Injectables And Fillers

Quick Facts About Injectables And Fillers

Average Cost: Starting at $400
Procedure Time: Several minutes to an hour
In/Outpatient: Outpatient
Anesthesia: Local or topical
Recovery Time: 0-10 days
Duration of Results: 3-12 Months
Financing Available. Apply Now
What you should know

What Are Injectables And Fillers

The facial aging process varies from person to person.  The main causes are changes in bone density, loss or displacement of fat and the break down of collagen and elastin.

Anti-aging prevention coupled with minimally invasive facial cosmetic treatments and surgical procedures can be your key to lessening the signs of aging. While some factors, like bone changes, can’t be prevented, others like fat, collagen and elastin loss can be minimized. Lifestyle choices like diet and sun exposure can impact how quickly these factors come into play.

Today, doctors have a better understanding of what causes facial aging, and are able to address signs of aging like nasolabial folds, volume loss and deep facial lines or wrinkles to provide better results using injectable solutions like Botox or Dysport, hyaluronic acid fillers, collagen-based stimulators and fillers, and even naturally injected fat.

The injectable revolution is a driving force behind the increase in noninvasive cosmetic treatments, and advancements in the use of injectables have come a long way in preventing and reversing the visible signs of aging, with or without surgery. New York City and Miami, FL, dermatologist Fredric Brandt, MD, says, “Everybody can benefit from an injectable at some point in time to keep looking young.”

“Injectables can offer instant results, which is a major draw for many consumers; many patients don’t want or can’t afford the downtime that comes along with surgery,” says Palm Beach, FL, dermatologist, Layne Nisenbaum, DO.

Today’s injectable menu offers a wide array of products to address not only the wrinkles themselves, but the muscles that cause lines and furrows to form. Injectable fillers plump up wrinkles while denervating agents, such as Botox and Dysport, prevent the muscle contractions that lead to etched lines.

This “mix-and-match” approach is gaining popularity, and studies have shown that using denervating agents in conjunction with fillers can lead to longer-lasting results, since impairing the muscle function around the areas treated with fillers can slow the reabsorption of the product.

Neurotoxins

Doctors began to explore the medical uses for the family of neurotoxins called Botulinum Toxin type A as early as the 1950s. The first study to demonstrate its therapeutic value was published in 1973; it was first tried on humans in 1979.

Botox received FDA approval for the treatment of misaligned eyes, facial spasms and uncontrollable blinking in 1989, but it wasn’t until 2002 when Botox Cosmetic® was approved as a cosmetic treatment for improving facial frown lines and wrinkles.

Today Botox is a household name.

Botox and Dysport are injectable solutions known as “denervating agents” that temporarily block nerve receptors on the musclewhich helps prevent lines and wrinkles from forming. Botox has many cosmetic applications that help reverse various signs of aging like the appearance of deep lines and wrinkles, nasolabial folds, frown lines, and crow’s-feet around the eyes to name just a few. 

Beyond treating expression-related creases, physicians currently use Botox and Dysport for a wide variety of FDA-approved aesthetic and medical treatments—from excessive sweating (hyperhidrosis) and alleviating TMJ (temporomandibular joint) disorder, to chronic migraine headaches or as a nonsurgical wrinkle relaxer.

New uses continue to be discovered. These innovative uses are best left to experienced injectors, since they are extremely technique-dependent and there’s a higher risk of adverse effects.

Botox is manufactured in the U.S. by Allergan, Inc. for both therapeutic and cosmetic use. Other Botulinum Toxin type A denervating agents available in the U.S. and approved for therapeutic and cosmetic use include Xeomin (manufactured in Germany by Merz—it was launched in early 2012), and Dysport (from Ireland).  

These nonsurgical injectables are FDA approved to aesthetically treat frown lines between the eyebrows. Off-label, Botox, Dysport and Xeomin are used for treating crow’s-feet, horizontal forehead lines, down-turned corners of the mouth and skin bands on the neck. All have minimal downtime and results generally lasting about three to six months, with Botox typically delivering results lasting from three to four months; Dysport, up to four months; and Xeomin, up to three months, however, the effect may last significantly longer, or shorter, depending on the patient. Results are typically visible in a few days, but it may take upward of a week for the final results to be noticeable—the effects of Dysport are said to take effect quicker. Denervating agents are not permanent solutions—you will want to repeat treatments every three to four months.

Your doctor may choose to use them in conjunction with a filler to provide the best results. 

