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Injectables – What they can do for you

Nobody needs to know. This can be your best kept secret. The secret that keeps you young and beautiful.

One of the most commonly performed cosmetic treatments involves the use of injectable products. There are a wide variety of products that fall into this category. The two most common types of injectable products include neuromodulators and fillers.

The neuromodulators include one of the most widely known products, BOTOX ®. Other products in this same category include Dysport ® and Xeomin ®. For the most part, these treatments achieve a particular result that nothing else, including surgery, can do. And they can be an excellent complement to the results achievable with surgery. The way they work is by selectively inhibiting the activity of the muscle they are injected into. The results start to become noticeable in a few days, reach maximum effect in about 1-2 weeks, and last for 3-4 months.

As a facial plastic surgeon, I take advantage of these properties to weaken the activity of specific muscles in the face that are creating wrinkles from over activity. By inhibiting the muscles, they stop the ability of those muscles to produce a wrinkle. For my younger patients without the wrinkle present at rest, they can help to prevent that wrinkle from ever developing. Once the wrinkle is present at rest, then BOTOX ® and the other drugs in this class can help that wrinkle from getting worse and soften the appearance.

When it comes to the indications for these treatments, there are both on label uses and off label uses. What on label means is that there is a scientific study assessing the treatment for that specific area. An off label use means your treating physician knows how the product works and uses those properties to treat other areas, although no specific study has been done to verify that. Having been around for such a long period of time, many of the uses of neuromodulators are off label. The three most commonly treated areas include the area between the eyes (the glabella), the forehead, and the crow’s feet or wrinkles on the outsides of the eyes. The right dose can really help to soften the wrinkles, removing what some refer to as a less than pleasant resting face or angry appearing face.

In addition to the commonly treated areas, there are many other areas that BOTOX ® can be used to treat. For those patients who tend to wrinkle their nose when they smile, a few units can help these “Bunny lines.” Other patients tend to overuse the muscles of the chin which creates a dimply appearance. This is known as a peau d’orange or orange peel appearance. A few units into select muscles can remove these dimples. For those whose corner of the mouth turns downwards, selectively treating the muscle pulling the corner down can help to turn that frown upside down. A less common treatment for BOTOX ® is to help shape the jaw line. In some people they have over activity of one of the muscles that helps to close the jaw, called the masseter muscle. When this muscle is enlarged it creates a fullness at the bottom and back area of the jaw. Treatment with neuromodulators helps to weaken the muscle, and with enough treatment, shrink the muscle.

For those who are concerned about neuromodulators, I always remind my patients that these are used in much higher doses for non-cosmetic purposes all over the body. This includes treating migraine headaches, overactive bladders, excess sweating, eye lid twitching, and even scar improvement. And despite how they are commonly portrayed in Hollywood, the right treatment does not lead to an artificial or frozen appearance. Although they are not for everyone, for the right patients, as determined with an in person examination assessing not only your anatomy but your medical history, they can be an excellent treatment.

Now one thing that neuromodulators do not do is help with the volume loss that occurs with age or the loss of elasticity of the skin. This is important as many patients walk into my office and point to their entire face, lifting it up, indicating they just need some BOTOX ® to help lift everything. Although surgery is the gold standard for lifting and restoring volume, the other major class of injectables, known as fillers, can be very effective for those who don’t want surgery or are not appropriate surgical candidates.

The most commonly used class of fillers is the hyaluronic acid, or HA, based fillers. The nice thing about HA is that it is naturally found in the body, so the risk of any reaction is quite low. Furthermore, there is a separate product called hyaluronidase that can be injected, on the off chance you didn’t like the result, to completely remove it. It is nice to know there is this “parachute” out there for anyone who has been thinking about trying fillers but worried she wouldn’t like the result. And just as the neuromodulators had many off and on label uses, so do fillers.

One of the early signs of aging is the development of creases around the mouth. These are known as the melolabial (or nasolabial) folds which extend from the nose to the corner of the mouth, and the marionette lines going from the corner of the mouth towards the jaw. These areas develop these creases because as the volume of the cheeks begins to fall, there are attachments to the skin in those creases that don’t move. To treat these areas, you can go at the sign of aging and inject filler directly into the creases, or you can help to restore volume to the cheek and cheek bones by injecting the filler higher up to lift the cheek and soften the creases. In either scenario, fillers can do an excellent job softening these early signs of aging.

The lips are another commonly requested area to inject. Lip injection patients usually fall into one of two categories—those looking for a fuller lip and those looking for improved definition of the lip border and helping to minimize lip stick bleeding without wanting more fullness. As a facial plastic surgeon, I can take advantage of different properties of different fillers to help achieve the desired goals without creating an overdone or “duck lip.” It is quite easy to spot the overdone look, but most people would have no idea those who are treated appropriately have received any treatment, as the results are natural appearing.

One area that is quite delicate to treat is the tear trough, or the area below the eyes. This can become noticeable in those who have eye bags, hollowing around the eyes, or those who have cheeks that have fallen. Given the thinness of the skin in this area, it is always recommended that only very experienced injectors treat this area. In the right hands, for the right patient, amazing results can be achieved. For the novice injector, it is an area prone to irregularities and patient dissatisfaction.

For more superficial lines around the face, more mobile areas, weak chins, hollowing in the temple areas, etc., HA fillers can also help. All in all, there are many different HA fillers. The reason there are so many is they have different characteristics including how much water they absorb after injection, how closely the particles stay together, and how flexible the particles are. This in turn affects how long they last, how superficially they can be injected, and how much fullness they can achieve up to two weeks after injection. As a facial plastic surgeon I take advantage of these different properties to customize a treatment for the individual patient based on his or her anatomy and desired outcomes.

As you can see, there are many options available for injectable facial rejuvenation. Neuromodulators and fillers can help you maintain a more youthful appearance and even compliment surgical results. In order to learn what is best for you, I recommend you consult with a facial plastic surgeon who performs his or her own injections. This way you can learn the various surgical and non-surgical/injectable options to make sure your final aesthetic plan is what is best for you.


If you are ready to unleash your beauty, contact
W. Marshall Guy, MD
Facial Plastic & Reconstructive Surgeon
128 Vision Park Blvd., Suite 150
The Woodlands, TX 77384
832.956.1040 |

Category: BELLEZA