Neuromodulators: Botox Cosmetic and Xeomin
Softer lines, with your expression kept
Think of it as turning a muscle down, with your expression left switched on.
Here's what actually happens. Botox Cosmetic and Xeomin are prescription injectables that temporarily relax targeted facial muscles. A small, measured amount goes into a specific muscle, and that muscle contracts less strongly. The skin folding over it creases less, and over the following days the line softens. That's how they work on forehead lines, crow's feet, and the vertical "11 lines" between the brows, the lines your face makes when it moves.
A neuromodulator, the clinical name for this category, is a dimmer switch for one muscle. It turns the movement down, by an amount that is chosen, and it is designed to leave the muscles around it working as they were.
Your face is assessed first, and how it moves matters more than which lines you point at. Then comes a plan: which product, which muscles, and what dose, worked out from your anatomy and how much movement you want to keep. The injections themselves are quick. Then the effect builds over the following days, and in time it wears off, and the muscle returns to how it worked before. That is the whole cycle.
If Botox or Xeomin is the right treatment for you, we'll tell you. If it isn't, we'll tell you that too.
What are Botox and Xeomin, and how do they work?
Both are prescription forms of botulinum toxin type A, used in medicine for decades and in aesthetic treatment since 2002. The areas we treat most often:
Forehead lines, the horizontal ones across the frontalis muscle, which lifts the brows
The "11 lines" between the brows, formed by the corrugator and procerus muscles when you frown
Crow's feet at the outer corners of the eyes, formed by the orbicularis oculi when you smile or squint
Two products, one category
We stock both Botox Cosmetic and Xeomin. Same category, slightly different formulation. Both are neuromodulators used to soften dynamic facial lines, and both work by relaxing the targeted muscles that create wrinkles from repeated movement. Botox contains the active neurotoxin together with accessory proteins. Xeomin contains the active neurotoxin without them, which is why it's sometimes described as a more purified formulation. For many people, the results are very comparable. Which one we'd suggest for you depends on you and on clinical judgment, and it's a conversation we have at your consultation.
One thing worth knowing before you compare clinics. The units of these two products are not interchangeable. Both manufacturers' FDA labeling says so directly: a unit of one cannot be compared to or converted into a unit of the other.
Prescription only
Both are prescription medicines. They are given by a trained clinician after a proper assessment, under a medical director, and they are never sold as a product you take home. Your history, medications and any previous treatment are part of that assessment.
How your face moves decides where it goes
One of the biggest misconceptions about injectables is that a unit is a unit, and the only thing separating one clinic from another is the price.
The vial we open is the same vial every clinic on Long Island opens. What changes is the assessment, the placement, and the dose.
Same product, same number of units, two different sets of hands, two visibly different faces. A result someone didn't like came from a person's decisions.
Riviera's approach to neuromodulators is set by our Medical Director, Dr. Chris Davlantes. His position is plain: the brand matters far less than proper assessment, precise placement, and the right dose for the face in front of you.
He sets the protocols, and our nurse injectors, Marianna Nerantzinis, RN, BSN, and Victoria Vitale, RN, BSN, carry them out.
So before anything is drawn up, we look at how your face actually moves. Which muscles are strong, which ones are creating the line that's bothering you, and how much movement you want to keep. Men's and women's faces are read differently here, and so is every individual face.
And if you're asking for more than we think your face should carry, we'll say so. The aim is to soften the lines bothering you and leave you looking like yourself.
What keeping it up involves
The effect is temporary, and repeating it is a choice you make each time.
One treatment can soften the lines that move
Softer forehead lines
Softer 11 lines between the brows
Softer crow's feet
Your expression still yours
The effect is limited to where it's injected. The muscle contracts less, the skin over it creases less, and the line softens over the following days.
How much movement you keep is decided before anything is injected, and it's yours to choose. A conservative first dose is easy to add to. It cannot be taken away.
Keeping the result means repeating it
It wears off. When it does, the muscle returns to how it worked before, and the line with it. Nothing has been changed that can't change back.
How long that takes varies from person to person, and we'll tell you what we see.
What this will not fix
Straight answers, because the wrong treatment is worse than no treatment. Botox and Xeomin reduce muscle movement. That's the whole mechanism, and it sets a real boundary. If a line is only there when you move, this is the treatment for it. Two things sit outside that boundary.
It does not add volume where fullness has gone
If what's bothering you is hollowing or lost fullness in the cheeks or under the eyes, that is what filler is for. A relaxed muscle does not bring volume back, and we'll say so at consultation.
It will not remove a line that sits there at rest
A line that stays in your face when you're completely still usually comes from years of sun, thinning collagen, or volume that has moved. The same goes for texture, pigmentation and laxity. Different problems, different treatments.
One thing worth knowing before you book: it wears off
Every clinic in this category sells duration as the benefit. Temporary cuts both ways, though, and the second way is the one that should reassure you.
Nothing is cut. Nothing has been moved that can't move back. If you don't love the result, it fades, and we adjust the next one. That matters when you're deciding whether to start.
Who is a good candidate?
