Injectables: What You Need to Know


If you are looking to rejuvenate your appearance without surgery and you are wondering if injectables are right for your needs, here are a few things to consider:

1.  Why Choose Injectables:  

Injectables can provide subtle changes to the look of your face. Both men and women who are seeking to soften and reduce the appearance of wrinkles and lines on their face may consider injectables. Patients may be seeking to increase the volume in certain areas of their faces, such as the cheeks or lips.  Others may be looking to reduce volume in visible areas, such as the neck.  There are different injectables for different goals and the number of products on the market increases constantly.  Patients in their 20’s, 30’s, 40’s and 50’s may not be ready for cosmetic surgery, but they may desire some facial enhancement.  Injectables may be the answer.  

A common advantage of all injectable procedures is avoiding the scars, anesthesia, and downtime that comes with conventional cosmetic surgery.   The disadvantages of most injectables is that the result is usually, but not always, temporary and the effects can be less impressive than conventional surgery.

2.  Neurotoxins vs. Fillers vs. Cytolytic drugs

Any drug that is injected can be considered an injectable, but currently there are three typical classes of injectables used for cosmetic facial rejuvenation: Neurotoxins, Fillers, and Cytolytic drugs.

Neurotoxins: Botulinum toxin is the most popular injectable that temporarily reduces or eliminates facial lines and wrinkles. The most common areas to treat include: vertical frown lines between the eyebrows, transverse forehead creases, and crow’s feet around the eye area. Injections of botulinum toxin temporarily block the nerve signals to the muscle in which it was injected. Without a signal, the muscle is not able contract. The result is diminished unwanted facial wrinkles or appearance. Sometimes, botulinum toxin is injected to rebalance facial muscles to provide a younger look.  One application of this approach is the “chemical brow lift”.  Commonly known brands of botulinum toxin type A injections include: BOTOX®, Dysport and Xeomin®.

3:  Fillers 

Fillers help: plump thin lips, enhance shallow contours, soften facial creases and wrinkles, improve/diminish the appearance of recessed scars, reconstruct contour deformities in the face, decrease or remove the shadow of the lower lids.

Fillers are composed of a variety of formulations:

Hyaluronic acids are the most popular fillers.  These are glycosaminoglycans already present in the human body, so these products are considered natural and popular because they work well and last up to one year. The product is made from bacteria or rooster combs.  These fillers act like an inflated cushion to support deflated facial structures and tissues while enhancing the look and feel of the skin. Hyaluronic acid fillers may be used to plump the nasolabial folds, as well as wrinkles and depressed scars.  There are different formulations of hyaluronic acid that provide unique characteristics of the gel.  Some are soft and smooth designed to fill lines in and around the lips.  Others types are firm and stiff, intended to be injected deeper in the cheek to provide volume augmentation.  Brands include: Restylane®, Juvéderm® Ultra, Juvéderm® Volbella, Juvéderm® Vollure, Juvéderm® Voluma, Bolotero, Prevelle Silk, Elevess, Captique, Hylaform

-Collagen is a protein found in the human body that has been used as a filler in cosmetic surgery. It’s used to touch up wrinkles around the mouth and forehead or to create fuller lips. Many of these fillers may last up to 4 months. They are typically the shortest lasting fillers available and usually require an allergy test before injection since some brands have a bovine (cow) source.  Now that hyaluronic acid fillers are available, there use is much less common.  Brands include: Evolence, Cosmoderm, Fibrel, Zyplasty, Zyderm.

-Calcium hydroxylapatite is a mineral found in human bone and teeth.  It is suspended in a gel and is used to fill moderate to severe creases in the face such as frown or marionette lines around the nose and mouth or to contour the cheeks.  It can last up to 18 months, but it can obscure xrays because it is radio-opaque.  Brands Include: Radiesse®

-Poly-L-lactic Acid (PLLA) is a synthetic substance that has been used for many years in absorbable suture material.  It may be given in serial injections, separated by months, and its effects may last up to two years.  It has been used in patients with HIV that develop facial fat loss that occurs as a side effect of the antiretroviral medication.  Brands include: Sculptra®

Polymethylmethacraylate beads (PMMA microspheres) are a non-biodegradable synthetic  material that is commonly used in bone cement for orthopedic procedures.  They are typically suspended in a protein gel and injected into the face.  This is a permanent filler.  Brands include: Artefill

Fat can be used to augment the face.  It is used in a deeper plane of the face than most of the other fillers because injection of fat is not as smooth as these products.  Correction can be less predictable because the fat needs to survive to produce a long lasting effect and it needs to be harvested from the patient which requires some form of anesthetic.

– Unapproved fillers include liquid silicone or silicone gel.  These are NOT recommended and NOT approved by the US FDA for filling lines and increasing facial volume.

Cytolytic Drugs: This is a relatively new class of drug approved by the FDA to eliminate fat cells in the neck below the chin, commonly to reduce or eliminate a “double chin”.  Deoxycholic acid is essentially a synthetic bile acid that is injected, usually in several treatments separated by weeks, into the fat of the neck to destroy fat cells.  It does result in swelling and numbness for a period of time.  It can cause nerve injury to the jaw, result in an uneven smile or other facial weakness, or cause difficulty swallowing.  Brands include: Kybella®

Where Fillers are Used: Fillers can be added around the eyes, mouth, temples and in the apples of the cheek to make the face appear plumper/younger.

Where Neurotoxins  are Used: Neurotoxins are used primarily in the upper third of the face.  The first approved area is the “glabella” , the anatomic area between the eyebrows where vertical lines commonly appear from frowning.  It is also used in the forehead for transverse lines and around the eyes for crows feet.  It can allow rebalancing of asymmetrical muscles and provide some elevation to the brow.  It can also be used around the mouth, nose and neck less commonly for more subtle changes.


Where are Cytolytic Drugs Used:  Kybella® is used only in the neck, below the chin to reduce or eliminate a double chin.  It usually requires several treatments separated in time.


Board Certified Plastic Surgeon: As with any cosmetic procedure, you first need to find a qualified board certified plastic surgeon who specializes in fillers to conduct your procedure and has extensive training and experience with injecting soft tissue fillers in the face. Discuss with your board certified plastic surgeon about the best treatment options for your needs and the risks associated with the procedure(s).