Hyaluronic Acids

Injectable fillers are a rapidly expanding approach to treating facial aging (such as nasolabial folds) and firmly established wrinkles.  Fillers restore volume and can add structure depending on the type of filler used and the depth of the dermal injection.  All of these injectable fillers carry some risk of bruising, lumpiness, redness, product specific adverse reactions and in rare cases local infections.

Levels of hyaluronic acid decline with age due to exposure to free radicals, and women over 50 are estimated to have half the hyaluronic acid they had in their youth. With the ability to hold up to 100 times its own weight in water, hyaluronic acid (a sugar found naturally in human skin) is responsible for retaining moisture in the skin. Hyaluronic acid binds to water similar to the way a sponge absorbs water.  Because of this, it hydrates the skin in the treated region. Hyaluronic acid fills the space between collagen and elastin fibers, enhancing the skin’s plumpness.

Kansas City, MO, dermatologist Audrey Kunin, MD, believes that at the very least, hyaluronic acid is a “wonderful moisturizer.” Washington, DC, dermatologist Tina Alster, MD, agrees, adding, “Hyaluronic acid is a natural substance in the skin that serves as a superior hydrator. It feels light on the skin and will not clog pores, so it’s good for oily or acne-prone skin, as well.”

After treatment, you may experience swelling, bruising or even discoloration, all of which will subside after a few days. A major benefit of this filler class is that allergic reactions are extremely rare and no pre-treatment skin testing is necessary. The body eventually absorbs hyaluronic acid fillers. You can expect results to last anywhere from three to 12 months depending on treatment area. 

Hyaluronic acid fillers contain lidocaine to reduce pain. Before the approval of Juvéderm XC, Perlane-L and Restylane-L, doctors found themselves mixing in lidocaine, or injecting it into the patient, to make the procedure more tolerable. “One advantage to these new fillers is that we may not need to inject as much anesthetic into the patient before using the filler. Injecting the area to be treated with anesthesia can cause some swelling and distort the creases and folds that we’re correcting,” says West Palm Beach, FL, dermatologist Kenneth Beer, MD. 

Collagen Boosters

Sculptra Aesthetic is long-lasting because the microscopic particles in the filler stimulate collagen production within the skin. This boost in collagen is essentially an immune reaction to the filler that helps plump the area injected from within. Sculptra Aesthetic can last anywhere from 18 to 24 months, but it’s important to know that most patients require an average of three treatments spaced three to four weeks apart to achieve optimum results. Using a combination of different injectables, aging cheeks, under-eye hollows, nasolabial folds and thin lips can be addressed. “Sculptra Aesthetic, used off-label, can restore fullness to the cheeks and mid-face; Restylane can create smoothness around the eye and the tear-trough area between the eye and the cheek,” says New York facial plastic surgeon Minas Constantinides, MD. 

Longer-Lasting Fillers

Radiesse, which is currently used off-label for cosmetic purposes, consists of calcium hydroxylapatite microspheres suspended in a polysaccharide (sugar-based) gel carrier. The filler is broken down by the body in two phases, first the carrier and then the spheres.  During this process, collagen in-growth occurs, which is expected to provide a long lasting effect.  This prolonged degradation process makes Radiesse a longer lasting filler than those previously discussed, with expected results lasting a year or more.  

Artefill is a filler made of a collagen gel and microspheres of non-absorbing polymethylmethacrylate.  The collagen component has absorption characteristics similar to other collagen-based fillers, but the microspheres cannot be degraded by the body.  This type of filler is permanent; it is important to seek treatment with an experienced injector. Reported to last two to five years (as opposed to months) Artefill is not for lips, fine lines or areas of high mobility.  It’s best suited for deeper filling and shaping of creases and curves.


Fat Transfer

Fat transfer is a filler technique that removes fat using liposuction from a selected area and reinjecting it into the face, hands or other treatment sites. This is one of the safest ways to fill skin depressions and recontour facial lines because the filler comes directly from the patient’s own body.

Results are immediate and can last indefinitely because fat is re-absorbed. 

Are these treatments for me

Injectables are an enormous area of cosmetic medicine and with their explosive growth, concerns about unqualified injectors and illegal, unbranded injectables have increased. In an effort to protect and educate consumers, the Physicians Coalition for Injectable Safety has united most of the premier aesthetic medical societies—the American Society for Aesthetic Plastic Surgery, the American Academy of Facial Plastic and Reconstructive Surgery, the American Society for Dermatologic Surgery and the American Society of Ophthalmic and Plastic Reconstructive Surgery—with one simple message: Injectables are not cosmetics.

