Many individuals are familiar with Botox, the number one nonsurgical treatment option to date. However, despite this treatment’s popularity, there are still many misconceptions and questions regarding it. We have compiled a list of commonly asked questions regarding neurotoxins to help clear up any confusion.

Types of botulinum toxin

There are 5 different types of botulinum toxin currently available for facial injection. Only Botox® has been approved by the FDA for the temporary reduction of moderate to severe facial wrinkles in the forehead, around the mouth, and in the glabella—the lines in between the brows, commonly referred to as 11s.

The remaining neurotoxins are only approved for the treatment of moderate to severe glabellar lines and are used off-label to achieve the same results.

• Botox® (onabotulinumtoxinA)

• Dysport® (abobotulinumtoxinA)

• Xeomin® (incobotulinumtoxinA)

• Jeuveau® also called “Newtox” (prabotulinumtoxinA)

• Daxxify® (daxibotulinumtoxinA-lanm))

How do neurotoxins work? And how does this effect lines and wrinkles?

The use of neurotoxins has changed the cosmetic industry and how we treat dynamic wrinkles. Neurotoxins block signals from the nerves to the muscles. When neurotoxins are injected directly into facial muscles, they stop contracting. This causes the wrinkles to relax and soften. Not only will the wrinkles improve, the injection of neurotoxin will also prevent those lines from getting deeper.

How long do neurotoxins last? How are they different and similar to injectables?

The effects from neurotoxins will last three to six months. The amount of product injected, the patient’s metabolism, and the patient’s age, are just a few variables to take into consideration when determining how long the product will last. As the muscle action gradually begins to come back, the lines and wrinkles will begin to return. However, the neurotoxins shrink the muscles over time, so continued use of the product will help make the lines and wrinkles appear less severe with time.

Hyaluronic Acid filler injections are indicated to last 9-24 months, depending on the product being used. These products work to replace volume and are slowly broken down by your body over time. Again, there are a lot of variables that go into determining how long the fillers will last, such as patient age, amount of volume loss, and patient metabolism. The combination proves to make both neurotoxins and injectables last longer. Inhibition of muscular activity with neurotoxins has a beneficial effect on the duration of fillers. Less muscle action may result in fillers lasting longer since the muscle movement negatively affects filler duration.

Who is a good match for neurotoxins?

Individuals may consider neurotoxins for cosmetic reasons as they begin developing lines and wrinkles on their face due to common facial movements. Lines can appear on the face as early as your late twenties to as late as your early forties depending on genetics. Individuals who are prone to lines and making facial expressions may also choose to use neurotoxins as a preventative measure. Overall, it is important to seek a consultation with a board certified plastic surgeon to ensure that this treatment is right for you.

Can neurotoxins be reversed?

Unlike dermal fillers, which can often be reversed with an enzyme called hyaluronidase, neurotoxins cannot be reversed. Patients must simply wait until the neurotoxin wears off, which is usually between 3-6 months.

How long does Botox® take to work?

Botox® and other neuromodulators usually take a few days to start showing noticeable effects, with the full results taking effect 7-14 days after the injection.

During this time, the botulinum toxin gradually blocks nerve signals to the targeted muscles, causing them to relax and, in the process, smoothing the skin’s appearance by reducing wrinkles and fine lines. The precise onset varies from person to person—influenced by factors like your body’s metabolic rate, the area treated, and the amount of product used.

How long does Botox® last?

The effects of neuromodulators like Botox® and Dysport® typically last 3-4 months, at which point re-treatment is often necessary to maintain the desired appearance.

The newest injectable neurotoxin on the market is Daxxify, which is similar to existing neuromodulators in that it is used to reduce the appearance of facial wrinkles. Unlike its predecessors, Daxxify is known for its longer-lasting effects compared to other botulinum toxin products. Typically, Daxxify lasts for about 6-9 months. Again, your personal results will be determined by factors such as the area treated, your metabolism, and the amount of product used.

What are the benefits of neuromodulators?

The benefits of Botox® and other neurotoxin treatments are many. They effectively reduce wrinkles, prevent dynamic lines, and deliver natural-looking results with a quick, downtime-free appointment.

• Reduction of wrinkles: Neuromodulators diminish the appearance of fine lines and wrinkles, particularly around the eyes (crow's feet), forehead, and between the eyebrows (frown lines).

• Prevention of dynamic wrinkles: By relaxing facial muscles, neurotoxin injections can prevent the formation of new dynamic wrinkles—those caused by repetitive facial expressions.

• Natural-looking results: Neuromodulators provide natural-looking results, which means you will still look like you—just a bit fresher.

• Safe & FDA-approved: Neurotoxin treatments are FDA-approved for cosmetic use and have a well-established safety record when administered by trained professionals.

• Quick procedure: The injection procedure is typically quick, often taking just a few minutes, and there is no downtime so you can return to your daily activities immediately after treatment.

• Long-lasting results: The effects of neuromodulators typically last for several months, providing youthful, refreshed skin for extended periods.

• Goes well with other injectables: Neuromodulators can be used with other treatments, like dermal fillers, to create a naturally refreshed, plump, and youthful look.

What is a unit of Botox®?

Botox® and other neurotoxins are measured in units, which measure the amount of botulinum present on a molecular level. The number of active neurotoxin molecules determines the product’s biological potency or effectiveness at paralyzing targeted muscles. 

Can you work out after Botox®?

Neurotoxins can sometimes migrate from the injection site and intended muscle or muscle groups. The possibility of product migration is highest within the first 24-48 hours post-injection. 

Desiree recommends waiting 24-48 hours after injections to do any workout that increases your heart rate to 130 BPM. This includes weight training, swimming, hot yoga, pilates, or yoga inversions like downward dog. In addition, spending time in saunas, hot tubs, tanning beds, or very hot baths and showers can further augment the risk of bruising, swelling, and product migration.

Because these activities increase your heart rate, they also increase the blood circulating in your body—elevating the chances of product migration, swelling, and bruising. That being said, doing light exercise 4 hours after your neurotoxin treatment is fine.

How long after Botox® can you lie down?

After receiving Botox® or other botulinum toxin injections, Desiree recommends staying upright for about 4 hours. If you have received facial botox, your head must remain upright—so no dental appointments, massages, or bending down for the 4 hours following your treatment. Waiting this time before bending or lying down helps prevent the product from migrating to different areas, which can cause unintended and undesired effects like drooping or asymmetry. 

Can you get Botox® while breastfeeding?

There has been no evidence in clinical studies demonstrating that the neurotoxin used in injections enters the breast milk. Currently, botulinum toxin is classified as an FDA category C drug, which means that its safety profile for pregnant women has not yet been sufficiently evaluated. However, as a medical provider, Desiree always airs on the side of safety when it comes to Botox® and breastfeeding and suggests waiting until you are no longer breastfeeding to receive injectables.