Botulinum and Facial Fillers

Botulinum toxinBotulinum toxin injection is the most popular cosmetic medical treatment in the US, and is a favorite among men and women looking for non-surgical facial rejuvenation. Botox® is a brand name for botulinum toxin; other brands include Dysport® and Xeomin®. These products all have the same active ingredient, but the main difference between them is their formulation, which influences the dosage and effect. All three brands are FDA approved and have been used safely and effectively for years.

Botulinum toxin has a long history in ophthalmology and was first used for spastic eyelid disorders in the 1980s. It is still the most effective treatment available for blepharospasm, and most ophthalmologists have many years of experience in its use. Oculofacial plastic surgeons are among the foremost specialists in use of Botulinum toxin for lines, wrinkles, and facial reshaping at the eyebrows, jawline, lips, and neck. It has proven to be safe, effective, and economical.

Facial fillers are also an enormously popular alternative in non-surgical facial rejuvenation. They are sometimes employed alone, but can also be an adjunct to Botox®. They work by safely restoring lost volume under the skin thereby effacing wrinkles and emptiness from aging. For many years they have often been used to improve the shape and fullness of the lips and creases around the mouth. They also work well to improve contour and fullness at the cheeks, eyebrows, earlobes, and to partially hide dark circles under the eyes. Recent advances in technology have resulted in far more long-lasting and natural improvements than ever before.

Botulinum toxin is a safe, naturally occurring substance that causes muscle relaxation typically lasting three to four months. In high doses, botulinum toxin will weaken muscles substantially, while in lower doses, the relaxation and weakening are subtle. These effects can be harnessed by your physician to improve frown lines between the brows, crow’s feet at the outer corners of the eyes, horizontal lines in the forehead, and eyebrow height and shape. Botulinum toxin can also be used to treat vertical lip lines, down-turn at the lips, and twitching or spasm of the eyelids, cheeks, and face.

Your physician will review your specific concerns and medical history and advise you about the best uses for botulinum toxin in your situation. It is injected with a tiny needle directly into the muscle(s) causing wrinkles, spasm, or facial aging. Mildly uncomfortable, the injections take only a few seconds. Effects begin to be visible at two to three days and are usually fully evident by one week. Bruising rarely occurs and fades naturally. Improvements in facial appearance and muscle relaxation typically last three to four months.

Commonly used facial fillers include hyaluronic acid, a naturally occurring substance already present in your skin (brands include Restylane®, Juvederm®, HylaForm®), and synthetic microspheres (Radiesse®). Hyaluronic acid typically lasts six to eighteen months and can be used by your physician to improve lip shape and/or size, creases around the mouth, frown lines between the eyebrows, fullness and shape of the cheeks, eyebrows, and earlobes, facial scars and depressions, and dark circles below the eyes.

Your physician will review your specific concerns and medical history and advise you about the best uses for facial fillers in your situation. Fillers are injected with a tiny needle directly into the area of concern, sometimes with ice, anesthetic cream, or anesthetic block injections to minimize discomfort. Effects are visible immediately, but mild local swelling occurs rapidly and lasts for about 24 hours. Bruising infrequently occurs and fades naturally. Improvements in facial appearance last six to eighteen months with hyaluronic acid; shorter with collagen, and longer with synthetic microspheres.

Risks and Complications
Bleeding and infection, which are potential risks with any procedure, are very uncommon. Bruising can occur with any injection. Be sure to tell your surgeon if you are on blood thinners as their use may put you at increased risk for bleeding complications. Botulinum toxin injections can rarely induce weakness in a nearby muscle, causing asymmetry, or a droopy eyelid or lip. To minimize this risk, your physician will recommend that you avoid touching the injected areas for several hours so that the botulinum toxin will bind to the intended muscles only. Facial fillers can also cause asymmetry, and rarely, a local sensitivity reaction.

Your surgeon cannot control all the variables that may impact your final result. The goal is always to improve a patient's condition but no guarantees or promises can be made for a successful outcome in any surgical procedure. There is always a chance you will not be satisfied with your results and/or that you will need additional treatment. As with any medical decision, there may be other inherent risks or alternatives that should be discussed with your surgeon.

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