"BOTOX"
It’s common to hear about people receiving “Botox®” injections. The term “Botox®” is often used to describe cosmetic wrinkle-relaxing and injections for facial lines. But Botox brand is only one of five Health Canada approved brands of neurotoxins used by health professionals to relax muscles in targeted areas, thereby treating fine lines and wrinkles. The five brands we have in Canada are Botox®, Dysport®, Xeomin®, Nuceiva™, and – as of September 2023 – Letybo®. When individuals refer to getting “Botox” treatment, they may not be receiving the Botox® brand, since the term is commonly used to describe the treatment in general.
These neurotoxins (also known as neuromodulators) are widely recognized, non-surgical aesthetic treatments to soften or eliminate wrinkles. Approved by Health Canada, these products utilize a purified form of botulinum toxin A – a naturally occurring substance – to temporarily relax the muscles responsible for causing wrinkles and fine lines. By injecting small amounts of neuromodulator into specific areas such as frown lines, crow’s feet, and forehead wrinkles, the treatment effectively smooths out undesired facial wrinkles, resulting in a more youthful and rejuvenated appearance.
The mechanism of action of the product involves blocking the nerve signals to the targeted muscles, causing them to relax, which reduces the appearance of wrinkles and lines. The procedure is typically quick and painless, with minimal or no downtime required. The effects of neurotoxin injections are temporary, usually peaking 7-14 days after treatment, and lasting for 3-4 months. Follow-up treatments are typically recommended to maintain the desired results, although with repeated treatments the effects tend to last longer over time.
Botox
Botox® brand was the first cosmetic neurotoxin on the market. Pioneered here in Vancouver, Canada by ophthalmologist Dr. Jean Carruthers over 30 years ago, Botox was initially used for treating eyelid twitching (blepharospasm). Coincidentally, she and her dermatologist husband, Dr. Alastair Carruthers, discovered that Botox treatments for blepharospasm also improved the appearance of fine lines and wrinkles in the frown and surrounding areas. They began clinical trials to establish the safety and efficacy of Botox ® for the treatment of fine lines and wrinkles. Today, these neuromodulators are widely used as an accessible, non-invasive treatment for maintaining youthful looks and smooth skin.
Botox ® brand is known for its precision, allowing medical aesthetics doctors to carefully target specific areas while leaving the surrounding muscles unaffected, resulting in a natural-looking outcome. Although Botox holds the brand name recognition, that doesn’t necessarily mean it is superior to the other products on the market for cosmetic treatments.
DYSPORT
Dysport was approved by Health Canada in 2009, as a cosmetic injectable that is used to treat wrinkles and facial lines. It is derived from the same botulinum toxin type A as Botox, but with some differences in formulation. Like Botox, Dysport works by temporarily relaxing the muscles responsible for causing wrinkles and fine lines, resulting in a smoother and more youthful appearance.
One of the key differences between Dysport and Botox is that Dysport is a smaller and lighter molecule, so it tends to have a wider spread, meaning it can potentially treat larger treatment areas with fewer injections. This can be advantageous for certain areas, in some patients. Additionally, some individuals may find that Dysport takes effect faster than Botox and may last slightly longer, although individual responses to all treatments vary.
Nuceiva™
Nuceiva™, a close alternative to Botox® and another popular cosmetic injectable, was approved by Health Canada and the FDA in 2019. Nuceiva™ has the same molecular weight as Botox, making it an attractive option for treating certain areas of the face which require precision. Similarly, the full effect of the treatment will be visible anywhere between 7-14 days, but patients often notice results 3 days post-treatment.
Although structurally very similar to Botox, Nuceiva™ was created and designed specifically and solely for cosmetic-related treatments. Unlike Nuceiva, Botox® is prescribed by physicians for non-cosmetic treatments in addition to cosmetic applications. Sometimes referred to as “Newtox”, Nuceiva is a welcome addition to the world of wrinkle-relaxing cosmetic treatments.
Letybo®
The most recent addition to the cosmetic neurotoxins approved by Health Canada, this product was developed in Korea, and is the most popular brand in many international settings. Letybo ® was approved by Health Canada in June 2022, and – as of September 2023 – it is available for use in cosmetic treatments in Canada. Letybo ® is known for its even spread around the targeted muscles, quick onset of action, and reported longer lasting effects in some patients. Dr. Esther Grunau is excited to introduce this newly available product at her clinic!
Before & After
WHAT TO EXPECT
At your initial consultation, Dr. Esther Grunau will discuss your medical and cosmetic history, your goals, and come up with a treatment plan. At your treatment, initial photos are taken, and the areas of your face targeted for treatment will be cleaned and Dr. Grunau will map out the injection points. Using a tiny needle, the treatment is administered. Usually the whole appointment takes 15-20 minutes, but may vary depending on the number of areas being treated.
Your treatment is personalized, no “one size fits all”
Whether it’s your first time getting neuromodulator treatment, or if you have been treated by other practitioners in the past, Dr. Esther Grunau will work with you to get to know your particular facial anatomy, find the optimal dosing, neuromodulator and treatment approach. Developing the optimal plan for each patient is a journey. At times, follow up appointments will include tiny micro-adjustments, as part of the process of finding the perfect treatment plan for your unique facial anatomy.
What areas may be treated with Neurotoxins?
