Neuromodulator vs Fillers
Injectables fall under two categories. One is used to help with dynamic wrinkles- on the forehead, between the eyes (11 lines), crows feet (around the eyes) and are referred to as Neuromodulator agents. The other is used to fill in hollows (volume loss) in the nasolabial lines, marionette lines, cheeks and lips and are referred to as Fillers.
Neuromodulator agents, aka wrinkle reducers are developed around the botulinum toxin molecule. Botulinum Neurotoxins have been used since 1997. They are extremely safe with over 6 million injections being performed in the US per year. Common brands of neurotoxins include Xeomin, Dysport and Botox. They work to smooth away wrinkles by stopping or relaxing the facial muscle movements that cause them. Botox Cosmetic has been used in the United States since it was approved by the FDA in 2002. The formula is also used as treatment for migraines, cervical dystonia and excessive sweating (hyperhidrosis).
*Individual results may vary.
Who is it For?
Neuromodulator agents work on dynamic wrinkles, which are wrinkles that appear when certain facial expressions are formed. The injectable treatment is primarily used on the following areas:
- Glabellar Lines – Vertical wrinkles between the eyebrows (frown lines)
- Horizontal forehead creases
- Periorbital Lines – fine lines in the outer corners of the eye (crow’s feet)
- Smokers or vertical lip lines – that run vertically on the upper and lower lips
- Brow lift – strategically placed injections of botox can cause the lateral brow to be raised, opening the eyes, decreasing hooding, without undergoing a brow lift.
- Drooping of the corners of the mouth – placed into the DAO (depressor anguli iris) muscles
- Excessive Chin wrinkling
- Hyperhidrosis – for those who experience excessive underarm sweating, whether after working out or spending time in humid weather or those who easily sweat and are bothered by the odor or staining of clothes. Neuromodulators work to decrease the sweating to a manageable level, making you much more comfortable when out and about.
- Masseter muscle hypertrophy – for those patients with a wide face from an enlarged muscle that sits on top of the jawbone in front of the ear. Artful placement into the masseter muscle will decrease it size and cause the face to appear more narrow and angled.
How does it Work?
Botox is administered using very fine needles. The area can be anesthetized with topical numbing medication or with topical ice packs. This combined with a gentle touch, results in little or no discomfort for the patient. Each individual muscle of interest is injected with a specific number of units. In general, the number of units is decided based upon the size of the area and the strength of the muscles. Location of the treatments is strategically placed to have the greatest impact on the identified facial muscles without disrupting normal facial expressions. We have patients follow up after 2 weeks to assess the results and to see if any tweaking is required at that time.
What are the Results Like?
There is no downtime after these injections; patients may return to work and regular activities right away. Results from treatment may be seen a day or two after treatment and continue to improve over the next two weeks following the procedure. These injections soften your appearance and make you appear more rested. You will still be able to make facial expressions, however you will appear less forceful when doing so. Botox injections last 4-6 months in most patients.
Xeomin and dysport are other neuromodulator agents that works the same way as Botox. There are some clients who prefer these other brands and some who state that one brand no longer has any effect on them, so for those patients, we can offer alternatives.
Facial Fillers for Volume Loss
The most commonly used treatments for volume loss include dermal fillers. There are many different brands available. They vary by the thickness and consistency of the product and by what the product is made from. Its easiest to categorize them first by primary ingredients. The two categories are fillers that are made from Hyaluronic acid (HA) and non-HA fillers.
Hyaluronic acid is a sugar, naturally present in our cells that can hold water. Common brands of HA fillers include Juvederm Ultra, Juvederm Ultra Plus, Voluma, Restylane and Belotero Balance to name a few. Common Non-HA fillers are Radiesse, Artefill and Sculptra.
Different fillers are used on different areas of the face or hands. Selection of filler is based on the thickness of the filler being injected and how deep into the skin it is being placed. Some fillers have a thinner, softer consistency and are used to fill more superficial areas such as the lips, nasolabial and marionette lines, temples and the tear troughs under the eyes while others have a thicker profile and are placed deeper or for areas where larger volume replacement is needed such at the cheeks or into the back of the hands. Other areas that can be injected are the superficial lines and wrinkles around the mouth and lips (smokers lines) and even into the top of the nose for a liquid rhinoplasty. Fillers placed in the back of hand readily adds volume and immediately rejuvenates the appearance by softening the obvious veins and tendons that appear over time. Radiesse is a hydroxyapatite based dermal filler that is approved for hand rejuvenation and fat transfer is also an option for adding both volume and stem cells
As with the neuromodulator agents, maximal comfort is achieved by placing some topical anesthetic cream or topical icepacks to numb the areas. The fillers come premixed or are mixed with local anesthesia such as lidocaine, to further increase comfort associated with the procedures. They take about 10 minutes to perform and results are seen immediately.
We generally like to be conservative with the amount of fillers that are placed at one time as most patients usually require more than one filler. We commonly combine different fillers in layers to achieve the best and most natural cosmetic result. For example, most people require at least 2-4 syringes of filler to achieve optimal results. At CHG, we suggest coming in for an evaluation and starting with one, maybe two syringes of filler. Then returning for an evaluation after 1-2 weeks to allow time for the filler to settle then placing a touchup filler if needed at that time. A profound understanding of dermal fillers and placement techniques will ensure safety and natural results.
Depending on the number of syringes and types of filler used, results can be maintained from 6 months up to 2 years. Combinations of dermal fillers can be layered for optimal results or can be placed in different areas of the face at the same setting. The key to fantastic results is in the hands of an experienced injector who has experience with multiple different types of fillers and an thorough understanding of the anatomy and aesthetics- the ‘expert injector’.
Our Aesthetic Care Plans include the use of fillers/neuromodulator agents with skin resurfacing procedures to achieve optimal rejuvenation results and a maintenance skincare regimen to further benefit maximally from the rejuvenation effects. The injections may be administered alone or in conjunction with other injectable treatments. Often referred to as a liquid facelift, the combination of Botox and soft tissue/dermal fillers can offer dramatic alterations to both facial contouring and wrinkle minimization. Another Aesthetic Care Plan is to combine these agents with Ultherapy for combination wrinkle reducer, volumizing and skin tightening.