December Spotlight: Neuromodulators

Neuromodulators, aka neurotoxins, aka Botox, are naturally occurring substances produced by a bacteria called clostridia botulinum. In the ’70s and early ’80s, ophthalmologists used neurotoxins to treat strabismus and blepharospasm.

In the late 80s, two Canadian physicians noticed that when some of the toxin got in the forehead while injecting around the eyes, their patients’ wrinkles disappeared. Allergan purchased the rights to the drug in 1991 and the rest is history.

There are now four different brands of toxin, Botox, Dysport, Xeomin, and Jeauvea. They have minor differences, which can be used to advantage in different situations but all four work in the same manner, namely blocking the release of acetylcholine at the synaptic junction. This means the nerves cannot stimulate the muscles to contract.

Our job as injectors is determining where to put the toxin, and at what depth and dosage. On average, the effects will last 3-4 months. Some questions we hear about these products are:

“Will starting Botox when lines first appear help lessen their appearance as time goes by?”

Yes, yes, and yes. It will even help prevent the formation of new lines. As it wears off, it does not cause your skin to stretch. When you first get the product, your face appears tighter, which may be why people think this.

“Botox doesn’t work on me.”

It may be that you need more units or a different brand of toxin. It takes two weeks to see the full effect. Stay with your injector, and come back in two weeks to show them what you look like. We can tweak it at this point. This is often a process, and only sometimes a one and done.

“Can you become tolerant to neurotoxin?”

Perhaps. Some injectors feel you should rotate brands of toxin to prevent this, but there aren’t a lot of studies to document this.

What has been studied is the formation of antibodies to the proteins around the toxins. This is a fairly rare occurrence. If it is the problem, we will switch to Xeomin, which does not contain the proteins. A better way to prevent tolerance is to let the product wear off before getting more.

The dosage can be increased at your next session to compensate for this. In this fashion, you will be getting product less often.

New on the horizon, Daxxify. Supposed to last 6 months.