It may be a miracle in a bottle and the ultimate wrinkle eraser, but do you really know what’s going on when a single dose of any neuromodulator (Botox, Dysport or Xeomin) gets injected? Neuromodulators temporarily inhibit the nerves that signal certain muscles to contract. Once these muscles are weakened, they can’t make the movements that cause lines and wrinkles (you can still make facial expressions, but they may not be as exaggerated). After a few months, the muscles regain activity, the line-smoothing effects begin to diminish and the treatment needs to be repeated. Before you have anything injected into your face, make sure to always see the bottle, which should have a hologram on it, to verify that counterfeit products aren’t being used. Here’s the lowdown on what’s really going on. Small bumps appear, but only last for a few minutes. Pea-size bumps (or smaller) tend to pop up right after an injection—literally seconds later—but no need to worry, they’ll disappear. New York plastic surgeon Z. Paul Lorenc, MD, explains that these bumps are actually fluid (saline) that’s used to dilute the material because neuromodulators come as a powder. Once the fluid is absorbed by the skin, which can take a few minutes to half an hour, the bumps diminish.
It can go to work within one minute. Any time a neuromodulator is injected, the nerves that create muscle movement are blocked. “Botox does not directly treat the wrinkle. It reduces muscle activity so that the wrinkle is no longer creased and reformed,” says Las Vegas plastic surgeon Mary Herte, MD. “When the muscle activity causing the folding stops, the body can start repairing these wrinkles.” According to Dr. Lorenc, the effects of Botox go to work within one minute, but it can take a few days to see full results. “Once the nerves are blocked, they disappear and later regenerate when muscle activity returns.” Your skin becomes much smoother. One effect of neuromodulator is smoother skin, especially on the forehead. The reason for it is a reduced amount of muscle activity, which leads to skin that’s more pliable because the underlying muscles have been temporarily put to rest. New York dermatologist Hooman Khorasani, MD, says, “When muscle tone is reduced, there is loss of a folding of the skin on top of the muscle, which makes lines less noticeable.”
It stops future wrinkles from forming. While some doctors don’t feel that it’s necessary to inject neuromodulators before lines and wrinkles are evident, others feel using them proactively can prevent the formation of lines and wrinkles so that they never surface. “Botox is a great basic essential treatment for expression lines, but only for the ones that are there when you are moving your face and contracting your muscles,” says Dr. Herte. “If Botox is started before the lines become etched in, and persist even when your face is quiet and at rest, you will be preventing the wear that causes the lines to form in the first place.”
The results will start to wear off in three months and you’ll need to do it again. Neuromodulators aren’t permanent—you can expect wrinkle-free skin for three to four months. To maintain the results, you need to keep up with the treatment. The chemical reaction that bonds Botox to muscle cells is permanent, but new nerves sprout connections to the muscle so communication resumes after a few months. “Once that muscle regains activity, any lines that were originally there will start to come back,” says Dr. Herte. While the skin will revert back to baseline, Dr. Khorasani says there’s a misconception that the lines will be worse than they were when you started. The more often you do it, the less you’ll need. Dr. Lorenc says that the more frequently you get injections (and we’re not talking about abusing them or getting injected more often than what’s really necessary), the less product you’ll need over time. That’s because your muscles tend to have a longer response as product is used more often. And, over time, the muscles have been weakened and aren’t as active, so the amount of product necessary to smooth out lines and wrinkles starts to decrease.