Botox can be combined with injected dermal fillers and often is, even though it is not a dermal filler itself. Dermal fillers are substances that add volume to dry areas, adds plumpness to lips and cheeks the client considers too thin and smooths out wrinkles. Dermal fillers and Botox are both injected cosmetic treatments and are outpatient procedures, but there the similarities end.
What is Botox?
Botox is purified and diluted form of botulinum A, which belongs to those toxins that can cause botulism, a form of food poisoning. The toxins are produced by a type of bacteria. Scientists learned that the toxin also had benefits, and use it to ease painful spasms in different areas of the body, including those of cervical dystonia. It is also used to ease excessive sweating, overactive bladder and chronic migraine headaches. Then, they noticed that Botox helped to smooth out wrinkles and fine lines and that this effect lasted for a long time.
Botox works by interrupting nerve signals from a neurotransmitter called acetylcholine. When these signals are interrupted, the muscle found beneath a wrinkle is paralyzed. This causes the wrinkle or line to smooth out since the muscle can no longer move. Having this procedure done is an outpatient treatment performed in the doctor’s office, which means that the client can go back to their usual schedule soon after it is over. Each session lasts between 15 minutes and a half an hour depending on how many areas of their face or neck the patient wants treated. There is no downtime, and no one has to drive the client home, stay with them overnight or pick up pain medicines or antibiotics for them. Because of this, Botox is the most popular minimally invasive cosmetic procedure in the world. In 2016, there were over 7 million Botox treatments in the United States alone according to the American Society of Plastic Surgeons.
There are different types of Botox. Dysport is a more diluted type that is augmented with human albumin, while Xeomin does not need to be refrigerated before it is used. Both Dysport and Xeomin have a lower protein load than regular Botox, so the chances of a client having an allergic reaction to them is lessened.
Dermal Fillers
Injectable dermal fillers are temporary, semi-permanent or permanent and are made of various substances. They not only ease the look of wrinkles, but can prevent wrinkles in the first place. This is why younger people have dermal fillers prophylactically.
Dermal fillers such as Restylane, Juvéderm and its offshoots are made of hyaluronic acid, which is a sugar that draws water to an area of the body and locks it in. Hyaluronic acid is a natural product found in every living thing, though in dermal fillers it is synthetic to cut down on the risk of allergic reactions. Collagen is also a natural substance found in the body. Among other things, it makes skin springy and supple. Collagen used as a dermal filler is taken from cows or human cadavers. Because of this, clients who want collagen need to have an allergy test before they are treated. Zyderm is a brand that uses collagen.
Calcium hydroxylapatite is made of calcium and phosphate and makes up the bones and the teeth. It is often used to treat scars, furrows and trenches and adds volume to the cheeks. Radiesse contains this substance. Polylactic acid, found in Sculptra, is almost exclusively used as a volumizer. What it does is stimulate the client’s body to lay down its own collagen, which thickens the skin and makes it more elastic.
Over time, the body absorbs temporary fillers, and the client can return to their esthetician for maintenance injections. There are also permanent fillers that the body does not absorb. These include tiny spheres of PMMA suspended in bovine collagen or injected silicone.
A client can even use their own fat as a dermal filler. This fat is harvested from a liposuction procedure, cleaned and re-injected into the patient.
Using Botox and Dermal Fillers
Doctors use Botox with dermal fillers because it paralyzes the muscles around the area to be injected and helps the dermal filler last much longer than it usually would. In some cases, the effects of the dermal filler lasted two or even three times as long as it would have had Botox not been used. However, if the Botox and dermal filler are to be used in the same area, the doctor or esthetician needs to inject the client with Botox at least two weeks before they have the dermal filler for the best results.
One procedure might be to inject three or four syringes of Juvederm into a client’s cheeks to make them a bit more prominent. The client may also receive some dermal fillers in their chin to balance the face, and keep it symmetrical. They may also receive a dermal filler in the lips to improve the pout. The glabellar lines in the forehead are treated with Botox during the same session.
The client will experience some swelling and bruising after they’ve had Botox, dermal fillers or both. This can be eased with cold compresses pressed to the injection areas. They should see the improvements after a couple of weeks, and these improvements can last as long as six months before the client may need to return for touch-up treatments.
Dr. Ruth Hillelson is a board certified plastic surgeon known for her development of Iridesse® Skin Crèmes to restore damaged skin to its youthful suppleness and vitality. She received her medical degree from the University of Vermont College of Medicine and her board certification from the American Board of Plastic Surgery. Residents of Richmond, Virginia who are interested in minimally invasive cosmetic treatments should give her a call at 1-800-686-0203.
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