Lines and wrinkles in the face are a source of concern to many of our patients. While procedures such as facelift and browlift may improve wrinkles to some degree, there often are facial folds deep enough to require direct augmentation.
In recent years, many excellent materials have become available for the long-term correction of deeper facial lines and wrinkles, enhanced facial volume and fuller lips. During your appointment, Dr. Beaty or our Nurse Injector Katrina will guide you through the advantages of various fillers.
What are injectables?
Injectables are comprised of both what are called neuromodulators (Botox® and other brands) and dermal fillers (Juvéderm®, Restylane®, and others). These products are injected either beneath an existing wrinkle or crease and they “fill” in the depression, or they are injected to stop a muscle from contracting and forming a wrinkle on the surface above. Kybella® is also an injectable, but is intended solely for reducing fat in what is colloquially known as the double chin.Injecting substances under wrinkles to push them back up has been tried for a long time, most notably the reinjection of a person’s own fat. But results were unreliable. Everything changed in 2002. That was the year the FDA approved Botox® for the treatment of facial wrinkles on the upper third of the face. Botox® was the first neuromodulator and remains the world’s most popular cosmetic procedure year in and year out. The first dermal filler, Restylane®, was approved by the FDA in 2005. Since then, many different injectables have come to the market.
What injectables does Dr. Beaty offer?
Dr. Beaty offers a wide range of injectables:
How are dermal fillers different than neuromodulators like Botox?
While the end goal may be the same, to erase or dramatically reduce the appearance of wrinkles, creases, and areas of volume loss, dermal fillers and neuromodulators go about it in entirely different ways.
Dermal fillers, as their name implies, “fill” a wrinkle from beneath. They are classified as either “natural” or “synthetic” fillers. They work on “static” wrinkles — these are the wrinkles that are on display at all times, such as nasolabial folds or lip lines.
Natural fillers, such as Restylane® and Juvéderm®, are made mainly from hyaluronic acid. Hyaluronic acid is a naturally occurring substance in our bodies that is responsible for hydrating and plumping the skin. It does this by binding with nearby water molecules.
Synthetic fillers, such as Sculptra®, are made with synthetic substances. They use structural support elements, such as calcium microspheres, to provide artificial structure where injected. Many synthetic fillers also trigger the body to produce new supplies of collagen (the protein responsible for creating the skin’s structural framework) as a secondary aspect of skin firming.
Neuromodulators are a wholly different deal. Botox® (and other brands) is made from the botulinum toxin type A. This is the bacterium responsible for botulism, which sounds scary, but it’s not. Way back in the 1950s doctors discovered that when injected into a muscle in miniscule amounts, the botulinum toxin temporarily stopped the muscle from contracting. It does this by blocking the nerve signal from the muscle to the brain, so the brain never signals the muscle to contract. This proved helpful when used to stop involuntary muscle contractions in the eyelids and some other areas. But when Botox® was approved for the treatment of facial wrinkles it became incredibly popular and is a worldwide aesthetic legend.
Botox® works on what are called “dynamic” wrinkles. These are the wrinkles that form on the skin surface when we make certain expressions, such as frowning or squinting. These occur on the upper third, the expressive, area of the face. Over time, making these repeated expressions begins to form wrinkles around the eyes (crow’s feet), between the brows (the 11s), and on the forehead. But when Botox is injected into the muscle that forms the wrinkle on the skin above, it stops the muscle from contracting, so the wrinkle above never forms.
What are the target areas of the Juvéderm fillers Dr. Beaty offers?
The Juvéderm® family of fillers has been expanding, with different products intended for different areas of volume loss. Here’s what each does:
- Juvéderm® XC — Adds volume beneath the skin to smooth moderate nasolabial folds (from the nose down to the mouth), marionette lines (from corners of the mouth downward), and parentheses lines (frame the mouth on each side).
- Juvéderm Voluma® XC — Adds volume to the cheeks.
- Juvéderm Vollure® XC — Adds volume to moderate to severe nasolabial folds, marionette lines, and parentheses lines.
- Juvéderm Volbella® XC — Adds subtle volume to the lips. Erases vertical lip lines.
How often can I receive Botox or dermal filler injections?
There isn’t a limit to how often you can have injectables given. But patients return when the filler or neuromodulator begins to lose its wrinkle-erasing ability.
Botox results last around four months. At that point, the muscle will begin to contract again and the wrinkle it forms will return.
Dermal fillers have different durations. At some point, the body will eventually absorb the filler material and the wrinkle or crease will begin to show up again. The longest lasting hyaluronic acid/natural filler is Juvéderm Vollure® XC, which lasts 18 months. Most of the other natural fillers last up to one year. The synthetic filler Sculptra® lasts up to two years.
Can I combine dermal fillers with Botox?
You can combine these injectables. Remember, they work on different types of wrinkles. For instance, some forehead lines are static and are there to see all the time. Other forehead lines only form when you make an expression. So you could use a dermal filler such as Juvéderm® along with Botox to address the different types of wrinkles in the same area. Or you could use Botox on your crow’s feet and Juvéderm Voluma® XC on your flattened cheeks.
What Results Can I Expect from Fillers and Injectables?
Aside from correcting wrinkles, these fillers may also be used to enhance facial volume in tear troughs, the midface, and pre-jowl area. For many men, this can correct volume loss in a minimally invasive manner. There is no downtime associated with injectable fillers and treatments are performed in the office.
Are my results immediate with all of these injectables?
Dermal fillers immediately “fill” the depressed area under the wrinkle or fold, so your results are instant. Botox, however, take from 4-6 days to get the muscle to stop contracting, and that is when you will see the wrinkle disappear.
Are there side effects with these injectables?
The most commonly observed side effects with fillers are swelling, redness, pain, bruising, headaches, tenderness, lump formation, and itching at the injection sites. These are typically mild in severity and usually resolve themselves in seven days with smile and marionette lines, and within 14 days on the lips.
Because hyaluronic acid is a naturally occurring substance in the body, there are very few reactions to Juvéderm and Restylane® products. Occasionally, lumps or granulomas can form near the injection sites. This side effect can be reversed with an injection of hyaluronidase, an enzyme that speeds up the natural degradation of the hyaluronic acid in the filler.
Botox® has the same possibilities of redness, minor swelling, etc. at the injection sites. But once you have your Botox® injections, the patient needs to be sure not to rub the injection site, as this can make the Botox® migrate to an unwanted muscle. This can create problems such as a droopy eyelid. Overall, however, Botox® is very safe and has been proven in millions of injections around the world.
As with all injectables, the expertise of your injector is important to achieve the best results and avoid side effects. Dr. Beaty has received special training and has extensive experience in the use of all of the fillers we offer.
Dr. Beaty and team specialize in non-surgical procedures, facial plastic surgery options and more.
If you would like to learn more about our services, please contact us to speak with one of our experts.