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Guide To Injectable Therapies For The Face

(Including Fillers, Wrinkle Relaxers (Ex. Botox) And Kybella)

What is Injection Therapy?

Injectables Over the last 15 years, there has been tremendous growth in the area of injection therapies for rejuvenation and the consumer has a remarkable array of choices for looking their best.

Naturally, with more options comes the “burden” of having to sort through what is available, and to determine what is best for each individual.  This guide will provide you with a basic understanding of these treatments, and assist you in starting your journey toward the best results.

What are the Different Types of Non-Surgical Facelift Injectables?

Presently, there are three main classes of injectables, sometimes referred to as Non-Surgical Facelifts, that are FDA-approved in the U.S. and have a reputable track record of results:  Neurotoxins, Fillers, and Fat Dissolvers.  Each category is so distinctly different from the others that it is important to understand the role of each one and recognize that they are not interchangeable.

What are Neurotoxins?

Neurotoxins are agents that are injected in an area specifically to decrease muscle contraction that causes wrinkles or asymmetry.  The muscle relaxation and smoothing effect will persist for up to four months.  At the time of this writing, three such medications were approved for use in the U.S.: Botox, Dysport, and Xeomin.

While these medications are slightly different on a molecular level, patients would find it difficult to distinguish them when receiving treatment or assessing their effectiveness.  These neurotoxins act at the cellular level by reducing the ability of the target facial muscles to receive the signal to contract and wrinkle the skin.  Once the effect wears off, muscle function will generally return to baseline.  Neurotoxins can, thus, be thought of as muscle “relaxers” or wrinkle “smoothers” of the face or neck.

What are Dermal Fillers?

Injectables Fillers are agents that are used to add volume to areas of the face, whether on a “fine” level such as filling individual wrinkles or on a larger scale such as adding cheek volume.  Fillers can be subdivided into categories based upon their chemical composition.  They are primarily composed of molecules that are designed to be similar to molecules found in the human body so as to make them highly compatible.

A very popular class of fillers are made of hyaluronic acid (“HA”), which is a widely found class of molecules in the human body.  Examples of HAs include Restylane, Restylane Refyne, Restylane Defyne, Restylane Silk, Juvederm Ultra, Juvederm Ultra Plus, Voluma, Belotero, and Volbella.  Another successful category of fillers is comprised of calcium hydroxyapatite (CaOH), a molecule like that found in human bone tissue.  The popular filler composed of CaOH is called Radiesse.  A unique filler that some categorize separately from the other fillers is Sculptra.  This is an agent composed of poly-L-lactic acid (PLLA) which, when injected into an area, causes the body to produce its own collagen thereby adding volume.

Based on its mechanism of action, many consider this Sculptr to be a collagen “stimulator” rather than a filler per se.  In contrast to the classic fillers, Sculptra volume will increase over time, while other fillers will gradually decline over time.  In general, how long a filler will last depends on a number of factors including the type of filler, where it is placed, and the individual.  Fillers placed in areas of a greater movement, for example, tend to dissipate a bit faster because of movement in the area.  Also, certain fillers that are prepared in a special way so as to create more chemical bonds between its molecules are also designed to slow the breakdown.

What is Kybella?

Currently, there is one injectable on the market that is used to dissolve fat: Kybella.  This is a specific chemical that is devised to “melt” fat from the area of the neck and below the chin while avoiding an effect on the skin and other tissues in the area.  Chemically, it is a component that is found in human bile, which aids in the digestion of fat in the intestine.

How Long After a Kybella Treatment Do You See Results?

The effect of Kybella is quite rapid and can be seen within four to six weeks.

How Many Kybella Treatments Will I Need?

It is common for several treatments to be needed for a full correction of neck fat.

Are Injectables Safe?

When the FDA approves an agent for use in the medical field, they do so with specific “indications,” or guidelines in which the agent “should” be used.  These specific guidelines are called “on label” use.  In the case of the injectables, they can be used effectively in other ways, termed “off-label,” provided it does not violate safety or ethical guidelines.

This kind of flexibility works in the patient’s favor by offering more ways for these therapies to make people look their best, but demands that the physician be well-versed on the agent and its safe administration.

How Do I Choose Which Injectable is Right For Me?

Woman standing with mask on Given the ever-increasing choice of injectable agents available nowadays, it is no wonder that many patients are confused as to how to move forward.  It is essential that patients receive the best guidance from an expert, ideally a physician with aesthetic expertise.  Because these injectables can be ordered and administered by any licensed physician, regardless of whether he or she has expertise in facial anatomy and aesthetics, patients may not realize their best results.