- Frown (also known as 11’s)
- Crow’s feet
- Under eye lines
- Forehead lines
- Lip lines
- Gummy smile
- Bunny lines
- Neck bands
- Downward smile
Frequently Asked Questions
Botox, short for Botulinum Toxin, is a protein produced by the bacterium Clostridium botulinum. In medical cosmetic applications, it is used to temporarily relax muscles and reduce wrinkles. Botox ® is one brand of Botulinum Toxin type A used for cosmetic treatment of facial wrinkles, also referred to as a “neurotoxin” or a “neuromodulator”. There are 5 brands available for use by medical practitioners in Canada: Botox®, Dysport® , Nuceiva™, Xeomin© and Letybo®.
Neuromodulators work by blocking signals from nerves to muscles, preventing the muscles from contracting. This relaxation of muscles reduces the appearance of wrinkles caused by repetitive muscle movements. For static wrinkles (wrinkles we see when the muscle is not contracting), Botox will soften the lines and make them less obvious, but they will not disappear completely.
Botox is commonly used for treating wrinkles and fine lines, such as frown lines (between the eyebrows), crow's feet (around the eyes), and forehead lines. It can also be used to create a more lifted or arched brow appearance, and for treating other areas of the face such as “gummy smile”, “cobblestone chin”, neck lines, downward smile, fine lines and the “lip flip” to increase show of the upper lip.
The effects may wear off a little faster than regular cosmetic neuromodulator treatment, because the treatment is placed in the microfibers (not the main muscles of the face). Micro-tox may be incorporated into your regular appointment, based on your goals and your facial assessment during your consultation with Dr. Grunau.
When administered by a trained medical professional, cosmetic neuromodulator treatment is generally considered safe. However, like any medical procedure, it does carry some risks and potential side effects.
Side effects may include mild discomfort at the injection site, or small temporary bruises. In some cases, the effects of Botox may result in subtle asymmetry, which may be adjusted at your follow up appointment.
Other side effects - specifically when treating the forehead above the brow - may include a very slight drop of the brow(s), or in very rare cases - dropping one eyelid. Although it is very rare, it is possible to develop a mild headache after Botox treatment, particularly after treatment done on the forehead. Very rarely, patients report puffiness around the eyes, theoretically caused by reduced muscle movement, although the exact mechanism of this is not clearly understood. If Botox is placed in a neighboring muscle, it may inadvertently affect a muscle with unindented results.
Tiny marks in the skin (smaller than a tiny pin prick) are common, and disappear within 15 minutes after the treatment is done. Very small bruises at the injection site are rare, and generally disappear after 3-4 days. They may be covered up with a bit of makeup in the meantime.
Your 2 week follow up appointment is an opportunity to check on the result of the treatment, and for Dr. Esther Grunau to make any micro adjustments. Lid droop is very rare, and may be treated with special eye drops.
Most people see results starting to take effect 3 days after the treatment. The full effects peak around 10-14 days. This is why we recommend a follow up 2 weeks after your initial treatment.
The effects of neuromodulator treatments are temporary, and typically last for 3 to 4 months. After this period, the muscle activity gradually returns. Some people report the effects lasting longer, after having several regular treatments at 3-4 month intervals.
The injections are relatively quick and minimally painful. Most people describe the sensation as a slight pinch or prick. Dr. Grunau uses numbing cream for sensitive areas such as around the lip. Some patients prefer applying a small ice pack to their skin right before the injection, which may be provided at the time of your treatment upon request.
Due to factors such as genetics, sun exposure, skin care routine, skin tone and texture, smoking, and other environmental factors, everyone’s skin ages differently. The decision to start neuromodulator treatments is a personal one. The best time to start treating wrinkles is when you see fine lines and wrinkles forming in areas that you wish to treat. In Canada, neuromodulators for cosmetic treatments are not approved in patients under 18.
There are cases of patients who eventually stop responding to neurotoxin treatment. This means the body has started to produce antibodies to the protein over time. In those situations, an alternate brand of neurotoxin may be tried. It is not possible to predict who might build up antibodies, or if a different brand will work.
Dr. Grunau does all the treatment planning and injecting herself, for all of her patients.
You should not have neurotoxin injections if you:
- Are pregnant or nursing.
- Are allergic to albumin.
- Had an allergic reaction to any other botulinum toxin product.
- Have an infection, skin condition, or muscle weakness at the planned injection site(s).
- Have a disease that affects your muscles and nerves, such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), myasthenia gravis, Lambert-Eaton syndrome, or Parkinson’s.
Yes, botulinum toxin type A has various medical applications. Dr. Grunau currently treats TMJ/teeth grinding and hyperhidrosis (excess sweating of the armpits).
There is no downtime after Botox injections. You can typically resume your normal activities immediately, although it is advisable to avoid strenuous exercise until the next day.
Photos are routinely taken of all patients, prior to facial treatments. The photos are part of your medical record. They are used to monitor treatment, and to guide follow up care. At your 2-week follow up appointment following neuromodulator treatment, your “after” photos will be taken.
Photos will not be posted or shared on social media or other platforms, without your signed consent.
The number of units required to treat will vary, depending on the targeted areas, individual anatomy and desired outcome. For example, the area between the brows (“11’s” or frown) may require approximately 20 units, but may need a little more or less depending on the depth and size of lines, the strength and size of the targeted muscles, whether there has been previous neuromodulator treatment, and the desired outcome. All treatments are customized for individual patients.
Your initial consultation with Dr. Esther Grunau is complimentary.
The cost of Cosmetic Neuromodulator treatment is $10/unit.
The number of units required to treat will vary, depending on the targeted areas, individual anatomy and desired outcome.