Reviewing Your Injectable Options, From BOTOX® to Dermal Fillers

Craig W. Colville MD, FACS

When we think of injectables or nonsurgical rejuvenation for the face, many different options come to mind. First, let’s distinguish between dynamic smoothers (neuromodulators) and rejuvenating dermal fillers. Dynamic smoothers address the muscles that cause unsightly wrinkles; dermal fillers address lines that show while the face is at rest.

How do you get rid of dynamic wrinkles?

The most well-known neuromodulator in the world is BOTOX®. It was first presented to the cosmetic market in 2002 when it was approved by the FDA to temporarily improve the appearance of moderate to severe frown lines between the eyebrows (glabellar lines). However, I was utilizing BOTOX in my Toledo practice 5 years prior.

We now have four neuromodulators on the market: BOTOX, Dysport®, XEOMIN® and Jeuveau®. All of these injectables are botulinums with a different side chain that makes them slightly different but similar. The point of all of these products is to slow down the muscle motion, which then slows down or decreases facial wrinkling.

Over time, chronic movement can often damage the dermis, the layer of skin between the epidermis and subcutaneous tissue. These repetitive movements cause lines and creases that are undesirable to patients.

Do dermal fillers get rid of wrinkles?

The original filler on the market went to a deeper level of the skin and helped with hard lines and depressions. The fillers on the market today have become much more refined. Some fillers are softer, some are more flexible, and some give a more lifted appearance.

Rejuvenating fillers were originally designed to treat nasolabial folds or smile lines but are now used to treat several areas of the face such as in between the eyebrows, the cheeks, and lips (lip lines or lip volume).

Soft Tissue Fillers

As we continue to progress with different types of fillers, we also have fillers that create soft tissue volume—think of lost volume in your cheekbones, the temples of the face, or even the hands. Two common soft tissue fillers for volume are JUVÉDERM Voluma®, Perlane® Plus.

Radiesse® is a filler to add volume to the hands. It is made of calcium hydroxylapatite (CaHA) microspheres that work immediately upon injection and give a long-lasting result.

Hyaluronic Acid Fillers

Many of the other fillers we use are made from hyaluronic acid. Hyaluronic acid is a clear gel substance that is naturally produced by your body. The largest amounts of it are found in your skin, connective tissue, and eyes. Its main function is to retain water. Most of the hyaluronic type fillers I use can last several years, but they typically have a softer, more natural look and can create volume restoration. For this reason, these hyaluronic type volume fillers are great for over the cheekbone, down the jaw line and in front of the jowl area.


For volume lost in the cheeks or hollowed cheeks, Sculptra is ideal. Sculptra is injected into the hollow of the cheeks and gradually restores volume over time. The correction is not immediate but very gradual, ensuing over several months.

What happens during a consultation for BOTOX or fillers?

When I have a consultation with a patient and we are discussing non-invasive or injectable options, I usually suggest a gradual start. I prefer to avoid the overdone, over-injected look that can be very difficult to reverse.

Some patients don’t want more volume, in fact, they are looking for less volume especially in areas like the jowl, double chin, or neck. KYBELLA® is an injection that can dissolve adipose tissue, or unwanted fat in those areas of the lower face. Kybella can also be used off lable for dissolving fat around the bra line, anterior axilla or armpit area. To get the optimal results, Kybella is typically injected two to three times over several months.

Injections can come with side effects such as bruising and or swelling. Most of these side effects are temporary and resolve themselves within the first couple of days after the treatment. With all of my new patients, I reiterate the importance of keeping a record of where they are starting and what their desired result is. During my consultations I prefer to utilize my Vectra 3D Imager. With a 3D image of the face or the injection area, we can track the progress and see the changes over time.

What qualifications do you need to give BOTOX or fillers?

BOTOX and fillers (injectables) are wonderful for nonsurgical facial rejuvenation, but it is important to remember that this is a medical procedure that should be done by a board-certified plastic surgeon like myself or a Certified Aesthetic Nurse Specialist working with me.

In the past 17 years BOTOX Cosmetic has managed to become a household name and has even been referred to as a mood booster—the term “frown lines” is not a happy phrase. My patients gain peace of mind knowing that as they age, wrinkles and unsightly lines can easily be treated.

If you are considering injectables to diminish signs of facial aging, don’t hesitate to contact my plastic surgery practice in Toledo, Ohio. I would be glad to discuss any of the above-mentioned treatment options with you and help guide you on the best treatment plan designed to give you the best results. Please use our online form to request a consultation or call us at (419) 534-6551.

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