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Injectables, commonly referred to as Neuromodulators, relax the facial muscles in order to give you that smooth, unwrinkled, relaxed upper face.

The three most common injectables are Botox®, Dysport®, and Xeomin®.

Most people tend to use the term Botox no matter which product has been used to reduce wrinkles.

What’s the difference?

Dr. Swengel feels there is not much difference in the different types of wrinkle relaxers. There are some subtle distinctions. They are all variants of onabotulinum toxin A. It’s not so much the product as the placement and the injector’s skill and experience. When the correct dose is precisely placed in the correct muscle, you look relaxed, not frozen.

Botox® Cosmetic

Produced by Allergan. Dr. Swengel has personally used this product and have had great success over the years with it. He calls Botox® his “silver bullet” as it is very precise in its placement and very predictable in length of treatment time.


Produced by Medicis.  Dysport® tends to soften muscle motion a day or two earlier and in my experience seems to drift a bit beyond the injected area for a softer, more diffuse effect.


Produced by Merz. Shipping is easier, and the protein is the most purified of the three. It can be useful on patients who are seeing decreased response to Botox® over the years.

How long does the relaxation last?

In the range of 4 months for most areas. Many of our “frequent flyers” come in twice a year for full treatment. The longer you do it, the longer the effect lasts, simply because you forget to use the muscle and it atrophies from non-use.

As we are injecting with lower amounts to avoid the “frozen-face” look we find muscle recovery seems to be a little earlier, but this seems to be a reasonable trade-off for a more natural look.

Can’t just anyone inject Botox®?

Only licensed professionals are legally allowed to inject Botox®. This includes MDs, DOs, NPs, PAs and RNs. Injection skills are totally dependent on the practicioner’s personal skills, knowledge of facial anatomy and years of experience. Dr. Swengel is the primary injector in his office, and both of the nurse practitioners are highly qualified as well.

Nurses at spas are injecting under the license and the insurance of the physician who “manages” the spa, who is usually not on site to supervise or consult. Who wants a droopy eyelid, a forehead that comes down like a plate, bad bruises, a droopy corner of the mouth or even difficulty swallowing because of poor injection skills?

What do you mean, not the real thing?

Botulinum toxin is available for purchase in several illegal ways. The concentration and purity of product is not guaranteed. This illegal use has nearly cost physicians their licenses and put a Florida dentists and his friends in the hospital on ventilators for several months. None of this is worth the risk, gentle readers. We only use the real thing distributed directly to us from Allergan, Medicis and Merz.


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