Neuromodulator injections are perhaps the most popular cosmetic treatments worldwide today. There are two commonly used types of neuromodulators in the U.S.: BOTOX® Cosmetic and Dysport®. All three work via the same mechanism with very similar clinical effects even though subtle differences exist between the three compounds. Even though the FDA-approval varies slightly between the three different compounds, they are often used for the same purpose. Please discuss with your facial plastic surgeon what the differences between the compounds are and which substance may be best suited for you.
Both injectables treat wrinkles by temporarily weakening certain muscles that are injected. BOTOX® Cosmetic and Dysport® all contain the naturally-derived botulinum "toxin" type A that selectively blocks nerve signals and hence weakens muscles. The injections may also be performed in underarms, palms, or soles for excessive sweating. Other common uses are for chronic migraine headaches, amongst other applications.
Neuromodulator injections are individualized to every patient, depending on the patient’s needs and desires. They cannot stop the process of aging. They can, however, temporarily diminish the look of wrinkles caused by certain muscle groups. Neuromodulator injections may be performed as an isolated procedure or as an adjunct to a non-surgical or surgical intervention (dermal filler injections, browlift, facelift, etc.).
Types of Botulinum Toxins Available and their usage
Dysport® is FDA-approved to treat moderate to severe frown lines between the eyebrows and cervical dystonia (stiff neck). Other areas of the face and neck, such as crow’s feet wrinkles, forehead creases, and neck bands, may be treated with Dysport® in an “off-label” fashion.
How long does it take until the effects can be seen and how long do they last?
Even though slight differences exist between BOTOX® Cosmetic and Dysport® clinical results following injections are typically seen within 48 to 72 hours with the full effects within 7 to 14 days. This is typically the time when we ask our patients to come back for re-evaluation and for a possible minor “touch-up” to make sure you have the best and most natural results. The injections usually last from three to four months, sometimes longer.
Avoiding "Frozen Face"
A common misconception about neuromodulator injections is that they lead to a frozen, expressionless face. The key to avoiding this lies in the skill of the injector and not in the substance itself. By using microdroplet injections targeting specific muscles and by avoiding certain areas, a natural result can be obtained without looking artificial or “fake”. Furthermore, Dr. Walker places emphasis on conservative injections, particularly in patient who are new to BOTOX® Cosmetic and Dysport®.
Procedure and Recovery
BOTOX® Cosmetic and Dysport® can all be injected as an in-office procedure, requiring no anesthesia. The injections are performed using tiny needles (the smallest needles on the market). Discomfort is usually minimal or absent. Very few patients may experience some injection site redness, minimal bruising, and on occasion a minor headache at the injection site, which may last as long as 24 hours. These reactions are usually minor and clear up quickly. Most patients can return to normal activity immediately after receiving injections. It is important that you do not massage the area in which the injections were administered because you can cause the medication to migrate and affect other muscles other than the ones that were targeted.
What is the right age for injections and does the amount injected differ by age group?
All patients must be above age 18 years. Other than that, there no right or wrong age for injections. Even though younger patients tend to have less skin creases, neuromodulator injections help prevent the formation of wrinkles if started at a younger age. Dr. Walker believes is it important to always start with the lowest possible dose of BOTOX® Cosmetic or Dysport® regardless of the patient’s age.
What are the qualifications/credentialing required to perform BOTOX injections?
Even though neuromodulator injections appear to be relatively minor procedures, they are often misconceived as a procedure without side effects or risks. The human face contains over 43 muscles, and it is important to understand which muscles may be safely injected and which muscles ought to be avoided. It is very important that you only allow an experienced and trained healthcare professional to perform this procedure. To our knowledge, there are no qualifications or education requirements in the state of Georgia needed to perform neuromodulator injections. As a fellowship-trained facial plastic and reconstructive surgeon who performs a vast array of facial surgeries (both cosmetic and reconstructive), Dr. Walker possesses the fundamental knowledge of facial anatomy and skill set to safely administer such injections.
A misplaced injection can result in a very unnatural look, asymmetries, blurry vision, mouth drooling, and other side effects depending on which muscles were injected. In rare instances, the injected substance may migrate away from the injection site and cause slurred speech or even breathing problems.