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What Are Neurotoxins, and How Can They Be Used?

In recent years I’ve noticed a jump in the amount of people I know who get Botox injections. In fact, based on The American Society of Plastic Surgeons, Muscle relaxant treatments overall have increased by 459% from 2000 to 2021. While Botox is the most commonly discussed neurotoxin, there are others that I recently discovered are widely used for both cosmetic and medical purposes. The four most popular formulations include Botox, Dysport, Xeomin, and Jeuvau and all serve the same purpose, though they do differ slightly in chemical composition.

Originally I got my first treatment as a teenager strictly for medical purposes: I had been suffering from TMJ for years. TMJ (temporomandibular disorder) is a disorder of the jaw muscles (masseters), temporomandibular joints (connecting the mandible and temporal bones of the jaw), and the nerves around the jaw. Because this disorder results in myofascial pain, it can be incredibly uncomfortable, leading to jaw soreness, headaches, and grinding of the teeth. Unfortunately, there is no real cure for this, which is why my doctor suggested I try chemical denervation of my masseters to relieve some of the tension (which is common practice in patients with TMJ). Though the idea of getting what is primarily known as a cosmetic treatment at age 19 was strange to me, I ended up getting it after being reassured that this was nothing but a medical treatment.

After years of getting my masseters injected, I lost the initial fear that I had, and ended up getting the real thing in my forehead as a preventative measure to avoid the formation of wrinkles. In my years of getting various neuromodulator injections, I’ve learned that this concoction serves a variety of both cosmetic and medical purposes and benefits.

What’s the science behind neurotoxins?

Neuromodulators such as Botox (also called Onabotulinum toxin type A) are drugs that are made from a precursor produced by the bacterium Clostridium botulinum. When injected in small doses, they can treat a variety of medical conditions as well as confer various cosmetic benefits.

They work by causing temporary paralysis in the muscle in which they are injected by inhibiting the release of acetylcholine, a neurotransmitter responsible for signaling muscles to contract at the neuromuscular junction. In other words, when the medication is injected into a muscle, they cause temporary paralysis causing limited muscle contractions in the treated area.

The drug is administered using a syringe (typically 30-gauge) and measured in units. There is no specified dosage based on weight and age, as with most other drugs. Instead the doses are typically based on a recommended number of units per treatment area and are then titrated taking into account the patient’s individual needs and desired results. An average number of units used in most areas of the face is twenty, however, this number can vary significantly and reach over one hundred units depending on the case.

During the procedure, the treatment area is sanitized and the muscle relaxed is injected with a small needle. The overall procedure typically takes 10 – 20 minutes, depending on the size of the area being treated. Results are seen within 3 – 5 days in smaller areas such as the horizontal forehead lines, frown lines, and crow’s feet, and 2 – 3 weeks in larger areas such as the masseters, and may last up to five months.

What are the benefits of neuromodulators?

Onabotulinum toxin type A was first FDA approved in 1989 for injection, for intramuscular, intradetrusor, or intradermal use and is now a widespread treatment for various medical conditions and cosmetic corrections.

While they are best known for their ability to reduce and prevent the formation of wrinkles and lines, there is a list of additional cosmetic and medical uses for toxins.

Cosmetic Uses

1. Wrinkle reduction and prevention

When the medicine is injected into a muscle, it causes temporary muscle paralysis, relaxing the muscle and restricting muscle contractions. Wrinkles in our faces are caused by constant facial expressions inhibited by muscle contractions.

As an example, we raise our eyebrows using our frontalis muscle. If this solu is injected into the frontalis muscle, its contractions will be reduced, limiting the extent to which we are able to raise our eyebrows, and thus, reducing the formation of horizontal lines formed through frequent raising of the eyebrows. For this reason, these formulations can be used for both wrinkle reduction and prevention.

Treatment areas for wrinkles in the face include the horizontal lines on the forehead, frown lines between the eyebrows, and crow’s feet around the eyes.

2. Turkey neck prevention

Turkey neck is the result of stretched out skin on the neck caused by flexion of platysmal bands in the neck. Platysmal bands are the vertical cords on your neck that often protrude outward during intense exercise. When the compound is injected into these bands, it relaxes the platysma muscle, reducing the outward protrusion of the bands and reducing the chances of the skin on the neck stretching as a result.

3. Jaw slimming

Muscle inhibitors are often injected into the masseter muscles (the same ones injected to treat TMJ) for jaw slimming. When the masseters are tense, they can hypertrophy (become larger) just like any muscle grows when it is trained. When this formulation is injected into the masseters they become relaxed, reducing them in size.

4. Lip Flip

A lip flip is a minor (illusional) lip enhancement that works through the injection of a small number (5 – 10) units of Botox into the orbicularis oris, the muscle located directly above the lip. This causes the top lip to pull upward slightly, which makes it appear slightly larger in size.

5. Gummy Smile

A gummy smile is characterized by a significant part of your gums showing while smiling with your teeth. When the muscle relaxer is injected into the zygomaticus minor muscle located above the corners of your lips, the top lip will no longer pull upward, leaving you with less of a gummy smile as a result.

Medical Uses

Common medical conditions in which this compound is used to treat include TMJ, hyperhidrosis (excessive sweating), and chronic migraines

1. TMJ (temporomandibular disorder)

TMJ is a disorder affecting the jaw muscles (masseters), temporomandibular joints, which connect the mandible and temporal bones of the jaw, and the nerves around the jaw. It is characterized by myofascial pain, jaw soreness, headaches, and grinding of the teeth.

When these muscle inhibitors are injected into the masseters it relieves the tension that causes the above mentioned side effects, making this the only treatment for TMJ.

2. Hyperhidrosis (excessive sweating)

Hyperhidrosis is a common condition in which a person sweats excessively (particularly in the hands, feet, and under the arms), not necessarily related to exercise or heat. This condition is caused by overactivity of the nerves that signal your sweat glands to produce sweat. Because botulinum derived agents inhibit nerve activity, they are used as a treatment for hyperhidrosis through injection into the affected areas.

3. Chronic migraines

Based on studies providing evidence that neurotoxins reduce chronic migraines, doctors think that the injection of this numbing agent into various muscles in areas like the forehead, temples, and the back of the head and neck block neurotransmitters that carry pain signals from your brain. The ideal treatment plan typically includes several injections of the solution in these regions every three months.

What are the dangers?

The injection of this drug typically involves limited risks and side effects. The average person may experience minor bruising and swelling post injection, which will subside within 2 – 3 days. Other possible risks and side effects include:

  • Headaches
  • Droopy eyelids or asymmetry
  • Eye dryness and excessive tearing
  • Blurred vision

A very rare poisoning called Botulism can occur with too much of the muscle relaxer, but is nearly impossible through the approved treatments mentioned above.

Botulism can include difficulty swallowing and speaking and in extreme cases, paralysis and death. In order for this to occur, the solution would have to enter the bloodstream in large quantities, which is why it is incredibly rare.

Are neurotoxins right for me?

Neuromodulators can provide a number of cosmetic and medical benefits in any healthy adult. The best way to find out whether you are a candidate is to consult with a medical professional.

While I do get Botox injections, I would never have thought to get them unless my doctor hadn’t recommended them for my TMJ. I now feel comfortable getting the treatment for both medical and cosmetic purposes and personally haven’t experienced any negative side effects. They can be beneficial if used correctly, so the most important thing is to find a doctor that you trust to do it properly and get you the results that you are looking for.

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