Neurotoxins for Wrinkles: What You Should Know

Botulinum toxin has become a major part of facial rejuvenation, with an abundance of research demonstrating that therapeutic injections of the toxin improve the cosmetic appearance without significant complications. Different forms of the toxin are available, and more than 7.2 million injections of botulinum toxin were performed in 2017 alone. The most well-known botulinum toxin is Botox, but there are multiple forms available.

The U.S. Food and Drug Administration (FDA) has approved botulinum toxin to treat aesthetic concerns in different parts of the face. In addition to the forehead, botulinum toxin is also approved for the glabellar, or the lines between the brows, and the lateral canthal lines, more commonly referred to as crow’s feet.

Doctors are also increasingly using botulinum toxin for off-label purposes in other parts of the face and to treat specific conditions. However, for cosmetic uses alone, the use of botulinum toxin increased 680% between 2000 and 2012.

How long do botulinum toxin results last?

When botulinum toxin is injected, the effects occur rapidly, within hours. These effects, however, are often not noticeable for about a week until broader chemical changes have taken place. The clinical effects of botulinum toxin generally last 3 to 4 months.

The specific duration for which botulinum toxin injections last depends on several factors. For instance, higher doses and concentrations may enable clinical effects to last longer. How the injections are performed and patient characteristics can also play a role in how long the effects are noticeable.

Is botulinum toxin safe?

Yes, botulinum toxin has been shown to be generally safe and effective for both aesthetic purposes and other functional indications. Most of the complications associated with the use of the toxin are cosmetic and local and can be addressed quickly and easily.

Injections of botulinum toxin can be painful, but topical anesthetics and ice are often used to help minimize pain. In addition, the person administering the toxin will usually use the smallest gauge needle possible to help reduce the pain the injections cause. The glabella region is associated with the lowest level of pain during minimally invasive facial procedures like botulinum toxin injection, whereas the malar region over the cheeks is associated with the highest pain level.

In rare cases, severe adverse events such as botulism or anaphylaxis can occur following botulinum toxin injection. Additionally, prolonged use of botulinum toxin has been reported to lead to unwanted muscle atrophy, and it is not yet clear whether this type of atrophy and the accompanying loss in muscle strength is reversible.

Botulinum toxin vs. fillers

Some people think that neurotoxin injections are equivalent to fillers, likely because of the way that these injections appear to fill in pre-existing wrinkles.

Botulinum toxins and fillers are, however, different ways of achieving aesthetic results. Unlike fillers, botulinum toxins are paralyzing agents that prevent muscle movements that lead to and worsen wrinkles.

There are four types of botulinum toxin that are currently available on the market for cosmetic purposes. These botulinum toxins are type A botulinum toxins and include Botox, Dysport, Xeomin, and Jeuveau.

Botox

Botox is the form of botulinum toxin that most people recognize and think of when they consider botulinum toxin injections to address wrinkles. Though Botox had been used for therapeutic purposes for several years, in 2002, the FDA approved it as an anti-wrinkle treatment. It has since grown in popularity and is considered an affordable alternative to more invasive techniques for addressing cosmetic concerns.

Because the body produces antibodies to botulinum toxin, people who use Botox over a long period of time develop resistance, which makes Botox less effective. The loss of effect can be combated with higher doses or by switching to a new form of botulinum toxin.

Dysport

Dysport was approved for cosmetic use by the FDA in 2009. Dysport differs from Botox in the way it is purified, which leads to it diffusing across a larger area once it is injected. Dysport is therefore often used in patients who want widespread muscle paralysis throughout the face, whereas Botox is more often used in patients looking for localized treatment of specific wrinkles.

Xeomin

Xeomin was approved by the FDA in 2010. Studies have shown that Xeomin is comparable to Botox, with equivalent doses of each achieving the same effects. Studies on Xeomin have shown that one advantage to this botulinum toxin is that it may be able to avoid resistance compared to the other botulinum toxins because it has less of the protein to which the body develops antibodies. People using Xeomin may therefore continue to see results from this toxin longer than they would from the alternatives.

Jeuveau

Jeuveau, which was approved by the FDA in 2019, is especially valuable for treating moderate to severe glabellar lines. It is not clear if Jeuveau is more effective than Botox or if the results that are seen in those using Jeuveau appear superior because people using Jeuveau have already developed resistance to Botox.

With four botulinum toxins approved as anti-wrinkle treatments, consumers have several options to consider if they are looking for a minimally invasive, cost-effective option to address unwanted wrinkles. More research will help to clarify the differences between these options and for whom each option is most appropriate.