What are Neuromodulators

What are Neuromodulators? (Botox®, Dysport®, Jeuveau® and Xeomin®)

The neuromodulators Botox®, Dysport®, Jeuveau® and Xeomin® are FDA-approved proteins medications available in the United States indicated to smoothing lines and wrinkles on the face. They use the power of nature tempered by science to relax away wrinkles and prevent new ones from forming. Botox Cosmetic is FDA approved to treat the frown lines, the horizontal forehead lines and the squint lines. The other neuromodulators are FDA approved to treat the frown lines, but all are used “off-label” to treat the above-mentioned lines and also to treat vertical lip lines, rough texture of the chin, downturned corners of the mouth, enlarged masseter muscles (jaw muscles) and neck banding. Neuromodulators also help the texture of the skin. The exact mechanism is unclear, but it is likely due to the effects of the medicine on the sweat and oil glands in the skin. MediSpa Maui proudly provides patients in Maui, HI with fully customized neuromodulator treatments designed to rejuvenate the look and feel of your skin.

 

How do Neuromodulators work?

Neuromodulators such as Botox Cosmetic® work by blocking the release of a chemical called acetylcholine that causes the muscles to contract. When the muscles are relaxed the skin lays flat which greatly reduces the appearance of facial lines and wrinkles. Neuromodulators only work in areas where lines and wrinkles are formed through consistent repetitive movement.

Are Neuromodulators safe?

Neuromodulator injections such as Botox® are very safe treatments. There is no downtime and the most common complication that occurs is minimal discomfort or a small bruise at the injection site. Mild headaches, body aches, and brow or lid relaxation are rare side effects that typically last anywhere between 1-2 weeks.

What should I expect after a Neuromodulator treatment?

You can expect to see results sometime between 2-10 days after receiving your treatment. Results typically last approximately 3-4 months. The newest approved neuromodulator and can last 4-6 months and sometimes longer. Neuromodulators such as Botox®, Dysport®, Jeuveau® and Xeomin® are commonly used in conjunction with other treatments offered at MediSpa Maui in order to achieve maximal skin rejuvenation. We offer Complimentary Consultations where we can create a treatment plan to help you achieve your desired results. We do require an appointment fee that goes toward treatments or product costs. This fee is only collected in the event of late cancellations or No Shows.

Are You an Ideal Candidate for Neuromodulators (Botox®, Dysport®, Jeuvea®u and Xeomin®?

Ideal candidates for Botox® and other Neuromodulators are those who desire youthful appearing skin without undergoing a highly invasive surgical procedure. If you are currently dealing with the signs of aging such as fine lines, wrinkles, and crow’s feet, Botox® and the other neuromodulators can help turn back the hands of time and help you reclaim your youthful look. Winkles in other areas that can be treated include the lines on the side of the nose (Bunny Lines), chin wrinkling, and vertical lip lines. Botox® and other Neuromodulators can also improve downturned corners of the mouth and soften the lower smile lines in some patients. Enlarged masseter muscles and be reduced to slim the face and to treat bruxism (grinding and/or clinching of the jaw) that can lead to TMJ pain and dysfunction. Vertical neck bands, horizontal necklace lines and rough skin texture can also be treated with Neuromodulators.

What do Neuromodulators not treat?

Neuromodulators do not give volume back to the face and they do not treat skin laxity. Other treatments will be discussed, often in conjunction with neuromodulators such as Botox®. If your lines are “etched in”, you will likely benefit from other procedures in addition to Neuromodulators. If your neck bands are already visible at rest, Neuromodulators such as Botox® will not likely lift them. Although present, the texture changes present with heavily sun-damaged or aged skin will likely not be appreciated.

Who Should not be treated?

Contraindications to Neuromodulators include neuromuscular disorders such as myasthenia gravis, allergy to constituents of the botulinum toxin product, unrealistic expectations, body dysmorphic disorder, infection and the injection site and pregnancy. While neuromodulators have not been tested in pregnancy and breastfeeding, there are no known issues related to pregnancy or breastfeeding. Despite the lack of evidence related to using Neuromodulators in pregnancy, as an added precaution, this product is not used in someone who is known to be pregnant. Because no safety studies have been preformed, the makers of these neuromodulators do not recommend the use of them during breastfeeding. It is, however, very unlikely that the Neuromodulators can make it into breast milk in any significant amount due to the large size of the molecule and dilution effect of the subject. Various unofficial recommendations exist including to breastfeed before treatment, pump prior to treatment and use pumped milk from 1-4 hours after treatment. The consideration of “pumping and dumping” after 1-4 hours for extra precaution has been discussed in the medical literature. But due to the size of the molecule and the need for a significant amount needed to have an effect on the infant, these techniques are unlikely to have a true effect. Dsyport® has the protein lactose as a constituent, therefore; individuals with known cow milk allergies should avoid this products use. If someone is in overall poor medical condition, it is not advisable to your neuromodulators. If someone has brow heaviness, Botox® will not be recommended for the forehead as these muscles raise the brows and loss of this function can lead to brow and subsequent lid heaviness (from the brows weighing down on the lids).

