rejuvenation Treaments


Not all lines and wrinkles that appear on the face are due to aging or sun damage. Wrinkles that appear around the eyes (crows’ feet), in between the eyebrows (frown lines), or the horizontal creases that develop on the forehead (worry lines) are due to hyperactive facial muscles. Individuals who have very animated faces tend to activate these facial muscles of expression when communicating. With time, the repetitive contraction of these muscles causes permanent lines to develop, similar to creasing a sheet of paper repeatedly.

The treatment of choice to soften or erase these lines is to inject a small amount of a protein solution that binds to neural receptors and blocks activation of the desired muscles. This results in the muscles not squeezing the skin so strongly, allowing facial lines to soften or disappear. The amount of protein injected can be tailored to obtain your desired effect. Some individuals prefer to maintain some facial movement and others prefer to have no movement at all in these areas.

There are currently 2 neuromodulators that are FDA approved for aesthetic use: Botox® and Dysport®. Botox® was approved in 2002 by the Food and Drug Administration for cosmetic therapy of dynamic frown lines. It has been used off- label extensively and effectively in many other areas. Botox or botulinum toxin is the most popular cosmetic procedure performed in the United States.

The onset of action varies from 3 to 7 days with the full effect peaking in a few weeks. To maintain the desired result, it is recommended that the frown lines be injected every 2-3 months, in some people, the effect wears off sooner. Other areas may need to be injected every 4-6 months. If your lines are deeply etched into your skin, the botulinum toxin may not completely efface the furrows and you may need dermal fillers injected into the area to smooth the skin surface. If you choose to treat these lines with fillers alone, be advised that your hyperactive facial muscles will crease the filler and the lines will reform.

Both Botox® and Dysport® are purified botulinum toxin A proteins and there is virtually no clinical difference between the two. Initial reports suggested that perhaps the onset of the effects of Dysport® were a few days faster than Botox®. Dr. Wong has not observed in her practice that either form has a noticeable difference in onset of action nor in duration of effect. If you prefer one versus the other, let her know and she will be happy to accommodate your choice.