The ABCs of Neurotoxin Injections – Aka Wrinkle Reducers A Q&A Session Brought to you by the Skin Cancer & Dermatology Institute .


According to the American Board of Cosmetic Surgery, botulinum type A injections, also known as neurotoxin injections, are the most popular cosmetic treatments performed nationwide. We sat down with our local Elko cosmetic dermatology expert Brandie Oros, APRN, to learn more about these wrinkle-reducing cosmetic treatments.


  1. What are neurotoxin injectables and how do they work?
  2. Neurotoxin injectables block nerves from activating muscles thus preventing the muscles from contracting. This results in the smoothing out of fine lines and wrinkles caused by muscle movement and contraction.


  1. What is the best neurotoxin on the market, and why is this your favorite?
  2. There are four FDA approved neurotoxins in the U.S., and BOTOX® Cosmetic is my favorite. It has been around the longest, is the most researched, and is most effective for targeting specific areas. It is also FDA-approved to treat a wide range of locations of the face and can even be used for medical management of problems such as hyperhidrosis (heavy sweating), chronic migraines, and TMJ (temporomandibular joint disorder).


  1. Neurotoxins vs. Fillers – what’s the difference?
  2. While these terms are often used interchangeably when people talk about cosmetic injections, they are very different. Neurotoxins prevent muscles from moving and therefore improve wrinkles. Fillers are substances used to add volume to an area. As we age, we lose volume in our faces, and fillers help to restore the volume to a more youthful appearance. Fillers can also be used to plump up the lips and correct asymmetry of the face. Neurotoxin and fillers are therefore very different in purpose and effect, and I like to use them both synergistically to obtain optimal results.


  1. What are the funniest or most memorable names your patients have called their wrinkle lines?
  2. It is always fun to hear some of the different ways we name our wrinkles and lines! I have heard patients describe them associated to emotions like smile, laugh, worry, or frown lines. Then there are the lines named after animals, like bunny lines or crow’s feet. And others include elevens (11’s) marionette lines, smile parentheses, and cobblestone chin.


  1. Which neurotoxin or neurotoxins last the longest?
  2. The most common neurotoxin injectables, BOTOX and Dysport®, can last three to four months, but this often unique to each individual.


  1. Do some brand-name neurotoxins work better for certain parts of the face?
  2. Yes, BOTOX is approved for forehead, glabella (the skin on your forehead and between your eyebrows). I like it the most for the glabella (these are the wrinkles often referred to as the 11’s) and crow’s feet because it is less likely to disperse to other areas.


  1. What should we know before trying neurotoxin injections for the first time?
  2. Neurotoxins are very safe and have been used for years as anti-aging treatments to help reduce the appearance of wrinkles. Bruising and tenderness at the site are normal and do not usually last long. It is often called a lunch hour procedure because there is minimal downtime, and you can typically return to work after your treatment. For its full effect to be apparent it usually takes about 2 weeks, so if you are preparing for a big event, make sure you plan ahead a couple of weeks in advance.


  1. How much BOTOX should we start with?
  2. Allergan®, the manufacturer of BOTOX, recommends a dosage of four units each in five sites on the forehead, totaling 20 units. Recommendations for treatment of the glabella and crow’s feet brings the total to about 40-50 units. The Nevada State Board of Pharmacy has strict regulations regarding sharing of vials; therefore, I typically use the recommended 40-50 units on each patient to get the best result for the cost. It all depends on my patient’s desired result. During our consultation prior to treatment, we talk about your goals and we create a plan based on that. After your first treatment I like to see you again two weeks after to ensure you are pleased with your results, and sometimes we do some more final touchups.


  1. Will a neurotoxin injection make me look older once it wears off?
  2. No, you may feel like you look older initially as the effects wear off, but it will return only to the previous state and not worse. Also, if you get neurotoxin injections regularly, the muscles will decrease in strength and the permanent wrinkles will take longer to return to their previous severity.


  1. How often will I need neurotoxin injections?
  2. Neurotoxin injections typically last three to four months, but it depends on the strength of the muscle, individual metabolism, and the treatment area.


  1. How much should I budget annually to use neurotoxin injectables regularly?
  2. You should budget between $1,800-$2,400 per year for neurotoxin injectables to get the best cosmetic outcome.


  1. How can I avoid the frozen look with neurotoxin injections?
  2. Because we approach our cosmetic treatments in a consultative fashion, I take great care to discuss the desired outcome with you and I alter your treatment plan accordingly. We can work together to achieve a very natural look if that is what you want. And to ensure your results are proceeding according to your plan, I like to see you again two weeks after treatment.


Schedule your cosmetic dermatology appointment in Elko with Brandie Oros, at For more information about medical and cosmetic dermatology subscribe to Skin Cancer & Dermatology’s blog Skin 101.


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Bringing you patient-centered, world-class dermatological care with nine locations in Nevada and California. Skin Cancer & Dermatology Institute specializes in medical dermatology, Mohs skin cancer surgery, and cosmetic dermatology.

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