfacing that both resurfaces the skin and promotes new growth of collagen for a younger appearing skin.