Application and effect of the muscle relaxant

The wrinkle injection with the muscle relaxant is a classic, non-surgical treatment in aesthetic medicine. The active ingredient is used in particular to combat expression lines (dynamic wrinkles) on the face. The muscle relaxant is a bacterial protein that specifically blocks nerve signals for muscle contraction. Injected in very small quantities with a very thin needle under the skin into the facial muscles, this is minimally weakened and existing wrinkles, e.g. on the forehead, are reduced. So it can help remove wrinkles and regain a visibly fresh look.

In addition to the treatment of wrinkles, the active ingredient can also be found in other medical fields. A qualified doctor can treat excessive sweating (hyperhidrosis) with the help of muscle relaxants. The substance has an obstructive effect on the nerve transmission to the sweat glands. In addition, it works effectively in the context of other treatments and therapies: In the event of spasticity as a result of a stroke, it effectively releases blockages in the muscles and thus supports rehabilitation. The same applies to cases of infantile cerebral palsy. In the right amount, the substance has a function as a drug for movement disorders and is used successfully in these diseases.

What is a muscle relaxant?

A muscle relaxant is a protein produced by the bacterium Clostridium b. will be produced. These bacteria produce eight different types of muscle relaxant (A, B, Cα, Cβ, D, E, F, and G). The muscle relaxant A has the strongest effect. The substance has been used for muscle relaxation since 1980 and for treating wrinkles since 1990. It has also been used to treat sweaty hands since 1996. The well-known active ingredient was first approved by the US FDA in 2002 for the treatment of frown lines and frown lines. Since 2013 it has also been used to treat wrinkles around the eyes, also known as crow's feet. There are currently three FDA-approved products with the ingredient variant A for wrinkle treatment: Dysport® / Azzalure®, Vistabel® and Xeomin® / Bocouture®. Nowadays it is used on the face for smoothing wrinkles and also for lifting the eyebrow (aesthetic lifting of the eyebrow).


How does the muscle relaxant work?

In very low concentrations, a muscle relaxant injection inhibits the signal transmission from the nerves to the respective muscles and thus functions as a muscle relaxant. The visible wrinkles on the skin are reduced and the complexion becomes smoother. The signal is transmitted by the messenger substance acetylcholine. This is stored in small vesicles within the nerve switch points. When a nerve impulse reaches the muscles, the messenger substance acetylcholine is released from the vesicles, like an air bubble that comes to the surface of the water. On the inner surface of the nerves, the muscle relaxant prevents the vesicles from rising to the surface. They get stuck below the surface of the water, so to speak. After a certain time, the nerve cells regenerate the protein that is required to open the vesicles (synaptosomal protein weighing 25 kilodaltons, SNAP-25 for short). Therefore, the effect of the muscle relaxant gradually decreases. It unfolds in a certain radius around the injection point of the treatment. The size of the treated areas is determined by the product properties of the muscle relaxant preparation, the dose administered and the volume, as well as the technique of wrinkle injection. At a diameter of about one centimeter around the injection site, the muscles relax and the sweat gland production decreases.


How long does treatment with a muscle relaxant last?

The result of the method begins to unfold on the face just two days after use. Ninety percent of the patients show a clear result of the wrinkle treatment on the skin on the seventh day. The desired, natural result can be expected from the fourteenth day. When and to what extent the result unfolds depends, among other things, on the product, the dosage and the injection technique used to smooth out the wrinkles. Of course, it also plays a role whether the wrinkles are particularly deep (e.g. pronounced frown lines / deep frown lines on the forehead). The effect lasts for an average of four months. In a third of the patients, a satisfactory effect can still be demonstrated five months after the wrinkle treatment procedure. The general indication is: A repetition of this minimally invasive wrinkle treatment makes sense after three months at the earliest. After multiple wrinkle injections as part of a continuous anti-aging therapy of aesthetic medicine, the duration of the action can be extended and the skin and its wrinkles are smoothed for longer, as the cross-section of the relaxed muscles is reduced.


What does a wrinkle smoothing with the muscle relaxant cost?

An exact cost calculation is carried out individually at the consultation appointment with the doctor. If you would like to get an overview of the price framework in advance, please take a look at our costs page.


For which treatments with the muscle relaxant are the costs covered by the health insurance?

The health insurance company can only assume the costs in medically necessary cases. You can find more information on our page on health insurance obligations.


What is the difference between Vistabel®, Dysport® / Azzalure® and Xeomin® / Bocouture®?

