Wrinkle Relaxers

image005Overview of treatments that relax areas of excessive ‘animation’ wrinkles.

What exactly is are the relaxers or ‘neuromodulators’?  What are they made of and why do they work?

Botox, Dysport and Xeomin are really nothing more than proteins that attach to a specific spot on a muscle cell.  When these proteins stick to that particular spot, the muscle cell stays relaxed and doesn’t contract even when there is a nerve signal telling it to do so.  Each of the products has a slightly different make up of proteins, and therefore they have different names (i.e. Onabotulinum Toxin A for Botox, Abobotulinum Toxin A for Dysport, and Incobotulinum Toxin A for Xeomin).

How are these medications used?

Botulinum Toxin is injected with a tiny needle into muscles that we want to stay relaxed, whether those hyperactive muscles are vocal cords in spasm, eye muscles that cause double-vision, or just muscles beneath the skin that form wrinkles and make us look older.   The main areas for use of Botox and the other products in the face are to reduce the appearance of 1) the horizontal lines of the forehead, 2) the vertical (or diagonal) frown lines between the brows, or 3) the ‘crow’s feet’ that are just outside of the eyes.  The forehead lines occur when the brows are raised, the frown lines (appropriately named) occur when you frown or look stern, and the crow’s feet accompany a big bright smile with squinting of the eyes.  Each of these areas can be treated effectively without causing a frozen or overdone look, and without affecting your ability to show all of your emotions fully. So if you need relaxing in your forehead or crow’s feet treatment, it can be done quickly and easily.

Less commonly, these medications can be used to relax the active bands that can occur in the neck while talking or smiling, or can be used very conservatively in the lips to reduce the appearance of ‘smoker’s lines’.  Rarely, they can be used in the lower frown line areas below the mouth to raise the corners of the mouth.  Each of these less common areas requires great experience and expertise for proper treatment with predictable results.

Finally, Botox, Dysport and Xeomin can be used for hyperhydrosis (excessive sweating) and they beginning to be used to treat some types of migraine headaches. Though it doesn’t always produce consistent results with headache treatments, they are highly effective in preventing sweating in the underarm, under-breast and forehead areas, and can also be used in the hands to prevent sweating as well.

How long do these treatments last?image013

Each of these four medications all last about the same length of time, which is about 3 months for muscle relaxing and about 6 months for treating excessive sweating.  These treatments need to be performed again in order for the patient to continue to get the benefits of the medications.

Botox vs Dysport vs Xeomin – what’s the difference?

There are more similarities than differences among the different medications in this category.  All last about the same duration, and all have a similar effect on the muscles which will relax them into natural results with Botox. Botox and Xeomin are almost identically clinically, while Dysport has a couple of minor differences.  Dysport takes effect faster, beginning in 1-3 days as compared to the 3-7 days the Botox and Xeomin require.  However, Dysport has a tendency to spread out or ‘diffuse’ just a bit more than the others, which some think makes it a little less precise in its placement, and others feel may be an advantage to get wider treatment with fewer injections.

I said that Botox and Xeomin are almost identical clinically; meaning that they are used in the same way and in the same amount, and the effect appears identical.  But one difference is that Xeomin is far purer in terms of the amount of active protein versus other proteins in the injection.  Whether this will have any significant benefit down the road remains to be seen.

image040Why are these treatments safe?

As well as creating a natural results with Botox and the other relaxers are safe because of the very small amounts used compared to what would be required to cause any significant problems.  Many medications come from nature and are toxic when used in large doses, such as the pain reliever aspirin and the heart medication digoxin.  Most medications would actually be dangerous in large doses, partly because they are such powerful tools in smaller doses.  As long as a competent and ethical physician is doing the treatment, there is nothing to be worried about with the very small doses of Botox, Dysport and Xeomin being used for cosmetic injections.