A Dive Into Injectable Treatments: A Three Part Series

By Melanie Keith, FNP- BC

A Dive into Injectable Treatments: A Three-Part Summer Series

During my previous blog submission, I discussed Daxxify, the newest FDA-approved neuromodulator on the aesthetic market. This three-part series takes a step back, diving deep into the various categories of injectable treatments currently available on the U.S. market today. 

Part One: Neuromodulators

As far as injectable treatments go, there are certainly a lot of fish in the sea. Limited injectable options were available in the early nineties; however, it was the 2000s that brought the majority of what we currently see on the injectable market, including Botox and the several other neuromodulators commercially available.

Neuromodulators: An Introduction

Botulinum toxin is derived from the gram-positive bacillus, Clostridium botulinum, the bacteria that causes botulism, a potentially life-threatening neurological illness affecting the human nerve cell, which results in difficulty breathing, paralysis, and in rare cases, death. Clostridium botulinum, discovered in 1897, has been found to have seven subtypes, including serotypes A, B, C1, D, E, F, and G. Serotype A is the most common serotype used in both clinical and aesthetic applications. 

As early as the late 1960’s, scientists were able to isolate the botulinum toxin molecule for localized use, which was found to be both safe and beneficial in various clinical conditions; initially, in the treatment of strabismus, a disorder affecting proper alignment of the eye, and later, in the treatment of various clinical disorders involving muscle hyperactivity and spasticity. While Botox, the first neuromodulator on the market, was FDA-approved in 2002, reports of neuromodulator use for the purpose of aesthetic indications were reported as early as 1992. Neuromodulators, popularly referred to as Botox, are the MOST requested procedure on the aesthetic market. 

So how do neuromodulators work?

To truly understand how neuromodulators work, or the mechanism of action of neuromodulators, let’s first briefly discuss anatomy and physiology, specifically how our nerves and muscles work together to cause muscle movement. Motor neurons, or nerve cells, are located in our brain and spinal cord, communicating with the various muscles in our bodies, which allow us to move, speak, swallow, and even breathe. Muscle action, or movement, is elicited when acetylcholine, an electrical neurotransmitter, released by our nerve cells, binds to the many corresponding receptor sites on each of our muscle fibers. 

Neuromodulator products, such as Botox, prevent our nerve cells from releasing acetylcholine, thus resulting in weakened muscle movement or complete paralysis. 

Think back to the nineties when home phones were a commodity in nearly every household. Electricity from the wall travels through the phone cord to the phone piece itself. If the phone cord was to be cut, communication between the two individuals speaking would be lost. Essentially, neuromodulators are the scissors that cut the phone cord, resulting in a temporary loss of communication between the nerve and the muscle. 

Scissors Cutting Phone Cord Stock Photo - Download Image Now - Cutting,  Telephone, Cable - iStock

Aesthetic Use of Neuromodulators

As many of us have already discovered, aging results in several skin and other aesthetic-related changes, not only on the face, but on the body as well. Over time, age-related changes such as volume loss, decreased skin elasticity, and repeated muscle movement results in the development of fine lines and wrinkles, particularly on the face, neck, chest, and other highly sun-exposed areas. 

Neuromodulators are used to prevent or treat these inevitable age-related changes. FDA-approved indications or “on-label” use of neuromodulators include treatment of glabellar, forehead, and lateral canthal lines. Neuromodulators are often used “off-label” for treatment of various concerns in the lower face, such as “gummy smile” or “golf-ball chin.” Results of most neuromodulators can typically be appreciated within a week, lasting anywhere between 3 and 6 months, depending on the product. 

As with all things related to aesthetics, neuromodulator outcomes are enhanced when utilized alongside other aesthetic offerings, such as high-quality skin care, dermal fillers, and laser and/or light-based energy procedures.

Am I a good candidate for a neuromodulator? 

The good news is, most people are great candidates for neuromodulator treatment, particularly when considering upper face, on-label indications discussed above. Product selection, dosing, and injection placement are determined by the patient’s unique anatomy and response to the neuromodulator itself. As with any aesthetic treatment, neuromodulator outcomes may differ from patient-to-patient and from treatment-to-treatment, making it so that no two treatments are ever the exact same. 

Individuals with severe loss of skin elasticity and deep lines at rest may be poor candidates for neuromodulator treatment as the effects of the neuromodulator may exacerbate the appearance of skin elasticity loss, which typically involves marked brow ptosis (downward drop of the eyelids) following neuromodulator administration. 

Are neuromodulators safe?

Most side effects are temporary such as injection site pain, swelling, bruising, and headache, all of which typically resolve within 12-24 hours. Fortunately, anything more troublesome, such as an unwanted aesthetic outcome, will resolve within 3 to 6 months as the effects of neuromodulators are not permanent. 

Contact Skin Appeal today at (520) 261-7546 to schedule a free consultation to see if you are a candidate for injectable treatments!

STAY TUNED FOR… Part Two: Dermal Fillers & Part Three: Collagen, Collagen Stimulators, and Poly-L Lactic Acid (Kybella)