Botox® and dermal fillers are two categories of injectables that are ideal for correcting signs of aging or achieving an aesthetically pleasing look. Our entire goal when using these products is to help our patients look like themselves, but better.
If you are new to this world and worried about the possibility of having your look transformed – and not in a good way – I always suggest doing research to understand the difference between good and great outcomes. Keep in mind that experience and knowledge are important factors for the best outcomes. Physicians who are well-versed in anatomy and facial aging – and take facial balancing into account – can produce better results.
Before we go on, let’s define some terms to avoid confusion. “Dermal fillers” actually refer to soft tissue fillers. The term “dermal fillers” is no longer used by physicians, because fillers are less commonly injected into the dermis (the upper layer of the skin); rather, they are injected into soft tissue below the dermis for volumization and contouring.
Botox and other muscle-relaxing drugs (there are now 5 of them on the market in the US) are generally referred to as “neuromodulators”. When injected, neuromodulators affect the communication between muscles and nerves, which leads to muscle relaxation. Both fillers and neuromodulators are injectables.
In this article, I will walk you through everything to know before you get anything injected into your face. Let’s start with the role that injectables play to achieve facial balancing.
What is facial balancing?
To achieve beauty in a person’s face, we can use the same mathematical ratios used by the ancient Greeks to create harmonious architecture. These ratios are found throughout nature, and they are even evident in DaVinci’s paintings. Facial balancing is one of the ways in which classic principles of beauty are applied to facial enhancement or rejuvenation
In my practice, I apply the principles that underlie classic beauty and harmony to optimize a patient’s overall aesthetic. However, I don’t apply the ratios in a rigid way, otherwise my patients would look the same. I always take a patient’s unique facial anatomy into consideration so their upper, middle, and lower face are in balance.
For example, if someone has a tall forehead but the distance between their bottom lip to their chin is short, I might use an injectable in their chin to help balance those two distances and make them appear aesthetically proportionate. I would do the same for someone with prominent cheekbones and a recessed chin; enhancing the chin’s projection will help create balance.
The facial balancing concept can also help counter the effects of aging. As we age, we lose fat in our faces, and prominent facial features can become even more prominent. In this case, I look to balance the surrounding facial structure to restore a more youthful appearance.
For example, maybe someone naturally has really strong cheekbones. If they are petite and lose even a little bit of fat, the soft part of their cheeks becomes hollowed and their cheekbones appear even more prominent. By adding a dermal filler to the hollow area, their face will look softer and less harsh. In this case, the procedure is both restorative and creates aesthetically pleasing balance.
Botox and dermal fillers are my go-to products for facial balancing. Cosmetic surgery can play a role as well, but injectables allow for finer adjustments noninvasively. At the end of the day, I want to create harmony and balance and help my patients achieve natural outcomes.
The differences between injectables is probably not what you think.
There are different ways to understand dermal fillers. One approach is to consider how long the effects last. Temporary products eventually fade away but they last longer than most people think – up to a few years in many cases. Semi-permanent also last a couple of years, while permanent ones last forever. (There is only one FDA-approved permanent filler on the market called Bellafill®, and I only use it to treat depressed scars.)
Another approach to help understand fillers is the effect they produce when injected. If I want to lift your entire face, I need a “stronger” product. If I want to treat the fine lines on your upper lip, I would use a softer product. And If I am treating the area around your mouth, I would use a product that has some stretch to ensure your smile looks natural.
Semi-permanent injectables are a really interesting group, because they may be used to either provide volume or structure or, when used in a very dilute solution, to enhance skin quality. They work by stimulating or activating our bodies to produce collagen and elastin, both of which are important structural “building blocks”. Biostimulatory fillers can enhance skin quality in ways that cannot be accomplished by other means. Common areas where these products are used include the neck, chest, abdomen, above the knees, arms, and other areas. Biostimulatory products are the future of fillers.
We match products to desired outcomes.
In my practice, we use Botox and dermal fillers to achieve three outcomes:
Reduce the appearance of wrinkles and fine lines.
Botox and the other neuromodulators (Xeomin®, Daxxify®, Dsyport®, Jeuveau®) are used to relax or eliminate lines produced by facial muscle contraction (like frown lines, “crow’s feet” lines, and some forehead lines).
Soft tissue fillers may be used to treat lines that are present when our faces are at rest, including some forehead lines, lines between our eyebrows, and “smoker’s” lines on the lips.
Correction of wrinkles is perhaps the best known application of fillers but, in my practice, is actually the least commonly performed. I typically focus on first helping patients look their best from a comfortable social distance, then come back to the fine lines that sometimes are only visible in a 10x makeup mirror.
When performing recontouring, my goal is to balance (or rebalance) a patient’s facial aesthetic. Botox and fillers can be used, often in combination, to achieve facial recontouring.
I might inject filler behind the hairline to lift the mid- and lower cheek or in the back of the jawline to support jowls that have come forward. I may also use fillers to strengthen a cheekbone or chin or change the place in which light is reflected from the face.
Similarly, Botox can enhance facial contouring when injected along the jawline, into the chin, and in other areas.
As I mentioned above, we lose volume in our face over time, a phenomenon that can lead to an aged appearance. Strategic replacement of volume with fillers can restore a more youthful contour to the eyebrows, temples, cheeks, jawline, lips, chin, and other areas.
I always restore volume in a way to ensure the entire face stays in harmony and balance. If the entire face has lost volume and only one area is treated, the outcome will not be natural or balanced.
How much downtime to expect with Botox and dermal fillers?
Patients often ask about downtime after injections. Downtime is typically caused by swelling and/or bruising. Some people don’t swell or bruise at all, some may swell and bruise a little bit, and others may do a good bit of both. I always take precautions to try to minimize both bruising and swelling. I usually tell people that if they’re worried about what people think at work, have the procedure done on a Friday. It’s always a good idea to have a little bit of downtime, just in case.
We can help you look your best.
My staff and I are here to give advice and provide guidance to help you achieve outcomes that enhance your natural beauty. We simply want to help you look like the best version of you and for your appearance to reflect the way you feel inside. We pride ourselves on bringing integrity and honesty to every conversation so you have a wonderful experience.
If you value a practice that wants to give you the best possible experience and ensure you get superb results with Botox and dermal fillers, call us at (615) 329-1110 to schedule an appointment today.