No Tox

No-Tox refers to a toxin free Botox treatment for those weary of having botulinum toxin injected into their skin or muscle. But does a product like this actually exist? Not a product, but there is a procedure available and several topical creams or serums that claim to gain a space in the ever popular space of diminishing frown lines!

First, a little about Botox (and why there is very little reason to fear it). Botulinum toxin has been in use for around 30 years now for cosmetic improvements with an excellent safety profile.  Even though it is true that Botox is made of bolutinum toxin, the amount of toxin is very small.  Even if the entire dose of Botox were to accidentally be injected into a blood vessel, it would be easily diluted and not cause any dangerous symptoms.  Local spread of the botulinum toxin into neighboring muscles can occur occasionally.  The most disturbing for facial aesthetic treatments are a temporary eyelid ptosis (eyelid droop) if botox spreads into the eyelid muscles or an asymmetric smile if botox diffuses incorrectly during a depressor angularis oris treatment to soften the downward lip movement that shows sadness.  But even the most feared symptoms dissipate quickly as Botox is not permanent and breaks down over just 3 months.  There are currently three brand names of Neurotoxins:  Botox Cosmetic, Dysport and Xeomin.  In our practice, we use Dysport and Botox Cosmetic primarily as they give good long lasting improvements.  We also keep Xeomin for patients who may be allergic to egg products.  

Several topical preparations have been made but they are not strong enough to give the same effect as Botox that is injected specifically and directly into the muscle of concern.  Some of them have shown to be mildly effective and may prolong the effect of Botox injections.

No-Tox can also refer to injections of dermal fillers instead of Botox to soften wrinkles.  This can work well but the dermal filler may wear off quicker than normal if the creasing the lines continues as it will break down the filler.  In a small number of cases, fillers can also move slightly away from the line or wrinkle itself with movement of the line.  I recommend using fillers in conjunction with Botox for best results if the lines are very deep.

There are two procedures which are fairly similar referred to as No-Tox as well.  They are known as GFX treatment (Glabellar Frown Treatment) and ThermiRase.  These treatments utilize a small radiofrequency probe directed at the nerve fibers which innervate the glabellar complex of muscles as they arise from the temples.  Both procedures work beautifully for the frown lines in between the brows for an immediate and long lasting to potentially permanent improvement of the frown lines.  If 2 cm of the nerve is treated, generally the treatment can be expected to be permanent.  We have successfully helped many of our patients to never require Botox in their frown lines again.  However, the shortcoming here is that this procedure really only works on the frown lines between the brows sometimes referred to as the 11's.  GFX and ThermiRase are not recommended for forehead lines or crow's feet.  One other interested application however is for neck bands, though clear protocols have not yet been established for this area.  

So, as a patient, you definitely have some options for how you choose to get rid of frown lines that make you look angry, depressed or anxious.  You will feel naturally happier too as there is evidence that relaxing these muscles actually does improve mood and depression.  For headache and migraine sufferers, this can be nothing short of a miracle too.  

ThermiRase before and after photos.

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