Facial plastic surgery in Salt Lake City, Utah
Insights, timelines, details, and more.
ConsultationsA neuromodulator is an injectable form of botulinum toxin type A — sold as Botox, Dysport, Xeomin, and Daxxify — that temporarily relaxes specific facial muscles to soften the wrinkles caused by their movement. It is most often used for frown lines between the brows, horizontal forehead lines, and crow’s feet. Results begin in three to seven days, peak at about two weeks, and typically last three to four months. Dr. James Manning performs the procedure in Salt Lake City, Utah.
A neuromodulator is botulinum toxin type A, a purified protein that blocks the nerve signal telling a muscle to contract. Injected in small amounts into a targeted muscle, it relaxes that muscle so the overlying skin creases less when you make an expression. The effect is local and temporary — it works only where it is placed, and it wears off as the nerve signal returns.
The treatment targets named muscles, not skin. Frown lines between the brows are created by the corrugator and procerus muscles; horizontal forehead lines by the frontalis; crow’s feet by the orbicularis oculi at the outer corner of the eye. Relaxing the right muscle, at the right dose, is what softens the line — and choosing the wrong muscle or too high a dose is what produces a heavy brow or a flat, expressionless look. The placement should follow the muscle, not a template.
A neuromodulator is a good fit if your main concern is lines that show up with expression — a frown line that deepens when you concentrate, crow’s feet that fan out when you smile, or forehead lines that appear when you raise your brows.
It suits patients who want to soften those lines while keeping normal movement and expression intact, treated with conservative dosing matched to your own muscle anatomy.
It is a poor fit on its own for a line that is already etched into the skin at rest — that static wrinkle usually needs a different tool, discussed below.
Not every wrinkle responds to a neuromodulator. The distinction that matters is whether a line appears with movement or sits in the skin at rest. Many faces have both kinds of line, and the two approaches are frequently combined.
| Dynamic wrinkles | Static wrinkles | |
|---|---|---|
| What causes them | Muscle contraction — the frown line that deepens when you concentrate, the crow’s feet that fan out when you smile. | Etched into the skin and visible even when the face is relaxed. |
| What treats them | A neuromodulator — relaxing the muscle reduces the movement that creates the line. | Dermal fillers, which add volume beneath a crease, or laser resurfacing, which remodels the skin’s surface. |
| What to expect | The line softens as the muscle relaxes; normal expression stays intact at a conservative dose. | A neuromodulator does little for a line already at rest — a deep static fold often needs filler or resurfacing instead. |
The most common reason patients hesitate is the worry that they will look frozen, surprised, or no longer like themselves. That outcome is real, and it is worth taking seriously:
Dr. Manning treats the face as an anatomist, not a menu. Before any injection, he maps which muscles are actually producing the lines you are concerned about — because two people with the same frown line may need different placement depending on how their muscles pull.
The dose is matched to that anatomy and to your goals, with a deliberate bias toward conservative treatment: it is straightforward to add a small amount at a follow-up, and far harder to wait out an overcorrection.
FDA-approved cosmetic uses of botulinum toxin type A are the frown lines between the brows (glabellar lines), the lateral lines at the corner of the eye (crow’s feet), and horizontal forehead lines. Other uses — softening a gummy smile, a downturned mouth, or neck bands — are common but off-label, meaning they fall outside the specific cosmetic indications the FDA has cleared. Dr. Manning will tell you plainly which category your treatment falls into.
Day 0
Treatment visit
A brief in-office appointment. Product is injected into each target muscle; no anesthesia needed.
Days 3–7
Onset begins
The treated muscles start to relax and the lines they cause begin to soften.
~2 weeks
Full effect
The result peaks. This is the right time to judge the outcome, or add a small touch-up.
3–4 months
Effect fades
Movement gradually returns as the medication wears off and lines return to baseline.
3–4x / year
Maintenance cadence
Most patients repeat treatment on roughly this schedule to maintain the result.
