Botulinum toxin demystified...

Updated: Jun 12, 2019



Test your knowledge on neuromodulators


Nueromodulators regulate nervous activity in the body by controlling the physiological levels of several classes of neurotransmitters. Specifically botulinum toxin is a neuromodulator protein that block signals from the nerves to the muscles. Specifically it blocks release of acetylcholine, the signal that activates muscle fibers to contract. By doing so it effectively weakens muscles until the process of activation can be renewed in the affected areas. This takes about 3 months.


So, when botulinum toxin is injected into facial muscles, you can expect that after 2 weeks approximately the effects will take place. The muscles will relax along with softening of associated skin creases/wrinkles. Since its discovery in the 1970s usage has grown exponentially as it has been applied to cosmetic indications. The FDA first approved the cosmetic use in the central forehead/glabella area but now approval has extended to the forehead and area around the eyes (crowsfeet).


There are currently four FDA-approved version of botulinum toxin, Allergan's Botox, Galderma's Dysport, and Merz' Xeomin. The biggest difference is that Xeomin does not have accessory proteins that can destablize with temperature changes and so it does not need to be refrigerated. Evolus company has recently released Jeuveau or NewTox and it is the newest FDA approved Toxin to treat lines and wrinkles. All of these products works through the same mechanism.


Know your injector


All four FDA-approved botulinum toxins work by the same mechanism but results may vary among products. One of the factors affecting the result is of course the dose given but another factor may be the experience and technique of the injector. Trust your face to an experienced injector with certification and training in the field of cosmetic surgery for great results and safety. Adverse side effects may occur and the risks are increased especially with off-label use in areas outside the forehead and area around the eyes. Even with the best injector, there may be variation among the toxins among patients and some may even develop an immunity to one or more of the products. If you are not seeing expected results it may be time to change to a different product and you may see that it works better!


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