Neuromodulators All Pages


    A physician named Kerner first thought about the possible therapeutic use of botulinum toxin. In 1897, Emile van Ermengem found the organism responsible for the production of the botulin toxin was a bacterium, which he named Clostridium botulinum. In 1949 it was discovered that botulinum toxin blocks neuromuscular transmission.

    Medical and cosmetic use

    Medical and cosmetic uses Although botulinum toxin is a lethal, naturally occurring substance, it can be used as an effective and powerful medication. Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of botulinum toxin would result in decreased muscle activity by blocking the action of a chemical called acetylcholine from the neuron at the neuromuscular junction. This will effectively weaken the muscle for a period of three to four months.

    Side Effects

    Side effects are generally minor, temporary and rare. Paralysis of the wrong muscle group by improper application and allergic reactions are uncommon but have been reported. In cosmetic use, this can result in inappropriate facial expression such as drooping eyelid, double vision, uneven smile, or loss of the ability to close eyes. This will wear off in around six weeks. Bruising at the site of injection is a side effect not of the toxin, but rather the mode of administration.


    There are currently three approved BTX products approved by the FDA for use in the United States. Botox is the most familiar having been used since 2002 with over 12 million treatments. The benefit of one product over another is still up for discussion.


    There are no specific pretreatment requirements. If you tend to bruise you should be off products such as aspirin and ibuprofen. Also certain vitamins and herbs may increase bruisability. Ask you injector for a list of item to avoid. If you have any active skin infections in the areas to be treated your procedure should be postponed.


    Being that BTX products are injected with an extremely fine needle in most cases anesthesia is not necessary. Some injectors may offer a topical anesthetic or ice packs.


    Needle/Syringe Because the BTX are not viscous, more like water, they can be injected through a very small diameter needle. Actually insulin needles are frequently used. The needle or syringe (if one piece) should be changed frequently. These very fine needles become dull very quickly, generally after 2-3 injections. Dull needles push, rather than cut, their way through the skin causing more discomfort and increased bruisability.

    Reconstitution / Dilution

    When BTX is received by the end user it is in a freeze dried state and needs to be reconstituted. In the case of Botox the bottle appears to be empty when received. Close inspection reveals a circular, fine white powder residue on the bottom of the vial. The BTX is reconstituted with a sodium chloride (NaCl) solution (salt water).

    The Procedure

    Each office has it’s own routine for the procedure. In many ways it is similar to the injection of fillers. The injector will discuss what your particular concerns are. He will watch your face move as you talk and will ask you to make many facial expressions.

    The Consent

    Although facial fillers as well as neuromodulators are very safe medical products when used by highly trained and experienced injectors an informed consent must be signed for both the protection of the patient and the injector. The consent will include a description of the procedure, alternate available treatments (if any), precautions, risks, possible adverse reactions and complications. An “informed consent” is required to be signed before any medical procedure. Feel free to ask your injector for a copy of the consent if you wish.

    Post Treatment

    Your injector will give you their specific post-treatment routine. In general you must keep the area clean and dry for 12 hours. There should be no manipulation of the treated area (like facials). You can expect redness, and swelling to be present to some degree when leaving the office. If bruising develops it may last from 24 hours to a week depending on how you heal. You may wish to purchase a supplement called Arnica Montana with bromelin to help limit bruising. If bruising does develop you may wish to gently apply ice to the area.

    Price- Units/Areas

    To clearly understand the cost of BTX (botulinum toxin) you must understand how it is sold. Unlike fillers where you purchase as a fixed amount in each tube BTX comes in a bottle, the injector removes the amount that you need for your treatment. BTX is sold two ways; by the area and by the number of “units” used. A “unit” is a measure of BTX product.