If you want to turn back the hands of time and smooth out fine lines on the face, you may be considering Botox or soft tissue filler injections.

These treatments are cosmetic, not medical. They address individuals’ concerns about their appearance, smoothing wrinkles and skin folds that can result as we get older.

“Injectables, including Botox and fillers, are very popular treatments that improve your appearance with very little downtime, if any, says Yale Medicine plastic surgeon Tito Vasquez, MD. “For many patients, they are not quite ready to undergo plastic surgery, so injectables are an excellent way to rejuvenate their appearance and turn back the hands of time.”

At Yale Medicine, we recognize that these treatments are not one-size-fits-all. "Cosmetic injectables should be administered by a skilled dermatologist or plastic surgeon in order to safely and effectively enhance your appearance," advises Kathleen Suozzi, MD, director of Aesthetic Dermatology at Yale Medicine Dermatology.

Botox (OnabotulinumtoxinA) is the brand name for an injectable neuromodulator used in cosmetic beauty treatments to block nerve signals to facial muscles.

When a muscle is directly injected with this neuromodulator, it temporarily paralyzes the targeted muscle. The paralyzed muscle no longer receives nerve messages telling it to contract in response to our most commonly expressed emotions. Instead, the surrounding skin relaxes, temporarily appearing softer and smoother.

This treatment is considered very safe and is used widely. Botox now ranks among the top non-surgical cosmetic surgery treatments in the United States.

There are a variety of other botulinum toxin injections that go by other brand names than Botox, which has become an umbrella term for this treatment. Other injectable neuromodulators that that dermatologists administer include:

• Dysport (abobotulinumtoxinA)
• Myobloc (rimabotulinumtoxinB)
• Xeomin (rimabotulinumtoxinB)
• Daxxify

To understand what injectables do, it’s important to understand what happens to the aging face. Over time, people acquire facial lines and wrinkles and the skin on their faces also starts to look less full. How wrinkled you get is partly genetic, but mostly determined by exposure to the sun. Sun exposure weakens the collagen and elastic tissue of the skin, which causes sagging and wrinkling. Over the years, the face also loses volume from a natural decrease in bone and fat that happens as we age.

To help minimize the visible effects of aging, botulinum toxin injections and soft tissue fillers serve different purposes:

• Botulinum toxins soften lines by preventing muscles from contracting when we talk, chew or make facial expressions. This selective weakening of the facial muscles smoothes the appearance of lines and helps prevent new lines from forming over time.
• Soft tissue fillers smooth wrinkles and help plump up “hollowed out” areas of the face, such as in the cheeks where facial volume has been lost during the aging process. They can also help smooth scars and plump lips. Overfilling and other complications can result when fillers are administered by an unskilled individual.

If you’re considering an injectable cosmetic treatment, your dermatologist or plastic surgeon can work with you to determine if you would benefit from Botox, a soft tissue filler, or both in order to meet your aesthetic goals.

Injectable treatments can cost several hundred dollars and are not covered by medical insurance when administered for cosmetic reasons.

Botulinum injections are commonly used to reduce the appearance of wrinkles in several parts of the face:

• Crow’s feet at the outer corners of the eyes
• Forehead wrinkles
• Vertical “11-lines” between the brows
• Wrinkles around the mouth

The length of time between treatments varies depending on the type.

Botulinum toxin injectables last three to six months. Beyond that time, muscle mobility gradually returns, although patients may notice wrinkles appear less pronounced because the muscles may become weaker over time, especially with repeated injections.

Soft tissue fillers last between three months to three years on average, depending on the kind used:

• Hyaluronic acid gel is the most common type of soft tissue filler. It varies in its duration but typically lasts 6-18 months. There are many types of hyaluronic acid fillers and consulation with your provider will help determine which type is right for you. Brand names include Juvederm and Restylane.
• Calcium hydroxylapatite products last up to a year. Brand names include Radiesse.
• Poly-L-lactic acid lasts one to three years. Brand names include Sculpta Aesthetic.
• Polymethylmethacrylate is considered a permanent filler option. Brand names include Artefil.
• Fat injections use fat from your own body removed during liposuction, and these treatments can last one to three years.
• Collagen, a well-known skin plumper, lasts for two or three months.

At Yale Medicine's Botulinum Program, botulinum injections are used to treat neurological disorders, outside of the dermatology field. Our experts use botulinum toxins to care for patients with a variety of neurological conditions, including cervical dystonia, hemifacial spasm, blepharospasm, limb dystonia, and spasticity. They also treat chronic migraines and excessing sweating (hyperhidrosis).

Botulinum toxin injections are very safe when administered by a qualified physician. The American Academy of Dermatology strongly recommends against having this procedure done at a spa, hair or nail salon to ensure the best results and also to protect your health and safety.

Though considered rare, side effects can occur with these treatments. These side effects can include:

• injection site reaction
• Bruising
• Drooping or unevenness of the eyelids or smile
• Drooling
• Dry eyes
• Headache

Although very unlikely, it's possible for the effect of botulinum toxin to spread to other parts of the body and cause a variety of symptoms. Call your doctor right away if you notice any of these effects hours to weeks after receiving this kind of injectable:

• Muscle weakness all over the body
• Vision problems
• Trouble speaking or swallowing
• Trouble breathing
• Loss of bladder control

Soft tissue fillers can cause the following temporary side effects after treatment:

• Temporary swelling or bruising
  
• Lumps or bumps called nodules
• Over-filled areas
• Infections
• Injury or occlusion of blood vessels, which is rare and one the main reasons that these treatments should be administered by a skilled provider

According to the American Academy of Dermatology, more serious side effects can result from injectable fillers when administered at a salon or spa instead of by a skilled dermatologist. The risks include:

• Lumps
• Ridges
• Over-filled areas
• Allergic reactions
• Discoloration
• Infections
• Excessive swelling

Our dermatologists and dermatologic surgeons can help you develop a comprehensive treatment approach to address your aesthetic concerns.

“At Yale Medicine, our dermatologists can be a trusted source for helping you determine what cosmetic procedures, such as neuromodulators or soft tissue fillers, are right for you and your cosmetic concerns,” says Dr. Suozzi. “We take a comprehensive look at your skin and make its health and your self-confidence a priority so that you can put your best face forward.”