What is a neuromodulator and how does it work?
A neuromodulator is a chemical substance that interferes with nerve communication. In aesthetic medicine, neuromodulators are used to soften wrinkles by temporarily blocking the interaction between nerve endings and the muscles they innervate. Botox (onabotulinumtoxinA) and Xeomin (incobotulinumtoxinA) are the two neuromodulators most commonly used at Carlsbad Vista Dermatology.
What is the difference between Botox and Xeomin?
Although both contain botulinum toxin (the active molecule that inhibits muscle movement), Botox contains complexing proteins whereas Xeomin does not. Clinically this does not make much of an impact, however very rarely individuals may develop antibodies to the complexing proteins in Botox rendering it ineffective. Because Xeomin does not contain these proteins, there is no risk of this happening in patients treated with Xeomin.
What areas can Botox and Xeomin be used to treat?
Botox and Xeomin are both FDA-approved products indicated for the temporary treatment of glabellar rhytides, the vertical wrinkles between the eyebrows sometimes referred to as the “11 lines”. In addition, Botox has indications for the crow’s feet (horizontal wrinkles radiating from the corners of the eye), frontalis (horizontal forehead lines), and for the treatment of axillary hyperhidrosis (excessive sweating of the underarm area).
Aside from these indications, Botox and Xeomin can be used off-label by experienced dermatologists in other areas on the face, neck and body. Some of these treatments include:
“Eyebrow Lift”: Injecting a small amount of Botox or Xeomin at the lateral eyebrow can help keep the eyebrows elevated and create a feminine arch to the eyebrow.
“Bunny Lines”: The wrinkles that appear on the side of the nose when scrunching the nose are commonly referred to as the bunny lines. A small amount of Botox or Xeomin injected on either side can soften the appearance of those lines.
“Gummy Smile”: Although it is a sign of youthfulness to have some of the upper gums show when smiling, some individuals may have excess show resulting in a “gummy” smile. Injecting Botox or Xeomin into the muscle that elevates the upper lip when smiling can help to improve the appearance of a “gummy” smile.
“Smoker’s Lines”: The small vertical wrinkles around the mouth that worsen with age and can be exacerbated by repetitive actions such as smoking can be softened by small injections of neuromodulators along the upper and lower lips.
“Downturned Mouth”: With aging, the corners of the mouth start to droop. Small amounts of either product can help to correct downturned corners of the mouth and create a more pleasant appearance of the mouth at rest.
“Pebbled Chin”: A wrinkled or pebbled chin can sometimes resemble an orange peel. This can be improved by injecting small amounts of Botox or Xeomin into the chin.
“Platysmal Bands”: The platysma is a muscle in the neck that can create vertical bands called “platysmal bands”. Botox or Xeomin can be injected along these bands to make them less noticeable.
“Masseter Hypertophy”: Certain individuals may develop enlarged masseter muscles, which can create a square and bulky jawline. Injecting neuromodulators into this muscle can create a narrower and more appealing jawline.
What are the possible side effects of Botox and Xeomin?
Side effects with neuromodulators are not common with correct placement by an experienced dermatologist. The majority of side effects are temporary and injection-related. These include localized swelling, pain, bruising or infection at the site of injection. Uncommon but more serious side effects include headache, tiredness, double vision, blurred vision, or drooping eyelids.
What is neuromodulator treatment like and what is the downtime like?
Treatment with Botox and Xeomin is quite simple and almost painless. Your skin will be cleansed with an alcohol pad and very fine needles used to administer small aliquots of Botox and Xeomin into the specific treatment areas. For patients requiring additional pain relief, topical anesthetic cream and/or ice packs can be used during treatment if desired.
There is virtually no downtime following neuromodulator treatment. However, it is recommended that individuals avoid laying down flat for 4 hours, vigorous exercise for 24 hours, and rubbing or massaging treatment sites for 48 hours. This will decrease the chance of the Botox or Xeomin migrating into an unwanted area and causing an undesirable result.
How long does it take for Botox or Xeomin to set in and how long will the results last
Improvement of wrinkles following Botox or Xeomin injections usually occurs within 2-7 days following treatment. Neuromodulators typically last 3-4 months, although the length of effect will vary from person to person. Neuromodulator effect in areas of frequent movement, such as around the eyes and mouth, tends to wear off more quickly. Treatment of neck bands may yield results for up to 4-5 months or longer in some patients. Botox used for hyperhidrosis (excess sweating) of the underarm can last 6 months or longer
Moderate to severe frown lines:
All Photos provided by: Allergan Company
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