Facial wrinkles and forehead furrows or eye lines (crow’s feet) produced by reducing the function of specific muscles of facial expression, repeatedly creasing the skin, can be effectively treated through some cosmetic procedures. Neurotoxins (Botox, Dysport, Xeomin and Jeuveau) are sterile, purified proteins produced from the bacterium Clostridium botulinum in the laboratory.
Neurotoxins injected in small amounts into facial muscles bind to nerve endings, preventing nerve impulses from traveling to the muscles. When injected, they weaken or paralyze the muscle around the applied area for a typical period of several months. The resulting effect of this weakening or paralysis temporarily reduces or eliminates the previous skin fold and prevents a new fold. Botox can take several days to take effect, and it usually lasts for three to four months in most individuals before full muscle movement returns. At this point, the treatment can be repeated as desired.
Injectable fillers are substances used by your doctor to replace lost volume in certain areas of your face. When used properly, they can result in substantial and reasonably long-lasting improvements. They are not replacements or alternatives to neurotoxins, as they treat a different set of problems: deeper creases and folds that are not due to muscle activity. FDA-approved fillers are an ever-changing landscape, but some of the common products in use today are as follows:
Hyaluronic Acids (Juvederm, Restylane and others): These products are made up of a gel-like substance that is found in our bodies, between cells. This substance is lost as we age, so one can consider this type of filler as replacement therapy. These fillers are soft to the touch and are used on the lips and other areas where a softer product is needed. They typically don’t last as long as some of the other fillers.
Calcium Hydroxyapatite (CaHA) Microspheres (Radiesse): This product is another compound that occurs naturally in our body and has a pasty consistency. It is used in areas where a thicker, firmer filler is required. It has a variety of uses, ranging from facial augmentation to hand rejuvenation when there are many tendons showing after volume loss. Most studies have found that it lasts a little longer than Hyaluronic Acid products.
Poly-L-Lactic Acid (Sculptra): This product is a synthetic polymer that has long been used in dissolving suture material. It works differently from other loads: it stimulates the body to generate new collagen. It is actually intended for deeper injection sites, such as the cheek or temple areas, and should not be used on the eyelid or lips. It requires multiple injection sessions to achieve the goal of correction, while most other fillers can be used to achieve correction in one or two sessions.
Fat grafting creates a natural augmentation for the face using its own “filler”. Fat is usually harvested from the abdomen, flanks or inner thighs; and about a third of the volume remains after treatment. Fat grafting can be repeated for fullness.
Compared to typical cosmetic surgical procedures, the office time for these procedures and the subsequent recovery period is minimal. Botulinum toxin therapy typically takes a few minutes to perform, and most patients can return home or work immediately. Minor local irritation, redness, bruising, or swelling at the injection sites are the most commonly seen side effects, which usually subside within a few hours.
Likewise, load injection therapy can be performed with a five to 15 minute procedure. For fillers, it is common to have a topical application of anesthesia prior to injection into the treatment areas. Some irritation, swelling, or light bruising at injection sites is common, but these effects can be easily camouflaged with standard makeup if necessary.
Some fillers can be used for fine lines, although fine lines are often enhanced with neuromodulators. Other fillers are better for increasing facial volume. Anyone can require more than one treatment session to get the most positive results.
