Many people are looking for non-surgical, no-downtime options to look their best for photos and gatherings. With the immense popularity and effectiveness of BOTOX®, this is the leader in non-invasive perks sought by patients. BOTOX® works well for eye area and forehead, but can make the face look unnatural if injected around the mouth. I much prefer fillers in this area. As our face ages, it loses fat and volume. This is very noticeable around the mouth as we develop smile lines, puppet lines and flat lips. Fillers are substances injected with a tiny needle that restore volume (and youth) by placement of a substance underneath the skin. The substance injected will determine the longevity of results. Longer lasting injectables are frequently being introduced.
Collagen was one of the first injectables introduced. It is deposited directly under the skin for improvements of fine lines and wrinkles. The injections last 1 to 3 months on average. Some collagen preparations are made from bovine (cow) derivatives, and these require skin testing prior to injection. A collagen derived from pigs (it is kosher!), Evolence, is now available and offers much greater longevity.
A need for a longer lasting injectable spurred the development of hyaluronic acid preparations. Currently, there are several forms of hyaluronic acid on the market, and these comprise the most popular class of injectables. Most last for 6 to 8 months and gradually are removed by an enzyme that is naturally present in the skin. This enzyme can also be injected to help contour filler if requested. Hyaluonic preparations include Restylane, Captique, Hylaform and JUVÉDERM®. Captique and Hylaform were shorted acting and are no longer available. Restylane and Perlane persist for 4-6 months on average. JUVÉDERM® has an FDA indication and has been shown to last 8-12 months.
Radiesse and Sculptra are now widely available long-lasting injectables. Radiesse is made of bony mineral paste and lasts for 6-12 months. It can be used for volume improvements in the smile lines, pre-jowl area, cheekbones or under the cheekbones, or along the brow (to achieve a subtle "lift"). Results are apparent immediately, although a touch-up may help in achieving optimal results. The discomfort and swelling with injection is slightly more than that of the hyaluronic fillers. Sculptra is poly L-lactic acid and is used primarily in the deep tissues of the cheek to fill in large volume deficiencies. It is approved for HIV associated fat loss in the face. Injections may take 6-8 weeks before results are seen, and several treatments may be necessary.
Artefill is currently the only FDA approved filler that is permanent. The manufacturer, Artes Medical, is no longer in business and limited quantities are still available. It is made of polymethylmethacrylate beads suspended in collagen and lidocaine. Skin testing is required one month prior to injection. The filler is used for the smile lines (melolabial folds) and patient satisfaction is excellent. It is not generally recommended for patients as an initial treatment, but for those looking for permanence after achieving satisfaction with a temporary filler.
All injections can be performed in a doctor's office under numbing cream or blocks (numbing shots, like dentists use). Ice and Tylenol are generally all that required after injections. Avoiding ibuprofen, aspirin, naproxen and similar blood-thinning anti-inflammatory medicines will minimize bruising (which is usually minimal). Massage after injections may be recommended.
A perfect "gift-wrapping" for the face, fillers will help you look your best for holiday photos, and keep people guessing!
Botulinum toxin- sound scary? It should- it is the most potent toxin known to man! Even so, BOTOX® use has been increasing dramatically each year around the country. BOTOX® is purified Botulinum toxin- made in a lab and specially packaged. Each container of BOTOX® has a very specific amount, and the result is based on the amount injected. There is very little fluctuation from person to person with the recommended dosages. This makes it very safe and effective- and reproducible with each injection.
The benefits of BOTOX® are enormous. BOTOX® started out with use in strabismus- kids with crossed eyes. The cosmetic improvements around the eyes were quite apparent, and now it is used for the area between the brow, the crow's feet area and the forehead for both prevention and treatment. It has many other uses, and it is still being investigated. It can be used for hyperhidrosis (excessive sweating), facial tics and Bell's Palsy, muscle spasms around the eye and even for cerebral palsy muscle spasms. It works by blocking the release of a neurotransmitter across a muscle junction. This weakens the muscle. Unfortunately, the results are short-lived, and the muscle returns to normal in 4-6 months. BOTOX® typically takes 2-7 days before any effect is seen, and continued improvements in wrinkles and fine lines may be apparent for the duration of its activity. It has received FDA approval for many uses, including cosmetic, and it is very safe in trained hands.
