BOTOX® and Dysport® · New York and New Jersey
Neuromodulators
Neuromodulators are the injectable treatments, BOTOX® Cosmetic among them, that relax the small muscles of expression so the lines they make soften: frown lines, forehead lines, crow's feet, and more. At Ovadia Plastic Surgery, every treatment is planned for precision around how your face moves. The practice is led by board certified plastic surgeon Dr. Steven Ovadia, with offices in New York City and New Jersey.
How they work
Lines made by movement
Every time you frown, squint, or raise your eyebrows, a small muscle under the skin contracts and folds the skin above it. Early on, the line disappears when the muscle relaxes. After thousands of repetitions, the fold starts to stay, and the line is there even at rest.
In aesthetic medicine, "neuromodulator" is the name for the family of injectable treatments made from botulinum toxin, BOTOX® being the best known. Placed in a muscle in a very small, purified dose, it blocks the signal from the nerve that tells that muscle to contract. The muscle relaxes, the skin over it stops folding, and the line softens. The effect is local to the muscle treated, and it is temporary: the nerve forms new connections over a few months and the muscle goes back to normal.
Neuromodulators treat lines made by movement. Lines and folds that are there at rest because the skin has lost volume, such as the folds beside the mouth or hollows under the eyes, are treated with dermal fillers instead, and the two are often used together.
Treatment areas
What neuromodulators can treat
The upper face is where most treatments go, because that is where expression lines are strongest. The lower face and neck can be treated as well, with smaller doses and more care, since the muscles there are used for talking and eating.
Upper face
Where most treatments goForehead lines
The horizontal lines that appear when you raise your eyebrows. Treated lightly so the brows still move and do not drop.
Frown lines
The vertical lines between the eyebrows, sometimes called the "11s". The most common area treated, and the first one BOTOX® Cosmetic was approved for.
Crow's feet
The lines fanning out from the outer corners of the eyes when you smile or squint.
Brow lift
A few units placed in the muscles that pull the outer brow down can let it sit a little higher. This is a subtle lift, not a replacement for surgery.
Mid and lower face
Lighter, precise dosesBunny lines
The small diagonal lines on the sides of the nose that appear when you scrunch it.
Lip lines and lip flip
Softens the fine vertical lines above the upper lip. A "lip flip" relaxes the muscle at the lip border so slightly more of the upper lip shows, without adding volume.
Gummy smile
Relaxes the muscles that lift the upper lip too far when you smile, so less gum shows.
Downturned mouth corners
Relaxes the muscles that pull the corners of the mouth down, so the resting expression looks less tired or stern.
Chin dimpling
Smooths the pebbled, "orange peel" texture of the chin that shows when the chin muscle tightens.
Jaw and neck
Shape as well as linesJaw slimming (masseter)
Relaxes the large chewing muscle at the angle of the jaw. Over a few months the muscle shrinks, which softens a square or wide lower face and can ease clenching and grinding.
Neck bands
Relaxes the vertical bands of the platysma muscle that stand out in the neck, and can soften the jawline slightly.
Other uses. Neuromodulators are also used for excessive underarm sweating, for chronic migraine, and for some muscle conditions. Ask us if one of these is what brings you in.
The products
BOTOX® and Dysport®
Ovadia Plastic Surgery offers two neuromodulators: BOTOX® Cosmetic and Dysport®. BOTOX® is the best known brand, and many people use the name for the whole category. Both contain botulinum toxin type A, both are FDA approved for frown lines, and both give similar results for most patients.
If you have had one before and liked it, you can stay with it. If you are new to treatment, we go over both at your consultation and help you choose.
| BOTOX® Cosmetic | Dysport® | |
|---|---|---|
| What it is | Botulinum toxin type A | Botulinum toxin type A |
| Approved for frown lines | 2002 | 2009 |
| Takes effect | About 3 to 7 days, full at about two weeks | About 2 to 5 days for many patients, full at about two weeks |
| Lasts | About 3 to 4 months | About 3 to 4 months |
| Dosing | Measured in BOTOX® units | Measured in its own units, which are not the same as BOTOX® units |
Your visit
What a treatment is like
A first visit includes a consultation and, if you want to go ahead the same day, the treatment. Return visits are usually quick.
Consultation
We watch how your face moves, ask what bothers you, and go over your health history and any medications. Together we set a plan: which areas, how much, and how natural you want the result to look.
Photos and markings
Photos are taken at rest and with expression, and the injection points are marked. The skin is cleaned. Numbing is rarely needed because the needle is very fine, but ice or a numbing cream is available.
The injections
A small amount is placed in each muscle through a fine needle. Each point takes a few seconds, and a full treatment usually takes 10 to 15 minutes. Most patients describe a quick pinch.
Aftercare
You can go straight back to your day. The main rules: stay upright and do not rub or press on the treated areas for the rest of the day, and skip hard exercise until the next morning.
Who injects you matters more than which product is used. Placing the right dose in the right muscle, and not in the one next to it, is what separates a natural result from a heavy brow or a drooping eyelid. That is why every treatment here is planned for precision: the dose, the exact points, and how much movement to keep, set for your face rather than taken from a standard menu.
What to expect
After your treatment
There is no recovery to speak of. You can go back to work straight from the office. The effect does not appear right away, because the product takes a few days to act on the nerve endings, so do not judge the result on the first day.
The rest of the day
- Stay upright for about four hours; do not lie down or bend over for long
- Do not rub, massage, or press on the treated areas
- Skip hard exercise, saunas, and facials until the next day
- Normal washing, makeup, and work are fine
Keeping the result
- Most patients return every three to four months
- Regular treatment keeps the lines from re-etching between visits
- The dose and the areas can change from visit to visit as your face changes
- A small adjustment at two weeks is included in planning, not a sign something went wrong
This is a general guide. Everyone responds a little differently. We go over your own plan at your visit.
