Cosmetic Wrinkle Injections (Nerve Blockers)

Nerve blockers stop nerve endings from sending the message to a muscle that makes it contract. Without a nerve impulse, the muscle stays in a completely relaxed state. This is useful in the treatment of dynamic lines (see next question).

Doctors first began using neuromuscular blockers in the mid-80s to help people with blepharospasm, annoying muscle spasms around the eyes that disturb vision. While treating this condition, a Vancouver ophthalmologist noticed that it reduced wrinkles around patients' eyes, and she told her husband, a dermatologist, about this phenomenon. He began to use it for wrinkles, and the rest is history. In 2017 in the USA about eight million cosmetic nerve blocking treatments were performed.

Nerve blockers reduce dynamic wrinkles that are produced by muscle activity such as frowning and smiling.* Nerve blockers will not help static wrinkles that are the result of the aging process (loss of collagen and elastin).

Nerve blockers are now also used for the treatment of migraine headaches, excessive sweating, neck tension headaches, chronic back pain, spasticity, and bladder problems.

The most common areas treated are the forehead, glabellum (between the eyebrows), and the outside rim of the eyes (for crow's feet). Less commonly, the upper lip and the muscle that turns the corners of the mouth down can be treated.

Women and men in their 30s to 60s are candidates. Generally speaking, by the time people are in their 70s, static wrinkles predominate, and nerve blockers have no effect on these wrinkles. However, there certainly are many people over 70 who would still benefit.

Younger people will benefit from nerve blockers because early use will prevent deep dynamic wrinkles from forming.*

Smoking and excessive sun exposure age skin more rapidly, so there are many people younger than 70 who are poor candidates for nerve blockers.

Look in the mirror and compare the wrinkles in your relaxed face with the wrinkles that appear when you frown, smile, and raise your eyebrows. If there is no substantial difference, then nerve blockers will not help. (If you find yourself in this category, don't despair! There are several treatment options that can improve your skin including dermal fillers, peels, laser resurfacing, microneedling, and facelifts.* You should also stop smoking and wear sunscreen!)

At each site where you want your dynamic wrinkles reduced, several tiny injections are placed in the muscles using a very fine needle. Generally 5 shots are given for the forehead, 3 around each eye, and 5-8 shots are given in the glabellum (between the eyebrows).

Treating the entire face takes 10 minutes.

There is no downtime. The tiny holes created are usually not visible by the time you get to your car to drive home.

When done properly, the injections are almost painless. Ice packs and topical anesthetics can be used to reduce discomfort, but almost no one needs these.

It takes 2 to 7 days before results are noticeable. The effect wears off after about 4 months.*

Treatments are most commonly repeated at 3 to 4 month intervals in the first year. In the second year, treatments are often done at 5-6 month intervals, and a lower dose may be required.*

Bruising can occur but it is not very common. Bruises tend to be small and disappear in a week or less.

If the nerve blocker spreads too far, weakness of muscles other than the targeted muscles can occur. This is uncommon.

As with any and all drugs, there is a limit to how much can be used before an overdose occurs. A typical cosmetic treatment only uses about 1 to 2% of a dangerous dose, and this means it is very safe.

Nerve blockers can aggravate nerve and muscle disorders, so it cannot be used in people with rare nerve diseases such as myaesthenia gravis, Eaton-Lambert syndrome, and amyotrophic lateral sclerosis.

Occasionally, headaches and flu-like body aches can occur.

Very rarely, the immune system produces antibodies against the nerve blocker, neutralizing it as it enters the body. In these cases, it will no longer work.

Allergic reactions are extremely rare.

There are several treatment options that can improve your skin including peels of varying strengths, laser resurfacing, and facelifts. You should also stop smoking, start using cosmeceuticals regularly, and wear sunscreen.