Neuromodulators (Botox, Xeomin, Dysport)
Botox®, although off label for many uses, is able to treat wrinkles by inhibiting release of acetylcholine which causes weakness of muscles that create wrinkles. Beneficial effects are seen within 1 to 3 days and can last for 4 to 6 months. Sequential treatments are necessary to maintain effect. It is most commonly used at the forehead, glabellar area (junction between the forehead and nose), the nasolabial crease (junction between the upper lip and cheek), the bunny lines (on the sides of the nose), the crow’s feet area (adjacent to the eyes), the dimpled chin, and neck bands. In mild to moderate cases, the entire forehead can be treated by injecting the lower central forehead (glabella) as these muscles are brow depressors and by relaxing them, the frontalis, a brow elevator, smooths out and raises the brows. If this fails to fully correct the forehead, additional Botox® can be injected into the frontalis muscle, but this decreases animation and may lead to descent of the brow.