How do Neuromodulators like Botox & Dysport actually work?

How Tox Works: 

"Tox" is a fun and non-brand-specific nickname for neuromodulator or neurotoxin which we use to relax away wrinkles, and for other medical applications as well. The famous botulinum toxin is a naturally occurring molecule produced by a bacteria, Clostridium botulinum, and it is synthesized in the laboratory under the brand names of Botox, Dysport, Xeomin, Jeuveau, Daxxify for aesthetic use. These medications only work when injected below the skin, and are administered in very tiny doses so as to affect only very specific muscles for medical aesthetic purposes. 

Each of the different brands of neuromodulator is very similar in its effect, with subtle differences in strength and duration between brands. At Skinbeam we carry Dysport and Botox, and may consider adding Daxxify in the future depending on how their first year on the market goes. 

Tox is a long-acting muscle relaxer, with Dysport and Botox lasting 3-4 months. Bigger doses last longer (4 months) and when you reduce the dose, you reduce the duration.  Some people wonder: if it's a muscle relaxer, how can it lift the brows? We can use tox to produce a brow lift by selectively treating muscles that pull down on the brows (glabellar complex, orbicularis oculi) while leaving the lower forehead muscle (frontalis) alone to a certain extent, because it's the only muscle that lifts the brows up! It's a balancing act between relaxing away forehead lines, while leaving enough of the forehead muscle working to keep those brows lifted!

Tox physiology for physiology wonks: 

Caution: nerd alert! Tox works on the acetylcholine receptor which transmits motor impulses from the nerve to the muscle. The medication binds to the acetylcholine receptor and functionally destroys it permanently. Boom. When there is no neuromuscular transmission via the acetylcholine receptor, the muscle stays in the relaxed state even when the brain sends motor signals for it to move.  

Then what? How does the medication "wear off?" It's not so much that it wears off. It's the body making new acetylcholine receptors. All parts of the skin, subcutaneous tissue, and muscular layers are continuously being regenerated by the body, including acetylcholine receptors. These are naturally regenerated about every 90 days, and at that point, there is typically some or all muscle movement regained. The duration of the tox is related to how thoroughly the medication has wiped out the acetylcholine receptors in the area. Bigger doses knock out more receptors, and smaller doses may leave some receptors still working. 

Here's the fun link to microneedling with PRP: as a regenerative treatment, microneedling with PRP helps the layers of the skin regenerate faster, and it's theorized that the regeneration may increase return of new acetylcholine receptors, potentially making tox offset faster. This is why it's generally recommended to separate tox treatments from microneedling with PRP. 

After 3-4 months, the results from tox injections dissipate, and your face very gradually returns to how it would have been if you hadn't been treated. There is a preventive effect to being treated with tox which is related to the skin spending long periods of time without being creased, as well as a bit of muscular atrophy that can occur after several re-treatments with tox. 

Questions or comments? Get in touch on Instagram @skinbeam_aesthetics or (714) 450-6735

Cheers!