Neuromodulators

Neuromodulators are medications that “modulate”, or impact, “neuro” (nerve) signals, causing a reduction in dynamic wrinkles, or wrinkles of expression. Some common brands are Botox and Dysport. These work by temporarily disabling the signal between the nerves and the muscles in the area of treatment. The muscles eventually regain the ability to respond to the nerve signal, so movement is regained over time. During the time that the muscle can not respond to a nerve impulse, the muscle in the treatment area does not contract, so it allows the overlying skin to remain smooth.

Our goal with neuromodulators like Botox and Dysport should not be to hinder facial expression and human communication, but to soften or reduce the deepening of permanent creasing in the areas of facial expression. Neuromodulators reduce muscle movement, to allow the overlying skin to remain still so that, over time, deeply etched lines are able to smooth out. Some people use low doses of neuromodulators to prevent the creation of deeply etched lines before they form.

Neuromodulators like Botox and Dysport can help to minimize new wrinkle formation in some cases, but over time may induce alternative wrinkles instead. The decision about when to start using neuromodulators is very individual and should be discussed with your board-certified dermatologist.

Many neuromodulator molecules are now on the market, with some more tested and trusted than others. Abobotulinumtoxin A is the molecule in Botox and Dysport, the most well-known and commonly used and reliable neuromodulators. Daxxify, Juveau, and Xeomin are also brands of abobotulinum toxin A.

Neuromodulators such as Botox and Dysport are not the same as fillers, even though many people say “filler” as a catchall term for “injectables”. Neuromodulators are injected, but do not take up space under the skin or remain underneath to help shape an area like dermal fillers do. Neuromodulator molecules do their job of temporarily cutting the signal from the nerve to the muscle and then are completely gone from your skin, while the muscles work over weeks to months to recreate the ability to respond to nerve signals. Dermal fillers such as Juvederm and Restylane don’t have any impact on nerve signalling or muscle movement. They just physically sit under the skin taking up space to help support facial structure.

Neuromodulators wear off on average at about 3 months. Some, especially when very small doses are used, such as in micro or baby Botox, last closer to two to 2.5 months. Occasionally, and especially after many years of regular use, the effects may last up to 6 months, since at this point, muscles may be thinner and weaker already from years of being kept in a resting state.

After treatment with neuromodulators such as Botox or Dysport, effects begin to set in within a few days, and are fully set in by two weeks. This varies by patient and by which medication is used.

Neuromodulators like Botox are also used in non-cosmetic settings such as for chronic unremitting migraine, TMJ, and hyperhidrosis (medically excessive sweating). They are also used in certain bladder conditions and when needed to help muscles relax in chronic neurological conditions.

Neuromodulators like Botox and Dysport are generally used about every three months, but some patients need to come more often and some like to stretch out the time between visits as long as possible. Discuss with your board-certified dermatologist.

Neuromodulator treatments are often combined with fillers and with laser treatments. Discuss a comprehensive plan with your board-certified dermatologist.

The most important thing to do to prepare for your neuromodulator treatment is to make sure you have spoken with your board-certified dermatologist and understand what to expect and to ask whether your own physician has any rules for treatment, such as “no exercise for 24 hours” or “don’t lie down right away”.