Injectables are the most popular procedures in the aesthetic universe, led by one of the world’s most well-known brand names — Botox®. Injectables are broken into neuromodulators (Botox®, Dysport®, Xeomin®) and dermal fillers (Juvéderm ®, Restylane®, Sculptra®, Radiesse®). At Optimization Centre, Dr. Albert offers a wide assortment of both types of injectables, and he administers all of the injections. In fact, Dr. Albert is a lead instructor for the Allergan Facial Aesthetics Injector Training Program, so you can count on exactly the results you seek.
Some of our Boca Raton patients are confused by the difference between neuromodulators and dermal fillers. So, let’s get into what these are all about.
These injectables are made from the botulinum toxin type A. That sounds scary, but it’s not. Back in the 1950s scientists discovered that if they injected a miniscule amount of the botulinum toxin into a muscle, it temporarily stopped the muscle from contracting. Botox® was a direct result of that research. It was first approved by the FDA for the treatment of blepharospasm, involuntary eyelid spasms. But Botox® became a legendary brand in 2002. That was the year the FDA approved Botox for aesthetic use erasing wrinkles on the upper third of the face.
Botox® was the original neuromodulator. Since then, Dysport® was approved in 2009 and Xeomin® in 2010.
When we make expressions such as frowning, squinting, showing stress, surprise, and others, muscles around our eyes, between our eyebrows, and on our forehead engage. Over time these contractions begin to create wrinkles on the surface of the skin above the muscle. These wrinkles are known as “dynamic wrinkles.” These are crow’s feet on the outside of the eyes, the 11s between the eyebrows, and forehead lines. When a neuromodulator is injected into the muscles that create these wrinkles, it blocks the nerve messages from the muscle to the brain. Since the brain doesn’t receive the message to contract the muscle it stays relaxed and the wrinkle on the surface skin doesn’t form. This lasts for a period of around four months. At that point, the muscle will begin to contract again, and the wrinkle will return, but another injection session will maintain your results.
Our Optimization Centre neuromodulators:
Botox® — Botox® has been the world’s most popular aesthetic treatment every year since it was approved for the cosmetic treatment of wrinkles on the upper third of the face in 2002. It takes 4-5 days to fully relax the muscles it is injected into. Botox is a little thicker than Dysport®, so it is superior for smaller areas, such as the 11s between the brows.
Dysport® — The second FDA-approved neuromodulator, Dysport® is virtually identical to Botox, but it is a little thinner, more diluted. Because it is a little thinner, Dysport® can be better for wider areas, such as forehead lines.
Xeomin® — The third FDA-approved neuromodulator, Xeomin® is colloquially known as “the naked neuromodulator.” This is because, unlike Botox® and Dysport®, which have some proteins added to the botulinum toxin, Xeomin® is made of just the botulinum toxin. This can be advantageous if a patient has found they have allergic reactions to Botox or Dysport®.
Where are neuromodulators used?
Botox®, Dysport®, and Xeomin® are injected into the muscles that form crow’s feet on the outside of the eyes, frown lines (the 11s) between the eyebrows, and forehead lines. They generally provide results for about four months. It is also used in the neck bands and lines around the mouth.
How are neuromodulators injected?
Dr. Albert injects our neuromodulators with a very tiny needle, and they are not injected to great depth. Patients typically equate the feeling of these injections to that of a pinprick, and they don’t need topical numbing cream prior to their session. Neuromodulator sessions take just 10-15 minutes.
Dermal fillers work in a completely different manner than neuromodulators. Fillers are true to their name. When injected beneath a wrinkle, crease, or area that has lost volume, they simply “fill” in the space, pushing the skin back upward and erasing or thoroughly diminishing the crease or area of volume loss. Synthetic fillers also encourage the body to create new amounts of collagen, which firms and thickens the skin. At the Optimization Centre, our numerous dermal filler options each target a specific area where volume loss has occurred.
