The Fountain of Youth now comes in a vial. Of the 15.9 million noninvasive and minimally invasive procedures performed last year, botulinum toxin type A and soft tissue fillers have ranked one and two on the American Society of Plastic Surgeon’s yearly statistics report, the same top spots they’ve been in for the last 12 years. There’s no denying their popularity, but it can still be difficult to navigate the world of needles, vials and units. Firstly, it’s important to note that there are three different types of injectables: neurotoxins, hyaluronic acid fillers and collagen-stimulating (aka longer-lasting) fillers. Secondly, it’s best to go to a board-certified doctor practicing in the scope of their specialty training to help identify which injectables are best suited for each specific concern. “I’m a big believer in Malcolm Gladwell’s rule of having 10,000 hours of practice to achieve mastery in a field,” says Chicago plastic surgeon Julius W. Few, MD. “You can look on Instagram, where there are different injectors of varying experience, but sometimes they’re injecting a product under the eyes you shouldn’t put there. Ultimately, it’s not just about hype; it’s about choosing someone who has the training and expertise—a plastic surgeon, a facial plastic surgeon, an oculoplastic surgeon, or a dermatologist—that’s who you want to go to.”
Neurotoxins
These line erasers work double-duty when it comes to reducing signs of aging. By temporarily blocking nerve receptors to facial muscles, they soften the look of existing lines and wrinkles while also preventing others from forming.
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Brand Names: Botox Cosmetic, Dysport, Jeuveau and Xeomin
Treatment Areas: A saggy brow line, crow’s feet, forehead wrinkles and frown lines
What to Expect: Dysport kicks in within a day or two; Botox Cosmetic, Jeuveau and Xeomin can take three to five days. Results typically last three to four months. But, after repeated injections, results may last up to six months.
Additional Uses: Treating neck bands, excessive sweating, a gummy smile, cleavage wrinkles, migraines and TMJ. In clinical trials, many patients with depression who were treated with Botox noted dramatic improvement. “The effect may be at least partly due to a similar mechanism of action as for migraines,” says New York dermatologist Doris Day, MD. “We know that expression is tied to emotion as much as emotion is tied to expression. Using Botox to reduce sad or negative expressions can help reduce the negative or sad emotions that are connected to them.”
Average Treatment Cost: $300–$1,200 per area
Hyaluronic Acid Fillers
Lines and wrinkles, a natural by-product of aging, are caused when space is created between skin’s aging collagen and elastin fibers. Hyaluronic acid fillers work to counteract this by attracting water to the deficient areas to plump them up and restore a more youthful look.
Brand Names: Belotero Balance, Juvéderm, Juvéderm Volbella, Juvéderm Vollure, Juvéderm Voluma, Juvéderm Ultra, Restylane, Restylane Defyne, Restylane Lyft, Restylane Refyne, Restylane Silk, and Revanesse Versa
Treatment Areas: Nasolabial folds and wrinkles; volume loss in the cheeks, chin or jawline; the backs of the hands; thin lips; and under-eye hollows
What to Expect: Procedure time is around 15 to 30 minutes, depending on how many areas are being injected. There’s no downtime and recovery time can last from a few hours to a few days. Results can continue to be seen from three to 12 months depending on treatment areas.
Additional Uses: Correcting nose bumps; lessening droopy brows; adding volume to a bony chest; reducing acne scars; lessening droopy earlobes; treating foot pain; and filling in sunken temples
Average Treatment Cost: $550–$1,400 per syringe
Longer-Lasting Fillers
Also known as collagen-stimulating fillers, these provide immediate results that continue to improve over time. Formulated in a gel or water base, they stimulate the body’s own production of collagen, which provides a longer-lasting effect that adds volume and lifts the soft tissues, ultimately diminishing lines.
Brand Names: Bellafill, Radiesse and Sculptra Aesthetic
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Treatment Areas: Nasolabial folds and wrinkles; the backs of the hands; volume loss in the cheeks; thin lips; and under-eye hollows
What to Expect: Just like with hyaluronic acid fillers, procedure time is around 15 to 30 minutes, depending on how many areas are being injected. There’s no downtime and recovery time can last from a few hours to a few days. Results can last one to two years for Radiesse and Sculptra Aesthetic; and up to five years for Bellafill.
Additional Uses: Filling in nose depressions and sunken temples; reducing acne scars; and correcting nasal asymmetries
How They Differ: In addition to longevity, results aren’t immediate and can be less predictable than with hyaluronic acid fillers.
Average Treatment Cost: $550–$1,000 per syringe
Fat Transfer
Fat transfer is a filler technique that removes fat using a small amount of liposuction from a selected area of the body and then re-injects it into the face, hands or other treatment sites. This is one of the safest ways to fill skin depressions and re-contour facial lines because the filler comes directly from the patient’s body. Results are immediate and can last indefinitely because not all of the fat is reabsorbed. According to La Jolla, CA plastic surgeon Robert Singer, MD, “generally about 30 to 50 percent of the injected fat lasts permanently. Long-term, fat injections are usually more cost effective than other fillers and tend to improve the quality of the skin.”
A Customized Approach
There is no one-size-fits-all formula to aesthetic injectables. Combining procedures is often the best way to achieve the “filtered” appearance most patients want. “If someone has a moderate degree of volume loss, as well as frown lines on their forehead, then using a form of botulinum toxin type A with filler can create a more balanced result,” says Dr. Few. “Injectors can use the appropriate combination of all the tools in their toolbox, whether it be a neurotoxin, filler, or even a fat melter like Kybella under the chin, to create the best result that takes away distracting issues in the neck, allowing the viewer to focus on the face.” At New York plastic surgeon Z. Paul Lorenc’s practice, less-frequent visits for injections is what’s trending with his patients: “The combination of Bellafill and fat transfer gives a really beautiful, long-lasting result.” New York oculoplastic surgeon Irene Gladstein, MD says, “Trust your doctor. Appropriately spaced, creatively combined and masterfully executed procedures are all integral to creating the most natural-looking results.”
On the Horizon
There are currently only a handful of brands offering neurotoxins, but that may be changing. “Newer neurotoxins have claims that they are longer-lasting, and only time will tell,” says Boca Raton, FL oculoplastic surgeon Steven Fagien, MD. “Hopefully, the competition with the newer products will not only allow more choices, but also stabilize and perhaps lower the price, ultimately to the consumer.” With the growing number of options, choosing the right physician is paramount. “New, improved fillers are coming to our market and will continue to expand the growing portfolio of hyaluronic acid products, while the choice of neurotoxins will be more vast in the near future as well,” says Dr. Gladstein. “Overall, picking the provider that will filter through new products and innovative options and guide you through the protocols that work the best for you will give you the best results.”
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Techniques used to administer injectables are also evolving. “Using microcannulas to creatively apply volumizing agents is currently revolutionizing the aesthetic industry,” Dr. Gladstein says. In addition, some injectables can be placed under the muscle in the lower third of the face, as opposed to just in the skin. This deeper injection extends the life of the filler because the body does not metabolize it as quickly. Dr. Fagien adds, “I’ve done research with Allergan that has shown that some hyaluronic acid gels with specific injection technique showed dramatic and sustainable improvement of skin collagen, elastin, and generalized moisture and elasticity.