Most healthy adults with lines that come from movement, which is the honest answer and also the least useful one. More specifically, this suits you if you:
Have forehead lines that deepen when you raise your brows
Have 11 lines between the brows when you frown
Have crow's feet when you smile
Are in good health
Want a softer version of your own face, with the expression kept
Understand the effect is temporary and will need repeating
Who may not be?
Some things mean we won't treat you, or will pause first:
A known allergy to any botulinum toxin product, or to any ingredient in the formulation
An infection where we'd be injecting
A neuromuscular condition, such as myasthenia gravis, ALS or Lambert-Eaton syndrome
Certain medications, including some antibiotics, muscle relaxants and anticholinergics
Pregnancy or breastfeeding
Some medications, medical conditions and previous treatments change where we inject, what we use, or how much, and a few mean we wait.
So tell us what you take, what you've had done and where, and what you react to. If we don't think this is going to give you what you're after, we'll tell you before we treat. Sometimes the right answer is filler, sometimes a skin treatment, and sometimes it's nothing at all.
What to expect during and after your treatment
The injecting part is short, and most of your visit is the conversation before it.
The needles are very fine. What people usually describe is a brief pinch or a small sting at each point, over in a second or two.
Afterward
Small raised bumps at the injection points are normal and settle. Some redness is normal. Some people bruise and some never do. A mild headache in the first day or so happens to some people and passes.
In studies across decades of use, most side effects have been mild, temporary, and local to where the injection went.
Most people go straight back to their day.
Get medical help straight away if you notice trouble swallowing, speaking or breathing, or muscle weakness anywhere away from the treated area, hours or weeks afterward.
Frequently asked questions
Science and safety
What is a neuromodulator, and is that the same as Botox?
Neuromodulator" is the category. Botox Cosmetic and Xeomin are two products in it. Both are prescription injectables that temporarily relax targeted facial muscles to soften the lines those muscles create.
How does it actually work?
A small, measured amount goes into a specific muscle. It reduces the signal from nerve to muscle at that point, so the muscle contracts less strongly. The skin creasing over it creases less, and the line softens over the following days. The effect is limited to where it's injected, and it's temporary.
Is this the same as filler?
No. Filler adds volume. Neuromodulators reduce muscle movement. They solve different problems, and sometimes people need one, the other, or both.
Is it safe?
Botulinum toxin has been used in medicine for decades and in cosmetic treatment since 2002, and it's among the most studied treatments in aesthetic medicine.
Like every prescription medicine, it carries risks. Both products carry an FDA boxed warning about the possibility of the effect spreading beyond the injection site. That is the reason this is a prescription treatment given by a trained clinician after a proper assessment, and never something you buy.
We go through your medical history, your medications and supplements, and any botulinum toxin treatment you have had anywhere before, before we agree a plan.
What's the difference between Botox and Xeomin?
Same category, slightly different formulation. Botox contains the active neurotoxin together with accessory proteins. Xeomin contains the active neurotoxin without them, which is why it's sometimes described as a more purified formulation.
For many people the results are very comparable, and which one we'd suggest depends on you and on clinical judgment.
The units of the two products are also not interchangeable. Both manufacturers' FDA labeling says a unit of one can't be compared to or converted into a unit of the other, so a per-unit price at two clinics using different products describes two different things.
Quality and our approach
Who injects at Riviera?
Our approach to neuromodulators is set by our Medical Director, Dr. Chris Davlantes, who oversees the medical protocols. The injections are performed by our nurse injectors, Marianna Nerantzinis, RN, BSN, and Victoria Vitale, RN, BSN.
How do you decide my dose?
We look at how your face moves before we decide anything. Which muscles are strong, which ones are creating the line you're bothered by, and how much movement you want to keep.
Anatomy differs from person to person, and it differs between men and women, so two people with the same line often need different amounts in different places.
We start conservatively and review. You can always add. You can't take away.
Do you treat men differently?
Yes. Men often have stronger muscles in the forehead and between the brows, which changes the dose and the pattern. It's also usually important to preserve a flatter, lower brow, because a lifted brow on a man reads as wrong even to people who couldn't say why.
Why don't you list a price per unit?
Two reasons, and the first is technical.
The units of Botox and Xeomin are not interchangeable. Both products' FDA labeling states that a unit of one can't be compared to or converted into a unit of the other. A price per unit is only meaningful if you know which product, how many units, and for which areas.
The second reason is that the number of units you need is a clinical decision made on your face, and we can't quote it before we've seen you. So we quote the treatment after the consultation.
What if I don't like the result?
Tell us. That's what the review appointment is for.
And the reassuring part is structural. This treatment is temporary. If a result isn't what you wanted, it fades, and we change the plan next time.
Results and what to expect
Will I look frozen?
That's the thing people ask us about most, and it's why we plan the treatment with you. The goal is a refreshed look with your expression preserved, and how much movement you keep is part of the conversation before anything is injected.
It's also why we start conservatively and bring you back. A smaller first dose that gets adjusted is a better route to a result you're happy with than a large one you have to wait out.
How soon will I see it?
Needs an answer....
How long does it last?
Needs an answer......
Is there any downtime?
Most people go back to their day straight away. There are a few things to avoid for the first few hours and we'll go through them with you.
What happens if I stop?
Nothing dramatic. The effect fades and the muscle returns to how it worked before.
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