Neuromodulators

What are neuromodulators?

Neuromodulators are wrinkle-relaxing injections of botulinum toxin – commercially known as Botox Cosmetic, Dysport or Xeomin – that are used to treat wrinkles, frown lines and crow’s feet. A minute amount of the neuromodulator is injected directly into the underlying muscle, causing it to relax and gradually smooth out the appearance of the overlying skin. The effects typically last about three months.

Before (left) and after (right) Botox to glabella, IPL to skin, Restylane to tear troughs and outer eyebrow.
Photo courtesy of B. Fitzgerald

Before (left) and after (right) Sculptra to full face and Botox to masseters.
Photo courtesy of B. Fitzgerald

Neuromodulators are wrinkle-relaxing injections of botulinum toxin – commercially known as Botox Cosmetic, Dysport or Xeomin – that are used to treat wrinkles, frown lines and crow’s feet. A minute amount of the neuromodulator is injected directly into the underlying muscle, causing it to relax and gradually smooth out the appearance of the overlying skin. The effects typically last about three months.

Botox is the only neuromodulator FDA-approved to treat excessive sweating and crow’s feet – it’s actually been FDA-approved for the most treatment options. However, any neuromodulator can be used for these treatments. Their applications for these purposes is called “off-label” use, which simply means that they are being used in a way that was not part of their FDA clinical approval. A doctor must inform you if any neuromodulator is being used “off-label.” (See the ASDS blog for more information on “off-label” versus “contra-indicated” use.)

What should first be done before considering neuromodulators?

Before (left) and after (right) Botox treatment to the masseter/jawline area.
Photo courtesy of Shannon Humphrey, MD - Vancouver, Canada

Before (left) and after (right) Botox treatment to the masseter/jawline area.
Photo courtesy of Shannon Humphrey, MD - Vancouver, Canada

Before the procedure, an ASDS member dermatologist will review the patient's medical history. This is the time for the doctor and patient to discuss expectations, potential risks and outcomes of the procedure. Patients should tell their doctor if they use, have recently taken or have had:

  • Blood thinning drugs
  • Over-the-counter medication and supplements
  • Previous neuromodulator therapy
  • Antibiotics by injection
  • Muscle relaxants
  • Allergy or cold medicine
  • Sleep medicine

Neuromodulators and Soft-Tissue Fillers

Heather Rogers, M.D., discusses how neuromodulators work on the face.

When are neuromodulators appropriate?

The procedure is appropriate for the following conditions:

Who is not a candidate for neuromodulators?

People who are not in good overall physical, mental and emotional health may not be good candidates for the procedure.

Are neuromodulators painful?

Pain is minimal. If requested, a topical anesthetic or ice pack can be applied prior to the treatment.

What are the potential complications of neuromodulators?

Before (left) and after (right) Botox treatment to the masseter/jawline area.
Photo courtesy of Shannon Humphrey, MD - Vancouver, Canada

Before (left) and after (right) Botox treatment to the masseter/jawline area.
Photo courtesy of Shannon Humphrey, MD - Vancouver, Canada

  • Soreness
  • Mild bruising
  • Temporary weakness of surrounding muscles
  • Headache
  • Drooping eyelid

What can I expect after having had a neuromodulator treatment?

  • Virtually no recovery time is required after neuromodulator injections.
  • Patients should take care not to rub treated areas, which could cause it to migrate to another area.

For excessive sweating:

  • A decrease in sweating within about two weeks.
  • The reduction lasts for about six months, so most patients will need to be treated twice per year.

Before (left) and after (right) Crows Feet - Dysport
Photo courtesy of J. Peterson

Before (left) and after (right) Crows Feet - Dysport
Photo courtesy of J. Peterson