Are Botox Sprinkles The Way To Go?

Injectables are constantly evolving, and what was considered the gold standard yesterday may be passé by tomorrow’s standards. One class of injectables that has largely proven to be trend-proof: Neuromodulators and their ability to limit muscle contraction and soften the look of fine lines, wrinkles, and other age-related concerns. In fact, Botox® Cosmetic is celebrating the twentieth anniversary of its approval by the United States Food and Drug Administration (FDA) for the temporary improvement of the appearance of moderate to severe frown lines in adults. It was the first of its kind when it entered the market, and it’s since been joined by Dysport®, Jeuveau®, and Xeomin®.

Since no two faces are the same, no two dosages of these products are necessarily the same to achieve a desired result. That’s where so-called ‘Botox sprinkles’ – also known as ‘baby Botox’ – come into play. Not to be confused with microbotox, the sprinkle technique is essentially just a smaller dose of a neuromodulator. A modest amount of Botox® and the like may produce a more natural result for younger patients or newbies who are just dipping their toe into the wrinkle-relaxing pool and concerned about appearing frozen.

So, what are the pros and cons of Botox sprinkles, and how can you tell if you are a candidate? We tapped top dermatologists and plastic surgeons for the scoop.

What Are Botox Sprinkles?

A tongue-in-cheek reference for a smaller dose of a neuromodulator, the term ‘Botox sprinkles’ are injections of Botox®, Dysport®, Jeuveau®, or Xeomin® into a specific part of the face to soften the look of fine lines and wrinkles without eliminating all movement. “Botox sprinkles are great for smoothing fine lines and wrinkles on the face without completely removing muscle movement,” says Michele Green, MD, a NYC-based board certified dermatologist.

The trend of less-is-more shows no signs of slowing down, and some injectors and patients are preferring to use minimal amounts of neuromodulator to preserve expression. At his Arlington, VA, practice, double board certified facial plastic and reconstructive surgeon Jonathan Cabin, MD, says a large percentage of his patients opt for these treatments to soften facial wrinkles and prevent traditional aging-related wrinkles while preserving natural movement. “It is the ideal option for first-time Botox patients who are a bit nervous, younger patients interested in prevention, and patients who depend on powerful emotive facial expressions for their work,” he explains.

Like traditional injections of neuromodulators, the ultra-light dose version still requires a medical professional to inject botulinum toxin type A under the skin to temporarily relax the underlying muscle. A sprinkling of a neuromodulator within a particular area may provide a reduction of wrinkles and lines and their formation but not to the same degree as a standard treatment, says Brendan Camp, MD, a board certified dermatologist in New York City. Striking this balance is dependent on the skill of the provider. “An experienced injector will be able to determine the right amount of Botox to inject based on how strong your facial muscles are and how deep the wrinkles are,” Dr. Green says.

The just-right amount of product will soften the visible appearance of wrinkles while limiting – but not paralyzing – the movement that causes them in the first place. Botox sprinkles aren't the best route if you want very little to no movement in the treatment areas. Using less Botox is less likely to completely paralyze the muscle and, therefore, results in more expression, says Marisa Garshick, MD, a board certified dermatologist in NYC. “Ultimately, with Botox sprinkles, you retain some movement and some wrinkles but soften the overall appearance,” she notes. Most injectable patients eschew the fully frozen look (though some want it) and the overarched eyebrows and difficulty moving that accompany it. If you specifically request baby Botox, you are less likely to have that frozen appearance since your doctor injects smaller amounts of the product.

Even though the name ‘sprinkle’ implies injecting a dusting or smidgen of neuromodulator into any one area, it's a little more precise than that. While there is no set requirement for what a sprinkle treatment consists of since each patient requires a different dose, expect about half the unit use compared to complete treatment. “For Botox sprinkles, I use as little as five units of Botox in the forehead and glabella, whereas the official dosing is 20 units for each,” Dr. Cabin says. “For the crow's feet, I use about 2.5 units per side, whereas the official dosing is 12 units per side.” Again, a consultation with your injector will dictate the best approach for you.

It should be noted that a full dosage doesn’t necessarily mean an unnatural or immobile result. If your doctor recommends using the standard dose of a neuromodulator, it still can provide a refreshed look that allows for facial movement. “However, if a patient is interested in maintaining a lot of movement, a lighter treatment with neurotoxin can be a great option,” Dr. Camp says.

Where to ‘Sprinkle’

It's safe to ‘sprinkle’ the same areas of the face that providers commonly treat with larger amounts of neuromodulators – like the glabellar lines (a.k.a. the elevens), crow's feet, and even the horizontal lines on the forehead. For the most part, smaller areas don't require as much product to begin with to erase wrinkles and lines seamlessly. Dr. Green prefers to use the sprinkle technique on areas of the face with lighter lines or where the skin is just starting to develop them. “It also works wonders in reducing mild to moderate wrinkles while still looking natural, but it often fails to yield the desired results for deeper lines etched in the skin,” she says.

