As we age, we begin to get wrinkles in our face. Wrinkles can be caused by the muscle action of the many muscles under the skin of our faces, or they may be caused by permanent indentations in the skin. Wrinkles caused by the muscles in the face are amenable to Botox® or Dysport® treatment. Common wrinkles caused by the muscles in the face include those in the forehead, between the eyes (“11s”), and around the outside of the eyes (especially seen with smiling). Botox® and Dysport® can also be used to raise the eyebrows (non-surgical brow lift), raise the corners of the mouth, and give you a less “gummy” smile by reducing the amount of your gums showing. These injectable medications can also be used to dramatically decrease excessive under-arm sweating and excessive sweating from the hands.
Wrinkles caused by permanent indentations (present even when the muscle is not moving) are amenable to filler treatment. Common wrinkles amenable to filler treatment include fine wrinkles around the mouth and chin and to restore fullness thin lips. Fat loss due to aging can also be restored with filler, including plumping of the cheeks, eyelids, eyebrows, and chin. Filler can also be used to correct deformities of the nose in some patients. Non-surgical facelifts can also be performed using fillers (“liquid facelift”).
Botox®, Dysport®, and fillers are injectable medications. They are done in the office using very fine needles. You may feel the injections, but they are universally well-tolerated by patients. If necessary, your skin can be numbed using a topical cream prior to the injection.
You will need to apply ice to the treated areas right after the procedure for about 5-10 minutes. There are many different filler products available, including temporary, semi-permanent, and permanent fillers. You will discuss your concerns with your surgeon during the consultation and determine which filler is right for you.
Anesthesia
Typically none, sometimes a topical anesthetic may be applied if necessary
Length of procedure
5 to 15 minutes
Back to work
Same day as injection
Exercise
24 hours after injection
Discomfort
Very mild
Swelling
Mild to moderate
Bruising
Uncommon, but if bruising occurs it generally resolves in 7-10 days and can easily be covered with makeup
Final result
Botox® and Dysport® results will be seen in 4-7 days, filler results will typically be seen immediately and get better over time (depending on the type of filler used – some may take longer), and fat injections will be seen immediately but will change over time and take a week or two for results to stabilize.
How long does Botox®/Dyport® last?
It generally takes 2-5 days before you begin to see the effects of your Botox®/Dysport® treatment and the effects will generally last between 3-4 months. Your surgeon will work with you to develop an on-going follow-up plan to keep your face looking rejuvenated as time goes on.
Is Botox®/Dysport® safe?
Botox®/Dysport® is very well tolerated and safe when used for cosmetic surgery. The amount of Botox®/Dysport® used for cosmetic purposes is very small. While Botox®/Dysport® does “paralyze’ the muscles in the face, the effects are temporary and do not lead to permanent problems.
Where should I use Botox®/Dysport®?
Botox®/Dysport® can be used to treat any wrinkle in the face caused by the muscle actions under the skin. The most common places targeted include the forehead, glabella (“elevens”), around the eyes, and lip lines. It can also be used to raise the eyebrows, raise the corners of the mouth (to make it look like you have more of a smile instead of a frown), give you a less “gummy smile,” and soften the “bands” in your neck. Your surgeon will evaluate your face with you to develop a treatment plan that is right for you.
What if I don’t like the effects of my Botox®/Dysport® treatment?
Though Botox®/Dysport® treatments require repeated applications and are considered temporary, this is an advantage in the rare event that you are dissatisfied with your new look. The effects of Botox®/Dysport® generally last 3-4 months and will wear off as time goes on.
How long does my filler treatment last?
There are many different types of filler products available, each with its own duration of action. Some fillers are temporary while others are permanent. In general, the temporary fillers last between 3 months and 2 years depending on the specific product. You will need to discuss this with your surgeon to develop a treatment plan that works for you.
Are fillers safe?
While any injectable treatment carries some risk, most filler products are very well tolerated and safe when used for cosmetic enhancement. There have been reports of adverse sequelae after filler treatments, but most fillers carry few risks.
Where should fillers be injected?
Filler injections can be used to treat wrinkles all over the face. Some wrinkles may also be amenable to treatment with Botox® (see “What are the differences between Botox® and fillers”). Additionally, both shallow and deep wrinkles can be treated with cosmetic filler products. Filler products are also used extensively to add volume to the face, including the cheeks and lips to give you a more youthful appearance. Your surgeon will provide you with a thorough evaluation and help you develop a treatment plan that is right for you.
What are the differences between Botox® and fillers?
Both of these injectable treatments are aimed at reducing the visibility of wrinkles in the face. However, they work differently to achieve this result. Wrinkles in the skin may be caused from the natural aging process and loss of collagen and structure in the skin, or they may be caused by muscle actions underneath the skin. Fillers work to fill in the wrinkles that are on your face all the time, whether you are moving your face or not. Botox® on the other hand, works to decrease the muscle actions underneath the skin, thereby reducing the amount of wrinkling. Fillers may also be used to add volume and fullness to the face, whereas Botox® cannot do this. Both injectable products have valuable uses and just need to be used accordingly. You may even require use of both products to optimally correct your problem.
What if I don’t like the effects of my filler treatment?
If you have chosen a temporary filler treatment (the most common type of filler used), then the effects of the treatment will diminish and go away over time. In addition, some of the more common types of fillers can be treated with a second “anti-filler” injection to make them go away much faster. However, if you have chosen a permanent filler treatment, unsatisfactory results may be harder to correct and may require excision of the product with resulting scars.
What if I don’t notice enough difference after my filler treatment?
Your surgeon will evaluate the results of your filler treatment after a week or two. If you find that there is not enough improvement, you can always have an additional treatment to supplement your results. Alternatively, your surgeon may recommend that you undergo the addition of filler treatments to treat additional persistent wrinkles (see “Different Between Botox® & Fillers).
Does it matter if the person performing my injections is a physician?
Yes. Patients should do their homework and make sure that the person injecting any medication into their face or body is a physician certified by the American Board of Plastic Surgery. While these injections are generally very safe, why add risk by having a non-physician or a non-certified physician performing the injections? At NorthShore Plastic Surgery Center, all injectable treatments are performed personally by Dr. Warner, as he feels you should expect nothing less than a board certified plastic surgeon to perform these procedures. Additionally, Dr. Warner is certified by both the American Board of Plastic Surgery and the American Board of Facial Plastic & Reconstructive Surgery, making him uniquely qualified to give you a natural and consistent result in the safest way possible.
I’ve read the term “off-label.” What does that mean?
When injectable products are approved to be used in the United States, the Food and Drug Administration (FDA) lists specific uses those products. Most injectable products have been “approved” to treat specific areas of the face, and list these approved treatment areas on the product label. However, the principle effects of the product may be the same if used elsewhere on the face. When a product is used on an area of the face not specifically listed on the FDA package insert label, the use of the product is considered “off-label.” For example, Botox®/Dysport® may only be FDA approved to treat the wrinkles in the glabella area (“elevens”), resulting in an elimination or softening of those wrinkle and improved facial appearance. However, injection of this same material around the eyes may achieve the same cosmetic effect, but has not been officially approved by the FDA for that purpose. It is acceptable for physicians to use products in an off-label manner in the United States, but you need to be informed and aware that the products are being used in this way.