The downsides to BOTOX® primarily lie in the fact that it does not produce permanent changes, and is quite expensive. An injection can cost $100-500, depending on the number of sites and amount of BOTOX® injected. These injections must be repeated every 4 to 6 months to achieve the best results. It is not recommended for women who are pregnant or breast feeding. Side effects are relatively rare but may include a bruise at the site of injection, headache, or ptosis (a droopiness of the eyelid). All side effects are also temporary.
Do I like BOTOX®? I love it! It is the best treatment for wrinkles around the eyes, forehead and glabella there is and there is no down-time. Injections are quick and painless and results start occurring in a couple of days. I do not like it around the mouth in most patients- I think that with a few exceptions, it will affect the mobility and expressiveness of the mouth that is noticeable (apparent that you have had "something done"). I personally recommend fillers (such as JUVÈDERM®) for most smile lines and puppet lines around the mouth.
|Juvederm Ultra||Local volume (lips)||9 months|
|Juvederm Ultra Plus||Local volume (smile folds)||12 months|
|Volbella||Fine lines (lipstick lines)||12 months|
|Vollure||Local volume (smile folds)||18 months|
|Voluma||Regional volume (cheeks, temple)||24 months|
|Restylane||Local volume (tear trough hollow)||9-12 months|
Fillers are constantly being added to the list as they receive FDA approval. At WFPS we typically advocate against permanent fillers, as your face will continue to lose volume with age and you will need more fillers eventually anyway.
Some patients receive more benefit from surgical options to lift drooping facial features and usually require far LESS filler after surgery. Over time, surgical options in selected patients can be more cost effective than trying to over-correct with fillers.
is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in people 18 to 65 years temporarily. (Allergan) Dysport is a prescription injection for temporary improvement in the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults less than 65 years of age. (Medicis)
Both Dysport and Botox are botulinum toxin type A proteins that are injected into the facial muscles that cause wrinkles. The toxin paralyzes the muscles which in turn results in fewer frown lines and wrinkles. The resulting cosmetic appearance delivered by both drugs seems to last about the same amount of time. The difference in treatment cost is negligible. Side effects of both treatments are similar and include numbness in the area that is being treated, as well as the possibility of swelling or bruising which can be relieved using an ice pack after treatment.
Dysport may not last quite as long (duration of efficacy). This is still being debated and studied; Dysport has a slightly quicker onset (2-5 days vs 4-7 days for Botox) in some people. Dysport appears to diffuses more (i.e., spreads to a wider area). This is an advantage in some areas of the face and a disadvantage in others; This means that larger areas can be treated with fewer needle sticks. On the other hand, for smaller areas like under the eyes, it can be difficult to control the spread of the toxin so that it doesn't go beyond the area it was intended to treat. While the cost of Dysport is less, more is required for the same effects delivered by Botox.
Ultimately, it is far more important WHO is injecting your Botox or Dysport, than which of these two products you are using. Botox/Dysport mistakes and bad results are made by people, not the product. Please meet with our experienced injectors prior to choosing a wrinkle-removing injectable and to discuss alternatives to Botox
All injectables aside from Artefill are temporary and need to be repeated to maintain results. Longevity varies based on product selected. Swelling and bruising are possible; other possible complications are rare but will be reviewed at your appointment. TO MINIMIZE BRUISING: we strongly recommend discontinuing aspirin, Ibuprofen, Advil, Motrin and all over-the-counter pain medications aside from Tylenol for 2 weeks prior to injection. Ice may be gently applied post-injection. Avoid all herbal supplements for 2 weeks prior to injection as many, such as fish oil, glucosamine, chondroitin and many others will increase your risk of bruising. Bruising is possible with any injection, please plan appropriately!