Dr. Megan Jack - Board-certified Plastic Surgeon in Knoxville, TN
Despite aesthetic injectables being VERY commonplace now, there is often still confusion for many patients on the difference between Botox and Fillers. Let’s walk through exactly what Botox® and fillers are and what they can (and can’t) accomplish with respect to your cosmetic goals.
"A common misconception is that Botox and fillers make you look fake."
As we mature (who really loves to see that word age?), we start to see lines, skin laxity and descent, and volume loss. These unwelcome changes develop due to natural changes in our body that happen to ALL OF US—yes men, you too. Three main factors contribute to an aging appearance of the face:
1. Thinner, damaged skin
2. Loss of natural, youthful fat
3. Bone resorption
We can help slow the process of some of these things—namely the changes specific to the skin (check out my blog 10 Skin Tips for 2021 to see what you can do). There are also interventions along the way that your friendly neighborhood Board-Certified Plastic Surgeon can help with--Botox® and injectable fillers.
2 Types of Facial Wrinkles
There are two basic types of wrinkles we see on the face—I describe them as dynamic and adynamic wrinkles. Dynamic wrinkles are the ones that we see mostly when we move or animate the muscles of our face (i.e. raising and/or furrowing the eyebrows, squinting the eyes, pursing the lips, wrinkling the chin, tensing the neck muscles). These muscles are attached in certain locations to our skin. Each time we use the muscle it pulls on those attachments at the same location and over time causes creasing--similar to you wadding up a piece of paper then trying to smooth it out over and over. As time goes on, those creases will become deeper and can even become more permanent, static wrinkles.
Adynamic wrinkles are the ones we see when our face is at rest (i.e. laugh lines, marionette lines, etc.). Adynamic wrinkles are due to volume (fat) loss in the face and/or from that chronic crinkling of the skin as we move our muscles. In addition to adynamic wrinkles, fat loss contributes to hollowing and our skin heading south . . .and it’s not just for winter.
"If I could turn back time. . ."
The cosmetic goals of Botox® and injectable fillers are to prevent, slow down, and/or reverse these uninvited aging annoyances. However, Botox® and injectable fillers are NOT interchangeable—they do completely different things. That being said, they ARE absolutely complementary and can be used together or independently to create a natural, rejuvenated face. As Cher so famously sings, “If I could turn back time” – well Cher, as you well know . . . we can do just that.
Botox® (Allergan Aesthetics) is one of now four FDA-approved injectable medications that belong to a family called “toxins”. We really don’t particularly like the word toxin because it can be misconstrued and confused with “toxic”, which they definitely are not. We prefer the more current terminology of neuromodulators. Neuromodulators are precisely used by cosmetic injectors to target the DYNAMIC wrinkles by blocking muscle receptors to nerve stimulation that causes movement. In doing so, it relaxes the muscles that cause dynamic wrinkles causing softening and often removal of those lines. Started early enough, it can also prevent them from even developing in the first place. Neuromodulators come in VIALS and are injected in UNITS. Key points to know about neuromodulators:
- DOES temporarily treat wrinkles that result from muscle movement
- DOES NOT plump and fill
- Most common treatment areas: forehead, glabella, crow’s feet, smoker’s lines, neck bands (some of these are on label and some off label uses)
- Initial results are seen in most cases by 1-2 weeks post-treatment
- Effect is dose dependent (see below)
- Results last on average 3-4 months
- Effect can’t be reversed – time has to run its course
- Number of units required is individualized at each treatment session to reach your desired goals and depending on the strength of your muscles
One common MYTH about Botox® is that it will “freeze” your face or leave you looking surprised all the time. While this is certainly possible, it doesn’t HAVE to be that way. Neuromodulators are “dose dependent” meaning if we inject a little bit, we get some relaxation and softening of the muscles. If we inject a lot, we can get complete paralysis of that muscle leaving no movement. For most, the ideal natural sweet spot is to find that balance of enough product to get rid of or significantly reduce the appearance of wrinkles while still leaving some movement so you can still show your kids how angry you are when they act up. LOL
