What is Botox?

Botox is a type of injectable neurotoxin. It is the brand name for OnabotulinumtoxinA and it was the first in the class of botulinumtoxin A to be produced. Since then, Dysport (AbobotulinumtoxinA), Xeomin (IncobotulinumtonxinA) and Jeuveau (prabotulinumtoxinA-xvfs) have emerged, all of which stop neurotransmission from nerve endings to targeted muscle(s), relaxing the muscle(s) thereby reducing dynamic lines and muscle tension.

What are some conditions treated by Botulinum Toxin A?

  • Dynamic wrinkles: These are wrinkles that are created with muscle contractions (think frowning, squinting, raising eyebrows, etc.). Typically, these wrinkles are not visible unless the muscles are moving. However, with repetitive movement, permanent or static lines may persist. This is one of the ways to prevent static wrinkles.
    • Best examples: glabella lines, crow’s feet lines, forehead wrinkles.
  • Static wrinkles: These are wrinkles that are present at all times. Typically, they are seen as small fine lines on the face, neck, upper chest and hands. They are present due to a multitude of reasons. Though botulinumtoxinA does not eliminate static lines, it helps reduce the severity of these wrinkles when the patient is moving or animating.
    • Best examples: crow’s feet, forehead wrinkles, smoker’s lines (perioral fine lines)
  • Muscle spasm: Treating muscle spasms is actually one of the first approved uses of botulinumtoxinA. Frank muscle spasms like that of blepharospasm (twitching eyes) or increased muscle tension, as seen in TMJ or migraines, can be treated with strategically placed injections of this neurotoxin.
    • Best examples: twitching eyes, TMJ, migraines
  • Muscle bulk: Muscle bulkiness can be reduced by botulinumtoxinA treatment, as it decreases the force of contraction. When the bulkiness of a muscle is reduced, it can change body or facial contour.
    • Best examples: masseter muscle bulkiness, platysmal bands
  • Facial synkinesis: This is a condition that develops in patients who suffer from facial nerve disorder / inflammation. Patients with this condition experience abnormal facial contraction at rest or with movement, which can be mitigated with botox injections.
  • Excess sweating / Hyperhidrosis: The injected neurotoxin can block the nerve endings to sweat glands in order to stop or reduce sweating.

How long does it take for neurotoxins to work?
Typically, injectable neurotoxins takes 10-14 days to reach their full effect. The results can last 3-6 months depending on the person and the problems treated.

Which brand of neurotoxin is right for you?

There are four neurotoxins for clinical use. All FDA approved neurotoxins are effective in treating listed conditions. The effects of all of the products are expected to take place in 3-7 days and with peak effect around 10-14 days. All products provide correction duration of approximately 3-6 months depending on the dosage and areas / problems treated.
But there are some differences…

  • Botox (OnabolutinumtoxinA) the original neurotoxin that has been used in all indications. Given its long history, it has the most evidence and experience related to usage of neurotoxin. New products released later are often measured against Botox as the gold standard neurotoxin.
  • Dysport (AbobotulinumtoxinA) contains the largest molecule out of all of the neurotoxins. It permeates better and likely can create faster onset of results, but it also has a slight higher likelihood to propagate to areas beyond the desired muscles.
  • Xeomin (IncobotulinumtoxinA) contains the smallest molecule out of all of the neurotoxins, which means it may permeate slower than the rest of the toxins. However, it is least likely to produce an immune response related resistance in the long run.
  • Jeuveau (ProbotulinumtoxinA-xvfs) is the newest addition to the family of toxins. Less is known about this toxin due to the short amount of time it has been in the market, but it has demonstrated that this product is not inferior to any of the prior toxins that are on the market.

When do you start doing neurotoxin treatments?

This depends on the problem that is being treated and the anatomy / condition of the patient.

If you have the following conditions, please discuss with your physician if neurotoxin treatments are for you:

  • Pre-existing conditions: movement disorders, hypersensitivity, pre-existing breathing or swallowing disorder
  • Medication: aminoglycoside antibiotics, anticholinergic medications, muscle relaxant
  • Pregnant or nursing

Care After Treatment:

  • Minimal Downtime
  • Avoid steam room or hot shower four hours after treatment

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