The active ingredient in Dysport® / Azzalure® is manufactured by the pharmaceutical company Ipsen, headquartered in Paris. In 2007, Galderma, a Swiss pharmaceutical company based in Lausanne, acquired the exclusive rights to develop, market and distribute Dysport® / Azzalure® in Europe. Vistabel® is manufactured by the Allergan pharmaceutical company headquartered in Irvine, California. The pharmaceutical company Merz Pharmaceuticals GmbH, headquartered in Frankfurt, manufactures the Xeomin® / Bocouture®. These products differ in terms of the manufacturing process and additives. All three products contain the A1 subtype of muscle relaxant A with a molecular weight of 150 kilodaltons. All three products contain human serum albumin. The substance contains approx. 0.9 nanograms of muscle relaxant A per 100 units, Dysport® contains 1.6 nanograms per 300 units and Xeomin® approx. 0.4 nanograms per 100 units. There are few good fact-based studies that show any significant difference between the three products. Dysport® / Azzalure® and Xeomin® / Bocouture® have an earlier onset of action than Vistabel®. The effect of Dysport® / Azzalure® lasts a little longer compared to Vistabel®. Dysport® / Azzalure® and Vistabel® should be stored at temperatures below eight degrees Celsius and Xeomin® / Bocouture® at temperatures below twenty-five degrees.


What is a muscle relaxant unit?

A unit of muscle relaxant is a quantity. The unit of this muscle relaxant has been defined in laboratory tests and is abbreviated as "E". Since the test conditions were not specified down to the smallest detail, the units differ from one manufacturer to another. Muscle Relaxant Units are specific to each product and are not interchangeable. For the treatment of frown lines on the forehead (between the eyes), for example, the following doses are recommended for injection: Dysport® / Azzalure® 50 E, Vistabel® 20 E, and Xeomin® / Bocouture® 20 E.


Can I get immune to wrinkle treatments with muscle relaxants?

This is a common question. The organism can develop different antibodies. However, only neutralizing antibodies can lead to a loss of effectiveness and a reduced result. Neutralizing antibodies only develop in very rare cases. The risk of this is very low indeed. Very few cases have been described in the world literature in which patients have developed neutralizing anti-bodies after aesthetic treatment. If, for example, small wrinkles next to the eyes, so-called crow's feet, are treated with a muscle relaxant injection, very small amounts are required. In addition, it is only necessary to repeat the wrinkle injection with the active ingredient after a long time.

Some patients do not respond well to muscle relaxant treatment. Occasionally, undesirable side effects occur in the first week after the injection, but they do not last long and can be mild to moderate. The cause of an allergic reaction can be insufficient dosage, improper storage or preparation, or incorrect injection technique. However, allergic reactions are very rare. Normally only a slight swelling occurs after the procedure.

What should be considered before a wrinkle injection with the muscle relaxant muscle relaxant?

In any case, it is recommended that muscle relaxant therapy only be carried out by an experienced doctor. The treatment is carried out on an outpatient basis. No inpatient stay in a clinic is necessary. Choose a specialist in aesthetic and plastic surgery, because they don't just know about cosmetic surgery. With him you are in the best of hands for a wrinkle injection, as he has extensive experience. The attending physician analyzes the initial situation in detail. He explains in detail which different types of folds exist (static folds, dynamic folds, etc.) and recommends the most suitable method for you. Of course, you will also receive information about alternative methods, such as the use of fillers for wrinkle injection on the face (e.g. hyaluronic acid or autologous fat). The specialist with many years of experience will explain the process, as well as any pain, possible risks, side effects and complications that can occasionally occur when injecting the type A muscle relaxant. Of course, he also answers any further questions about wrinkle treatment.


What should I watch out for after a wrinkle injection with a muscle relaxant?

How you should behave after the procedure so that a good result is achieved and you prevent swelling, you will find out in the consultation with the doctor. The treating specialist will take this opportunity to point out appropriate precautionary measures.


Before and after pictures of a wrinkle injection with muscle relaxant

Patients are usually interested in getting a better picture of how the aesthetic appearance is improved even before the procedure. That facial expressions are frozen by the method is a widespread but untrue myth. However, patients usually want to see the extent to which the wrinkles are reduced after the cosmetic application and to make sure that their facial expressions will not be negatively affected when they are injected with a muscle relaxant. Therefore, ask the cosmetic surgeon for pictures of treatment results (without make-up). Before you decide on a wrinkle injection, you have the opportunity in our practice to view the recorded results in a personal conversation with the doctor. The doctor chooses the images carefully as they must be comparable. You can find more information about the possibility of viewing such photos on our page on before and after pictures.


Experience reports on wrinkle injection with a muscle relaxant

On the picture you can see an experience report on the muscle relaxant treatment at Centerplast. You can find out where you can find further reviews of our experienced specialists and testimonials on the treatments that have been carried out on our testimonials page.


Author's statement

Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

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