The newest injectable that is FDA approved in the United States for treating facial lines and wrinkles is Xeomin® (pronounced ‘zeemin’). It comes from Merz, a pharmaceutical company based in Germany, which established over a century ago. Other aesthetic products made Merz that are available in the US are the injectable fillers Belotero® and Radiesse®.
Botox Cosmetic® was the first neuromodulator that was approved for use in the US for temporarily weakening or paralyzing facial muscles to reduce facial wrinkles in 2002 and Dysport® was next in 2009. All of the neurotoxins are forms of Botulinum Toxin, which is a naturally occurring bacterial toxin produced by Clostridium Botulinum that are commercially manufactured for aesthetic purposes.
Mechanism of Action
All of the toxins work the same by interrupting the communication between the nerve and the facial muscle. Once the toxin takes effect, an electrical impulse that reached the nerve end no longer results in the release of the neurotransmitter acetylcholine that is housed in vesicles in the nerve ending. Since the acetylcholine cannot be released, the muscle is unable to contract or contracts considerable less than it normally would.
Onset of Action
Once the toxin is injected, it takes a few days to start working and have a noticeable effect. Generally two to three days for the initial onset of action and five to seven days for maximum benefit. It is usually best to wait for ten to fourteen days for a touch up injection in the event that you do not see the full benefit of the injection right away. The effect of the neurotoxin injection lasts three to four months on the average.
Post Injection Instructions
To avoid having the toxin move away from its intended muscle target into adjacent muscles that were not planned to be treated, it is recommended that you do not rub the area treated or perform strenuous physical activity for at least three hours. Rumor has it that the product will work better, faster or longer if you repeatedly flex the muscles that were injected soon after the treatment. There is no proof that any of this is true and this muscle motion could cause the injected product to move out of its intended area.
Xeomin® was approved by the FDA in 2010 for the treatment of dynamic frown lines between the eyebrows (glabella). It is not FDA approved for injection into other dynamic lines of the face but can be done as an “Off-label” use; which means that it is OK to do these injections, it is simply something that cannot be advertised or discussed by the representatives from Merz.
The possible advantage of Xeomin® over other neurotoxins, is that the nonfunctional proteins that are attached to the neurotoxin molecule have been removed in their patented purification process. These proteins do not contribute to the efficacy of the product but they, theoretically, can generate an immune response and potentially reduce the effectiveness of the toxin. Although this if felt to be a rare occurrence with injectable neuromodulators, it essentially can’t happen with Xeomin®.