Muscle Relaxers/Neuromodulators

What are muscle relaxers?

Muscle relaxers are known as Injectable neuromodulators. There are three main types/brands of neuromodulators used in the United States for aesthetic purposes: BOTOX® Cosmetic (onabotulinumtoxin A), XEOMIN® (incobotulinumtoxin A) and DYSPORT® (anobotulinumtoxin A). All are purified proteins that are injected directly into the muscle and cause that muscle to relax for a prolonged period of time. These proteins work by blocking the chemical signals that create nerve impulses to the muscle. This leads to muscle relaxation and disappearance in visible wrinkles. The proteins are produced in a controlled laboratory setting from the bacterium Clostridium Botulinum.


Muscle Relaxer Injections

How does a muscle relaxer injection affect my appearance?

From a broad perspective, muscle relaxers are used in aesthetics to accomplish two main goals. The first is to treat dynamic wrinkles. These are formed by repetitive furrowing of the skin due to the facial expressions we routinely make. Unlike static wrinkles, which develop primarily due to the effects of ultraviolet and visible radiation on the skin, dynamic wrinkles are caused by repetitive movement of the musculature that resides below the skin. Over time, these dynamic wrinkles can become pronounced. Muscle Relaxer Injections work by relaxing the muscles that are attached under the skin. This will then decrease the forces that cause dynamic wrinkles, allowing the skin to appear smooth and creating a more relaxed facial expression.


How are Muscle Relaxer Injections Performed?

The first step is to schedule a consultation with one of our two physician extenders Allison Kyle ARNP, or Jennifer Webster PA-C. Both are highly experienced injectors and are trainers for the USF Dermatology resident physicians. They will review your past medical history, assess the areas you want to have treated, review the best options for your needs and will answer any questions you have.

After an analysis of your facial anatomy, muscle tone and overall skin condition, she will mark out the treatment sites and recommended dosages. If you decide to move forward with the treatment, she can perform it immediately following your consultation.

We’ll take some “before” photos so you can see the improvements the treatment makes. The products we use all comes in a clear glass vial in the form of a vacuum sealed powder. Unlike some aesthetic clinics, we always purchase all our products directly from the manufacturer – never from third party discount vendors/overseas vendors which may have diluted/contaminated product. The muscle relaxant will be diluted with a sterile, non-preserved 0.9% sodium chloride solution, and the physician extender will draw it up into a syringe.

We may apply some ice to your target treatment areas to reduce discomfort caused by the needle. The injections are made using a very fine 30 gauge needle, so discomfort is minimal. The entire session will only take a few minutes.

How Do I Decide Which Muscle Relaxer Product is Best for Me?

During your consultation, we will discuss the advantages, disadvantages and common misconceptions about BOTOX® Cosmetic (onabotulinumtoxinA), XEOMIN® (incobotulinumtoxin A) and DYSPORT® (anobotulinumtoxinA using an up-to-date, evidence-based approach from published data within the dermatology and plastic surgery literature.

Muscle Relaxer Injection Recovery and Results

After the treatment, we’ll give you aftercare instructions to take home with you. The injection site may be a bit red with some slight swelling and/or bruising, but this will subside within a few days. You’ll be able to return to your usual daily activities right away.

Muscle Relaxer Injection results usually take 24 to 48 hours to appear, and final results can take up to two weeks. The results can last on average from 3 to 5 months, and vary from patient to patient. You will notice that gradual movement of the treatment area will return if you do not receive another injection treatment.

It’s been noted that over time when patients keep up with their scheduled injections, the results last longer, and the time between subsequent treatments may be extended.


Common Muscle Relaxer Injection Treatment Areas

Muscle relaxer injections can be used to treat and prevent many conditions including the following:

• Horizontal Brow Furrows
• Bunny Lines in the Nasal Area
• “Gummy smile” appearance
• Corners of the lips and fine lines above the lips
• Crow’s feet
• Change in the eyebrow shape (rounded or peaked)
• Vertical muscle bands in the front of neck
• Pore reduction – reduce pore size and sebum production
• Frown Lines between the Brows
• Excessive sweating/hyperhidrosis
• Pre-Mohs surgery injections to reduce surgical scarring


The most common client requests are noted below:

Frown Lines – These are the lines that often for the shape of the number 11 on your lower mid forehead, above the nose – an area known as the glabella. These lines tend to be deep, and are caused by the action of the underlying muscle called the corrugator supercilii. Every time we frown or make a confused or worried expression, these tiny muscles contract, bringing the eyebrows together, and causing deep vertical furrows just above the nose.

Upper Forehead Lines – We raise our eyebrows when we become surprised or excited. This causes horizontal lines to form on the upper forehead. This is due to the contraction of the frontalis muscle underneath the skin of the forehead and scalp. Treating forehead wrinkles requires careful consideration to avoid causing eyelid drooping. Using a qualified and experienced injector in this area is especially important.

Crow’s Feet –Years of squinting in bright sunlight and movement of the eyelids cause lateral canthal lines, more commonly known as crow’s feet. These are the “smile lines” we see at the lateral aspects of the eyelids. A muscle called the orbicularis oculi lies under the skin here. It’s located around the eyelids, and extends onto the temple, low forehead and upper cheek. These lines respond nicely to muscle relaxants and are also wrinkles that can also be treated with retinoid derivatives such as Renova®.


