Getting poked in the face with needles didn’t use to be something considered part of one’s regular beauty routine, but in recent years that’s been changing. Whatever your personal opinion is on injectables like Botox or Xeomin and dermal fillers, these minimally invasive cosmetic procedures are increasingly discussed on public platforms. A 2019 global report released by Allergan projects that the worldwide medical aesthetic market will be worth $26.53 billion by 2024 and notes that the demand for facial injectables has been rising in particular. Granted, this is coming from the company that manufactures Botox and Juvederm, but those findings aren’t surprising if you’ve been paying attention to Instagram beauty trends. (That same study notes that 82 percent of U.S. consumers ages 21 to 35 are using Instagram as their biggest information source for aesthetic treatment.)
Among beauty editors, these treatments are discussed enough that they aren’t really shrouded in mystery. But outside of offices where you might spend your day paging through a new report on filler, there’s a lot of confusion over the different types of injectables and what you need to know before getting each one. To clear that up, we spoke to expert dermatologists who regularly administer them firsthand. So if you’re one of many considering your first appointment, brush up on the below before you make that call.
There are three main types of injectables.
The first category consists of neuromodulators, which are used to weaken and paralyze the muscles in the face. The most common one is Botox, but other options include Xeomin, Dysport, and Jeuveau. Dermatologist Timm Golueke, M.D., says this remains the most popular type of treatment in his clinic “because it’s easy and you see the results.” Most of his patients ask for it on their frown lines, although it’s also commonly used to smooth wrinkles on the forehead and around the eyes.
Then there are dermal fillers, which sit under the skin to provide volume and support in multiple areas of the face—like lips, for instance. The ones you’ll see most commonly are based on hyaluronic acid (yes, the same ingredient often used in your favorite hydrating serums): Restylane, Refyne, Defyne, Juvederm, Vollure, Volbella, and Belotero. Others are non-H.A., which feature different consistencies and typically last longer (more on that below). These include Sculptra (poly-L lactic acid), Radiesse (calcium hydroxyapatite), Belafill, and silicone.
Finally, there’s Kybella, a deoxycholic acid that dissolves small quantities of fat. It’s currently approved for use beneath your chin.
Expect any procedure to be expensive.
Whichever injectable you’re considering, it won’t come cheap. The best way to get an accurate estimate is to set up a consultation or call your doctor. There’s a huge range in price based on location, number of units used, and your chosen expert’s fees (some may charge more for specialized techniques or targeted treatments). Think about how large the area you’re treating is too. We’re basically talking in terms of pricey to even pricier—expect something between hundreds to thousands of dollars.
Some figures that may give you a clearer idea: Popular Beverly Hills cosmetic dermatologist Simon Ourian, M.D., estimates $3,900 to $5,900 as the average cost per area for facial contouring fillers. The American Society of Plastic Surgeons lists the average cost of hyaluronic-acid-based fillers as $682 per syringe but notes that most patients require multiple syringes. (On the other hand, if you’re subtly treating a small area like your lips, you won’t need a full one.) Botox is estimated at $397 per treatment (averaging $10 to $15 per unit), but that number can quickly climb based on how aggressively you want to erase fine lines and wrinkles or how much surface area you’d like to cover. It may also cost more if you’re going for a targeted option like Baby Botox.
Ultimately, if it sounds too affordable to be legitimate, it probably is. If in doubt, get a quote from several clinics near you. Dr. Golueke warns against injecting products without being able to trust exactly where they came from. “There’s a black market for Botox and fillers, so people get Botox and fillers which look like the original product, but they are fake,” he says. We’ve already seen the many deals floating around online, but this is one case in which you should definitely stick to reputable professionals. You just don’t want to risk it.
“Board-certified dermatologists and plastic surgeons are the only providers fully trained and qualified to administer injectables,” says dermatologist Jessica Weiser, M.D. “It’s always appropriate for a patient to ask the provider what their training and qualifications are for providing the suggested treatments.”
The consultation should cover a few key things.
We’ve all seen cases of objectively bad injectables. Beyond going to a board-certified expert, make sure you and your derm (or surgeon) are on the same page about what you’re trying to achieve. And in some cases you might be told it isn’t possible. While you can do a lot with injectables, they still need to work with the proportions of your features, and it’s possible to overenhance them. Dr. Weiser recommends going for a gradual approach and adding more later only if needed.
Dr. Golueke adds that you should also feel comfortable about changing your mind. “If you’re unsure, no real, serious doctor would mind if you said you needed to think about it,” he says. “If you don’t feel like doing it, don’t do it.” If you do, make sure you take this time to get any remaining questions or concerns addressed. “The doctor may ask you if you have had any adverse reactions to past injections, how long ago the last injection was, if you are taking any medications—those are all important,” he says.
Smoothing wrinkles is just one of many options.
