Achieving that Youthful Appearance
Botox and Dermal Fillers
When discussing facial injectables with people who come in to our office, the conversation usually starts with two questions: What exactly are injectables, and, what are their uses? The two main groups of injectables are botulinum toxins and dermal fillers. The line between botulinum toxins (the most well-known brand is Botox) and dermal fillers can sometimes seem blurred, so here is a quick primer on what they are and what they do. For clarity, from here on I’ll refer to botulinum toxins as ‘Botox’.
Botox is a natural, purified protein. The mechanism by which it works is really quite simple; when injected into facial muscles it blocks the transmitters between the motor nerves, but doesn’t actually affect the muscle itself. Once the motor nerve transmitters are interrupted the muscle cannot contract (or contract as strongly as before) which results in the skin wrinkle above the muscle smoothing out. In addition to smoothing wrinkles in the forehead, between the eyes, outside corners of eyes (crow’s feet), and around the lips, it can be used in the jaw muscle for clenching relief (TMJ), orofacial pain, some tension-type headaches, and as a complement to esthetic dentistry, e.g.; correcting ‘gummy smiles’.
Treatment time is very quick, 5 minutes or less, with no real downtime associated with it, although there are some rare possible side effects that will be reviewed by the treating physician beforehand. You may encounter some slight bruising or swelling, but this usually starts to fade in 24 hours and can typically be covered with make-up. Avoidance of alcohol, aspirin or anti-inflammatory medications for a period of time before treatment helps reduce bruising. The effects of Botox will start to be visible in 2-10 days and begins to wear off in 3-4 months. As the treated muscles regain movement, lines and wrinkles will begin to reappear and require retreatment. Over time, with each retreatment, the muscles become ‘trained’ to relax and usually either less Botox is required or treatments last longer.
Dermal fillers are smooth injectable gels made from naturally occurring hyaluronic acid. They add volume to weakened facial features and can stimulate collagen growth. Dermal fillers are all unique but all share two specific qualities. First, they plump skin and gently lift it, and second, they motivate the body to create its own natural collagen. As we age, our natural collagen and hyaluronic acid (HA) in the skin diminishes and our cells lose their ability to reproduce more of these youthful components. As this process continues, our skin starts to sag and lines and wrinkles develop. When filler is added to these areas, a lifting and smoothing effect occurs, giving our skin a more youthful appearance.
The treatment involves injecting the filler into targeted folds, lines and wrinkles. This process can be used in a variety of places. Including cheeks, mid face lines, smoker wrinkles around the mouth and the lips. Treatment takes between 30-45 minutes, depending on how many areas are treated and the amount volume loss. Results will be noticed immediately and can last from a year up to 24 months. Facial injection pain is very minimal, with the exception of the lips, which contain more nerves. As an added comfort bonus, in my office I can numb the lips, and make the experience pain free. Unlike Botox, fillers can be reversed if needed but are somewhat more apt to slightly bruise and swell in the areas injected. When the fillers start to diminish, you will need to ‘top off’ the area to maintain the youthful volume achieved at the initial appointment.
Often, patients will come in the office pointing to a specific line or wrinkle that they don’t like, but it’s best to look at the whole face and avoid treating just one line that could make the rest of the face look unnatural. Another scenario that often occurs is that someone says to me, “You’ve made my teeth look so great, now what else can you do to improve the rest of my face?” This is when my job gets really fun because I can make a great ‘frame’ around those gorgeous new teeth, completing the updated and refreshed look. Injectables are a great new tool to help people go forward in life with health and confidence.
Special tip: Schedule these procedures at least 1-2 weeks before a major social event, just to be safe.