Muscle Relaxer Injection Side Effects

No medical procedure is without risk. When you receive Muscle Relaxer Injection, possible side effects include, but are not limited to:

• Pain at the injection site
• Headache
• Allergic reaction
• Droopy eye

Before getting muscle relaxer injections, make sure you inform your provider of:

• Any nerve or muscle conditions that you have, especially if you see a neurologist for a nerve condition
• Any allergies
• Pregnancy status, plans to get pregnant, or current breastfeeding
• Other medical conditions
• Any recent infection, including cold sores
• Current medications, and whether you are planning to take medication in the near future
• Past facial surgery
• When your last muscle relaxer injection was
• Past reaction to muscle relaxer injection or other neurotoxins

Common Questions About Muscle Relaxer Injections

• Are muscle relaxer injections safe?

All aesthetic procedures have risk, but muscle relaxer injections are among the safest types of procedures. At Lumen we take extreme measures to reduce risk by doing several things. First, we only utilize experienced physicians and physician extenders in the core fields of aesthetics (primarily dermatology and plastic surgery). We do not allow aestheticians and RNs to perform Muscle Relaxer injections.

The second thing neuromodulators can accomplish is to reduce sebum production and pore size. Unlike the first effect, dynamic wrinkle reduction, the pore size reduction from neuromodulators tends to be less predictable, possibly because it is less well-studied and not used as commonly. Nonetheless, good results can often be seen. Its most commonly performed on the nose.

Muscle Relaxer Injections are currently the most popular cosmetic procedures in the aesthetics field because they usually have predictable and consistent results when used appropriately and judiciously.

• Do muscle relaxer injections hurt?

Most patients report that they can hardly feel a treatment. By using careful technique and a tiny 30 gauge needle the most you will probably feel is a little pinprick. Sometimes, we use ice to cool the skin which also creates an anesthetic effect. For clients that request it, topical numbing creams can be used, but they are rarely required.

• Will my wrinkles look worse if I do not continue getting injections?

After 6-9 months, the muscle relaxer effects will have completely gone away and you will back to your baseline. Your wrinkles will start to appear the way they did before your treatment sessions. They will not look worse, but they will get progressively deeper over time.

• How do muscle relaxer injections work to reduce surgical scarring?

The amount of tension and movement at a wound site influences that likelihood that a scar will become thickened and red (“hypertrophic scar”). This is a major reason why surgical sites on the shoulders/upper back are at higher risk of becoming hypertrophic or even keloids. Several studies have shown that muscle relaxer injections to the adjacent muscles around facial surgical wounds will significantly improve the final cosmetic appearance.

• What is the difference between muscle relaxer injections and dermal fillers?

They each accomplish different results and complement each other very well. Muscle relaxer injections are meant to soften and prevent fine line and wrinkle formation. Dermal fillers are meant to plump and fill areas on the face. If you are a good candidate, you may be able to combine both procedures in the same treatment session. Determining which areas would benefit from one versus the other is where the consultation comes in.

• If I am pregnant, can I be treated with Muscle Relaxer Injection?

We do not perform muscle relaxer injections on pregnant women. They are not intended for women who are pregnant or breastfeeding. The FDA approved labeling for muscle relaxers indicates that they are placed in pregnancy risk category “C”, and recommends that it should be “administered during pregnancy only if the potential benefit justifies the potential risk to the fetus”.

•I am a man that is considering muscle relaxer injections. Are men treated with the same technique as women?

An experienced practitioner will know that women require a different approach to muscle relaxer injections than men. For example, careful placement of the injections on the forehead in women can result in a subtle lateral flare of the eyebrow that can look compelling. In men, however, it can have a feminizing effect that some men may not desire.

In addition, men tend to be particularly concerned about not “overdoing” the injections so we usually take a more conservative approach and ask them to come back in 1-2 weeks for a “touch-up”, if needed. Men often require more units of the neuromodulator in order to see an effect.

• Is there any downtime after the injection?

No. After your session, you can resume your typical routine that same day.

• How long will the results last?

On average, three to five months. After 3-4 months, you may notice the gradual movement of the treated area, and reappearance of some of the wrinkles. If you are consistent with the scheduled injections, the effects will last longer, however. After several sessions, most clients find that they need to come in less often.

• How often can I get treated with Muscle Relaxer Injection?

For treatment of wrinkles we recommend treatment sessions ranging between every 3 to 5 months. For reduction of surgical scarring, the injections should occur prior to or within 1-2 days of the procedure.

• Will I look unnatural after a muscle relaxer injection?

A common misconception is that the injections will completely inhibit facial expression and movement. At Lumen, our goal is to maintain a natural appearance by softening natural lines but still allowing our clients the ability to display emotion.

• How do I find a qualified expert to administer muscle relaxer injections?

Any medical professional or facility offering muscle relaxer injections should be certified to perform the procedure, in good standing with their governing medical organization, and should work out of modern and clean facilities. They should also have good knowledge of facial anatomy, and be someone you feel absolutely comfortable with and can trust. Above all, they must be licensed to administer muscle relaxer injections.
We recommend finding a physician or physician extender that is one of the “core” aesthetic specialties (dermatology, plastic surgery, oculoplastic surgery, head and neck plastic surgery), and that has had a lot of experience with the procedure.

• I am in my 20’s. Is that too young to start Muscle Relaxer Injection treatments?

No. The goal of muscle relaxer injections in a younger client is different from that of other age groups. It’s really prevention, as opposed to treatment. By reducing muscle activity and the secondary furrowing of the overlying skin, you are preventing the deep, etched-in wrinkles that can develop in later years. You will still develop dynamic wrinkles over time but they will be more subtle and will take longer to develop, especially when combined with effective sun-protection and a daily home regimen.