Neuromodulators (Botox) and Dermal Fillers
Neuromodulators AKA Wrinkle Relaxers
Neuromodulators are done as a minimally invasive cosmetic procedure to relax facial muscles. The purpose is to help decrease the appearance of wrinkles, crow’s feet, and frown lines. Smoother skin lasts between 2 to 4 months, with visible improvements becoming apparent within just 2 weeks.
Botox® is the most popular injectable neuromodulator and is a prescription medication. However, there are different brands such as Xeomin® , Jeuveau ® , and Dysport® .
In our clinic, we offer Xeomin® for $ 10/unit
Botox® and Xeomin® are prescription injectable neurotoxins (forms of botulinum toxin type A) that have been approved by the FDA for minimizing fine lines and wrinkles. Many people think that Botox® and Xeomin® are basically the same thing. Probably the biggest myth about Xeomin® is that it is simply a cheap and generic version of Botox. In reality, there are some significant differences between the two products.

Similarities:
- Both are effective in eliminating expression lines and wrinkles that occur due to repetitious muscle contractions involved in everyday facial movements.
- Both are FDA approved for addressing forehead wrinkles that occur due to squinting or raising of the eyebrows.
- Both address lines and wrinkles in the same manner: by relaxing targeted facial muscles. When Botox® or Xeomin® are injected into the muscle they temporarily block the nerve impulses that are needed for contraction. The resulting muscle relaxation and decrease in movement reduce the appearance of lines or wrinkles in the area.
- The results from both products are temporary. This means that both treatments do require periodic maintenance (typically every 3-6 months) in order to maintain the results over time.
- Both products are dosed similarly (i.e. 20 units of Botox® equals the strength of 20 units of Xeomin® ). This is not the case when compared to other types of neurotoxins (i.e., Dysport).
Differences:
The main difference between Xeomin® and Boto® x has to do with the formulation. Xeomin® is a “naked” neurotoxin. That is, Xeomin® contains only a single ingredient (botulinum toxin A), while the formulation of Botox® includes various protective proteins clustered around the active molecule. The benefit of Xeomin’s® pure-form means users have a lower chance of developing resistance (antibodies) that can limit its desired effects.
Another difference between Botox and Xeomin® is the onset of results. While the results of both treatments last for about the same duration (3-6 months), Xeomin requires up to 4 days for results to fully form, while Botox® typically only requires about 72 hours.
The final major difference is behind the scenes: since the Xeomin® formulation does not contain additional additives it does not have to be refrigerated before use. This feature simplifies distribution and storage of the product, which may make it more desirable than Botox® to some clinical practices.
In the end, the choice between Botox and Xeomin® may be best left to an experienced injector. A skilled provider will analyze your current facial characteristics and health history to determine the best course of treatment given your desired end result.

Common treatment areas and units **typically needed:
Forehead Lines/Wrinkles – 10-20 units
Glabella (Frown Lines) – 15-30 units
Crows Feet – 6-12 units per side
Eyebrow Lift – 2-4 units
** needs will vary per individual


Dermal Fillers
Dermal fillers help to diminish facial lines and restore volume and fullness in the face.
As we age, our faces naturally lose subcutaneous fat. The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect facial skin include sun exposure, heredity, and lifetstyle.
Dermal fillers can:
- Plump thin lips
- Enhance shallow contours
- Soften facial creases and wrinkles
As a result, Dermal Fillers can be helpful in those with early signs of aging.
As with Neuromodulators, there are several brands of Dermal Fillers. In our office, we carry the brand Revanesse Versa.
Revanesse Versa is an FDA-approved hyaluronic acid (HA) dermal filler that can be used to smooth lines and wrinkles and enhance facial volume for a fresh, youthful appearance in patients 22 years and older.

