You have probably heard of friends, family or colleagues who have had BOTOX® injections. BOTOX® is just one of three wrinkle modulators available in the United States. Here, we will review what you need to know about these wrinkle modulators and how they help you maintain a more youthful appearance.

Brands available in the USA:

BOTOX®, Dysport®


Wrinkle modulators are neurotoxins called botulinum toxin type A (BOTOX®, Dysport®, Xeomin®). It is a natural substance made of purified protein that temporarily suspends the muscle movements, which eases and smooths creases in your face.

Treatment areas:

People often get confused about what areas that wrinkle modulators can be used on the face, thinking that the toxin can smooth out any wrinkle. To clear this up, we will first discuss the most common wrinkles on the face.

  • Worry lines: or surprise lines are horizontal creases on the forehead which are prominent when you raise your eyebrows
  • Frown lines: often called “11 lines” are vertical lines between the eyebrows and are prominent when you frown.
  • Crow’s feet: tiny lines which start from the outside angle of each eye and go towards your temple in a fan-like fashion, similar to the shape of a bird’s foot. They are prominent when you squint.
  • Smile lines: lines that extend from the edges of the nose to the angles of the mouth, also known as nasolabial folds.
  • Marionette lines: vertical lines that angle down from the corner of your mouth towards the chin.
  • Smoker lines: fine vertical lines around the lip. These are prominent when you pucker your lips.
  • Bunny line: crease at the bridge of your nose, visible when you smile or squint.

Wrinkle smoothing by neurotoxins happens as a result of the muscle relaxing, but it has no direct effect on the skin. When facial muscles are active, they pull on the skin in different directions making wrinkles. By injecting certain muscles, we can prevent or minimize certain motions. This diminishes the constant motion stress on the skin, causing wrinkles and lines in the skin to disappear. This happens faster in well-hydrated and elastic skin of younger individuals, but requires more time the older you are. When lines are static, meaning they are visible even when you relax your face, neurotoxins alone will not be able to smooth the line. Addition of micro needling, laser rejuvenation, and/or fillers are needed to complement the neurotoxin treatment.

Areas with most success from treatment with wrinkle modulators:

    • Worry lines
    • Frown lines
    • Crow’s feet
    • Bunny lines

Areas with some success from treatment with wrinkle modulators:

  • Smoker lines, though these are better treated with dermal fillers

Areas that do not respond to wrinkle modulators:

  • Smile Lines
  • Marionette lines
  • Sagging or lax skin
  • Hollow areas in the face
  • Tear trough deformities

These problem areas can be improved with the use of dermal fillers, micro needling, medical grade peels, and/or laser rejuvenation therapy.


Typically, the treatment takes about 15 minutes and there is no downtime, which we know is beneficial for our busy and active patients. There may be some bruising around the injection sites, but most people can return to their daily activities immediately.

Wrinkle modulators typically take effect 2-10 days following treatment.

Women who work out frequently may need more frequent treatments.


Do not touch or manipulate the treated area for 3 hours following the treatment. It is okay to do facial exercises, like smiling and frowning, to help the neuro-toxin disperse in the muscle. Do not lie down for four hours after your treatment. Laying down can cause the neuro-toxin to track down into the orbit of the eyes, potentially causing a droopy eye. Do not perform activities involving heavy lifting, straining, or vigorous exercise for 6 hours after treatment.


Follow this link to view the pre and post treatment information and to review the consent form. FORMS

Please email us at with any questions you have.