Is there an age in which I can no longer use Botox® or other similar Neuromodulators?

While sometimes it is written that Botox “is not recommended for individuals” 80 years of age or older, this is only because the studies did not include people older. There is no known issues with treating people above any certain age.

Preparing for Your Botox Treatment

Before undergoing Botox® treatment, you will have to schedule an appointment with MediSpa Maui for a consultation and often a treatment on the same day. During your consultation, please be clear about your medical history, including past allergic reactions and prior treatments. Any history of brow or lid heaviness with past treatments should be discussed. Please articulate your desired outcomes so that your injector can make sure that this treatment will be likely to achieve the results you are looking for. If you now the units used in other appointments, you can tell your injector. Do not guess or try to remember the number of units used. Ultimately, the provider must come up with a dose and pattern that is right for you given your wants, concerns and limitations. Light doses can be used, but these light doses may not eliminate all the bothersome winkles and will not last as long a more standard treatments. Avoid aspirin, Ibuprofen, other NSAID and herbs that thin the blood such as (but not limited to) kinkgo, high dose garlic, St Johns Wart, fish oil and other omega-3 fatty acids, Vit E, etc. If you have a history of light-headedness or fear of needles, please discuss this with your injector.

On the Day of the Procedure

Botox Cosmetic® is a simple and quick procedure that takes approximately 10-15 minutes. Ideally come in without makeup or remove it from the areas to be treated once you arrive. We will identify the areas to be treated and administer the Botox® cosmetic via small injections after cleaning the skin thoroughly. Ice or a topical numbing agent may be used to reduce discomfort for patients who are very sensitive. Botox® will work to relax the muscle contractions responsible for the formation of wrinkles. Once relaxed, the wrinkles will begin to fade and your youthful look will reveal itself.

How Will Your Face Look After Receiving the Botox Cosmetic?

When in the hands of a skilled cosmetic professional like Dr. Stolley and our other providers at MediSpa Maui, Botox® cosmetics can deliver stunning results that you can carry with confidence. You can expect a much more youthful version of yourself that’s free from signs of aging such as frown lines and wrinkles.

Do both men and women use Botox and the other Neuromodulators?

No! Both men and women can opt for the procedure. In fact, men in recent times are increasingly receiving Botox treatments to treat their frown lines and crow’s feet.

How Much Does Botox and Dysport Cost?

Botox® and other neuromodulators are fully customized cosmetic treatments that are designed with the needs of each individual patient in mind. The cost of a Botox® and similar treatments depends on the degree of correction desired and the amount needed to achieve one’s aesthetic goals.

What is the difference between Botox® Cosmetic, Dysport®, Jeuveau® and Xeomin®?

The main differences with these Neuromodulators is in relation to their accessory proteins. Just like some people like to wear watches, jewelry and carry purses, in nature, the core neuroprotein that does the work and has the actual desired effects is surrounded by other support/stabilizing proteins. Botox® and Jeuveau® have the full set of accessory proteins. Dysport® has a variable amount and Xeomin® has none. Another difference is in the amount of core neuroprotein in the vials sent to offices around the globe. Xeomin® has approximately .08ng, Jeuveau® .12ng, Botox® .18ng; and Dysport .27ng. This seems to correlate clinically to the relative strength and spread of these various products in that Xeomin® tends to be the weakest of the four and spreads the least and Dysport® tends to be the strongest and spreads the most. Jeuveau® and Botox® tend to be in the middle in regards to these two characteristics.

How long will Neuromodulators such as Botox®, Jeuveau®, Dysport® and Xeomin® last?

It is not possible to predict how long each of these medications will last for any one individual. Most patients will get at least a result that last approximately 3 to 4 months in the frown lines. The return of strength comes back gradually and typically starts at around 4-6 weeks after injection and becomes clinical noticeable around 3-4 months in half the tested subjects. The results do not tend to last as long in the forehead and squint lines/crows feet, approximately one month less than the frown in any given individual.

How long will Neuromodulators such as Botox®, Jeuveau®, Dysport® and Xeomin® last?

It is not possible to predict how long each of these medications will last for any one individual. Most patients will get at least a result that last approximately 3 to 4 months in the frown lines. The return of strength comes back gradually and typically starts at around 4-6 weeks after injection and becomes clinical noticeable around 3-4 months in half the tested subjects. The results do not tend to last as long in the forehead and squint lines/crows feet, approximately one month less than the frown in any given individual.