Also, injectables are often administered by allied providers whose background and training may be insufficient to provide expert treatments.  Certainly, common sense should make anyone reading this guide question whether he/she should trust receiving these treatments at an urgent care center or so-called medical spa!

There are several keys to successful treatment with injectables.  Here is a brief guide:

Non-Surgical Facelift Consultation

  • Be sure to get a consultation with an expert, such as a plastic surgeon or physician trained in both facial anatomy and aesthetics. Formulating a solid plan is absolutely essential for the best and most natural results.  A great plan with an expert will set you up for the best enhancements, the most natural results, realistic expectations of what can be achieved, and the most efficient use of your money and time.  A flawed plan can compromise any of these aspects resulting in possible disappointment or higher cost.  I strongly advise against shopping for the best price on these procedures, as that can ironically result in much higher expenses over time as more frequent and less effective treatments add up!  It is not always necessary to pay a fortune to see a physician who has a focus on injectable treatments.  Also, do not assume that an injection plan that works for your friend or family member will be ideal for you; generally, that is not the case!

How To Prepare for a Liquid Facelift Treatment Session

  • Once you are ready to move forward, be sure to prepare for the treatment. It is best to attend the visit with washed skin that has no other topicals applied such as makeup.  It is important to avoid medications that contribute to bruising or bleeding, such as aspirin, ibuprofen (Advil), Coumadin, Persantine, and the like.  Also, be sure that you are not planning on attending any important events within the few days following your treatment as it is possible to have mild bruising and swelling that will take a short time to disappear.

What to Expect After an Injectable Treatment Session

  • For the most part, the majority of injection treatments do not require specific follow-up care. However, this is not true for all treatments.  Sculptra, for example, requires a specific, albeit easy, follow up routine for about five days.  Most fillers will benefit from ice for the first day or two, but this is not essential.

What Results to Expect After Injectables Treatment

  • The best results depend on the follow-up and collaboration with your doctor. Specifically, in the case of the neurotoxins (Botox, Dysport, Xeomin), treatment is required at about four months apart.  While it is understandable to want a treatment that is “permanent,” none of the neurotoxins achieve a permanent effect.  In my view, this is not a criticism that should be a “deal-breaker.”  Excellent treatment requires only three visits per year, and all of the agents have an amazing record of both safety and effectiveness.  Three visits in a year are a frequency that is far less than many people's need for hairstyling, manicure, massage, or acupuncture.

What are the Benefits of a Liquid Facelift?

Although every individual benefits from a customized plan, there are two general concepts to consider as you embark on these exciting therapies.  First, the best results often come from blending the treatments rather than using one therapy alone.  For example, using Botox for smoothing and Restylane or Juvederm for filling can give much better overall results than either agent alone.  In addition, injectable therapies often work beautifully with other aesthetic treatments such as laser treatments or physician-grade skincare regimens.  Second, always remember that filler results depend on the volume given, and many great candidates for fillers do not realize their best results because the volume given was too low.  Most of the research studies conducted on fillers before they are approved by the FDA treated patients with multiple syringes.

Stay tuned for more detailed information about these non-surgical therapies at our web site!

Fillers & COVID Vaccine

It has recently been reported that several patients who had received dermal facial fillers have had reactions to the Moderna COVID-19 vaccine.  The reactions consisted of swelling in the filler areas, and were noted shortly after individuals received the vaccine.  In each of these cases, the reaction was considered mild and it promptly resolved with medication.  It is important to underscore that none of these reactions were severe or life-threatening, and no long-term consequences were reported.  There have been no reported cases of this reaction in patients receiving the Pfizer vaccine.

Individuals who have had filler injections should NOT refrain from receiving the COVID-19 vaccine based upon what we know thus far.  If you receive the COVID-19 vaccine and experience a reaction in the areas treated with fillers, call the office promptly and we will assist you in the proper treatment to resolve the issue.

As with many things related to the COVID-19 pandemic, information is continuously being accumulated and the situation remains fluid.  Stay tuned for further updates.


Schedule a Consultation Today!

To learn more about our Non-Surgical Facelift Treatments, call us at 818.245.6101 to schedule a consultation. Saul R. Berger, M.D. Plastic and Cosmetic Surgery is proud to serve Glendale, CA, and surrounding areas.

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