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Fillers and Neurotoxin: So Many Choices—Which is Best for Me??

Hi, this is Courtney Dunavant, a physician assistant with the New York Group for Plastic Surgery. Many people are confused by the various choices of fillers and neurotoxins used for facial lines and wrinkles, so I’d like to help with an overview:

Fillers and neurotoxin (most commonly know as “Botox”) injections are very common methods used to non-invasively treat the signs of facial aging, such wrinkles in the forehead or around the eyes and/or creases around the mouth. There are so many TV commercials and magazine ads for these products that it can be difficult to know what is best for what type of line/sign of facial aging. It’s all so confusing! Hopefully this breakdown and brief explanation of the common products will help make things more clear so that together, you and your plastic surgeon (or their experienced physician assistant or nurse) can develop a treatment regimen that will have you looking refreshed and rejuvenated!

Neurotoxin – commonly known as “Botox”.
A number of companies make neurotoxin:
Allergan Medical – Botox
Medicis Medical – Dysport
Merz Aesthetics – Xeomin
· Each company makes their own version of neurotoxin, or botulism toxin, and while there are subtle differences between each product, the premise is the same. They are all injected to soften or eliminate fine lines and wrinkles in the forehead, around the eyes, and between the brows by relaxing the muscles below these lines. By relaxing the muscle, the skin will no longer make the lines we don’t like. Don’t worry—in expert hands it is accomplished to give you a very natural look, not the “frozen” face you may see on celebrities who overdo it! (For some people, neurotoxin has the added benefit of alleviating migraine headaches and TMJ pain.)
· Cosmetic results usually take 3-10 days to appear
· Results usually lasts 3—4 months

Hyaluronic Acid Fillers
A number of companies make Hyaluronic acid fillers:
Allergan Medical – Juvaderm, Juvaderm Ultra, Juvaderm Ultra Plus
Medicis Medical – Restylane, Perlane
Merz Aesthetics – Belotero
· Again, each company makes their own version but they all work by the same general process. Hyaluronic acid (a product that your body also produces itself) is injected to fill in fine lines or creases. Hyaluronic acid is used for the nasolabial folds (the crease that runs between the nostril and corner of the mouth), marionette lines (line below the corner of the mouth), or smoker’s upper lip lines.
· Cosmetic results are immediate
· Results usually last 7—10 months.

Other Fillers
Merz Aesthetics – Radiesse
This filler is made of Calcium hydroxylapatite (a substance that occurs naturally in human bones and teeth). This product is thicker, more like toothpaste consistency vs. the gel consistency of Hyaluronic acid filler. Therefore, it is best for filling deeper set creases, augmenting the cheekbone, or redefining the jaw line.
· Cosmetic results are immediate
· Results usually last 8—12 months.

Other “Volumizers”
Merz Aesthetics – Sculptra
· Sculptra is an injectable form of poly-L-lactic acid (a synthetic material that is biocompatible, meaning compatible with your own skin tissue). This product works differently than others in that it doesn’t actually fill the lines or creases, but it causes your own body to make collagen over time.
· Sculptra is diluted with water and injected all over the face (temples, cheekbones, jaw line) to replace the loss of volume that accompanies aging. Replacing the volume results in softening of lines and wrinkles. Sculptra is injected over a series of treatment sessions. Typically, the average patient needs a minimum of 3 treatment sessions spaced 3-4 weeks apart.
· Cosmetic results start to appear within the first 3—4 weeks
· Results usually last 2—3 years

Someone administering facial fillers should be knowledgeable in comprehensive facial anatomy and aging problems related to changes of skin, supporting soft tissue, and loss of volume.  Therefore, it is important for a plastic surgeon to analyze the problems of aging in a comprehensive and holistic way to avoid leaving someone looking distorted or unnatural.  Plus, patients should seek highly qualified and experienced medical professionals like a board certified plastic surgeon for consultation and treatment.  Not all products are for all patients.

With this overview of facial fillers and neurotoxins, I hope you will be better informed about available methods for looking refreshed and ready for the spring!

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