This is a relatively common question that I get when people are just starting to learn about non-surgical treatments for the face. Botox® and filler are actually two different families that are used to treat different processes in aging. Botox® is a specific brand of of neuromodulator (medication affecting nerves and muscles function) that weakens facial muscles to reduce wrinkles. These wrinkles are created over time when we animate our face such as when we are surprised, frown, or squint. Filler is a substance that is injected into the skin or just below the skin in order to add volume to areas that may not be full enough. The most common placement for filler is in the lips to create a more voluptuous mouth. You definitely do not want Botox® injected into your lips! This would make talking, smiling, and possibly eating a difficult task!
What is Botox® used for and how do I know if I am a good candidate?
Botox® and other similar products such as Dysport®, Xeomin®, and Jeuveau® are used to treat dynamic wrinkles. Dynamic wrinkles occur when, at rest, there are no creases in the skin but with facial movement, wrinkles appear. The common areas that this occur are in the glabella region between the eyebrows (the frown lines), the forehead, and the lines around the eyes (also called crow’s feet). These products can also be used in other regions as well such as in the bands on the neck, for chin wrinkling, and even for headache relief. It is important to have a consultation with an experienced injector who can analyze your face and create the best plan for you. There is definitely an art and science to using these products and if not properly administered, there can be temporary unwanted muscle effects.
Are neuromodulators such as Botox® and Dysport® safe?
Neuromodulators are incredibly safe drugs. They are probably more safe than most drugs found in your medicine cabinet. These drugs only work locally in the muscle they are injected
into. There is no evidence that they travel throughout your bloodstream and system and they have an incredibly high safety profile.
What’s more, they act only temporarily and the effects wear off at about 3 to 4 months although people may still see some affects beyond this time. Most patients are extremely happy with the results they achieve and are actually a little sad when their Botox® starts to wear off! On the flipside, if the Botox® was injected and results are not ideal, the effects will wear off and the patient will be OK. Truly, it doesn’t hurt to try it!
Will I need to be under anesthesia to have Botox® or filler?
This is another question that our practice occasionally gets from people who are new to Botox® and filler. Dr. Lahar is able to perform this procedure in the office very comfortably. For Botox®, Dr. Lahar simply cleans the skin with an alcohol pad and uses an extremely small needle to inject the medicine. It causes a minor welt much like a mosquito bite that will go away in about an hour. For filler, an anesthetic is used on the skin and allowed to sit there for a few minutes to help numb the skin. This allows Dr. Lahar to plump the lips or other areas very comfortably.
What are fillers used for?
As their name suggests, filler is used to add volume to deficient areas. These deficient areas may be caused from aging or simply the patient is looking for volume enhancement. The lips are the most common area for people to ask for volume enhancement. As we age, certain areas of our face tend to lose volume. Some of the subtle changes can be addressed with filler but more significant changes may require surgery to get the best results. This is why a facial analysis is important to achieving the best result and help you reach your goals.
What areas can filler be used to treat?
While lip enhancement is the most common filler location at Lahar Plastic Surgery, filler is also used to create subtle and powerful changes to the cheekbones, the jawline, nasolabial folds, and the temples. Understanding the anatomy in these regions is very important for safety as well as understanding what looks aesthetically pleasing.
I don‘t want to look over done. I don’t think filler is right for me.
Patients frequently say they don’t want an overdone look and some will even say they don’t want to ever try filler for this reason. Many of the results that concern people are actually occurring in patients who have had too many procedures or poorly performed procedures. This creates a bias in our minds that tells us that everyone who has these procedures looks strange. If someone looks great, no one thinks that they have had anything done but that it must be natural. Many of the looks of older celebrities that have maintained their appearance are through the use of subtle enhancements over time as opposed to big changes all at once. Dr. Lahar is very conservative about volume enhancement, particularly if this is your first time having any sort of injectable. He will not use more than one syringe at your first visit and will allow a week or two to pass by before adding any more volume if any is required. This will allow your anatomy to adapt to the filler and not be overcome by excessive volume.
What is a liquid rhinoplasty?
A liquid rhinoplasty, as opposed to a surgical rhinoplasty, uses filler to create results that you are looking for in reshaping your nose. In patients who have poor tip support/downward tip or a small hump on the nasal bridge, subtle filler placement can be used to camouflage and enhance the areas. The filler can be used as a way to see if the patient would like to go forward with a full rhinoplasty. It can also be a way to avoid surgery if the patient is nervous about surgery. Filler in the nose can last more than a year depending on the product used and how the patient’s body reacts to the filler. It is very important to find a trained rhinoplasty specialist who understands the anatomy of the nose. This is an area that if done improperly can have devastating consequences. Dr. Lahar performs rhinoplasty regularly and also performs liquid rhinoplasty and has experience with this technique.
How long does filler last?
The longevity of filler is dependent on the type of filler used and how the body reacts to the filler. Certain fillers are more easily dissolved by the body and can take as little as six months to go away. Other fillers are permanent and can last a very long time. Smaller volumes of filler also tend to go away more easily than larger deposits of filler. Mobile areas such as the lips cause filler to go away more quickly than less mobile areas such as the nose.
What makes one filler better than another?
The most common filler that is used in aesthetic procedures is hyaluronic acid (HA) which is a natural component found in our own tissues. Different HA fillers have different properties. Some of the fillers are more firm and are good for adding structural component to the tissues. They can be useful in areas such as the cheekbones or the jawline to create sharper enhancements. Other fillers are softer and integrate well with your own tissues. This can be nice in lips where volume is desired but not firmness. There are also fillers that are good for general use.
Can filler be used in the under eye region?
The under eye region is a very delicate area that requires extreme precision for placement of filler. There is a relatively high risk of filler being seen in this region if it is placed in the wrong level and in some cases can cause a bluish tint to the skin. Additionally there is a delicate network of draining vessels in this region (called lymphatics) that can be disrupted with poor placement or aggressive placement of filler. This can lead to swelling around the eyes that can certainly look worse than the anatomy that was originally there. While it is possible to achieve wonderful results with filler in this region, it should definitely be approach with caution to minimize any adverse aesthetic outcomes. Sometimes it may actually be more beneficial to have a relatively small surgery (blepharoplasty) to correct the under eye region rather than have filler placed.
What can I do to minimize my chance of bruising?
Even the most experienced injectors occasionally get bruising. However, experience and technique definitely can reduce the risk of bruising or at least make it a shorter period of time. It is important to tell Dr. Lahar if you are taking any sort of blood thinning medication (such as Ibuprofen) or have easy bruising in general. He may change the timing of your injection depending on your personal risk factors. Thankfully, because he using very small needles and gentle technique, the bruising and discomfort are extremely minimal.
Learn more about the various injectables we offer at Lahar Plastic Surgery, book a personalized consultation online or over the phone today.
Disclaimer: Results may vary from person to person. Editorial content, before and after images, and patient testimonials do not constitute a guarantee of specific results. All images feature models except for before and after images.