Botox & Facial Fillers: What to Know

Fast facial fixes such as Botox and other injectables have gone mainstream. Before you take up the new needlepoint, here's what you need to know.

Injectibles are Here to Stay

The trout pouts, stationary brows, and puffed-and-buffed cheeks on actresses and celebrities from…well, you know who they are. Only these days, you might be just as likely to wonder whether your girlfriend, your boss, your neighbor isn't looking suspiciously unlined. And you might be right.

When it comes to looking younger, more and more women are eschewing the nip and tuck and going for the needle. Each year, Americans spend more than $10 billion on what doctors call "minimally invasive procedures"—skin firming and smoothing, lip and cheek plumping—with almost half purchased by women aged 40–54, according to the American Society of Plastic Surgeons. 

Injectables are technically a form of plastic surgery. But unlike traditional facelifts and nose jobs, you can get them everywhere, at neighborhood Botox parties, as an add-on at the dentist's office, at kiosks at the local mall.

Their appeal is clear: They're fast, easy, and cheap. Even doctors are fans. "It is nonsurgical, there are no scars, no downtime, and minimal risk," says Dr. Neil Sadick, clinical professor of dermatology at the Weill Cornell Medical Center in New York City. "It is safe, cost-effective, and reversible."

What's not to like, right? Hold on. Doctors will also tell you it's not that simple. Every one of the substances that might be injected into your face comes with risks and side effects, from mild redness and swelling to visible lumps and nodules. And please don't forget the aforementioned trout pout, etc. Factors from the content of the injectable to the skill of the person administering it can have an effect on the outcome. Minimally invasive or not, it's still a procedure—on your face. If something goes wrong, there's nowhere to hide. Treat injectables as you would any other medical procedure: Do your research, gather opinions, be safe and smart.

Start with this primer, which includes a rundown of the main categories as well as a list of doctor-approved dos and don'ts.

Meet the Medicine

Wrinkle reducers: These products temporarily paralyze muscles, preventing them from contracting and causing wrinkles, primarily on the forehead, around eyes, and on frown lines. The most common is Botox. Another brand is Dysport. Both are a form of the toxin that causes botulism food poisoning, but at much lower doses. Typically, results appear three to seven days after injection and last between three and four months. Costs vary depending on region and clinician, but generally run $300–$500 per treatment.

Hyaluronic acid fillers: These are the plumpers, puffing up lips and mouth lines, smoothing cheeks and jaws, inflating undereye hollows. Hyaluronic acid naturally occurs in the skin, but decreases with age, resulting in sags and loss of elasticity. Injecting it as a filler is like fluffing up a crushed pillow, essentially bolstering the skin. Well-known brands such as Juvéderm and Restylane are synthetic versions. Results are immediate and last from six months to a year. The average treatment is around $600, according to the American Society of Plastic Surgeons.

Volume fillers: Collagen is the sine qua non of youthful skin—but it declines as we age. Volume fillers trigger an increase in skin's collagen production. Radiesse, derived from calcium, is used to fill out the mouth and chin areas, and results are visible within a week. Sculptra, made from fruit acids, also causes the skin to thicken, and results are more gradual, appearing fully after a few weeks, and can require touch-ups. Effective for up to two years, both are considered permanent. Radiesse treatments average $650, according to the American Society of Plastic Surgeons, while Sculptra comes in at $1,060.

Fat injections: This recently popular procedure involves using the body's own fat stores rather than an external filler. Fat tissue is removed from a patient's hips or buttocks, processed, and then injected into the face. Results vary. Unlike other volume fillers, the fat filler dissipates, typically settling at 60 percent and often requiring refills. Due to the additional processes of fat removal and treatment, treatments run to $2,000.

DO Start small. Pick one area, get it treated, and see how your body reacts and how you like it. Better to go back for more than to suffer a face full of regrets. And that goes for the type of injectable, too. "Don't get a permanent treatment your first time," advises Kari Colen, a board certified plastic surgeon in New York City. "Try a nonpermanent, faster absorbing treatment first."

DON'T Wait. If you want to have something done for a particular occasion, earlier is better. "Don't do injectables two weeks before a major event," says Heather Woolery-Lloyd, a Miami-based boardcertified dermatologist and director of Ethnic Skin Care at the University of Miami Hospital. "There is always a risk of bruising."

DO Find the right doctor. "Make sure you pick somebody who has the same aesthetic vision as you," Colen says. That means interviewing potential clinicians about what they'd recommend for you and asking to see examples of their work. As with any doctor, you want to be on the same page in terms of treatment and results.

DON'T Take aspirin or ibuprofen before a procedure thinking you'll prevent pain. "Before injectables, they increase the chance of bruising," Woolery-Lloyd says. Instead, Sadick recommends taking the herbal medicine Arnica montana or the plant extract bromelain before treatment to help prevent or minimize bruising. You also can drink pineapple juice, which is high in bromelain, he says.

DO Ask for the box. When paying for a treatment, you're buying the whole package, not someone else's leftovers. "A box of Juvéderm or Restylane should be opened in front of you so you know it's a new, fresh box," Colen says. "If they're bringing a syringe from the back room, say you're uncomfortable with that." Likewise, she advises, throw away your own leftovers. "You might lose a little money, but it's a lot safer."


DON'T Get a filler with your filling. Again, this is your face we're talking about. Dentists, gynecologists, or any other doctors or clinicians who don't specialize in injectables and cosmetic procedures are not appropriate options. "You want to go to somebody who does it all the time," Colen says—"somebody who does it for a living, not a side business." And Botox parties are out, too. Medical procedures are not social occasions and should never mix with alcohol.


DO Ask about the future. Before you get treatment, interview your clinician to learn exactly how the procedure will go, what the potential side effects are, whether there are any post-treatment limitations, how long the treatment will last, and what your options are if you're not happy with the results. And take notes. You don't want any post-injection surprises.


DON'T Overdo it. Remember, you're doing this to look good. As Woolery-Lloyd says, "You want a natural look for best results."


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