Some benefits of Revanesse Versa lip filler include:
- No downtime involved
- Minimally invasive procedure
- Can be used in other areas of the face too
- Lasts up to 6 months
- Premium quality ingredients
- Cost friendly
In our clinic, we offer Revanesse Versa for $675 per syringe.
Cosmetic Filler Pre and Post Instructions
Skin filler treatment involves the injection of highly purified, individualized doses of hyaluronic acid (Restylane and Juvederm) into unwanted skin folds, creases, lines, and wrinkles. The skin filler acts by superficially “filling” in and simply smoothing out unwanted skin lines with a biologically natural product. The procedure must be performed by an appropriately licensed and trained physician or mid-level provider pursuant to physician supervision and according to prevailing state law. The following Self-Care instructions have been developed specifically for our patients.
BEFORE TREATMENT
- For one week before treatment, please avoid the following medications: Aspirin, Advil, Motrin, Ibuprofen, Aleve, Naprosyn, Excedrin (all OTC pain pills except Tylenol), Vit. E, Vit.A (RetinA, Renova, Tretinoin, Tazorac, Differin, Triluma), Gingko Biloba, Omega-3 fatty acids, cod liver oil, CoQ10, garlic and ginger.
- If you are taking any blood-thinning medications as per doctor’s orders (such as Coumadin, Warfarin, Plavix, Lovenox),do not discontinue without first consulting the prescribing physician. If you continue to take these medications the chances of developing an injection-related hematoma (blood clot) which can leave a dark spot if it becomes entrapped in the filler implant is higher. The dark spot may remain until the filler is naturally dissolved.
- Do not schedule any social events for the next 3-7 days as you may have bruising and/or swelling lasting this long or longer. You can cover up bruising with makeup.
- Arrive for your appointment wearing no makeup if possible. You will be able to apply makeup after your treatment although we recommend waiting at least 24 hrs.
AFTER TREATMENT
- Keep the treated areas clean. Light make-up coverage is acceptable if desired.
- You may apply ice for 5 minutes every 1⁄2 hour if there is any pain or swelling. Any bruising will eventually resolve on its own, typically within one to two weeks.
- If post-injection bruising is noticed, consider using the OTC homeopathic natural remedy Arnica Montana, which has been shown to rapidly relieve and even prevent bruising. Arnica is available at most health food stores and is safe (free of reported side-effects).
- As always, wear at least SPF 30 sun block when appropriate and try to avoid exposure to intense, direct sunlight & heat (example: sun lamp steam, sauna) for at least two to three days.
- Do not take aspirin containing products (see above) for the next 24 hours. These agents may increase bruising/bleeding at the injection site. Again, Tylenol may be taken.
- Avoid alcohol intake beyond a single drink, glass of wine, or beer for approximately 24 hours after treatment. You may sleep with an extra pillow if desired to minimize swelling overnight.
- As always, tobacco and illicit drugs are discouraged.
- Discontinue Retin-A (Tretinoin) for 3-5 days after treatment. It is best to wear no makeup or lipstick until the next day. Earlier use can cause pustules.
- One side may heal faster than other side. You may have bumps or nodules of filler under the skin that can last 4-8 months after the injection. If they are particularly troublesome you can massage them, we can also give a small injection to help dissolve them faster.
- If there is any leftover product, it must be used within 2 weeks of opening to avoid contamination.
- Keep in mind that evidence shows that having a follow-up treatment before the product has fully dissipated tends to enhance the lasting effect of skin fillers.
- Wait at least a week (preferably 2-3 weeks) after your injection before having other procedures done in the same anatomic area; example: microdermabrasion, laser treatment, chemical peel, etc.
- Please notify us with any further concerns/questions. Note that you can optionally schedule a follow-up visit to evaluate results after the initial swelling has dissipated. Typically hyaluronic fillers can be reshaped for up to two weeks post-injection.
Xeomin® Pre and Post Instructions
Botox® cosmetic treatment involves the injection of highly diluted, individualized doses of botulinum toxin A into (or in close proximity to) overactive facial muscles or sweat glands, which are responsible for wrinkles or excessive sweating respectively. Botox® relaxes muscle(s) and/or sweat glands by diminishing their ability to contract. The procedure must be performed by an appropriately licensed and trained physician or mid-level provider pursuant to physician supervision and according to prevailing state law. The following Botox® injection Self-Care instructions have been prepared specifically for our patients.
BEFORE TREATMENT
- For one week before treatment, please avoid the following medications: Aspirin, Advil, Motrin, Ibuprofen, Aleve, Naproxen, Excedrin (all OTC pain pills except Tylenol), vitamin E, Vitamin A (Tretinoin, Retin-A, Renova, Differin, Tazorac, Triluma), Gingko Biloba, Omega-3 fatty acids, cod liver oil, CoQ10, garlic and ginger.
- Avoid sun exposure to the area to be treated one week before treatment.
- Do not take ANY muscle relaxing medications (example: Soma or Flexaril) at least one month before treatment.
AFTER TREATMENT
- Remain upright for 6 hours following treatment. No lying down or bending over.
- Keep the treated areas clean. Light make-up coverage is acceptable if desired.
- You may apply ice for 5 minutes every 1⁄2 hour if there is any pain or swelling. Any bruising will eventually resolve on its own, typically within one to two weeks.
- If post-injection bruising is noticed, consider using the OTC homeopathic natural remedy Arnica Montana, which has been shown to rapidly relieve and even prevent bruising. Arnica is available at most health food stores and is safe (free of reported side-effects).
- As always, wear at least SPF 30 sun block when appropriate and avoid exposure to intense, direct sunlight and heat (example: sun lamp steam, sauna) for at least two to three days.
- Move the facial muscles (frown, smile, raise eyebrows) that have been treated throughout the rest of the day. This will help the muscles absorb the Botox® Cosmetic.
- Avoid vigorous exercise for 24 hours.
- Do not rub or massage the areas treated for 24 hours.
- Do not take aspirin containing products (see above) for the next 24 hours. These agents may increase bruising/bleeding at the injection site. Again, Tylenol may be taken. Discontinue RetinA (Tretinoin) for at least 3-5 days after treatment.
- Avoid alcohol intake beyond a single drink, glass of wine, or beer for approximately 24 hours after treatment.
- As always, tobacco and illicit drugs are discouraged.
- The onset of muscle relaxation usually begins in 7-10 days, but optimal results may take up to 2 weeks.
- *NOTE*: Results may vary. If there is partial improvement of a treated site, and re-treatment is desired, a second treatment may be performed no sooner than 2 weeks after the primary treatment. There is a subsequent charge for any “touch–up’s” or additional treatment.
- Please contact us should there be any side effects or questions regarding your treatment with Botox® Cosmetic.
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