There is certainly no shortage of people with a medical background who are offering injectable cosmetics in their offices now, specifically Botox and dermal fillers; but, finding the right practitioner to perform these long-lasting 'corrections' to your lovely face can be quite a challenge. Here I offer some tips and guidelines to help consumers who are considering these services to proceed with a little more confidence.
If you can actually see the face of a friend or acquaintance that has had work done by a certain practitioner, and you think they look just fabulous, that's a good start. If their practitioner is logistically convenient for you and you can afford his/her rates, then you should feel relatively safe about booking an appointment for yourself. One problem here can be that many people who use these products don't necessarily want to admit to it; and, in fact, their privacy should be protected and honored, especially by their practitioner! Also, your friend's 'correction' may have been the result of Botox injections, whereas your correction might require a dermal filler. A practitioner's skill at injecting Botox does not necessarily guarantee his/her skill at injecting dermal fillers (and vice versa), so your results could be less satisfactory. You may have very different needs and areas of concern from your friend. Let's talk for a minute about those areas and the products used for corrections.
Botox is used for correcting dynamic lines and wrinkles, mostly around the eyes (Crow's feet), between the brows ("11" lines), across the top of the nose (bunny lines), and the entire forehead. A small amount injected superficially under the eyes can also help reduce the appearance of bags. The Botox is injected, (using a very fine needle), not into the lines and wrinkles directly, but into the nearby muscles that are contracting repeatedly with facial expressions and creating those lines and wrinkles. Minimize the muscle contractions and you minimize the lines they cause. Botox is not a magic 'eraser', and a good practitioner will help you to have realistic expectations about your results. Properly injected, it can and usually does greatly reduce the appearance of lines and wrinkles in most people. By injecting it into the sweat glands, Botox is also highly effective for the treatment of axillary (underarm) hyper-hydrosis (excessive perspiration). It takes 3-7 days to see the full effects of Botox and it typically lasts 3-4 months. Keeping up with treatments can sometimes mean a little less product needed for subsequent corrections.
Dermal Fillers, as opposed to Botox, are injected directly into (under) and/or around the lines and wrinkles of concern, and they are also used to replace lost youthful volume to areas of the face. Two popular products, and the ones that I use in my practice, are Juvederm XC and Radiesse.
Juvederm XC is a hyaluronic acid, clear gel that comes in a 0.8 cc syringe and has Lidocaine, which is a local anesthetic, already mixed into it to increase comfort during injections. With a little bit of a 'softer' feel and finish than Radiesse, it is the product of choice for lip enhancements. It can also be used for filling deep naso-labial folds (the lines from the edge of the nostril to the upper corner of your mouth), as well as jaw-line contouring (to minimize the appearance of jowls), marionette lines (that come down from the corners of your mouth), and general volume replacement (most often used in the lower face). Results are seen immediately (there may be a little temporary swelling and/or bruising at injection sites) and its effects last about one year. One nice benefit to the use of Juvederm XC is that it can be instantly dissolved with the injection of an enzyme, hyaluronidase, into any over-corrected areas.
Radiesse is a calcium-based filler and comes in a 1.5 cc syringe. It is usually priced higher than Juvederm XC, but it delivers almost twice the volume. Before injecting it, your practitioner may add to the product Lidocaine, or Lidocaine with epinephrine, which helps reduce the possibility and/or extent of swelling, bruising and bleeding at injection sites. Radiesse also has properties that stimulate your body's own collagen production which enhance its effects. It is especially good for larger areas of the face that need volume replacement, such as the cheeks and jaw-line, but it can also be used to minimize naso-labial folds. As with Juvederm XC, Radiesse results are seen immediately, (there may be a little temporary swelling and/or bruising at injection sites), and it lasts a year or more.