Botox®, Dysport® and Xeomin® are similar products that all contain botulinum toxin, a medicine used to treat dynamic wrinkles in the face. Dynamic wrinkles are those lines that occur with contraction of underlying facial muscles. As the same muscles contract time and time again, these lines become deeper and more permanent. Common areas to develop these kinds of wrinkles are at the corner of the eyes (“crow’s feet”) with smiling, between the eyebrows with furrowing the brow or frowning, and forehead (glabella) with raising the eyebrows.
Botulinum toxin is delivered to specific muscle groups and works by temporarily weakening their action and thereby eliminating or improving dynamic wrinkles. Botulinum toxin can also be used to slightly elevate the brow and soften other areas of the chin, lip and neck. The effect of botulinum toxin begins just a few days after its injection peaks around 10-14 days. Most patients enjoy its effects for 3-6 months.
Initially, treatments are recommended every 3-4 months to maintain a weakened state. However, over time, injections can sometimes be spaced out as muscles become more permanently weakened or are “retrained” out of their constant use. When these muscles are constantly weakened, collagen remodeling in the overlying skin can lead to a more lasting improvement. Treating dynamic wrinkles earlier as they begin to form can also prevent their more permanent formation.
The main side effects of treatment are bruising and redness at the injection sites. However, this is usually mild when it does occur and amenable to coverup. Most patients feel comfortable returning to work directly after their injections. It is possible for botox treatments to cause a drooping eyelid. However, in trained hands, this is exceedingly rare. This type of side effect is temporary and wears off with the effect of the medicine.
A targeted injection pattern tailored to your face and the muscles that have led to its changes will give you the best results. Dr. Callahan’s extensive training in oculofacial plastic surgery has given her an understanding of facial anatomy and allows her to customize your treatment to achieve your goals.
The youthful face is characterized by a fuller face with round cheeks and full brows. As aging occurs, the face undergoes several anatomic changes including volume loss and descent as tissues shift downward with gravity. The combined effect of these factors is a more hollowed appearance with distinct shadows in areas of ligamentous attachments. Where volume is lost, some may describe the “mountain” or puffiness while others may focus on the adjacent “valley” or shadow. A perfect example of this is under the eyes where some may note a puffiness under the eyes while others note the adjacent dark circle or tear trough. Historically cosmetic surgeons targeted the mountain with subtractive surgery. However, as our understanding of the science behind the aging face has improved, greater focus has turned toward replacing early lost volume with minimally invasive injectable fillers to restore a more youthful appearance.
Areas commonly amenable to filler treatments include the under eye, cheek, nasolabial groove that extends from the nose to the mouth and jowl. Filler may also be used to augment certain areas of the face including the lips and brow, or can be used to “fill in” fine lines not suitable for botulinum toxin.
Several types of filler exist and choosing the appropriate filler for you is important as each one has been designed to target specific facial areas or goals. Depending on the type and location of filler, results can last anywhere from 6-10 months to several years.
Recovery time varies widely from patient to patient, particularly for filler injected under the eyes. Some patients look completely healed a few days later while others can have significant bruising and swelling that lasts a week or two. Please consider this when scheduling your appointments around your work and social calendar.
A hollow or dark circle often forms under the eyes with age, which can lead to a perpetually tired look. Filler can be used in this “tear trough” to smooth the transition between the fullness of the lower eyelid above and prominence of the cheek below below. With the hollowed area between these two elevations filled, the dark circles are lessened. Restylane® and Restylane Silk® are Dr. Callahan’s preferred fillers in this area because they are the safest in this area and engineered for more delicate areas. In some cases, the lower eyelid fat pads may be too pronounced for Restylane® to mask them, and a surgical blepharoplasty may be more suitable.
Descent of the cheek pad with age causes a flattening of the cheek prominence (as well as a fullness in the nasolabial fold below). Placing filler in this hollow is one of the most powerful areas for facial rejuvenation. When performed judiciously, it can restore a more youthful fullness to the cheek and smooth facial contours in direct and profile views, without creating an “overdone” look. The best fillers for this area are those with more support and “lift” for the overlying thicker tissues of the cheek. For this reason, Dr. Callahan prefers Voluma™ and Restylane Lift®.
Nasolabial folds, Marionette lines and Jowls
As the heavier cheek tissues descend with gravity, the fold extending from the base of the nose to the corner of the mouth becomes accentuated. Placing filler in this nasolabial groove lessens its depth and restores a smoother, more youthful, transition between facial units (cheek to mouth).
Many of us also develop vertical (marionette) lines extending downward from the corner of the mouth to a hollowed area at the jawline. Just behind this hollow point are the jowls and just in front of the hollow is the projection of the chin. A more youthful jawline can be restored by smoothing the transition between jowl and chin at the jawline (often in combination with botulinum toxin to relax the chin) with fillers like Juvederm™ and Restylane®. These may also be used to soften marionette lines as well as to turn up the corners of the mouth when they have developed a downward, saddened appearance.
Lips and Fine Wrinkles
Thinning of the lips is one of the underappreciated changes that occurs with aging and which is easily restored to a more youthful appearance with fillers. Much like in the cheek, judicious use of filler in this area can yield a subtly revitalized appearance while avoiding an “overdone” look. Dr. Callahan prefers Restylane Silk® and Juvederm™ for this more delicate area.
While dynamic wrinkles are often best addressed with botulinum toxin, very fine wrinkles or long-standing dynamic wrinkles can eventually become etched into our skin. Some of the finer fillers, such as Restylane Silk®, may be used to blend these fine lines into the surrounding skin.