Neuromodulators & The Many Sites They Can Be Injected

“Can you inject Botox in my lips to give me bigger lips?”

“Can you fill this line with Dysport?” (They pronounce it Die-sport.)

“Can I rest my frown lines, forehead and crows feet with only 20 units of Botox total because that is what I received at the last place?”

These are some of the questions my office will answer during a consultation if the patient is naïve to a neuromodulator, or naïve to our office. As an injector, I have one main goal after protecting the safety of the patient. I want to give the best outcome to that patient.

This starts with patient education.

It’s important for the patient to know what areas are even possible to be injected with a neuromodulator, and what are the typical amounts to inject in those areas. Xeomin and Botox Cosmetic are identical in their units, and Dysport is equivalent to three times the amount. Typically, this means the cost of Dysport (properly pronounced (Dis-port) would be priced at three times the amount to make it essentially “apples to apples” when thinking of amount and cost. In recent years, we have seen neuromodulators emerge into the marketplace such as Juveau and Daxify offering features such as lower cost or more longevity. However, these characteristics may be debatable depending on where a physician is tiered with the manufacturer of the product and can pass through a discount to the patient. Also, when it comes to longevity, there are clinical studies to show that the more product that is injected, the longer the duration of any of the neuromodulators making an argument against the use of some of the newer agents.

Each of the neuromodulators has a personality and can offer characteristics which can make it more desirable for the injector to choose for his/her practice and for each patient.

All of the neuromodulators can be injected into the various areas listed but they may not be FDA approved for those areas. Just because a drug may not be FDA approved does not mean that it is not the best choice for a patient, especially in the hands of an experienced injector and provider.

Of course, some of the neuromodulators are being FDA approved for other medical indications, but as this blog is more directed towards aesthetic healthcare providers, I have listed the sites where they can be used for aesthetic improvement. 

• Glabella
• Frontalis (Forehead)
• Perorbital (Crows’ feet)
• Nasalis (Bunnies)
• Orbicularis Oris (Upper and Lower Lip)
• Mentalis (Chin Dimpling/Peau d’orange)
• Masseter (TMJ or Jawline)
• Platysmal bands (Neck)
• Gummy smile
• Trapezius (AKA - Barbie Botox)
• Axillary region for Hyperhidrosis

 After the patient is educated on the locations where neuromodulator can be injected, it is important to remind the patient exactly what a neuromodulator does. Neuromodulators REST muscles of facial expression. They do not fill lines. If a patient has static lines, a neuromodulator can be used over several injections to continually rest muscles of facial expression. If used in combination with a collagen stimulator and/or laser or other collagen-stimulating devices, these static lines can be reversed.

Only fillers can be used to create bigger lips.

When it comes to cost, patients should be educated on the proper amounts by area. Sometimes that can be difficult if they have attended another provider, and I believe the truth can be distorted in the transfer process but WE are the experts and should remember what we know to be true as we practice aesthetic medicine. If a patient has an infection and needs an antibiotic, would we give a less-than-acceptable amount to achieve cure because the patient was trying to save money? Of course not. We would ensure the proper amount of medication was administered.

It should be the same with neuromodulators. If a patient has a particular budget, but would like multiple areas treated, consider encouraging one area to achieve proper rest of the facial muscles versus a substandard treatment approach to aesthetic medication.

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