Fillers and Botox - Is it for me?
Botox is the most common aesthetic procedure in the USA.
It is sometimes used for cerebral palsy, on children as young as 4-6 months.
There are therapeutic uses and cosmetic uses. Effects usually last around 3-6 months, and can vary from person to person.
theraputic - The unit price is significantly lower than cosmetic. Your MSP or extended healthcare might cover parts or all of the cost so have a talk with your family doctor, and you can still go to your favourite doctor for the injections.
reduce wrinkles on forehead, frown lines, crows-feet etc. by temporarily paralyzing muscles in the face
slim down jawline, shoulders, even calves by temporarily paralyzing muscles
lift the eyebrow
reduce smoke lines around the lip
Precautions. No anticoagulants such as aspirin and ibuprofen before treatment, since those types of drugs hinder blood clotting and increase the risk of bruising should the needle puncture a blood vessel. Which is why you should ask if they can use a needle or a cannula if you are concerned about bruising. Best avoid fish oil, multivitamins, green tea, cinnamon, ginger, and red wine a full week before treatment as antioxidants, though not all of them, can increase the fragility of blood vessels and prevent clotting. Ask your MD at least two weeks ahead of time for a full list of what to avoid.
Downtime. For several hours after your shots, avoid putting makeup, washing your hair, exercising, lying down, or messing with the injected zones. These activities could spread the toxin to muscles or weaken the injection. Avoid flying for several hours after botox, as there is some concern that change in cabin pressure will affect the spread of the toxin to muscles you do not want affected.
If you are getting botox for an upcoming event, have it a week before since it takes a few days to be fully effective.
Pricing is generally done by units used. Some establishments might go by number of “zones” on the face, but this isn’t the most ideal since you might be treating one area which requires balancing out on another area so instead of one “zone” you are being charged two. Going by units used is more fair in my opinion.
While physicians, dental surgeons, naturopaths who have been granted certification in aesthetic procedures, registered nurses and licensed practical nurses under the order of a physician are allowed to perform botox injections, it is important to consider the individual’s experience and aesthetic taste too. Clear communication and a thorough consultation beforehand would help with managing expectations so you don’t get any surprises after the injections. Ask any questions you might have and let the healthcare provider present you with possible solutions, it might not even be botox.
As we age, we lose the fatty tissue and volume under the skin, causing sagging and wrinkling of the lower face and lip area. Unlike botox injections that relax the muscle, fillers are injected into the face to lift and fill this lost volume, to fill the line, crease, or area, with one of several different substances. As a result, trouble spots nearly disappear. There are many types of dermal fillers that can be injected in your face, lips and around your mouth. The most common fillers today are products that contain Hyaluronic Acid (HA), which is a natural sugar substance found in the body. Filler treatments are FDA approved.
Fillers are being used for:
treat moderate to deep wrinkles around the mouth
fill in tear trough to minimize the look of eye bags
treat facial lines
add volume to sagging hands, lips, cheeks, jawline, chin, and temple
re-contour the chin, lower face, or nose bridge
The most popular category of wrinkle fillers is hyaluronic acid. Each type works in a slightly different way with varying results. I’m only focusing on the HA fillers since I am not familiar with the other types. Hyaluronic acid is a naturally occurring substance that is already found in your skin. It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The results are temporary, lasting 6 to 12 months or longer before the body gradually and naturally absorbs the particles. There are often different types of HA fillers for different “stiffness” depending on what you are trying to achieve. For example, filling tear troughs would require something softer, and building a nose bridge would require something stiffer.
Side effects. Rare, but can include redness, swelling, and bruising at the injection site. The filler may also show up under the skin as tiny bumps. This is a problem that often improves over time. Your doctor should be able to recommend massaging or other solutions.
How long the results last? It varies from several months to over a year or two. Some research shows that repeated injections may help stimulate the body's own natural production of collagen. That will help reduce the number of lines and wrinkles. There is also some evidence that less filler is needed over time to achieve the same look.
When selecting a provider for injectable treatments, give your decision the same level of care and scrutiny that you would for a surgical procedure. Non-surgical filler treatment is still a medical procedure that requires specific training, knowledge and skill to ensure safe treatment and natural-looking results. Choose a provider with an extensive knowledge of facial anatomy, a well-developed aesthetic eye, and a surgeon’s skill and precision.
Belkyra is made by Allergan, the same company which makes Botox.
Health Canada approved Belkyra (also known as ATX-101 and as KYBELLA® in the United States) is used in adults to improve the appearance of moderate to severe fat below the chin (submental fat), aka “double chin”. It is a non-invasive treatment that can be done in the office with relatively easy recovery and with visible results in two to four treatments. Belkyra can result in a newly-defined chin and jaw line that the patient had not seen in many years. It is not known if Belkyra is safe and effective for use outside of the chin/neck area.
The active ingredient in Belkyra is deoxycholic acid, a naturally-occurring molecule in the body that aids in the breakdown and absorption of dietary fat. When injected into the fat beneath your chin, Belkyra causes the destruction of fat cells. Once destroyed, those cells cannot store or accumulate fat.
How many treatments needed will be decided by the doctor. The treatment itself takes about 20 to 40 minutes. Most people will have visible results in two to four treatments. Follow up treatments are spaced four to six weeks apart.
Upkeep. Unlike Botox which usually requires twice a year maintenance, once the fat is dissolved you're pretty much done. An additional injection may be needed after four to five years.
