Years of smiling, laughing, frowning, and squinting create dynamic wrinkles, lines caused by repeated muscle movement that eventually become visible even when your face is at rest.
Neurotoxins temporarily relax the muscles responsible for those lines, allowing the skin to smooth.
A neurotoxin temporarily interrupts the signal between a nerve and a specific muscle. When that muscle relaxes, it pulls less on the overlying skin, and the dynamic line it creates softens.
Because the effect is targeted and temporary, only the treated muscles are affected, and untreated muscles continue to move normally.
The effect develops over days, settles over about two weeks, and gradually wears off over the following months as normal muscle movement returns.
Explore representative outcomes from patients treated by Dr. Gerrish and his clinical team.
Combination Injectables
A combination injectable approach using neurotoxin to address fine lines and wrinkles and hyaluronic acid dermal filler for facial balancing.
Individual results vary.
Facial Balancing with Dermal Filler + Botox
Facial balancing using dermal filler and Botox to refine facial proportions and overall balance. Treatment performed by Jocelyn Brackett, NP, at our Virginia practice.
Treated by Jocelyn Brackett, NP
Individual results vary.
Individual results vary. Outcomes depend on anatomy, treatment selection, treatment plan, and individual healing response.
Neurotoxins can address concerns tied to targeted nerve signaling, from expression lines and muscle tension to excessive sweating. Because treatments are temporary, they can be adjusted over time as your goals evolve.
Forehead lines
Frown lines ("11s")
Crow's feet
Bunny lines
Lip flip
Chin dimpling (pebbled chin)
Downturned corners of the mouth
Neck bands
Brow shaping and brow lift
Jaw tension, teeth grinding, and masseter slimming
Excessive underarm sweating (hyperhidrosis)
Every patient's muscles behave differently. Some metabolize neurotoxins quickly, while others respond better to one formulation than another. Rather than limiting you to a single brand, we offer multiple FDA-approved neuromodulators, which differ in onset, spread, formulation, and typical duration.
Botox is the original cosmetic neurotoxin and remains a widely recognized name in aesthetic medicine. With more than two decades of cosmetic use and millions of treatments performed worldwide, it has an extensive track record, and it works well for virtually every treatment area.
Typical Onset
3-7 days
Typical Duration
Approximately 3-4 months
Dysport works through the same mechanism as Botox but tends to spread slightly more after injection. This can make it useful for broader muscles such as the forehead while still producing natural-looking results when injected appropriately. Many patients notice it begins working a little sooner than Botox.
Typical Onset
2-4 days
Typical Duration
Approximately 3-5 months
Daxxify is formulated with a different stabilizing technology, and in clinical trials many patients maintained results for approximately six months, making it an option for those looking to reduce the number of treatment visits each year.
Typical Onset
Approximately 2-4 days
Typical Duration
Approximately 6 months for many patients
Letybo is one of the newest FDA-approved neuromodulators available in the United States. It gives experienced injectors additional flexibility when selecting the product that matches a patient's needs and goals.
Typical Onset
Often within several days
Typical Duration
Approximately 3-4 months
The treating clinician selects the product, dose, and placement based on facial anatomy, muscle strength, treatment goals, individual response, and how much movement you wish to preserve.
The goal is not to freeze movement. It is to decide which movement should be softened and which should remain.
“Natural neurotoxin results come from respecting expression, softening the patterns that make someone look tired or tense while leaving the movements that make a face look like itself.”Dr. Scott Gerrish
The product softens movement; the injector decides where, how much, and when to stop. Facial anatomy, muscle balance, proportion, and dosing are mapped before anything is injected.
If a follow-up shows that less product would have served you better, that is what your next plan will reflect.
The treating clinician determines
A neurotoxin may be appropriate when you
Another approach may be selected when
When the concern is volume loss or contour rather than movement, filler may be more appropriate than a neurotoxin.
When the issue is skin texture, tone, pigmentation, or sun damage, a resurfacing treatment addresses the surface that neurotoxins cannot.
Sometimes deeper, static lines respond better when neurotoxin is thoughtfully sequenced with other care, rather than treated alone.
Treatment itself is brief. The injections take only a few minutes using very fine needles, and numbing is not usually required, though a topical option is available for comfort.
Most patients return to their day right away, with a few simple precautions for the first several hours, such as avoiding rubbing the treated area and not lying flat. Temporary redness, small bumps, or minor bruising at the injection sites can occur and generally resolve quickly.
Over time, regular treatment can soften the repeated muscle movements that etch lines into the skin, which may help slow how quickly those lines deepen. Results vary from person to person.
Every treatment has considerations that depend on your health, anatomy, skin type, medications, and goals. We review these before recommending care and again before treatment.
Neurotoxin treatment is not appropriate for everyone. Pregnancy, breastfeeding, certain neuromuscular conditions, and active infection or skin conditions at the treatment site are reviewed during evaluation, and because the effect is temporary, an unintended result softens as the product wears off.
Read our safety and suitability guide.Neurotoxins soften movement; fillers restore volume or contour; UltraClear addresses surface quality through energy-based remodeling; skincare supports skin health.
Commonly considered with
You do not need to know whether this is the right treatment before you arrive. That is exactly why the consultation comes first.
The decision is which muscles to soften, how much movement to preserve, and which formulation, dose, and placement fit the treatment goal.
In Vienna, neurotoxin and dermal filler treatments are performed by experienced nurse practitioners working within Dr. Gerrish's clinical protocols.
Learn why wrinkles caused by muscle movement are treated differently from volume loss.
Learn MoreLearn how the same medicine is used beyond aesthetics to calm excessive underarm sweating.
Learn MoreSee how we determine which injectable approach fits your anatomy and goals.
Learn More