Dermal fillers treat the other kind of wrinkles, known as “static wrinkles.” Unlike wrinkles formed by muscle contractions, these wrinkles are due to sun damage, declining collagen production, personal habits, and simple aging. Static wrinkles show themselves at all times and have nothing to do with muscle contractions. These are all static wrinkles: smile and laugh lines, marionette lines, parentheses lines, and barcode lines. These are areas of volume loss that dermal fillers treat: the cheeks, the under-eye areas, the lips, and the backs of the hands. Fillers can also improve the appearance of the nose. It is a rhinoplasty done with injectables alone.
Dermal fillers are classified as either natural or synthetic. Natural fillers are made primarily from hyaluronic acid, a naturally occurring substance in the body whose job is to hydrate, plump, and firm the skin. Hyaluronic acid does this by binding with nearby water molecules. Synthetic fillers use man-made items such as calcium microspheres to add volume and structure under the skin.
Our natural dermal fillers:
- Juvéderm® XC
- Juvéderm® Ultra XC and Ultra Plus XC
- Juvéderm® Voluma XC
- Juvéderm® Volbella XC
- Juvéderm® Vollure XC
- Restylane® Refyne
- Restylane® Defyne
- Restylane® Lyft
Our synthetic dermal fillers:
Juvéderm® XC - As the skin loses elasticity and moisture, some people form relatively deep parentheses lines that frame the corners of the mouth and creases that run from the nose to the mouth (nasolabial folds). Juvéderm® XC adds volume beneath the skin to smooth these lines and folds. This was the original Juvéderm® product, and it provides results for 9-12 months.
Juvéderm® Voluma XC - Dr. Albert may call it “age-related mid-face volume loss,” but you simply know it as sagging cheeks. Over time, as you lose the collagen to support your skin and as your underlying muscles weaken, your cheeks flatten. Juvéderm® Voluma XC is designed to add volume beneath the skin’s surface to lift and contour the cheek area. It will also improve the appearance of nasolabial folds and marionette lines. Plump cheeks are a tenet of a younger look. Voluma restores cheek volume for up to two years.
Juvéderm® Ultra XC - Most people don’t think of their lips as having lost volume, but our lips thin as we get older, losing the same support as our skin. Others may never have been happy with the fullness of their lips. Juvéderm® Ultra XC provides or returns fullness and fills the vertical wrinkles that form on our lips. This was the first dermal filler created for the lips. It plumps the lips for up to one year. Dr. Albert's patients enjoy their results for 1-2 years.
Juvéderm® Ultra Plus XC - Like Ultra, Juvéderm® Ultra Plus XC adds volume to the lips and areas around the mouth. Ultra Plus is composed of bigger molecules than Ultra, making it thicker and a little longer lasting. Ultra Plus is better for severe wrinkles and folds and for extra lip volume enhancement. The volume increase is noticeable with both Ultra and Ultra Plus. Ultra Plus adds volume for up to 15 months. Dr. Albert has developed his personal technique that will provide results for a few years.
Juvéderm® Volbella XC - Juvéderm® Volbella XC is perfect for adding subtle volume and shape to the lips. Plus, it erases the vertical lines, known as barcode lines, that come from volume loss. Juvéderm® Volbella XC does this without overtly enlarging the lips. It is a more subtle option when compared with Ultra or Ultra Plus. Volbella provides results for up to one year.
Juvéderm® Vollure XC - Juvéderm® Vollure XC is the newest addition to the Juvéderm® family of dermal fillers. Vollure is designed for the correction of moderate to deep creases and wrinkles such as nasolabial folds running from the nose down to the corners of the mouth, and parentheses lines framing the mouth. Vollure provides results for up to 18 months.
Restylane - Restylane® was the flagship product, the first dermal filler. It remains very popular around the world. It targets marionette lines, nasolabial folds, and other wrinkles by adding volume beneath the wrinkle or crease and pushing the surface skin upward. Its results last from 6-9 months.
Restylane Lyft - Restylane® Lyft adds volume to the cheeks and corrects smile lines. Lyft also can be used to replace volume loss on the hands. Results last from one year to 18 months.
Restylane Refyne - Restylane® Refyne was approved by the FDA in December 2016. This addition to the Restylane® line (along with Defyne, see below) is used to correct smile (marionette) lines and nasolabial folds. Refyne is specifically formulated to treat mild to moderate lines and wrinkles. Galderma has cross-linked the gel in Restylane® Refyne and Defyne to help support the patient’s natural expressions — for real-life results that help maintain natural movement when smiling, frowning, or otherwise moving your mouth.
