Laughing, frowning, squinting, chewing—i.e., facial movements— contribute to the formation of wrinkles as we age. A quick and safe remedy to reduce the appearance of these wrinkles is an injection of a neurotoxin.
There are four neurotoxin products approved for use in the United States:
- onabotulinumtoxinA (Botox Cosmetic®, manufactured by Allergan Inc.)
- abobotulinumtoxinA (Dysport™, manufactured by Medicis Pharmaceutical Corporation)
- incobotulinumtoxinA (Xeomin®, manufactured by Merz Pharmaceuticals)
- rimabotulinumtoxinB, a type B neurotoxin (Myobloc®, manufactured by Solstice Neurosciences)
Currently, only Botox and Dysport are approved for cosmetic use by the Federal Drug Administration (FDA). Find out how these neurotoxins work and what might be the best option for you.
Botulinum toxin type A and botulinum toxin type B are both purified substances, derived from the bacterium, clostridium botulinum. When the toxin is injected into the muscle, it blocks muscular nerve signals, which then weakens the muscle so that it cannot contract— diminishing unwanted facial wrinkles. The areas treated are typically the forehead, between the eyes (glabellar region), around the corners of the eyes (crow’s feet), and around the lips.
While the procedure is quick and may appear simple, it requires an experienced and trained professional. There are 43 muscles in your face; the person who performs the injections must be able to pinpoint the exact spots to maximize your results. The number of injections depends on the extent of your wrinkles and the areas being treated. By injecting the toxin into specific muscles, your facial plastic surgeon weakens only the wrinkleproducing muscles, preserving your natural facial expressions. It is a minimally invasive treatment; no anesthesia is required. There is no down time or recovery time.
In 2002, the FDA approved Botox Cosmetic for the temporary improvement in the appearance of moderate to severe glabellar lines (the vertical lines between the eyebrows). Wrinkles formed by dynamic muscles (in motion), such as glabellar lines when we frown or crow’s feet when we smile or squint, can be temporarily smoothed out with Botox injections. After the injection, improvement is seen within three to seven days, with results lasting up to four months. Discuss with your physician a treatment schedule; you can receive injections every four months. With repeated treatments, thinning of the muscles occurs, which may produce longer lasting results.
Botox has proven to be an effective treatment for various conditions, including wrinkles, blepharospasm (excessive blinking), strabismus (misaligned eyes), hyperhidrosis (excessive sweating), cervical dystonia (disorder of head and neck muscles), and chronic and migraine headaches.
Dysport has been approved for aesthetic use in the United States since April 2009. Outside of the U.S., it has been used for aesthetic treatments since 2001. Similar to Botox, it is injected to relax facial muscles and smooth frown lines. Unlike Botox, Dysport is suspended in lactose; Botox is suspended in sodium chloride. Be sure to let your physician know if you are allergic to cow’s milk protein or had an allergic reaction to any other botulinum toxin product.
Results with Dysport show in one to two days and can last between three to five months. The manufacturer recommends that you wait at least 90 days between treatments. Clinical studies prove continued effectiveness with up to four repeated treatments.
Xeomin (incobotulinumtoxinA) was approved by the FDA in July 2010 for the treatment of cervical dystonia and blepharospasm. Xeomin has not yet been approved for any cosmetic indications.
Xeomin is the first neurotoxin that does not need to be refrigerated before use. Xeomin has no additives, just botulinum toxin type A. This may mean that there is less risk of developing antibodies against Xeomin than other available neurotoxins. The body develops antibodies in response to a foreign invader and attacks.
The effects of Xeomin occur within one week, and the results last from three to six months. More information and clinical studies are being done regarding the cosmetic uses.