Botox® & Fillers

Injections such as Botox® and other types of “neuromodulators” contain a protein called botulinum toxin, which can significantly reduce the appearance of fine lines and wrinkles by relaxing the facial muscles, particularly on the forehead, around the eyes (“crow’s feet”), between the eyebrows (known as “the elevens” for the typical appearance of two parallel lines), as well as on the neck and jawline.

In addition to tackling wrinkles, these products can be used to obtain a non-surgical brow lift and reduce the size of the masseter muscles, which can narrow the lower face, leading to a more pleasing shape for some individuals.

While the word “toxin” might sound off-putting, the substance has been extensively tested for over 50 years and is extremely safe when used appropriately by experienced doctors. In fact, Botox® and other neuromodulators are widely used in the medical field beyond aesthetic treatments—for non-cosmetic applications such as facial paralysis (from conditions like Bell’s palsy), migraines, TMJ, and even excessive sweating.

Though perhaps best known, Botox® is just one of many brands in the space; others include Dysport®, Xeomin®, and Jeuveau®. Each of these brands offers the same product, but with subtle differences that might be preferred by certain practitioners. Daxxify®, another name you might encounter, is a newer version that may have a longer-lasting result.

Fillers, which could be considered a cousin to toxin treatments, use medical-grade gel-like materials that are injected under the skin to enhance facial features like the lips, chin, or cheekbones by adding volume or altering contour.

Fillers can also be used to minimize wrinkles or restore areas of the face that look deflated because of age or major weight loss. One of the principal components of the aging process is volume loss in fat and bones and changes in the body’s elasticity, which can result in shadows and hollows throughout the face and surrounding areas. Fillers help fill and smooth these valleys and crevices, leading to a more youthful appearance.

Both botulinum toxin and filler injections are relatively quick “lunchtime” procedures.

With toxins, your physician will typically do a sequence of multiple injections with super thin needles in a specific area without numbing the area first. The effect of the injections normally lasts a few months. (Results of any injectable treatment will also vary from person to person, depending on factors like the product, age, skin type, sun exposure and genetics.)

Getting botulinum toxin treatments consistently, at set intervals, can help maintain results and potentially prevent the worsening of lines over time. A small percentage of individuals may develop “botox resistance,” which occurs when the body produces antibodies that negate its activity and reduce its effectiveness. To avoid this, patients should use the minimum effective dose needed for desired results, space treatments appropriately, and avoid getting too many “touch-up” treatments for minor issues.

Fillers are typically injected with needles or “cannulas” after the area is treated with a numbing injection or cream. Fillers may be injected either near the surface of the skin or at a deeper level depending on the type of product or issue that is being addressed. They can last much longer than toxin treatments, depending on the type of filler and the location of injections.

There are two primary types.

“HA” fillers contain hyaluronic acid, which naturally occurs in the body; it helps replenish lost volume and smooth out the treated areas. Some newer HA fillers can also help the skin retain moisture, keeping the face looking hydrated and moisturized. The differences among HA fillers are defined by the size of their hyaluronic acid molecules, their cross-linking technology, and their specific applications based on injection depth and area. One major benefit of HA fillers is they can be reversed with a dissolving agent, if you’re not happy with the results or there is a complication with the procedure.

The second type, non-HA fillers, tend to last even longer. They act more like a collagen stimulator than a direct filler, or provide a mix of both techniques, to address hollowness in the temples, cheeks, or lower face. The main disadvantage of these types of products is that they are not immediately reversible like their HA counterparts. Radiesse® , Sculptra®  and Bellafill® are the most commonly used alternatives to HA fillers.

Although both fillers and botulinum toxin are excellent non-surgical options, there are other ways to give your face a refreshed look. Over-the-counter skin care products, lasers, energy-based devices and surgical procedures such as facelifts can also be used as part of a comprehensive facial rejuvenation plan.

Speak with your physician about your preferences and target areas so they can best determine which treatment is right for you.

Before you go

During your consultation with your physician before the procedure, be sure to discuss your expectations, any medical conditions you have, any medications you’re taking, and any previous cosmetic procedures you’ve undergone. Some medications, like the blood-thinners and aspirin, can increase the risk of bleeding and bruising and your doctor may want to alter your regimen.

It’s also a good idea to avoid drinking and smoking for at least a few days before the procedure and to stay hydrated, all of which can minimize side effects and help with recovery.

During the procedure

With toxin treatments such as Botox®, your physician will typically do a sequence of multiple injections with super thin needles in a specific area without numbing the area first. Fillers are typically injected with needles or “cannulas” after the area is treated with a numbing injection or cream.

Using sharp needles for filler injections allows for precise placement and is often preferred for fine lines and smaller areas, but it carries a higher risk of bruising and bleeding. In contrast, cannulas, which are blunt-tipped, reduce the risk of injuring blood vessels and can result in less bruising and swelling. This makes them ideal for larger areas and more delicate procedures.

Botox & Fillers Aftercare

You may have mild bruising for a few days around an injection site. It is not uncommon to have mild redness, swelling, or tightness in the skin.

With any type of injectable, you should not exercise for 24 hours after the procedure and should stay upright during that day. It is also recommended to avoid massaging the injection sites unless instructed otherwise by your physician.

With toxins, results usually appear in a few days and peak within two weeks. As discussed above, the longevity of results can vary but typically last from two to six months. With fillers, you will usually see results immediately after the injection, though it may be a week or two for the effects to fully settle. (One exception is Sculptra® which usually takes several treatment sessions and a few months to see final results.)