Do I Need Anti Wrinkle injections, or filler, or both?

This is actually a common question that comes up during cosmetic consultations.  Neurotoxins and fillers are both injected into the skin, but they do completely different things.  Sometimes a patient only needs one or the other, but they commonly work very well together to achieve the desired effect.

There are two types of wrinkles Dynamic and Static. What kind of wrinkles you have dictates the best treatment option.

Dynamic Wrinkles usually = Anti Wrinkle injections

Botox is just one of the three FDA-approved neurotoxins.  The other two are Dysport and Xeomin.  We will refer to them generally as Anti Wrinkle Injections (AWI).

Dynamic wrinkles, lines that are present when you smile or squint, but go away when you relax your face, tend to respond best to AWI drugs. The drug temporarily impairs the nerve functioning of the muscle it's injected into. The relaxed muscle is then unable to produce the movement that results in wrinkling of the skin. Examples of dynamic wrinkles in the forehead are the "11" lines and the horizontal lines that are prominent with frowning and other facial expressions.

AWI neurotoxins are effective for about 3 to 4 months. 

Static Wrinkles usually = Filler

Static wrinkles are those that are visible when the face is relaxed and at rest.

As people age, the dermal layer of the skin becomes thinner. The loss of elasticity and fullness is manifested in static wrinkles. To complicate things, dynamic wrinkles can also eventually become permanent and no longer disappear when the face is relaxed.

Dermal fillers can help eliminate these types of wrinkles by adding volume to the dermal layer.

So, Fillers do just that– they “fill.”  They replace volume where volume is lost.  You’d be surprised how much collagen and even bone has already been lost in a 30-year old face.

This plumps up the tissue, returns it to a state similar to that of youth and pushes out the creases. 

Advanced dermal fillers include Ultradeep, RHA3 & 4, Belotero, Radiesse etc. Although each dermal filler has unique attributes, in general, most dermal fillers work in two ways. First, most of the fillers plump and lift the skin gently to replace collagen loss caused by the natural aging process. Secondly, most of the fillers also stimulate the body to produce its own natural collagen; some help more than others. Injections of fat are also used as fillers. The duration of results and possible side effects vary with the type of filler used.

Some fillers can be injected directly into wrinkles, like the smile lines between the nose and mouth.  However, Dr. Kelleher finds that the best use of fillers is when they are used to sculpt the face rather than just fill.  That’s where the art of medicine comes into play.  In our younger patients, we use them to define the cheekbones, strengthen the jawline, and gently enhance the lips.  In our older patients, we use them to “lift” more than to fill.  With the right filler placed strategically in the right places, one can achieve a “liquid” face lift.

The effects of most fillers are nearly instantaneous.  Most of the dermal fillers last from several months to a year or two before touch up treatments are necessary to extend results.

The answer!

Whether Anti Wrinkle injections or dermal fillers is the right choice for you will depend upon the positioning of your facial muscles and the type of wrinkles you have. In some cases a combination of the two is needed to smooth away both static and dynamic wrinkles. Also, the muscular structure of the forehead in some people may predispose them to unwanted side effects, such as eyelid drooping. With so many different factors to consider, it's important to discuss your treatment options with Dr. Kelleher so you can agree on the best treatment plan for you and your wrinkles.

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