People typically think of injectables as a treatment for wrinkles and fine lines, but there are many other reasons someone might get them. Dr. Weiser tells us that her most frequent requests used to come from women ages 40 and over. Now she’s seeing a dramatic increase in their use in patients from 20 to 40 years old, “primarily neuromodulators to reduce lines, but also dermal fillers to soften undereye hollows, lift cheekbones, and enhance lips.”
You may have heard the phrase off-label before, which Dr. Weiser defines as “using products for unapproved indications.” Injectables go through clinical trials for safety, but they’re not technically approved for their full range of popular uses. For instance, the brand Botox is the only neuromodulator approved for use in your forehead and around your eyes, but brands like Dysport and Xeomin are routinely used there too. Off-label uses for neuromodulators include injecting them into the masseter muscle at the back of your jaw (to lessen clenching and narrow your lower face), on neck bands (to relax them), and in the central jaw (to keep the corners of your mouth from pulling down).
Filler has even more uses. Dr. Weiser sees the most requests for use around the midface (to define and raise cheekbones), along the nasolabial folds (to soften frown lines), and in lips (to plump them or just to smooth the surface). “Many off-label uses include the hollow under the eyes, the temples, the jawline, and liquid rhinoplasty to finesse the appearance of the nose,” she adds.
In comparison, Kybella is pretty straightforward. It’s approved on-label for melting excess fat under your chin, but derms may also use it off-label in other “small stubborn pockets of fat.”
Pain is usually “minimal.”
Many people flinch at the idea of a huge needle approaching their face. It can be disconcerting, but it shouldn’t hurt. Dr. Weiser classifies the feeling as “minimal pain.” Dr. Golueke likens the feeling of neuromodulators to “a pinch, similar to when your blood is taken.” Dermal fillers are a step up, but your derm or surgeon will offer a numbing cream before treatment to reduce the insertion pain. Your doctor might also cool the area. According to Dr. Golueke, the two more painful filler areas on the face are the nasolabial fold and the lips. As for Kybella injections, Dr. Weiser says they will sting intensely, but that can be lessened with lidocaine injections and ice packs.
Recovery time is relatively short.
There’s a reason so many patients opt for minimally invasive treatments; they offer fast results and very little downtime. If you get Botox, you might see small pink dots immediately after treatment, but they should go away within 10 to 15 minutes. Dr. Golueke notes that you might see minor bruising in certain instances, but it fades in five to seven days.
Filler does cause swelling and bruising, but it lasts no more than a few days (and can even go away within hours, although you probably shouldn’t make any plans day-of). Sensitive tissues will probably swell more—your lips, for instance. Dr. Weiser warns that if swelling doesn’t go away within a few days, you should call your doctor.
Kybella has the longest recovery time—anywhere from three to 21 days of swelling. “The treated area will be jellylike and sometimes uncomfortable,” Dr. Weiser says. “Slight difficulty swallowing or pressure on the neck are common side effects.”
There are potential side effects.
Speaking of, there’s a big difference between mild bruising and swelling (what you should expect) and clear signs that something is going wrong. After a filler treatment, you might notice slight bumps under your skin, but these should soften within a week. Your body may also “wall off” the filler as a foreign material, but Dr. Weiser says this is rare and can be treated with additional injections of hyaluronidase or cortisone.
On the other hand, if your doctor uses improper technique or doesn’t have adequate knowledge, they risk injecting into a blood vessel, a complication that can lead to blindness. Dr. Golueke notes that this risk is especially associated with filler in the frown lines and nose. A sign of a serious complication is when your skin turns white immediately, then gradually turns “into a deep dark bruise that would scab.” Dr. Weiser explains that this shows cutoff blood supply and can happen away from the injection site. “This is a medical emergency, and the treating physician should be contacted immediately,” she says.
The last thing you have to look out for is the possibility of an allergic reaction, either localized or more severe. “You can have problems swallowing or breathing—that’s an emergency case,” says Dr. Golueke, who notes that this occurrence is very rare.
If you don’t like the results, you have a few options.
Out of this list of treatments, Kybella is the only permanent one; the others wear off over time. A Botox injection usually lasts between three and six months and takes about two weeks to fully set in, so give it time to settle before you make additional decisions. Although you can’t undo it, Dr. Golueke says, you can do additional injections to counteract previous ones “because the muscles of your face work together.”
Filler shelf life depends on the area of the face you treat and which one you use. Most last six to 12 months, but certain types like Sculptra can last up to two years. Fillers that aren’t composed of hyaluronic acid are not reversible, so you’ll have to wait it out. “Our bodies dissolve the material by their own metabolism, so the more you move the region that was injected, the faster it goes away,” explains Dr. Golueke. This is why your lips—which are constantly in motion—need more frequent touch-ups than the rest of your face.
If you do happen to get a hyaluronic-acid-based filler, this is the one instance when you can instantly reverse the results. This type of filler can be dissolved with an injection of hyaluronidase, an enzyme that melts it away.
But the goal is to like your first treatment, so make sure to do your due diligence beforehand.
Sarah Wu is a writer in Berlin. Follow her at @say.wu.
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