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The Facts

  • Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. It prevents the release of the neurotransmitter acetylcholine from axon endings in the neuromuscular junction, causing muscle relaxation. 

  • Although botulinum toxin can be poisonous, the doses used in medicine and aesthetics are so small that it is not toxic. Most people receive about 100u of Botox in treatment, where they would need greater than 35 times that much to be toxic. 

  • Since the 1970’s doctors have been using Botulinum toxin for treating medical conditions like strabismus and muscle spasticity. In the 90’s a pair of ophthalmologists recognized its effect on wrinkles around the eyes. From this, cosmetic applications were researched and developed. 


  • Neuromodulators like Botox and Dysport require a prescription from a Medical Doctor. 

  • Although the use of neuromodulators has become common for treatment of lines and wrinkles in aesthetics, they are only approved by the FDA for use on the glabella and crows feet. Use other places on the face is considered an acceptable “off label” use. 

  • Common applications include: Glabella, Crowsfeet, Forehead, Marionette lines, chin, lips. 

  • The application takes about 15 minutes. 

  • The effects last 3-4 months

  • The goal is relaxation of the muscles to reduce movement and wrinkles about 80%.

Possible Side-effects

  • Discomfort at the site of the injection is temporary

  • Bruising, swelling and redness at the site of injection is temporary

  • Numbness from injection may occur and usually resolves within a month

  • Headache from injection is temporary and acetaminophen is helpful

Adverse Risks

  • Development of tolerance- after repeated injections the neuromodulator may have less effect. 

  • Ptosis: In 2% of all injections, Neuromodulators can cause an eye droop to occur that can last up to 4 months.

  • Diplopia: In rare cases the Neuromodulator can diffuse to a muscle responsible for moving your eye from left to right causing you to have temporary double vision that can last up to 3- months.

  • Unwanted Facial Weakness: In some people, heaviness in the forehead, cheeks, mouth or other facial areas. Also in lower face, there is a risk of change in lip pursing, ability to enunciate words, sip from a straw or cup, and the possibility of a lip droop. These effects are temporary and can last up to 3-6 months.

  • Asymmetry: All faces are not perfectly symmetrical, and although we strive to create balance, in some cases, one might notice some differences in effect from one side compared to the other.

  • Pigment Changes: Although rare, during the healing phase, the treated area may appear to be darker. This is called PIH (“post inflammatory hyperpigmentation”). PIH occurs more frequently with darker colored skin, after sun exposure to the treatment area, or with patients who already have a tan.

  • Infection: Every time you are injecting through the skin there is a chance that there is a portal of entry for infection.

  • Allergic Reaction: Patients can be allergic to the neuromodulator and have varying allergic responses to it.    

  • Systemic Spread: In the rarest of cases the Neuromodulator can spread systemically causing difficulty swallowing, muscle weakness, blurred vision, nausea, chest tightness, and respiratory difficulties.

Post Treatment Care

  • Contracting the muscles that were injected every few minutes for one hour to ensure the neuromodulator is absorbed into the muscle injected.

  • Staying in an upright position for 3 hours to prevent migration of the product to another muscle.

  • Avoiding massage or manipulation of the area for six hours after injection.

  • Avoiding strenuous physical exercise, hot tub, saunas, facials, alcohol and or aspirin/ NSAIDS for 24 hours after treatment.​

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