Muscle Relaxation Injections (Neuromodulator i.e. Botox®, Dysport®)


Expression lines become more prominent as we age. They occur due to the repetitive movement of the facial muscles for expression. The most prominent are frown lines, crow’s feet and forehead lines. These lines are best treated with injections of muscle relaxants. The muscle relaxant is a purified protein that stops the signal from the nerve to the muscle and so the muscle relaxes and lines soften.

Some other areas can also be treated including top lip lines, mouth frown, jaw-line, neckbands, jaw grinding and excessive sweating. The treatment is almost painless with very fine needles used to inject into the muscles. There are very few side effects. It takes 3-14 days for the treatment to take effect and lasts up to 4 months.

Neuromodulators can be injected into humans in extremely small concentrations and works by preventing signals from the nerve cells reaching muscles, therefore paralyzing them temporarily. In order for muscles to contract, nerves release a chemical messenger, acetylcholine (a neurotransmitter), at the junction where the nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the muscle cells to contract or shorten.

Injected neuromodulator prevents the release of acetylcholine, preventing contraction of the muscle cells. Neuromodulators cause a reduction in hyperactive muscle contraction, allowing the muscles to become less stiff.

Neuromodulators is predominantly used as a treatment to reduce the appearance of facial wrinkles and fine lines.

Glabellar Lines

Glabellar lines (the vertical frown lines between the eyebrows, which often look like the number "11") are formed by repeated and involuntary contraction of the muscles between the eyebrows and around the eyes. As the skin becomes less elastic, excessive contraction of these muscles may cause visible, deep wrinkles between the eyebrows to form, even when the face is relaxed.

Canthal lines (crow's feet).

Crow's feet are the lines that form around the eyes when we smile or squint.  Over time, these dynamic lines (lines formed when making an expression) turn into static lines (lines or wrinkles that are there whether you make an expression or not). Static lines get etched into the skin after years of contracting the muscle around the eyes when making expressions such as smiling.  

·         Treatment for the Crow's Feet (Dynamic Lines) are best treated with Neuromodulators, which relaxes the muscle.

·         Treatment for the Crow's Feet (Static Lines), which have been etched in and are there even when you don't make an expression, is best accomplished by resurfacing procedure such as micro needling/microdermabrasion, chemical peels, or lasers.


Other applications

Beyond aesthetic applications, Neuromodulators are used to treat a variety of medical conditions, including eye squints, migraines, excessive sweating, and leaky bladders.

Neuromodulators are currently used to treat over 20 different medical conditions, with more applications under investigation.

Neuromodulators are currently approved for the following therapeutic applications:

·         Blepharospasm (spasm of the eyelids).

·         Idiopathic rotational cervical dystonia (severe neck and shoulder muscle spasms).

·         Chronic migraine.

·         Severe primary axillary hyperhidrosis (excessive sweating).

·         Strabismus (crossed eyes).

·         Post-stroke upper limb spasticity.

·         Detrusor (bladder wall muscle) overactivity - causing urinary incontinence.

·         Overactive bladder.

·         Hemifacial spasm.

Neuromodulators ae also used off-label (not approved) for:

·         Cerebral Palsy.

Neuromodulators are sold commercially under the names:

·         Botox, Vistabel, Botox cosmetic (OnabotulinumtoxinA or botulinum toxin type A) (link please)

·         Dysport (AbobotulinumtoxinA or botulinium toxin type A) (link please)