Restylane® Defyne - Approved along with Refyne, Restylane® Defyne also specifically targets nasolabial folds and marionette lines. The difference is that Defyne is designed for use on moderate to severe creases and lines. Both Refyne and Defyne provide results that last up to one year.
Radiesse® - Radiesse® is a synthetic filler that uses a two-pronged approach to plumping the skin and filling wrinkles. First, it uses calcium microspheres to add structure under the skin where collagen (protein responsible for the skin’s natural structural support) has dwindled. Second, it encourages the body to build new collagen in the area of the injection to continue supporting the skin for up to one year.
Radiesse® restores lost volume in the lower face. It is especially effective for smile lines, marionette lines, pre-jowl folds, drooping corners of the mouth, and chin wrinkles. It is also approved for returning volume to the backs of the hands. It provides results for up to one year.
Sculptra® - Most dermal fillers are injected, and they show instant results. In many cases, this can create unnatural instant plumping of the area. Sculptra® doesn’t deliver instant results. Rather than simply filling the injection sites, Sculptra’s poly-L-lactic acid triggers your body to produce its own collagen to correct lines and creases.
Sculptra® is effective for treating fairly deep lines and creases, and it has few restrictions. If you have the typical lines that form around the mouth and from the nose to the mouth, Sculptra® is a great, long-lasting solution — it provides results for up to two years!
Where are dermal fillers used?
Each of the fillers we offer at Optimization Centre is targeted to a specific area of the mid to lower face, but here are the types of lines and areas of volume loss that dermal fillers treat: smile lines (running from the nose down to the corners of the mouth), marionette lines (running from the corners of the mouth downward), parentheses lines (framing the outside of the lips), barcode lines (above the lips), adding volume and shape to the lips, and areas of volume loss on the cheeks and the under-eye areas.
How are dermal fillers injected?
As with our neuromodulators, Dr. Albert injects all of our dermal fillers, ensuring the level of expertise you can trust to deliver the results you seek.
How soon will I see results from these various injectables?
All of these injectables are a little different. As a rule, dermal fillers provide instant results, except for Sculptra, which takes time to build new collagen. When injected, fillers instantly plump the area and erase the wrinkles or return volume.
Neuromodulators don’t provide instant results. That’s because they need some time to relax the muscles they are injected into. With Botox and Xeomin, this takes 4-5 days. Dysport is somewhat quicker, needing 2-3 days to relax the muscle.
How long will my results last with injectables?
In the descriptions above, the duration of each different injectable is listed. Neuromodulators generally erase wrinkles and lines on the upper third of the face for four to six months. Most of the hyaluronic acid fillers (the Juvederm and Restylane fillers) provide results generally lasting from 1 to 1 and 1/2 years, although there is some variability. Sculptra is the longest lasting filler, relaxing moderate to severe lines around the mouth area for up to two years.
What are the side effects with injectables?
These products have been injected millions and millions of times around the globe and have proven to be safe and effective. All have been approved by the FDA and other similar governing bodies in other countries. Side effects are minimal and short lived.
With neuromodulators, the common side effects are redness and slight swelling at the injection sites. These issues resolve in a day or so. It’s important for patients not to rub their injection sites for 24 hours after their session with Dr. Albert. This can cause the Botox/Dysport/Xeomin to migrate to an unwanted muscle and cause issues such as a drooping eyelid.
The common side effects with all dermal fillers are swelling, redness, pain, bruising, tenderness, and itching at the injection sites after your session. These side effects are typically mild but may last for up to a week when treating smile and marionette lines.
Occasionally, lumps will form at the injection sites. This is rare, but if it happens, they can be quickly resolved by an injection of hyaluronidase. This is an enzyme that instantly degrades the hyaluronic acid, eliminating the lump.
What’s most important with the use of dermal fillers or neuromodulators is the experience of the injector. Dr. Albert has extensive training with all of our injectables. As mentioned above, he has such expertise with these products that Allergan (maker of Botox and the Juvéderm line) has designated him as a lead instructor for the Allergan Facial Aesthetics Injector Training Program.