A Plastic Surgeon Says This Is What to Know About Injectables and Fillers Before, During and After Treatment

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According to Boston plastic surgeon Joseph A. Russo, MD, the main reason that faces start looking older is volume loss. As he explains: “In the face we have three areas of loss: bone, subcutaneous fat and loss of skin thickness and elasticity. As the skin thins and loses support from below, we see wrinkles and sagging.”

So what can we do to slow it? “Using fillers addresses the loss of subcutaneous fat, and helps to thicken the skin,” Dr. Russo says. “When used in conjunction with neuromodulators [Botox, Dysport, Xeomin, and Jeuveau], which relax the muscles responsible for creating wrinkles, we can turn back the hands of time, at least temporarily. These treatments need to be repeated with some regularity as the process of aging never stops.”

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Sounds straightforward, but when you’re sitting in that plastic surgeon’s or dermatologist’s chair—or just thinking about making the step to get there—there always seem to be questions swirling. Here, Dr. Russo breaks down what he shares with patients before, after and during injectable and filler treatments to keep them in the know:

Dermal Filler: During + Immediately After Treatment

  • Filler is injected into the skin to soften wrinkles or folds by adding volume.

  • Most patients report mild discomfort typically associated with needle injections. Bruising at the site of injecting is a commonly reported side effect. 

  • To minimize bruising, inform your provider if you use blood thinners such as Ibuprofen, Aspirin or herbal supplements such as vitamin E, fish oil or excessive alcohol use.

  • You may temporarily experience minimal to moderate swelling following treatment. This should dissipate following injection. 

  • It is normal to experience some tenderness at the treatment site for a few days.

  • It may be normal to feel a "firmness" in your treated area(s) for the first few days after treatment, and then soften and settle, leaving you with a soft, natural looking result.

Dermal Filler: Post-Treatment Instructions

  • Application of an ice pack to the injection area after treatment may reduce bruising and swelling. 

  • DO NOT apply the ice pack for more than 10 minutes at a time.

  • DO NOT rub or massage the treated area.

  • Avoid strenuous exercise or activity for 24 hours. You may resume other normal activities and routines immediately after.

  • You may wear makeup after 24 hours and once any pinpoint bleeding has subsided.

  • Avoid drinking alcohol for a minimum of 24 hours as this may contribute to bruising and or swelling.

  • Avoid extended UV exposure until any redness or swelling has subsided. Be sure to apply an SPF.

  • Dr. Russo recommends you wait a minimum of two weeks before receiving any skin-care or laser treatments.  

What to Expect Following a Neurotoxin Treatment

  • Results may be seen in as early as two days but may take up to 14 days to see the full results.

  • 10 percent of people may not respond to neurotoxins for unknown reasons.

  • You should "exercise" the treated areas for 90 minutes on and off after the injections.

  • You should remain upright for four hours after being injected. No exercise for four hours. Do not wear any hats or headbands for 24 hours and do not massage the treated area.

  • Results may last for two-to-six months.

  • You may apply ice and Arnica to help prevent bruising, pain and swelling.

Possible Side Effects and Less-Common Complications for Neurotoxins and Dermal Filler

  • Side effects associated with the injection include; localized pain, infection, inflammation, tenderness, swelling, redness, bleeding, and bruising.

  • Less common reactions may include; nausea, fatigue, flu-like symptoms, headache, excessive weakness of the muscle, temporary eyelid dropping, and temporary brow dropping.

  • Infection at the injection site, asymmetry, bleeding, bruising and swelling, skin rash, under or over-correction and vascular occlusions.