Botox and Facial Fillers

One of the most popular, and least invasive, ways to improve lines, wrinkles, sunken areas and even change the shape of your face is with injectable products.  Injectables come in two major classes:  neurotoxins and fillers or volumizers.

Neurotoxins are chemicals such as Botox (Botulinum Toxin A) that are injected into the face to prevent muscles from moving in ways that create lines.  They do not “fill-in” the lines, but rather, make them less apparent, less deep or even disappear by preventing you from making the face that causes those lines.  The most common areas for neurotoxins are the forehead, the area between the brows (“frown lines”), and the crowsfeet (lines at the corner of the eyes).  Neurotoxins can also be used to help turn up a down-turned mouth, reduce dimpling of the chin, improve upper lip lines (like smoker’s lines), smooth the jawline by softening the pull of  the neck “bands” (muscles that run from the back of the jaw to the chest) and even reduce underarm sweating.  While Botox is the oldest and most well-known of the neurotoxins (having been used cosmetically for over 20 years), there are newer formulations of Botulinum Toxin such as Dysport and Xeomin.  These products work in the same way as Botox, but may be useful as alternatives if someone seems to be resistant to Botox or just wants an alternative. More similar products are on the horizon. Botox is injected with a very tiny needle, and bruising is rare, but can occur.

Fillers or volumizers are products which are injected into the face (or occasionally body parts) to plump up areas such as sunken cheeks or fill in lines such as nasolabial folds (the lines or folds running from the nose to mouth).  They can also be used to sharpen the jaw line, strengthen or enhance the chin or lips and make the cheekbones more prominent.  Some fillers, like Juvederm, Perlane and Restylane are primarily composed of hyaluronic acid (a natural component of the skin).  Hyaluronic acid fillers immediately plump the area into which they are injected, and also attract water to the area to keep it looking full.  Another type of filler, Radiesse, is made of a gel plus calcium hydroxylapatite.  Radiesse will also immediately plump up or enhance an area, and is especially good for bony areas such as the jaw line and cheekbones, but can be used anywhere but the lips. (Its particles are too large to work smoothly in that area.)  A third type of filler is Sculptra, or poly-L-lactic acid, is a powder which is reconstituted with water prior to injection.  The area it is injected into will immediately become full and plump, but the plumpness will disappear in a few days.  Over the next 6-8 weeks or so, Sculptra will help to build your own collagen and the area will become full again.

There are advantages and disadvantages to each of the fillers, and our medical staff can help you select the product that is right for you and your goals.  One of the advantages of the hyaluronic acids is that they can be easily dissolved if the results are not to your liking.  Radiesse and Sculptra cannot be dissolved. Fillers or volumizers can last anywhere from 3 months to 2 years, and the duration varies from person to person and from one area to another.  They are an excellent temporary alternative to fat grafting.  With injection of any filler, one must expect some swelling and often, bruising.

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