Injectables & Fillers for Lip Enhancement

Brand to look for: Kybella

Kybella, a type of deoxycholic acid that’s found naturally in the body, permanently dissolves fat when injected in strategic places under the chin. Instead of cutting or sucking out excess chin fat, patients can go to their dermatologist or plastic surgeon for this five-minute procedure that delivers the same results. Just like this natural acid breaks down dietary fat, Kybella causes those cells to burst and reabsorb back into the body. Reported side effects were bruising, swelling and temporary numbness and recovery time is between two to three days. Although Kybella is only FDA-approved for the chin area, it has made its way off the face and onto the body and is now being used off-label to treat fat on the inner thigh.

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.

Taking a preventative approach that includes 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 a loss of fat and decrease in collagen and elastin levels can be minimized. Lifestyle choices like diet, smoking, pollution 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 facial lines and wrinkles to provide better results using injectable solutions like neuromodulators such as Botox Cosmetic, Dysport and Xeomin, 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. Injectables have come a long way in preventing and reversing the visible signs of aging, with or without surgery. And, just about everybody can benefit from an injectable at some point in time to help keep themselves looking young.

Another benefit to injectables: their 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.

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 neuromodulators, such as Botox Cosmetic, Dysport and Xeomin, prevent the muscle contractions that lead to etched lines.

This “mix-and-match” approach of using an assortment of fillers and injectables is gaining popularity, and studies have shown that using neuromodulators 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.

Brands to look for: Botox Cosmetic, Dysport, Xeomin

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 Cosmetic 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 Cosmetic is a household name.

Botox Cosmetic, Dysport and Xeomin are injectable solutions known as “denervating agents”, “neuromodulators” or “neurotoxins” that temporarily block nerve receptors on the muscle, which helps prevent lines and wrinkles from forming. Neuromodulators have many cosmetic applications that help reverse various signs of aging like the appearance of deep lines and wrinkles, eyebrow and frown lines and crow’s-feet around the eyes to name just a few. 

Beyond treating expression-related creases, physicians currently use Botox Cosmetic, Dysport and Xeoin 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 Cosmetic 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 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 Cosmetic, 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 Cosmetic 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. Neuromodulators 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.  

Brands to look for: Belotero Balance, Juvederm, Juvederm Volbella, Juvederm Voluma, Juvederm Vollure, Juvederm Ultra, Restylane, Restylane Silk, Restylane Refyne, Restylane Defyne, Restylane Lyft

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 hyaluronic acid fillers carry some risk of bruising, lumpiness, redness, product specific adverse reactions and in rare cases local infections.

Our natural levels of hyaluronic acid decline with age due to exposure to free radicals and the aging process in general, 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.

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. In the event that you’re not happy with the results, the treated areas can be injected with hyaluronidase to dissolve the filler.

Hyaluronic acid fillers contain lidocaine to reduce pain. Before the approval of Juvéderm XC and Restylane-L, doctors found themselves mixing in lidocaine, or injecting it into the patient, to make the procedure more tolerable. One advantage to fillers now containing lidocaine is that not as much anesthetic needs to be injected 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 are being corrected. 

Brand to look for: Sculptra Aesthetic

Sculptra Aesthetic is a long-lasting filler 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 also restore fullness to the cheeks and mid-face.

Brands to look for: Radiesse, Bellafill

Radiesse consists of calcium hydroxylapatite microspheres suspended in a polysaccharide (sugar-based) gel carrier and can be injected into a multitude of different area including the smile and marionette lines, the corners of the mouth, the pre-jowl fold, chin wrinkles and the hands. The filler is broken down by the body in two phases, first the carrier and then the spheres. During this process, there is an immediate improvement in volume although 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. 

Bellafill is a collagen-based filler (it contains polymethyl methacrylate (PMMA) microspheres) used to correct both smile lines and acne scars. For lingering acne scars, Bellafill adds volume to them, bringing them to the level of the surrounding skin and keeping the skin like that for one year. It’s also the first and only injectable filler that's FDA approved to treat acne scars. Once Bellafill has been injected there is an immediate improvement in volume to correct wrinkles and acne scars. The injected microspheres stay in place to create smoother skin for up to 12 months; 5 years in smile lines. 

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. 

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.

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

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 Cosmetic 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.

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

Post-procedure you can expect minor 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 a few months to a couple of 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. Another word to the wise: An excess amount of fillers can result in an unnatural appearance.

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.

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.

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.