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!
Cannula for Dermal Filler Injection
Patient Education Topic: What is a cannula and why does it matter to dermal filler injection?
Well, all of that hyaluronic acid goodness needs to get under the skin somehow, right? When you think of injections, your mind automatically goes to needles. Indeed needles are a good tool for injecting dermal fillers like Restylane and Versa. Needles are preferred for injection of filler in some locations of the face (frequently lip filler), and are often favored for precision. The downside to using a needle to inject dermal filler is that needles are readily capable of piercing an artery or a vein. The concern here is that filller could be deposited accidentally into that artery or vein, causing (very!) rare problems like vascular occlusion (clogging of the artery) or in some (extremely!) rare cases, vision loss.
One useful practice to reduce the likelihood of accidental vascular injection is aspiration, or pulling back on the plunger of the syringe, and observing for backflow of blood. This is a common practice, and something that I do with every needle pass. Another way to decrease the likelihood of piercing an artery or a vein is to use this handy blunt-tipped injection device for filler: the cannula.
Cannulas kind of look like needles, but they aren’t sharp on the end, and the port where the filler comes out is actually on the side near the tip. A needle is used to create a port in the skin where the cannula initially enters, and then the cannula traverses under the skin to deposit dermal filler. Cannulas are great for cheek filler, marionette lines, temple filler, jawline filler, and sometimes the nasolabial folds. The idea is that if the cannula bumps into a blood vessel, it’s less likely to pierce it, making this injection technique safer from a vascular occlusion standpoint, and probably bruising as well.
The face is a literal minefield of blood vessels, and vascular concerns will always be top of mind for injectors when it comes to patient safety. Aspiration when a needle is used, and cannula use are two ways to increase the safety of dermal filler injections. Additionally, safe injectors will be packing a refrigerator full of reversal agent for hyaluronic acid dermal fillers, and as a patient, it’s okay to inquire about safety. You’ll want to know that your injector is a good ‘girl scout’ and has a plan to prevent and treat complications.