Atlanta plastic surgeon and current president of the American Society for Aesthetic Plastic Surgery, Foad Nahai, MD, says, “If we can educate the public by providing this information, it will go a long way toward assuring their safety. In this changing world, the safety of the public and our patients is a prime responsibility.”

Who they are for

The best candidates for injectables and filler treatments are men and women who are physically healthy, psychologically stable and realistic in their expectations. A typical Botox patient may once have been over the age of 30 but more men and women are deciding to have this procedure at a younger age in order to prevent premature wrinkles from appearing

Who they are not for

If you suffer from severe signs of aging, like extreme skin laxity, then a traditional facelift is most likely a better alternative.

What to Expect

Injectables are simple procedures compared to surgery because there is little to no downtime. While it produces beautiful results it isn’t as permanent as surgery either.

Know your injector

There is a serious level of skill required with injectables to achieve beautiful results. There are also serious risks if administered incorrectly. Choose only a board-certified plastic surgeon, facial plastic surgeon, dermatologist or oculoplastic surgeon. A specially trained registered nurse (RN), certified registered nurse (CRN) or physician’s assistant (PA) working under the direct supervision of one of these physicians is also an acceptable choice. An aesthetician, hair stylist, cosmetologist or other medical professional is not qualified to perform injections under any circumstances.

Know your injectable or filler

Only U.S. FDA-approved injectables defined by brand name should be used. Off-label use of injectables for applications similar to FDA-approved uses is acceptable as long as you know the risks. In either case, complete informed consent (a document that spells out the use of the injectable and potential risks) should be included. Clinical trials for injectables pending FDA approval may also be considered, but remember a formal process of informed consent and research protocols, as well as obligations, must be defined before you agree to participate. You should never accept a “lower-cost” equivalent that is imported, unlabeled, undefined and is not FDA approved.

Make an informed Decision

Injectables are a great way to improve the signs of aging and enhance your natural features. A cosmetic treatment using injectables and fillers is a serious decision. You may regret an impulsive decision. If you feel hesitant about the capabilities of the injector, about the injectable, or about your health, safety and results, don’t chance it.

Trust your doctor’s office

The only place you should consider having injectable treatments performed is in your doctor’s office. Medi-spas within a physician’s office, adjacent to a physician’s office, or wholly-owned and operated facilities by a properly core-trained physician with that physician’s on-site oversight can be safe and appropriate.

Spas and salons are not medically equipped for routine injections or for emergency procedures in case you are injured or suffer a health complication. They are not required to follow medically defined sterility and health standards and they are not supervised by an on-site doctor who takes full responsibility for your results and your health.

Post-Treatment Care

It’s likely that your doctor will first administer a nerve block or apply a numbing cream. Some of the longer-lasting and more permanent fillers and injectables contain lidocaine, “making them pretty painless after the first injection or so,” Dr. Minas Constantinides says. Your doctor may suggest you avoid taking aspirin, as well as other medications, a few days before.

Post-procedure you can expect swelling, redness and bruising, which can last from a few hours to up to a week or more. Once the swelling and bruising go down you’ll be able to see the results right away, but it may take a week or so for the filler to fully settle in. “Even though the results can last anywhere from four months to two or three years—depending on the fillers used and maintenance work—it’s important to realize the limitations of injectables and fillers. While they can provide fullness, they can’t lift or tighten sagging skin,” explains Dr. Minas Constantinides. Another word to the wise: An excess amount of fillers can result in an unnatural appearance.

Inside Tips

  • Avoid vitamin E, St. John’s Wort, ibuprofen, aspirin and other anti-inflammatory medications for 10 days to two weeks before your injections. This will reduce the potential for bleeding, swelling and bruising.
  • If you are seeing a new physician, it is important to notify your injector of the last time you had any injections, what was injected and specifically where. Not all injectables mix well; so avoid a problem by being thorough. And, if Botox is repeated in less than a 90-day cycle, you may develop antibodies or risk ptosis (a sagging of the injected muscle).
  • Don’t undergo injections if you are intoxicated or under the influence of any controlled substance. There is no such thing as a safe Botox party.
  • If you are prone to cold sores, notify your doctor in advance; a prescription for Valtrex or other anti-herpes medication can prevent a potential post-injection outbreak.
  • With the exception of Botox and collagen, don’t plan your treatment within a few days of an important event; you may have visible swelling and bruising, even with the help of a great concealer.

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