 

How long will Neuromodulators like Botox® last for me?

It is not possible to know how long neuromodulators like Botox® will last each individual person. The sensitivity to each product varies per person. The duration for any individual for each neuromodulator falls on a bell-shaped curve. Some patients see their results come back sooner than others. In general, over 50% of patients will see a return of frown lines in approximately 3-4 months using Botox®, Dysport®, Jeuveau® and Xeomin®. The FDA allows to say that the median duration of their product is 24 weeks (6 months).

How long will neuromodulators like Botox® last in different areas of my face?

Neuromodulators like Botox® and the others show consistent patterns on duration in different areas treated. In general, treatments in the frown will last longer with all the neuromodulators.

What is Median Duration:

Median Duration is the time it takes for 50% of study participants to see a return of movement. This is important because some patients will see a return of frown lines with sooner and some will see a return later than 6 months. Actually, 50% will see the return of frown lines sooner and 50% will see it later than 6 months. It is not possible to tell who will fall on either side of this curve, but there are a few clues to how long will last you. If you are someone in which Botox® does not last 3-4 months, you are unlikely to see 6-9 months out. Most likely last you longer than Botox®, perhaps 4-5 months, but the results will not be as long as other people.

What is a High Dose Botox and other Neuromodulator treatment?

Some physicians have experimented with significantly higher doses of Neuromodulators in various treatment areas. For example, instead of the standard 20 unit Botox® dose in the frown, doses of upward of 60 to 80 units have been used. These higher doses have shown longer result durations. Studies have shown that by increasing the dose of Dysport by 2-2.5x, the median duration increase to around 9 months. An approximate 9 month duration was also seen with a 5x increase in Xeomin and a 6 month median duration was noted with a 2-4x increase in Botox dosing.

What is a High Dose Botox and other Neuromodulator treatment?

Some physicians have experimented with significantly higher doses of Neuromodulators in various treatment areas. For example, instead of the standard 20 unit Botox® dose in the frown, doses of upward of 60 to 80 units have been used. These higher doses have shown longer result durations. Studies have shown that by increasing the dose of Dysport by 2-2.5x, the median duration increase to around 9 months. An approximate 9 month duration was also seen with a 5x increase in Xeomin and a 6 month median duration was noted with a 2-4x increase in Botox dosing.

If increasing the number of Units will increase longevity of Botox®, Jeuveau®, Dyport® and Xeomin®, can I try that?

This is a great question and the answer is, YES. While there are other differences such as no human proteins that may sway you to try the product, it is reasonable to try higher doses of products that you already use to see if you can achieve a longer result.

Could higher doses of Botox® or standard doses possibly have longer side effects such as brow or lid heaviness?

The short answer to this is Yes. Studies show that brow or lid heaviness does not tend to last as long as the desired clinical results, but for Botox and similar neuromodulators at standard doses in can last approximately 3-4 weeks. We do not have good evidence to suggest how long these side effects would last with higher doses, but we can reasonably postulate that it would be longer. The duration of lid ptosis is approximately 6-10 weeks with half of those effected lasting 6 weeks or less.

What can I do if I get lid Ptosis?

Lid Ptosis after neuromodulators such as Botox®, Dysport®, Jeuveau® and Xeomin® is a rare side effect that occurs in approximately 1-2% of treatments in which the upper lid is unable to lift to its normal untreated height. The median duration for standardly dosed Botox® and similar neuromodulators is approximately 3-4 weeks. The condition is related to the inadvertent treatment of the levator palpebrae muscle. The most common treatment for this condition is allowing time to pass and the prescription of medicated eye drops such as apraclonidine or brimonidine. These medicines work by stimulated a different muscle called the Muller’s muscle which runs directly under the effected muscle. Muscle exercise, massage and eyelid tap have also been recommended. Another effective, yet somewhat counter-intuitive treatment for lid ptosis is more neuromodulator. This is correct. The same medicine that caused the issue can also help to reverse it. Dose and placement are of extreme importance in this situation. In this case, the neuromodulator (a total of around 2 units Botox®) has to be placed directly on the lid-lash junction, typically on either side of the medial and lateral limbi (edges of the iris). The reason this works has to do with what the muscles in this area are doing and what muscles are not present in these area. Here, the affected levator palpebrae has transformed into its tendonous attachment as it inserts into the upper tarsal plate. The muscle closest to the eye lashes is the palpebral portion of the orbicularis oculi which is responsible for closing the lid and blinking. By treating this area with small doses of neuromodulators, an opening of the eye lid can be achieved. Dr. Stolley has used this technique with success in clinical practice.