Who’s the Best Candidate for Botox Sprinkles?

Botox sprinkles are suitable for anyone who doesn't have many lines yet or has lines that aren't very deep but wants to prevent further wrinkles, Dr. Garshick says. “It's also good for someone who prefers a very natural look with minimal correction but still wants a refreshed appearance,” she explains. “And it can be helpful for older patients with a low-set brow or those who rely on the muscle movement to keep the eyelids and brows open to soften the movement without causing the brow to drop.”

Not everyone will benefit from a smaller dose of neuromodulator injections. While Dr. Camp says it may be a “good option” for those with minimal wrinkling who don’t require a full dose, others may find that a smaller amount of neuromodulator does not produce their desired result. Dr. Green says some patients come in expecting to get baby Botox, but, upon consultation, find out they have strong facial muscles and need more product to achieve optimal cosmetic effects. “The key to getting the best results from a neuromodulator is to go to an experienced injector, like a board certified dermatologist, who can give you natural-looking results,” she notes.

Generally speaking, the deeper the line, the stronger the muscle, and the more product needed to create smoother skin. Dr. Green explains that, with baby Botox, such small quantities of Botox are added to the muscle that it is not entirely relaxed. For deep wrinkles that are the result of overly active or strong facial muscles that repeatedly crease in the same spot for years, too little of an amount won't effectively smooth the area. “It's difficult to undo years of wrinkles with small quantities of Botox, so a regular amount is better for deep lines,” Dr Green shares. “But always ask your doctor what is best for you.”

That’s not all. As Dr. Garshick explains, Botox improves dynamic wrinkles or wrinkles that form with expression as opposed to lines at rest. Regardless of the amount of neuromodulator used, if a line is deeply etched in while at rest, it may not go away with Botox alone. “For these types of deeply etched lines, it can be helpful to also use laser resurfacing or microneedling treatments, which can be helpful to improve the appearance of lines at rest,” she adds.

Skin health may also play a role in who Botox sprinkles do and do not work well for. As Dr. Cabin shares, patients with mild-to-moderately etched-in wrinkles but otherwise elastic skin with healthy levels of collagen can eliminate and prevent deepening with consistent sprinkles. “But, in people with poorer skin or those that have significantly deep etched-in lines, this treatment may improve their lines a bit but will not be powerful enough for significant improvement or reversal,” he notes.

Does Less Botox Mean Less of a Result?

In a single word: no. Just because you choose to go lighter on the amount of neuromodulator that is injected doesn’t mean the results are suboptimal. “Botox sprinkles can help the forehead look smoother, the wrinkles around the eyes less pronounced, and the lines between the eyebrows less deep,” Dr. Camp says. “However, the results are more subtle than standard treatments.”

Generally speaking, Dr. Green says baby Botox will yield a similar result to regular Botox, just on a smaller scale. “It is great for younger patients in their twenties and thirties who are looking to prevent fine lines and wrinkles from developing and subtly reducing the appearance of mild to moderate frown lines,” she shares.

Patient response to neuromodulators varies, and what may equate to a ‘lesser dosage’ for one person may be the standard treatment for someone else. “A ‘sprinkle’ for one could significantly decrease muscular movement for another patient,” Dr. Cabin notes. This is why first-timers are usually encouraged to come back for a follow up. “This is why I recommend two appointments with every new Botox patient,” he explains. “The first appointment is a conservative treatment, and the second appointment – two weeks later – is to see the response and if touch-ups are needed for undertreated areas.”

Certain features, like the forehead, actually respond better to smaller amounts of product versus larger quantities. For example, too much neuromodulator in the forehead can weaken the muscle in the area and force the brows to drop. “Injecting too many units can give the impression of a heavy brow,” Dr. Camp cautions.

As far as longevity goes, the lesser dose holds just as much weight in terms of results. It shouldn't wear away any faster or slower, so you can expect, on average, to stay wrinkle-free for about three to four months. In some patients, however, fewer units may equate to a shorter duration of results. This is especially true if the muscles are strong. But, “if the muscles are weaker, you will still notice some benefits for the same duration as expected with a full course of treatment,” Dr. Garshick says.

The Takeaway

Whether it’s a preventative treatment, gateway procedure, or aesthetic preference, Botox sprinkles can serve many purposes. By using less neurotoxin, the muscle will retain more movement than a standard dosage, which can lead to a more natural-looking result. Depending on the depth of your lines, the quality of your skin, and/or your goals for treatment, baby Botox may be all you need to enjoy a more refreshed appearance. Consulting with a board certified dermatologist or plastic surgeon is the best way to determine how much neurotoxin you’ll need to achieve your desired outcome.