We all have that friend. The one who looks magically rested, refreshed and youthful. You can’t put your finger on what she’s doing, but you really want to know. Did she go on vacation? Sleep in for a week? Does she just have incredible DNA? It could be any of those—but she may have seen a dermatologist for a little neuromodulator (aka Botox or Dysport, among others). And in that case, you have a whole other batch of questions, which we’re here to answer.

By Gina Way
Troy Covey

What exactly are neuromodulators?

Botox, Dysport, Xeomin and the newest option on the block, Jeuveau, are all made from purified, diluted botulinum toxin type A. (No, the shots do not produce botulism, the potentially fatal form of food poisoning.) The injectable medication is safe, with Botox—the first of its kind—earning FDA approval for cosmetic purposes nearly 20 years ago. All of them are neuromodulators, the same way Pepsi and Coke are both colas; they simply have different manufacturers. “Although each brand has some information suggesting that their product is better in some way, literature shows that similar results and longevity can be achieved with all of them,” says Heidi A. Waldorf, MD, a cosmetic dermatologist in Nanuet, NY. “Every physician has a different experience and opinion.”

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What do they fix?

Think of these injectable medications as wrinkle erasers. “We use them to treat lines that form due to repeated muscle movement, such as horizontal lines on the forehead, crow’s feet, the vertical frown lines between the eyebrows known as the elevens,” says Lara Devgan, MD, a plastic surgeon in NYC.

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How do they work?

A microdose of the medication is injected into specific muscles to immobilize them, which consequently smooths out the lines they create. (When you physically can’t furrow your brow, your brow can’t show off its usual stripes.) “The neurotoxin blocks nerve endings from sending messages to muscles, basically paralyzing them until results wear off,” Waldorf says.

  • Post-treatment tip: Don’t massage the area for 24 hours afterward, to prevent neurotoxin from spreading to unintended muscles.
Troy Covey

What else can they do?

Neuromodulators are also used to address the muscles that pull down your mouth (buh-bye, resting frown face!) and to help smooth the vertical bands and horizontal “necklace” lines on your neck. When artfully injected in the forehead, they can lift the brows a bit, which can make your eyes look bigger and less hooded. Injections under the arms are a solution for excessive sweating, and shots on the head and neck may alleviate chronic migraines. “They can even be injected into the muscles of the jaw to ease teeth grinding,” Waldorf adds.

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OK, so how much does it hurt?

The treatment takes about 10 minutes and feels like several sharp pinpricks. (The tiny needles are just a little bigger than the ones used for acupuncture.) “It’s no more painful than having your eyebrows tweezed,” Devgan says. “But if a patient desires it, we can apply a topical numbing cream beforehand.”

What are the side effects and downtime?

Besides a possible bruise at the injection site, there’s no downtime. To minimize bruising, avoid medically unnecessary blood-thinning medications, aspirin, ibuprofen and even fish oil supplements for 10 days prior to your appointment.

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How much does it cost?

“Physicians tend to price neuromodulator procedures by the area of the face being treated or by the units, or amount of medication, needed to treat it,” says Waldorf. (There are 100 units in a standard vial of Botox, for instance.) “The overall price can range from $400 to $1,800, depending on how many areas are addressed and how much is needed. For example, on average it takes 20 units of Botox for the elevens between the brows,” Waldorf says.

Will I look  frozen, like a Real Housewife?

“One big misconception is that a neurotoxin completely paralyzes your muscles and you will have no expression, but the truth is that the best and most beautiful results are somewhere in between, where you have natural movement without visible furrows,” Devgan says. Especially for first-timers, many doctors suggest a follow-up appointment two weeks after the initial one to inject a bit more neurotoxin if needed. This reduces the chances of going overboard.

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How long do results last?

“You’ll notice that your lines may start to soften in one to two weeks,” Waldorf says. The effects will wear off after three to six months.

Not ready to take the plunge?

“There’s no topical product that will give you the exact results of an injectable like Botox, but you can get some temporary wrinkle softening with topical products,” Waldorf says. Consider any of these.

1. CeraVe Hydrating Hyaluronic Acid Serum ($17)

This lightweight gel-cream is loaded with moisturizing ceramides and hyaluronic acid, a humectant that not only hydrates skin but also plumps fine lines.

2. StriVectin Line BlurFector Instant Wrinkle Blurring Primer ($39)

It’s packed with line-fighting niacinamide (in their patented Nia-114 formula) and light-reflecting microspheres that blur fine lines.

3. No7 Laboratories Line Correcting Booster Serum ($42)

This has a combo of concentrated peptides (to spur collagen production) and polymer technology (to smooth the skin surface).

4. Olay Regenerist Retinol24 Night Moisturizer ($29)

Retinol, a vitamin A derivative, increases skin cell turnover and boosts collagen production, which helps to soften lines over time.