A neuromodulator addresses lines of movement. Where a concern is volume loss or surface texture, it is often combined with other treatments in the same visit.
Dermal fillers restore volume to static folds and hollows. Laser resurfacing remodels the skin’s surface for fine etched lines and tone. For a heavy or hooded upper lid that a wrinkle relaxer cannot lift, upper blepharoplasty — eyelid surgery — is the structural answer, and a deep plane facelift addresses sagging of the lower face and neck that no injectable can.
Dr. James Manning is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology–Head and Neck Surgery. He specializes exclusively in the face.
Because he treats the face surgically as well as non-surgically, he reads the underlying muscle anatomy directly and doses to it — softening the lines that move while protecting natural expression, and telling you honestly when an injectable is not the right tool for the line you want gone.
Medically reviewed by Dr. James Manning, MD · July 2026
A neuromodulator is an injectable botulinum toxin type A — sold as Botox, Dysport, Xeomin, or Daxxify — that temporarily relaxes specific facial muscles to soften the wrinkles their movement creates. It is most often used for frown lines, forehead lines, and crow's feet.
All four are botulinum toxin type A and work the same way — relaxing a targeted muscle. They differ in formulation, dosing units, and how quickly some products take effect. The right choice depends on the area treated and is discussed at consultation.
The FDA-approved cosmetic uses are frown lines between the brows (glabellar lines), crow's feet (lateral canthal lines), and horizontal forehead lines. In a meta-analysis of seven randomized, placebo-controlled trials involving 1,474 patients, a 20-unit dose of botulinum toxin type A significantly improved glabellar lines. (Guo Y et al. Plast Reconstr Surg. 2015;136(3):310e-318e. PMID 26313835)
Yes. In a randomized, placebo-controlled trial of patients with moderate-to-severe crow's feet, 66.7% of those treated with botulinum toxin type A reached a “none” or “mild” rating at 30 days, compared with 6.7% of those given placebo. (Carruthers A et al. Dermatol Surg. 2014;40(11):1181-1190. PMID 25347451)
The effect begins in three to seven days and peaks at about two weeks. In a prospective study, 84% of the maximum effect was present within two to four days, and the result lasted more than five months in that group — though most patients see three to four months in practice. (Prager W et al. Clin Interv Aging. 2013;8:449-456. PMID 23650444)
A neuromodulator does not work instantly. The effect begins in three to seven days as the treated muscles relax, and reaches its full result at about two weeks. The right time to judge an outcome — and to add a small touch-up if a line is still showing — is at that two-week mark, not the day after.
The result is temporary. Movement gradually returns as the medication wears off, and the effect typically lasts three to four months before the lines return to their baseline. Maintaining the result means repeating treatment on roughly that cadence — most patients return three to four times a year. There is no requirement to continue; if you stop, the muscles simply resume their normal movement and the lines return to where they were.
A frozen look comes from too much product or placement in the wrong muscle, not from the medication itself. Conservative dosing and precise targeting are meant to soften specific lines while leaving normal expression — you should still be able to move your face.
Often only partially. A neuromodulator addresses dynamic wrinkles — lines from muscle movement. A line etched into the skin at rest is a static wrinkle, usually better addressed with dermal filler or laser resurfacing, sometimes alongside a neuromodulator.
Botulinum toxin type A has a long safety record for cosmetic use. In a meta-analysis of 5,298 participants across 18 studies, adverse events occurred in 42.1% of treated patients versus 35.8% of those given placebo, and most were mild. The side effects more common with treatment than placebo included drooping of the eyelid or brow, eyelid swelling, and a feeling of tightness — most of which are temporary and resolve as the product wears off. (Brin MF et al. JAAD Int. 2023;14:4-18. PMID 38035126)
Pricing depends on the areas treated and the amount of product used, and is quoted transparently at consultation. The $150 consultation fee is applied toward any treatment.
If you are considering a neuromodulator for frown lines, forehead lines, or crow’s feet, we would love to see you in consultation to determine if neuromodulators would best fit your needs.
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