Neuromodulators (such as Botox®Dysport®, Xeomin®, and Jeuveau®) are commonly used to decrease the appearance of facial wrinkles. These injectable medications are a purified botulinum toxin that work by relaxing targeted muscles, which reduces the formation of wrinkles that would otherwise result from the muscle contraction. Neuromodulators are commonly used to smooth wrinkles around the eyes (crow’s feet), between the eyebrows (glabellar frown lines), and at the forehead.

During the procedure, a tiny needle is used to inject the neuromodulator (either Botox, Dysport, Xeomin, or Jeuveau) at specific regions. This non-surgical procedure is quick to perform, and there is no downtime afterwards. Side effects are very rare, but the more common side effects include temporary swelling, bruising, and discomfort at the injection site.

Dr. Foulad highly optimizes the neuromodulator treatment for each patient, ensuring an exceptional experience and excellent results. He is meticulous during the injections and only uses high quality, delicate needles. Topical numbing creams are available to help reduce discomfort during the injection. In addition, Dr. Foulad offers the Zimmer Cryo Chiller device to cool the skin, which improves comfort and can decrease the risk for swelling and bruising.


When will I notice results?
It usually takes 1 to 3 days to start noticing the effect of neuromodulator treatment, and maximal effect can take 1 to 2 weeks. Some wrinkles that are still present at rest may continue to further soften over months and with additional future treatments. The expected improvement largely depends on the severity of the wrinkle.

How long does it last?
Neuromodulator treatment usually lasts 3 to 4 months using traditional dosing, but varies from person to person. Based on our extensive experience, we have seen treatments lasting between 1.5 and 9 months. Although we have a very lucky patient who benefits from Botox lasting 9 months, this is extremely rare.
Neuromodulator dosing will likely change in the future, and this will increase how long the treatment lasts. For example, using 4 times the amount of units will significantly make the treatment last longer. There are currently several investigations regarding this topic, and Dr. Foulad is highly active in such research. The key will be micro-focused droplets of highly concentrated neuromodulator to achieve a very natural, but long lasting effect. At this time, high concentration neuromodulator treatment is not feasible because of the high cost. However, this will likely change; it is just a matter of time as a result of competition between various manufacturers.

What are the different types of neuromodulators for treating wrinkles?
Botox was the first FDA approved neuromodulator for cosmetic use and has become a very popular brand.
Dysport is another type of neuromodulator that has a similar effect as Botox, but requires different dosing. Approximately 3 units of Dysport is equivalent to 1 unit of Botox. This conversion is factored into pricing, and thus 3 units of Dysport is usually a similar cost as 1 unit of Botox. Typically, the treatment results will be noticed quicker with Dysport as compared to Botox. This makes Dysport especially useful in situations that require quicker onset of results.
Xeomin is made with botulinum toxin type A, the same purified protein that is used in Botox and Dysport. However, unlike Botox and Dysport, Xeomin can be thought of as being “purer” because it leaves out various accessory proteins. This may reduce the risk of your body forming antibodies to the product. Many of our patients describe treatment with Xeomin as feeling relatively “lighter” compared to other neuromodulators. Occasionally, some patients will have a short period of headaches or a feeling of tightness after Botox treatment to the forehead; many of those patients have told us that those symptoms are reduced or eliminated when they use Xeomin. However, this “lighter” product may not last as long as the other neuromodulators.
Jeuveau is the newest neuromodulator that has been FDA for wrinkles, and is very similar to Botox.

Which neuromodulator product is best for me?
Each neuromodulator product has its specific advantages and disadvantages. Based on your goals, we can determine the best neuromodulator product for you.

What are the post-procedure instructions?
• For the first several hours after the treatment (ideally until the next day), avoid applying pressure to the treated areas. For example, avoid massaging or resting your head on the areas that were treated. When cleansing your face or applying makeup, perform this gently. This is to avoid pushing the neuromodulator treatment to other areas.
• Ideally, do not perform strenuous exercise until the day after the treatment.


Relevant Blogs:
What is botulinum toxin resistance?
Why didn’t my Botox work well?


Advanced Botox

Chin Botox

Botox can be used at the chin to improve the contour of the jaw and chin as well as to smooth indentations at the chin caused by hypercontraction of the associated muscles.

Frontal View

Oblique View

Profile View