Safety
Side effects and who should wait
Botulinum toxin products have been used in medicine for decades and for facial lines for more than twenty years. At the doses used in the face, side effects are usually minor and temporary, and the most important ones are avoided by placing the right dose in the right muscle.
Possible side effects
- A small bruise or redness at an injection point
- A mild headache for a day or two, most often after forehead treatment
- Temporary heaviness of the brow, or a drooping eyelid, if the product reaches a muscle nearby. This is uncommon and wears off as the treatment does
- A slightly uneven result, which is usually fixed with a small adjustment at the two-week visit
- Flu-like symptoms for a day, which are rare
Tell us before treatment if
- You are pregnant, trying to become pregnant, or breastfeeding
- You have a neuromuscular condition such as myasthenia gravis, ALS, or Lambert-Eaton syndrome
- You have had an allergic reaction to a botulinum toxin product or to one of its ingredients
- There is an active skin infection or rash where the injections would go
- You are taking certain antibiotics or muscle relaxants; tell us about every medication you take
Serious reactions are very rare at cosmetic doses. Trouble swallowing, speaking, or breathing, or muscle weakness away from the treated area, should be brought to a physician's attention right away. We go over the risks with you at your consultation.
Cost
Cost and insurance
Treatment of lines and wrinkles is unlikely to be covered by insurance. The cost depends on which areas are treated and how many units they need, and we go over it with you once your plan is set, before anything is injected. Neuromodulators for a medical condition, such as chronic migraine or severe underarm sweating, may be covered by some plans when their criteria are met.
If you have questions about cost, call or email us and we will go over it with you.
The practice
Injectables in a plastic surgery practice
Ovadia Plastic Surgery is led by Dr. Steven Ovadia, who is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
Because the practice also offers facelift, eyelid surgery, and facial feminization, neuromodulators can be planned on their own or alongside surgery when that serves you better. Patients are seen in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about neuromodulators
What is a neuromodulator?
A neuromodulator is an injectable treatment that relaxes the muscle it is placed in. In aesthetic medicine the term means the family of products made from botulinum toxin. In the face, relaxing those muscles softens the lines they make, such as frown lines, forehead lines, and crow's feet. BOTOX® Cosmetic and Dysport®, the two offered at Ovadia Plastic Surgery, are both neuromodulators.
Is BOTOX the same thing as a neuromodulator?
BOTOX® is one brand of neuromodulator, and the best known one, so people often use the name for the whole category. Dysport® works the same way. Both are offered at Ovadia Plastic Surgery, and we go over which suits you at your consultation.
Will I look frozen?
Not when it is done well. A frozen look comes from too much product, or product in the wrong muscles. The goal is to soften the lines while your face still moves and shows expression. We prefer to start with the right amount and add a little at the two-week visit if needed, rather than overdo it.
How long does it take to work?
The muscles begin to relax at around three to seven days, and the full effect is reached at about two weeks. Some patients notice Dysport® starting a little sooner.
How long does it last?
About three to four months for most patients and most areas. The masseter (jaw) lasts longer, often four to six months. With regular treatment, some patients find the effect lasts a bit longer over time, because the muscles are used less.
Does it hurt?
Most patients feel a quick pinch at each injection point and describe the treatment as very tolerable. The needle is very fine. Ice or a numbing cream is available if you prefer it.
Is there any downtime?
No. You can go back to work or your day right away. For the rest of the day, stay upright, do not rub or press on the treated areas, and skip hard exercise. Small bumps at the injection points fade within about half an hour, and a bruise, if you get one, can be covered with makeup.
How many units will I need?
It depends on the area and on how strong your muscles are. As a guide, frown lines often take about 20 units of BOTOX®, the forehead about 10 to 20, and crow's feet about 6 to 12 per side; Dysport® is dosed in different units, so the numbers are not comparable across products. The dose is set at your visit after watching how your face moves.
Can neuromodulators prevent wrinkles?
They can slow them. Lines that appear only with expression, when treated regularly, have less chance of becoming etched into the skin at rest. Starting before lines are set, often in the late twenties or thirties, is sometimes called preventive treatment.
What is the difference between a neuromodulator and a filler?
A neuromodulator relaxes a muscle, so it treats lines made by movement. A filler adds volume, so it treats hollows, folds, and lines that are there at rest. Many patients use both: a neuromodulator for the upper face and a filler for the cheeks, lips, or the folds around the mouth.
Is it safe?
Botulinum toxin products have been used in medicine for decades and in cosmetic treatment for more than twenty years, with a long safety record at the doses used in the face. Side effects are usually minor and temporary. Serious problems are very rare and are linked to injecting the wrong product, the wrong dose, or the wrong place, which is why who injects you matters.
What happens if I stop?
The muscles return to normal over a few months and your lines gradually come back to how they were. Nothing is permanently changed, and stopping does not make the lines worse than before.
Can I have it around surgery?
Yes. Neuromodulators are often used with a facelift, eyelid surgery, or brow lift, treating the lines surgery does not address. We usually schedule them a few weeks before or after surgery rather than on the same day, so that swelling does not affect the result.
Is it covered by insurance?
Treatment of wrinkles is unlikely to be covered. Neuromodulators for a medical condition, such as chronic migraine or severe underarm sweating, may be covered by some plans when their criteria are met.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey. The treatment itself is done in the office.
Next step
Start with a consultation
We will watch how your face moves, go over what you would like to soften, and set a plan with you. If you want to go ahead, treatment can be done at the same visit.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com