Question 1

What are the potential risks of Botox?

Accepted Answer

The risks of Botox are minimal but include: 1. Bruising at the injection site. 2. Lateral brow peaking, caused by an overactive frontalis muscle pulling the lateral eyebrow too high. A tiny amount of Botox at the apex of the peak can correct this. 3. Lower resting eyebrow position, which can occur when treating horizontal forehead lines. As the frontalis muscle no longer pulls the eyebrows upwards, they may slip down, making the upper eyelid more hooded. This risk increases with age and can be minimized by reducing the Botox dose to the forehead and fully treating the muscles that pull the eyebrows down. If this occurs, there is no quick fix, but the Botox will wear off, and the frontalis will start pulling the eyebrows upwards again in a few weeks. The key is to use less Botox to the forehead in the future, balancing a smooth forehead with a lower eyebrow and a higher eyebrow with more horizontal lines. 4. Mickey Mouse smile, which occurs when Botox at the crow’s feet area prevents the orbicularis muscle from tightening when you smile. The deeper smile muscle lifts the corner of your mouth, creating a single deeper "Mickey Mouse" crease. There is no quick fix for this, but the appearance will improve as the Botox wears off. The key is to use less Botox in the lower parts of the crow’s feet in the future. Always consult with a qualified professional for personalized advice.

Question 2

How do Botox and Dysport differ?

Accepted Answer

Botox, by Allergan, and Dysport, by Ipsen, are leading botulinum toxin products. Dysport has FDA approval for treating upper limb spasticity in children, excluding cerebral palsy. Botox is so dominant that botulinum toxin treatments are often called Botox treatments. Galderma's Azzalure, a smaller vial of Dysport, is now available for cosmetic use. Both contain botulinum toxin from Clostridium botulinum. Dysport and all botulinum toxin products have warnings about potential spread of effects, causing symptoms like swallowing and breathing difficulties. Dysport is contraindicated for those allergic to botulinum toxin, its components, or cow’s milk protein, and at infection sites. Dysport's potency units are specific and not interchangeable with other botulinum toxin products. Botox, Dysport, and Azzalure are equally effective. Dysport and Azzalure spread further at the same injection volume, useful for the forehead but less so near the eyes. Higher doses in smaller volumes are recommended around the eyes. Know the product and dose used, especially if switching practitioners. Avoid rubbing your face for 24-48 hours after injections and limit sun exposure. The FDA approves 20 units of Botox for frown lines, 24 units for crow’s feet, and 20 units for forehead lines.

Question 3

Fillers

Accepted Answer

Second only to Botox, fillers are the backbone of non-surgical aesthetic treatments. They are an extremely effective way of adding volume to deeper layers and hydration to superficial layers of your skin.
 Modern hyaluronic acid fillers are safe and controllable. They wear off slowly but should you not like the effect they can also be dissolved by an injection of hyaluronidase. The most popular areas are the lips, corners of the mouth, nasolabial lines, cheeks, tear trough and lateral brow.
 As the fillers need to be injected there is some discomfort. This can be reduced with local inaesthetic. Occasionally there can be some bruising. Most of my patients seem to prefer no local inaesthetic at all for all areas other than the lips. They find the numb sensation more unpleasant than the stinging of the injection. After the injection, the area is usually red and swells a little for the first few days, before settling down.
 The effects are immediate and last from 6 to 9 months for the thinner fillers and up to 2 years for the thicker fillers. It is important however to use the right filler in each location, as too thin too deep is poor value, and too thick too superficial is a lump that will need dissolving!

Question 4

So which filler is best? And how to price fillers?

Accepted Answer

I am personally not going to use any filler that I cannot dissolve. There may be longer lasting results with Sculptra and Radiesse, but the fact that I could not remove any excess filler tips the results for me. The Q-Med range are excellent, as is the Teosyal range, Belotero are incredibly good, and I've no problem with Juvederm.The Restylane family of products is among the world’s most widely used dermal fillers. With Restylane Lidocaine and Restylane Perlane Lidocaine consumers can now get rid of any unwanted wrinkles and experience more comfort during a treatment that is quick, safe, and long lasting and I think can all be used very successfully. The key is to use the right thickness filler for the depth and effect you want to achieve and in the precise anatomical structure.
 I charge full price for the first syringe and subsequent syringes are less. I do not like the overfilled look and would rather put in too little filler than too much. I therefore offer all my patients the option of returning after two -three weeks for extra filler at the second syringe price. This ensures there is no financial cost of using less filler.

Question 5

What should you know about cheek and tear trough fillers?

Accepted Answer

As you age, your midface can sag, causing the tear trough to extend and create curves on the cheek, leading to nasolabial lines and jowls. While facelifts or suture lifts address jowls, they don't replace lost volume. Deep cheek fillers are popular for restoring volume, especially effective in your 40s and 50s, and can complement facelifts in your late 50s and 60s. At BIOTEC USA, we use long-acting hyaluronic fillers that are effective, long-lasting, and reversible. Typically, a syringe per side is needed for flat cheeks. For tear trough fillers, it's best to address the cheeks first to gauge the amount needed for the tear trough. Dark circles under the eyes require different solutions beyond HA filler. Our customers report excellent results within a month using 20% DMAE serum. Tear trough fillers provide immediate results lasting 6-9 months. This advanced technique involves injecting filler deep to the orbicularis muscle on the bone, which can be unnerving but is crucial for effectiveness. Less is more; start with half a syringe per side and top up after two weeks if needed. Bruising is common but temporary and can be concealed with foundation. Hyaluronic fillers can be reversed if the result is unsatisfactory.

Question 6

What can go wrong with fillers?

Accepted Answer

1. Bruise at the injection point
 2. Overfilling. The aesthetic effect of fillers requires judgement, precise injection technique and the right viscosity filler for the anatomic structure.
 3. Lumps. The effect can be lumpy if the filler does not spread as desired, or if there is a local area of overfilling. There is a tradeoff between the thinner fillers which are less likely to create lumps but do not last as long and the thicker fillers that can be more lumpy but last longer. Lumps can be dissolved but the risk is that the main body of the filler is also dissolved.
 4. Allergy. The risk is exceptionally low but possible. 
5. Inadequate result. This is easy to resolve with additional filler
 6. Injection into a blood vessel causes an ulcer to the skin supplied by that blood vessel. This catastrophe must be avoided by knowledge of anatomy and careful injection. Blindness has been reported with fillers entering blood vessels that supply the retina. This is rare.
 8. Infection of the filler that does not respond to antibiotics has been reported, such that surgical removal is required. This is exceedingly rare.

Fillers I Botox I Frequently Asked Questions