AHHHHHH...the BIG question: “How much will I need?”

Sure wish there was an easy answer for that one! Neurotoxin for wrinkle relaxation is sold by the unit, or the area; depending on the clinic you choose. The amount of product it will take for wrinkle reduction is truly individualized. Lot's of things play into this including anatomy, age, treatment area and amount of correction desired. One overly simplified answer you may find on the internet is ‘one-unit-per-year-of-age for full correction’. Of course that may or may not be true for you, and serves only as a loose reference!

You may recall an earlier blog post where I mentioned that toxin works very well for “wrinkles of animation” (those that you see when you scrunch your face). Some rest-wrinkles may soften with toxin, but not disappear completely. Dosing can be aggressive or conservative. If you’re a first timer, you might want to “go light”—with the option for additional product at your follow up visit. If this approach is used just keep in mind that you may not achieve full correction (complete relaxation) and that the effect should not be expected to last the anticipated 3-4 months. But there isn’t a clear long term issue with this approach! Some deeper animation wrinkle lines benefit from relaxation “training”, and if you are committed to full correction every three to four months treatment you may note more dramatic relaxation and longer treatment effect after a year or so!

After a treatment I encourage you self-analyze its effect at two weeks or a month post treatment--that helps guide dosing for the next session. And as you evaluate focus on whether or not you continue to have movement, not whether or not a wrinkle remains. Repeated contraction can cause a little etching in the deeper layers of skin. Those may reduce over time with repeated relaxation, or you might be a candidate for other treatments to complement the neurotoxin, like lasers, microneedling or threads.

On label (meaning the FDA approved the product based on scientific data for efficacy and safety) dosing for onabotulinumtoxin A (aka Allergan's Botox®) is 20 units for the glabella (area between your brows); frontalis (forehead) is up to 20 units, and lateral canthal lines around the eyes (crows feet) is 12 units per side. There are other areas which are commonly treated "off label" (the industry generally feels it is safe, however there is no FDA formal approval simply because the cost of doing a study may be cost prohibitive).

Bottom line: there are generalities for dosing, but you are unique, and your goals and aspirations guide my recommendations. Come in! Let's chat about it!

How about this for a thought-provoking question: “why would I?”

Anyone who has considered, contemplated or actually engaged with wrinkle relaxation vea neurotoxin use has a very personal reason. There are plenty of drivers…here are just a few:

· Increased self-confidence

· Enhanced personal perception of beauty

· Professional appearance—looking the part to keep the role

· Enhanced approachability

· Hope

· and I’d be crazy to not mention outright vanity, though it’s rarely the sole trigger

As for me and my practice my goal is to learn what is important to you, and see if there are ways we can get you to your aspiration. Not every wrinkle, or person, is right for neurotoxin—and that’s okay too! For example it’s not for pregnant or breastfeeding moms. And the data is not as robust for those over 65 years of age (though I have a fairly impressive 73 y/o story you might ask me about sometime….). Neurotoxins do tend to be very forgiving especially to those with “animation wrinkles” (when you make a scrunchy face, the wrinkle really pops out!). Not sure? Lets meet and see what we think! Two minds are often better than one!

Why would I?? Why not try!

Who wants to learn about neuromodulators?

You’ve likely heard of Botox, Allergan’s neurotoxin—and maybe you’ve heard of Dysport and Xeomin, two others on the market with slightly less notoriety, but coming from the same source. And now there's a 4th! Jeuveau. Let's learn a little more!

Product: Botox, Dysport, Xeomin and Jeuveau are all purified protein derivatives from Clostridium botulinum, a bacteria toxin. They work by blocking neuromuscular transmission, inhibiting the release of acetylcholine (a naturally occurring communication chemical). Botulism is different (it blocks the muscle portion of the synapse rather than the nerve side). So basically, it prevents the nerve from saying “squeeze” to its nearby muscle, like an old time telephone without it’s cord—you can talk all you want, but you cant hear anything on the other end.

Treatment areas: most common treatment areas (and the only ones approved by the FDA) are found on the upper 1/3 of the face—the forehead, the worry lines between your brows, and the crows feet around the outside of your eyes. There are other "off label" treatment areas that you may have heard of (think lip flip, orange peel chin, downward frown, gummy smile), those are industry standards, but not government approved per se. Remember that neuromodulators treat wrinkles that happen when you make a face or animate, they don’t erase deeply etched wrinkles that are there at rest, but it can soften them over time.

Down Time: None! Some leave the office with little bumps like a mosquito bite—but those dissipate within 10 minutes.

Cost: I charge by the unit, not the area, so you only pay for what you need. You can start with a little to see if you like it, but please know, data strongly supports a full treatment and durability (how long it lasts) seems to be directly related to the dose and muscle strength. It may not last as long if you elect for a lower dose treatment.

Effects: kick in in 2-7 days with full effect appreciated at 2 weeks. Overall benefit lasts about 2-4 months (dose and person dependent).

Contraindications: Allergy or aversion to product with human albumin. Neuromuscular diseases such as Myasthenia Gravis, ALS, other neuromuscular swallowing issue; and it is NOT to be used if pregnant or breast-feeding.

Alternatives to neurotoxin for wrinkle treatment? Consider microneedling or LaseMD to stimulate your own collagen and fill in some of the fine lines. The muscles remain active with these treatments, but you have a chance to get a bit of your skins bounce back with these treatments!

Can you become immune? As with all therapeutic proteins, there is a potential for immunogenicity--but many have used neurotoxin for years with no decline in effect. If one product seems to lose it’s va-voom for you, first I recommend you ensure your dose is adequate; after that consider trying a different "brand". It just might calm that squeeze down!

I have regular hours available on beautiful Bainbridge Island and in Poulsbo! Please check out my instagram page for more fabulous insight, or text 360-994-0565 to ask me a question!