FDA-approved neuromodulators currently used in the US and available at ETPS:
Botox® (Allergan Aesthetics)
Dysport® (Galderma)
Xeomin® (Merz Aesthetics)
Jeuveau® (Evolus)
Injectable fillers are a family of FDA-approved injectable gels precisely used by cosmetic injectors to fill lines and hollows, lift, and provide volume to the face. There are a few subtypes of fillers but the most commonly used are those made from hyaluronic acid or HAs. In a nutshell, hyaluronic acid fillers are synthetic versions of the hyaluronic acid we naturally have in our skin/soft tissue. Other filler types aside from HAs may include calcium-based, PLLA, etc. Fillers treat ADYNAMIC wrinkles we see at rest and areas where we see hollowing from volume loss . . .or generally to augment areas that we simply want fuller and more plump. Fillers generally come in SYRINGES and are injected as such. Key points to know about HA fillers:
- DO temporarily plump and fill
- DO NOT affect or relax muscles
- Most common treatment areas: tear troughs, temples, cheeks, laugh lines, lips, marionette lines, chin, pre-jowl hollowing, jawline, hands (on/off label use depends on the specific filler)
- Initial results are seen immediately
- Effect is dose dependent (see below)
- Results last on average 6-18 months
- Can be dissolved if necessary (HAs)
- Number of syringes required is individualized at each treatment session to reach your desired goals and depending on the degree of volume loss and skin laxity
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One common MYTH about fillers is that they will leave you with an over-filled, over-done, fake look or duck lips (quack quack). Again, it’s certainly possible and man have I seen it out there BUT the effect of fillers, similar to neuromodulators, is dose dependent. You put in enough and you get a fuller, softer, NATURAL, more youthful face. You put in too much and well . . .you’ve seen those bad filler social media posts. Yikes. The key for us cosmetic injectors is counseling our patients on what is realistically possible and whether or not that aligns with our patients’ goals. There comes a breaking point when putting in filler becomes ridiculous, and we have to let you know that you really just need something surgical to get a natural, rejuvenated result.
FDA-approved injectable fillers currently used in the US and generally available at ETPS:
Juvederm® family (Allergan Aesthetics)
Restylane® family (Galderma)
Sculptra® (Galderma)
Radiesse® (Merz)*
RHA Collection (Revance)*
*Coming soon or available upon specific request as of the time of this article
"Consistent, longer-term use is more effective"
These products are not permanent, and maintenance is suggested to maintain your goal look and to stave off that beastly aging. Experienced injectors will tell you that consistent, longer-term use of neuromodulators and fillers will be more effective for anti-aging AND eventually less product will generally be needed to achieve the result you want. That being said, they don’t always prevent and certainly don’t take the place of surgery when it’s indicated. The duration of effect certainly varies by individual and is absolutely impacted by your body’s natural metabolic rate. Each specific neuromodulator and filler has its differences and idiosyncrasies—your best bet to find out which product(s) to use, which area(s) to treat, and how many units or syringes you’ll need is to schedule a consultation with ETPS or a board-certified plastic surgeon or dermatologist near you.
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Your ONLY male and female board-certified plastic surgeon team in Knoxville, TN.
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If this has raised questions or you’ve heard other things about neuromodulators/fillers that you’d like us to comment on or myth-bust send us an email or comment on this blog post on Instagram or Facebook. If you’d like to schedule a consultation for injectables at ETPS or have other questions, please visit our website or give us a call!
#staybeautiful #boardcertified
Dr. Tim Wilson and Dr. Megan Jack are board-certified Plastic Surgeons in East Tennessee. They offer the only male and female plastic surgeon team in private practice in Knoxville to give you the option for both perspectives and for your comfort. They offer East Tennessee over 35 years of combined experience in cosmetic and reconstructive surgery. Both doctors are passionate about delivering top-notch care and the best results possible.