Neuromodulators (Botulinum Toxin): What You Need to Know

• What it is: in aesthetic medicine, botulinum toxin is injected to reduce the contraction of facial muscles; type A is one of these treatments.
• How it works: the targeted muscle relaxes and the wrinkle formed by its movement softens; this relaxation is temporary.
• What it is used for: reducing the appearance of facial wrinkles; before choosing, ask which use is authorized in Canada for the proposed product.
• Duration: the effect appears after some time, then fades over several months. The result and how long it lasts vary from person to person, with no guarantee.
• The risk to be aware of: a poorly placed injection in the forehead or around the eyes can cause an eyelid to droop. Spread of the product to other parts of the body is rare but serious.
• Before any injection: the doctor must assess you and establish a treatment plan; you can also postpone your decision or decline the injection.

You have heard about neuromodulators and want to understand what is injected before you decide. In aesthetic medicine, botulinum toxin is used in small amounts to reduce the contraction of facial muscles and the appearance of wrinkles. Type A toxin is one of these treatments. It is produced by the bacterium Clostridium botulinum, which is also the cause of foodborne botulism; this article is about its medical use by injection, not about that illness.

Among cosmetic injections, this procedure aims to achieve temporary muscle relaxation. To choose an approach, start from what you would like to change rather than from the name of a product.

Botox^®, Dysport^® and Xeomin^® are brand names of botulinum toxin treatments. A brand name is not enough to make a choice: ask for the exact name of the product, its intended use and the risks that are relevant to you.

When looking for information in French, you may come across both "toxine botulique" and "toxine botulinique". To know which drug the doctor recommends, rely on its exact name and identification number rather than on this difference in wording alone.

The injection delivers small amounts of the drug into targeted facial muscles to reduce their contraction. The muscle relaxes and the wrinkles formed by its movement soften. This relaxation is temporary.

The intended effect therefore comes from the muscle. If a hollow, rather than a fold, is what bothers you, the doctor assesses its cause before discussing another approach. Ask the doctor what distinguishes muscle relaxation from filler and which one addresses what you would like to change.

The aesthetic use is to reduce the appearance of facial wrinkles. For example, you may want to change a line between the eyebrows, called a frown line. During the assessment, explain what bothers you about this line and what you expect from a treatment.

If your question is more about crow's feet, at the corners of the eyes, ask what risks an injection in this area involves. An injection error around the eyes can cause an eyelid to droop: knowing the planned use and its risk matters as much as knowing the product.

To check an approved indication in Canada, ask for the exact name of the drug and look up its product monograph in Health Canada's Drug Product Database. Authorization to sell a drug does not mean that every planned use has been authorized. The doctor must specify what they recommend for the area you are concerned about.

A doctor can prescribe a drug off-label, that is, beyond the conditions for which its sale was authorized. Ask whether the planned use is approved for the proposed product or goes beyond these conditions, and why it is being discussed in your situation.

If you clench your jaw and are considering a masseter injection, the first purpose of the assessment is to understand what bothers you. For bruxism, as for rosacea, ask the doctor which treatment they are considering and whether that use is approved for the product in question.

Medical uses in neurology and urology are not covered here: these concerns require an assessment in the relevant medical field.

The effect is not immediate. It appears after some time, then fades over the course of several months. The result and how long it lasts vary from person to person; no result is guaranteed.

If you are considering another injection, talk with the doctor about the result you obtained, the risks and what you would still like to change. When the effect wears off, you do not have to repeat the injection.

A poorly placed injection in the forehead or around the eyes can relax the eyelid muscle, causing the eyelid to droop: this is called ptosis. In the neck, injecting too much can cause muscle weakness and make swallowing difficult.

If neck bands lead you to consider a Nefertiti lift, ask this question before deciding: what risks does the proposed injection involve in this area? The risk of an injection in the neck is not, on its own, a basis for choosing a treatment.

Possible effects include a drooping eyelid, a rash or an allergic reaction. A doctor must assess what is happening; an allergic reaction must not be assumed to be a minor inconvenience.

Before the injection, ask the doctor what to do if you experience a side effect and how to get medical advice. This discussion must also make clear who manages a complication.

In Quebec, the doctor must examine you, make the diagnosis and establish a treatment plan that specifies, among other things, the injection sites and doses. The doctor can give the injection personally or entrust it to an authorized professional.

A nurse can administer the treatment under an individual prescription, with a detailed plan specific to the person; collective prescriptions are no longer authorized for these injections. A licensed practical nurse administers the prescribed treatment at the prescribing doctor's office, after the doctor's assessment.

At CARE MD, ask which of our professionals will assess you and who will perform the planned injection. Distinguish between these two roles and find out about the experience of the person giving the injection.

To check the product, ask for its exact name and its DIN: this eight-digit number appears on the label of a drug that has been evaluated and approved for sale in Canada. The Drug Product Database lets you check the authorization for sale and read the product monograph. The DIN identifies the drug; it does not tell you anything about the injector's experience.

• Who will assess you and who will inject? What experience does the person performing the injection have?
• What is the exact name of the product, and what is its DIN? Is the proposed use approved in Canada for this product?
• What additional risks are there given your medical history?
• What result can you realistically expect?
• Would another approach be more appropriate for your concern?
• Who manages a complication, and how can you reach the doctor after the injection?

You can choose not to have an injection. All medical procedures carry risks; it is up to you to decide which ones you are willing to accept, after discussing them with the doctor.

If what you need help with is excessive underarm sweating rather than a wrinkle, explain this from the start of the assessment. The question to ask is no longer about how a fold looks: ask which options address what bothers you and what risks they involve.

During the assessment, you discuss your medical history, the risks and what you would like to change. You can also wait, ask for more information or decide not to have the treatment.