BOTOX & FILLERS
Botox & Fillers

Non-Surgical Injectable Facial Treatments

Next to facial plastic surgery, nothing makes as big a difference in my patient’s facial appearance as injectables. What are injectables? They come in three categories: (1) Muscle Relaxers, like Botox® and Dysport®; (2) Wrinkle Fillers, such as Juvéderm, Prevelle, Radiesse, Restylane, and Voluma; and (3) Kybella, which melts fat to eliminate a double chin. What are they made of, what do they do, and how long do they last? I’m glad you asked! I present to you: Injectables 101.

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Botox® and Dysport®

Botox, technically known as BOTOX Cosmetic®, was originally created by scientists to treat eye spasm. Once it was discovered to relax the muscles that create wrinkles, it became a cosmetic classic. Dysport® was developed some time later and has many of the same attributes as Botox®.

What Are Botox® and Dysport® Made Of?

Both products are made from a highly purified, cosmetic form of botulinum toxin, a neurotoxic protein produced by bacteria. Injecting either of these products into the muscles beneath your facial wrinkles will cause those muscles to relax, creating a smoother skin surface. These two products are most frequently used around the eyes, forehead or mouth. Because they are very thin liquids, a very tiny needle can be used. Most people experience little to no discomfort from the treatment, but those who express any concern are pre-treated with numbing cream. It lasts 4-6 months.

What Is The Difference Between Botox® and Dysport®?

Compare a Fuji apple with a Red Delicious. Although they’re both different types of apples, they’re both apples, right? It’s similar with Botox® and Dysport®.

Here’s how they differ:

  • The effects of a Dysport injection appear sooner than those from a Botox® injection
  • Dysport® spreads across a broader area than does Botox®. This could be either a positive or negative, depending upon the patient.
  • Some patients believe that the results of Dysport® fade sooner than Botox®

How Long Do The Results of Botox® and Dysport® Last?

Although it varies from patient to patient, results last from 3-6 months, on average. Of note, however, is this: the longer you use these relaxants, the less frequently you need them. In other words, once the muscle becomes “used to” being relaxed, it tends to remain relaxed.

Three Times Not To Get Botox or Dysport

1. You are pregnant or nursing. Although there have not been any documented cases of damage caused by BOTOX® Cosmetic injections during pregnancy, better safe than sorry, right?
2. Right before a big event: you won’t look better (yet) but you may have visible injection spots or even some slight swelling. Not a good look.
3. You have sagging skin and/or volume loss. Without fillers, you’ll still have them after the Botox® or Dysport® injections.

Filler Facts

Maximum improvement is achieved when Botox or Dysport is used in conjunction with a filler, so that the Botox can relax the muscle that created the wrinkle and the filler can soften its appearance. It’s a match made in Heaven, you might say!

Prevelle, Restylane, Voluma, and Juvederm are hyaluronic acid fillers used to plump wrinkles throughout the face, including the nasolabial folds (the lines that run diagonally from the nose to the mouth), the glabellar lines (between the eyebrows) and the wrinkles around the lips and around the eyes. These fillers are composed of a laboratory-created protein called hyaluronic acid, similar to the natural hyaluronic acid in your skin that contributes to youthful skin’s volume and fullness. The lab-created hyaluronic acid in these products has been modified slightly to last longer than your own hyaluronic acid. The differences in the products have largely to do with how long they last.

Hyaluronic acid is hydrophilic, which means it’s "water loving," and as such, it attracts many times its own weight in water. Even as the hyaluronic acid begins to disappear, each molecule attaches to more water, which means it will maintain its volume and effect for between four and six months. Although a tiny needle is used, Restylane is slightly thicker than the other fillers and, therefore, can be more uncomfortable when injected. Numbing creams are applied to minimize pain, and fortunately, the products can also be mixed with a bit of Lidocaine to minimize discomfort during the injection.

Prevelle is pre-mixed with a small amount of Lidocaine to diminish the discomfort of the injection. The substance is quite uniform so the injections are very smooth. Because it already contains an anesthetic agent, there is very little discomfort or bruising, making it truly possible to “inject today to look great tonight”. It lasts approximately 3-4 months.

Perlane is also made of hyaluronic acid. It provides fullness and line reduction around the mouth, smile lines and lower corners of lips/chin. Perlane is a fairly long lasting injectable, lasting anywhere from 6-12 months, though lip augmentation results might not last as long as other facial areas.

Voluma is another hyaluronic filler, most often used to fill the mid-face, particularly the cheeks, giving a lovely “lifting” effect that lasts up to two years!

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Restylane is a hyaluronic acid gel that is injected to restore lost volume and provide fullness to the skin by filling the lines that run from your nose to the corners of your mouth (nasolabial folds). It has been used in over 70 countries for more than 1.4 million treatments and is one of the most popular fillers. It lasts for 6-9 months. It’s often used to fill in the more superficial lines and is a popular lip filler, as well as a wrinkle-filler for “crow’s feet” and lines between the eyes. Restylane lasts up to 9 months.

Juvéderm is a soft gel made of hyaluronic acid. Like Restylane, it is used to restore your skin's volume and smooth away facial wrinkles and folds, like your “smile lines” or the creases that run from the bottom of your nose to the corners of your mouth. It’s also been found extremely effective for plumping lips. It can last up to about 12 months.

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Radiesse is composed of tiny microspheres containing calcium hydroxylapatite, a protein found in our teeth and bones. When injected, these microspheres form a scaffold through which your body's own collagen grows, thus achieving a fairly long-term volumizing effect. Because Radiesse stimulates collagen production, you’ll see some permanent decrease in the injected areas even after the original filler has disappeared (normally 8-12 months). Although this varies from individual to individual, the chance to permanently diminish some of our wrinkles has made Radiesse an extremely popular filler!

Because Radiesse is a thicker filler, it is reserved for use in deeper tissues. An example would be to fill out the area around the cheekbones, to fill in scars, or to return volume to areas where it has been lost to aging, disease, or injury. It is very effective for deep nasolabial folds. Because men often have very deep nasolabial folds, Radiesse is a logical treatment for men in particular.

If the backs of your hands have a great deal of loose skin, you may like Radiesse for this area, as it’s very effective in restoring volume to the hands. It is not used in the lips because it creates more discomfort than some of the other lip fillers and can appear less smooth in the lips than our other options. Radiesse and Voluma are the longest lasting of the fillers, maintaining fullness for up to 2 years.

How It's Done

Filler injections take only about fifteen minutes to half an hour, and the results of fillers appear immediately. The final results of BOTOX® and Dysport® injections generally occur after 48 hours, with the majority of the improvement found in about a week.

Recovery

After injecting, we apply a cold compress. Some redness may be present for the first few hours, and you may have slight swelling around the injection sites themselves. However, this fades quickly, and by the time you leave the office, you will be unlikely to have any discomfort.

After receiving Dysport® or BOTOX®, you should not lay flat for four hours to avoid “spreading” the botulinum toxin beyond the desired area(s). You might have a slight redness around the injection site for the first two hours. The results of BOTOX® injections usually last about 4 months. It will be obvious to you when you should come in for another treatment, as the wrinkles will begin to reappear.

Because our office is very busy, we suggest that you make the appointment for your next treatment after each treatment, spacing the next appointment at the interval I recommend.

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Raghu G. Elluru, MD, FACS

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Raghu Elluru, MD, FACS