Botox, Restylane and Other Fillers

Ideal Candidates

The muscle relaxant, BOTOX®, and the fillers, Restylane, Radiesse, Juvederm, Prevelle, Perlane, and Sculptra are injectable treatments designed to address certain signs of aging such as fine lines and wrinkles. They are also often used to maximize the improvement of surgical procedures, putting the finishing touch on the benefits of a facelift or eyelid surgery. BOTOX® has also been proven to treat excessive sweating. Maximum improvement is often noted when Botox is used in conjunction with a filler, with the Botox relaxing the muscle that created the wrinkle and the filler softening its appearance.

Whatever methods are used, injectables are very effective in reducing lines and wrinkles and adding volume to your face. Michelle will review your skin's condition to establish the best treatment for your needs.

BOTOX® will relax the muscles into which it is injected, specifically those that are used for smiling or frowning (called “muscles of facial expression”), eliminating the muscles’ ability to contract and make the wrinkles. It is made from a highly purified, cosmetic form of botulinum toxin. It is most frequently used around the eyes, forehead or in the frown area between the eyebrows and is a very thin substance, allowing a very tiny needle to be used. Most people experience little to no discomfort from the treatment, but those who express any concern over potential pain are pre-treated with numbing cream. It lasts 4-6 months.

Prevelle, Perlane, Restylane and Juvederm are hyaluronic acid fillers used to plump wrinkles throughout the face, including the nasolabial folds (the lines that run diagonally from the nose to the mouth) , the glabellar lines (between the eyebrows) and the wrinkles around the lips and around the eyes. These fillers are composed of a laboratory-created protein called hyaluronic acid, similar to the natural hyaluronic acid in your skin that contributes to youthful skin’s volume and fullness. The lab-created hyaluronic acid in these products has been modified slightly to last longer than your own hyaluronic acid. The differences in the products have largely to do with how long they last.

Hyaluronic acid is hydrophilic, which means it’s "water loving," and as such, it attracts many times its own weight in water. Even as the hyaluronic acid begins to disappear, each molecule attaches to more water, which means it will maintain its volume and effect for between four and six months. Although a tiny needle is used, Restylane is slightly thicker than the other fillers and, therefore, can be more uncomfortable when injected. Numbing creams are applied to minimize pain, and fortunately, the products can also be mixed with a bit of Lidocaine to minimize discomfort during the injection.

Prevelle is pre-mixed with a small amount of Lidocaine to diminish the discomfort of the injection. The substance is quite uniform so the injections are very smooth. Because it already contains an anesthetic agent, there is very little discomfort or bruising, making it truly possible to “inject today to look great tonight”. It lasts approximately 3-4 months.

Perlane is also made of hyaluronic acid. It provides fullness and line reduction around the mouth, smile lines and lower corners of lips/chin. Perlane is a fairly long lasting injectable, lasting anywhere from 6-12 months, though lip augmentation results might not last as long as other facial areas.

Restylane is a hyaluronic acid gel that is injected to restore lost volume and provide fullness to the skin by filling the lines that run from your nose to the corners of your mouth (nasolabial folds). It has been used in over 70 countries for more than 1.4 million treatments and is one of the most popular fillers. It lasts for 6-9 months. It’s often used to fill in the more superficial lines and is a popular lip filler, as well as a wrinkle-filler for “crow’s feet” and lines between the eyes. Restylane lasts up to 9 months.

Juvederm is a soft gel made of hyaluronic acid. Like Restylane, it is used to restore your skin's volume and smooth away facial wrinkles and folds, like your “smile lines” or the creases that run from the bottom of your nose to the corners of your mouth. It’s also been found extremely effective for plumping lips. It can last up to about 12 months.

Radiesse and Sculptra are also popular fillers. Unlike those above, they are not made of hyaluronic acid.

Radiesse is composed of tiny microspheres containing calcium hydroxylapatite, a protein found in our teeth and bones. When injected, these microspheres form a scaffold through which your body's own collagen grows, thus achieving a fairly long-term volumizing effect. Because Radiesse stimulates collagen production, most patients see some permanent decrease in the injected areas even after the original filler has disappeared (normally 8-12 months). Although this varies from individual to individual, the chance to permanently diminish some of our wrinkles has made Radiesse an extremely popular filler!

Because Radiesse is a thicker filler, it is reserved for use in deeper tissues. An example would be to fill out the area around the cheekbones, to fill in scars, or to return volume to areas where it has been lost to aging, disease, or injury. It is very effective for deep nasolabial folds. Because men often have very deep nasolabial folds, Radiesse is a logical treatment for men in particular. If the backs of your hands have a great deal of loose skin, you may like Radiesse for this area, as it’s very effective in restoring volume to the hands. It is not used in the lips because it creates more discomfort than some of the other lip fillers and can appear less smooth in the lips than our other options.

Radiesse is the longest-lasting of the fillers, maintaining fullness for up to 2 years. Because it is injected deeper into the skin, a local anesthetic (like you’d receive in your dentist’s office) is used when injecting Radiesse. Michelle will spray the inside of your mouth with a numbing spray to lessen the discomfort of the local. Sculptra is made of poly-L-lactic acid and is extremely long-lasting, ie, up to 2 years. It was originally created for HIV patients whose faces lost significant volume as a result of their illness. Because Sculptra was used to replace this volume, it is often called a “liquid facelift”. It is used under the eyes, in the mid-face area for cheek hollows and in the temples. Because

Sculptra is derived from non-animal sources, there is no concern about an allergic reaction and it is often preferred by vegetarians and others who, for religious or ethical reasons, prefer to use a non-animal product.


How It's Done

The injections themselves take only about fifteen minutes to half an hour, and the results of fillers appear immediately with the exception of Sculptra, whose effects appear over time. The final results of BOTOX® injections generally occur after 48 hours, with the majority of the improvement found in about a week.


Recovery

After injecting, we apply a cold compress. Some redness may be present for the first few hours, and you may have slight swelling around the injection sites themselves. However, this fades quickly, and by the time you leave the office, you will be unlikely to have any discomfort.

After receiving BOTOX®, you should not lay flat for four hours so that the BOTOX® can settle. You might have a slight redness around the injection site for the first two hours. The results of BOTOX® injections usually last about 4 months. It will be obvious to you when you should come in for another treatment, as the wrinkles will begin to reappear.

If you have had Restylane, we recommend that you avoid exercise for 24 hours to ensure good absorption.

Because our office is very busy, we suggest that you make the appointment for your next treatment when you have each treatment, spacing the next appointment at the interval Michelle recommends. We have a special pre-payment option that provides a reminder for your next appointment as well as a small discount to reward you for your continued facial maintenance.


Meet Michelle Boone, ARNP
 

 Dr. Armando Soto and the Aesthetic Enhancements staff announce the addition of Michelle Boone, ARNP, to the Aesthetic Enhancements team!

Michelle Boone, ARNP, is one of the most experienced aesthetic nurse practitioners in Central Florida. Click here to learn more about Michelle.