Precautions. Inform your doctor about all of your medical conditions, including if you have had or plan to have surgery on your face, neck, or chin; have had cosmetic treatments on your face, neck or chin; have had or have medical conditions in or near the neck area; have had or have trouble swallowing; have bleeding problems; are pregnant or plan to become pregnant; are breastfeeding or plan to breastfeed.
Results will vary from person to person, which is why you should have a thorough discussion with the doctor to determine your expectations and the dosage and number of treatments needed.
Common side effects. Expect initial swelling and pain (which can be treated with OTC pain medications), possibly bruising, numbness, redness, and areas of hardness in the treatment area.
Glutathione has been used in Asia for years for skin whitening (shadeism and colonialism aside, since that can be a VERY long discussion, I’m skipping all ethics and classism in here and only talk about the treatment itself). It’s less about targeting pigmentation, and more overall whitening in the whole body. Supposedly it can lighten your skin to the colour of your inner forearm. Many medical spas offer this IV treatment. Glutathione has been shown to inhibit the enzyme that produces pigment and hence creating a skin whitening effect. Treatments are typically given once to twice a week for 6-8 weeks.
Glutathione is a substance produced naturally by the liver. It is also found in fruits, vegetables, and meats.
People take glutathione by mouth for treating cataracts and glaucoma, asthma, cancer, heart disease, hepatitis, liver disease, diseases that weaken the body’s defense system (including AIDS and chronic fatigue syndrome), memory loss, Alzheimer’s disease, osteoarthritis, and Parkinson’s disease. Glutathione is also used for maintaining the body’s immune system and fighting metal and drug poisoning. Glutathione is breathed in for treating lung diseases, including idiopathic pulmonary fibrosis, cystic fibrosis. Glutathione is administered as a shot for preventing poisonous side effects of chemotherapy and for treating male infertility. It can also be given intravenously for preventing “tired blood” (anemia) in kidney patients undergoing hemodialysis treatment, preventing kidney problems after heart bypass surgery, improving blood flow and decreasing clotting in individuals with atherosclerosis, treating diabetes, and preventing toxic side effects of chemotherapy.
Side effects. So far not known, but could increase asthma symptoms when inhaled. Personally I’d like to see more research on it, but I don’t think it’s unsafe since cancer patients use it.
Again, communicate with the injector.
Sculptra works deep under the skin as a collagen stimulator, to stimulate your skin to rebuild your own collagen. The filler gel itself dissipates a few days after treatment. As lost collagen is replaced, Sculptra gradually increases or restores volume to correct your wrinkles and folds.
Sculptra is an FDA-approved dermal filler manufactured by Dermik Laboratories. It is an injectable implant that contains microparticles of poly-L-lactic acid, a biocompatible, biodegradable, synthetic polymer from the alpha-hydroxy-acid family. For decades, PLLA is the main material used in making absorbable sutures such as surgical-dissolving stitches. Sculptra is reconstituted prior to use by the addition of Sterile Water for Injection, USP (SWFI) to form a sterile non-pyrogenic suspension.
The FDA initially approved the drug on the basis of small studies conducted on HIV patients, specifically “for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in patients with HIV. Facial lipoatrophy is a condition in which people lose fat in their faces, especially in their cheeks and around their eyes and temples. People with HIV who take anti-HIV drugs may develop lipoatrophy. Sculptra was subsequently approved by the FDA for use with non-HIV patients with wrinkles and deep creases in 1999.
Anti-aging creams containing collagen cannot get below the surface of the skin to replace lost collagen. But this injection can. Treatment effects differ from person to person. Touch-ups may be needed to maintain the desired effect. Your doctor will discuss the right treatment plan based on your needs.
Immediate side effects. Redness, swelling and/or bruising may occur at the injection site. These typically resolve in hours to one week after the injection. Patients treated with anticoagulants may run the risk of hematoma (blood spot under the skin) or localized bleeding at the injection site. Small papules (solid bumps) in the treatment area may occur. These papules beneath the skin are typically not visible and may be noticed only upon pressing on the treatment area. Visible nodules (small rounded lumps) or areas of induration have been noted in the injection area and are occasionally associated with inflammation or discolouration. For a complete list of possible side effects, please see here.
Aftercare. Instructions should be provided to you that may help minimize side effects. Aftercare may include massaging to evenly distribute the product and icing the treated area to reduce swelling and/or bruising. Do not apply ice directly to the skin
Results. Best visible results after 3-6 months (your skin needs time to produce the collagen). Can possibly last over 2 years. Touch-ups may be needed to maintain the desired effect.
So, if you are getting any kind of injections for an event, like a wedding, here is a recommended timeline -
Botox - Best done a week before, it takes 3-4 days to kick in.
HA fillers - Definitely NOT within 48 hours. 2 weeks before the event is best.
Belkyra - Since it takes 2-3 treatments, spaced 4-6 weeks apart, you are looking at months before your event.
Glutathione - It’s 1-2 times a week for 8 weeks, so that’s 2 months before at least.
Sculptra - It does depend on how many treatments you get, and how well your aftercare is, so it’s a case by case scenario.
I have a post on wedding/event beauty prep as well for more information.
Finally I’d like to thank my friend, Dr. Nina He, who performs all of the above procedures, for helpful information about this complex topic.
Great job you, making it till the end! Do you have any questions? Leave them in the comments! Thank you!