Neuromodulators

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Botox®, Xeomin®, and Dysport®: The Botulinum Toxins

Botulinum toxins (BoNTs), also referred to as “neuromodulators,” are muscle relaxants used to treat wrinkles and lines caused by muscle contraction. Although these drugs have an overall similar effect, there are subtle differences in each medication. All of these drugs are injected using a tiny needle to deliver minute, exact amounts of the medication into several locations on the face. Because the needle is so fine and the amount of liquid injected is so small, the discomfort associated with injections is minimal.  The duration of effect for all three medications is several months and all the BoNTs are priced similarly.
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Botox® (onobulinumtoxinA)

Practically a cultural icon in America today, Botox is a pharmaceutical product that is injected into the skin to relax specific muscles or muscle groups. Once injected, Botox works by affecting communication between nerve endings and muscle fibers at the treatment site. Safe and simple, Botox procedures take place in the office and typically yield results within a few days.

Despite its widespread popularity today, surprisingly, Botox is still widely misunderstood. Understanding this drug’s background and history lend some insight into its popularity today. Here are some highlights of its history:

  • 1979: Botox was first approved for use by the Food and Drug Administration for the treatment of “crossed eyes”. Shortly thereafter approval was granted for treatment of involuntary facial spasms.
  • 1990: The first use of Botox to improve the appearance of facial wrinkles and lines was reported around 1990.
  • Today: There are over 100 medical applications of this fascinating drug.
  • The aesthetic indications for which Botox is currently approved include relaxation of lines between the eyebrows and at the corners of the eyes (crow’s feet)

Typical Applications of Botox

When Botox is used for wrinkle reduction, facial applications include relaxation of the vertical lines between the eyebrows, smoothing of wrinkles in the forehead, crow’s feet (corners of the eyes), and on the sides of the nose, and improvement of unwanted lines in the lips and on the neck.  When used for facial shaping Botox may be used for elevation of the eyebrows and corners of the mouth, contouring the jawline, reducing the size of the muscle are responsible for grinding our teeth, improving the appearance of unwanted lines in the neck, and more.

Following a Botox injection, the treated muscles gradually become relaxed, allowing the overlying skin to appear smooth and unwrinkled, while untreated muscles are not affected. Botox does not act to fill in deep lines; it only relaxes muscles. Botox thus complements injectable fillers such as Restylane,  Juvederm, and Belotero.

Learn more about Botox

Dysport® (abobotulinumtoxinA), the first competitor to Botox®

After more than 10 years of use in Europe and several years of testing here in the United States, Dysport gained FDA clearance for the treatment of lines between the eyebrows in 2009.

How is Dysport different?

Dysport, like Botox and Xeomin, is a form of botulinum toxin although chemically the drugs are not identical.  Dysport may be used in all the same ways as Botox and Xeomin.  Some believe that Dysport has a slightly faster onset of effect than Botox and Xeomin, but this has not been proven scientifically. However, if you find yourself short on time before a party or event, Dysport may be the best choice.  Dysport also spreads differently after it has been injected and may be preferred in some areas such as the “crow’s feet,” or in a tall forehead, producing a softer, more diffuse effect than Botox or Xeomin.  Some investigators feel that Dysport generally lasts a bit longer than Botox but this has all not yet been proven scientifically.

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Xeomin® (incobotulinumtoxinA)

Xeomin received FDA approval more recently in 2011 for the temporary improvement of lines between the eyebrows. Xeomin was created in 2005 and studied and injected internationally prior to its FDA approval in the US. The drug had been previously FDA approved in 2010 to control specific types of spasms.

How is Xeomin different?

Xeomin is a purified neurotoxin. This means the drug has no additive surface proteins, just the botulinum toxin. There is less risk of an allergic reaction due to the absence of the added protein.

Learn more about Xeomin