Do I need Anti Wrinkle injections or Dermal Filler or Both?
This is actually a common question that comes up during cosmetic consultations. Anti Wrinkle Injections and Dermal Fillers are both injected into the skin, but they do completely different things....
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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Post Treatment Fact Sheet Toxin
Here are the Elanamie Clinic post treatment guidelines for Toxin treatment
Do not lie down, rub or massage the treated area for 4 hours after treatment
You can help activate the Botox by gently exercising the muscles that have been treated, i.e. frown and smile as frequently as possible.
Some patients experience slight discomfort around the treatment area for a short time after treatment.
Bruising can be avoided or minimized by avoiding aspirin and alcohol for 24 hours pre & post treatment
You may experience temporary swelling or bruising around the site of treatment. This will usually settle within a day or two.
We recommend arnica application to reduce bruising.
Normal make-up and concealer can be applied the following morning.
Some patients can experience a headache following treatment for which you may take paracetamol.
The results are not permanent and the duration effects last will differ from patient to patient.
The treatment normally takes 4-10 days to take effect.
Side effects, if they occur, are usually temporary and mild to moderate.
Should you experience any other symptoms following treatment please contact Dr. Kelleher at the contact details below.
Anti Wrinkle Drugs - A History
Anti Wrinkle drugs have a long history from sausages to…well, wrinkles. Read on to find out..
Anti Wrinkle type drugs have had a long, interesting and still-evolving story.
The 1820s
No one really understood the biological basis for food poisoning until Dr. Justinus Kerner began to study a batch of improperly prepared blood sausages responsible for the death of several dozen Germans. Kerner posited that there was something in the spoiled sausages that brought on the disease, something he called “wurstgift” (German for sausage poison).
His experiments (including injecting himself) and case studies led to a better understanding of the neurological symptoms of food-borne botulism (drooping eyelids, difficulty swallowing, muscle weakness, and if left untreated, paralysis and respiratory failure). He also offered up suggestions for treatment and prevention of food poisoning, and paved the way for today’s therapeutic use of the toxin. He also coined the name botulism (from the latin botulus meaning “sausage”).
The 1890s
Dr. Emile Pierre van Ermengem of Belgium was asked to investigate an outbreak of botulism following a funeral dinner where three people died and 23 were paralyzed (a bad ham).
Van Ermengem, was able to make a connection between botulism and a spore-forming bacterium he named Bacillus botulinus (it was later renamed Clostridium botulinum). Seven strains of botulinum toxin were eventually identified (A through G); four of them (A, B, E and F) would be shown to cause illness in humans.
The 1940's
With the outbreak of World War II, the U.S. began researching biological weapons, including botulinum toxin (the nerve toxin produced by Clostridium botulinum), considered to be deadliest substance in the world. One plan, according to a 2004 article in Clinical Medicine (The Journal of the Royal College of Physicians of London), was to have Chinese prostitutes slip tiny toxic pills into the food and/or drink of high-ranking Japanese officers. According to the authors, a batch of gelatin capsules filled with botulinum toxin was produced, but the project was abandoned before the poison pills could be put into action.
1949
Arnold Burgen discovered through experimentation that botulinum toxin blocks neuromuscular transmission through decreased acetylcholine (acts as neurotransmitter) release.
The '50s and ’60s
Dr. Edward J. Schantz and his colleagues were able to purify botulinum toxin type A into crystalline form. In 1953, physiologist Dr. Vernon Brooks discovered that injecting small amounts into a hyperactive muscle blocked the release of acetylcholine from motor nerve endings, causing temporary “relaxation.”
In the 1960s, ophthalmologist Dr. Alan B. Scott started injecting botulinum toxin type A into monkeys, theorizing its muscle-relaxing effects might help in the treatment of crossed eyes (or strabismus). Before long, botulinum toxin type A became the go-to toxin in research labs around the world (despite fears about its use in “germ warfare”).
The '70s and ’80s
In 1978, Scott received FDA approval to inject tiny amounts of botulinum toxin into human volunteers and soon, the results started rolling in. In the early 1980s, the eye doctor published a number of studies including a 1981 paper in the Transactions of the American Ophthalmological Society that asserted botulinum toxin “appears to be a safe and useful therapy for strabismus.” Additional research showed the drug’s benefits went beyond ophthalmology, providing patients with temporary relief from facial spasms, neck and shoulder spasms, even vocal cord spasms. In 1988, drugmaker Allergan acquired the rights to distribute Scott’s batch of botulinum toxin type A (or Oculinum, as it was then known) and a year later, the FDA approved botulinum toxin type A for the treatment of both strabismus and blepharospasm (spasms of the eyelid muscle). Shortly thereafter, Allergan acquired Scott’s company and changed the drug’s name to the compact, catchy “Botox.”
The 1990s
As research continued, other potential uses came to light. Bladder spasms, excessive sweating, even cerebral palsy in children all were alleviated — at least for a short time — by injections of the neurotoxin. But by far the most earth-shattering discovery came about by accident when Canadian ophthalmologist Dr. Jean Carruthers noticed her blepharospasm patients were starting to lose their frown lines. In 1992, she and her dermatologist husband published a study in the Journal of Dermatologic Surgery and Oncology stating that though temporary, “treatment with C. botulinum-A exotoxin is a simple, safe procedure” for the treatment of brow wrinkles. Dermatologistsimmediately took note (and took advantage of this “off-label” use) and by 1997, Botox use spiked so high the country’s supply temporary ran out, causing panic among its devotees and prompting the New York Times to announce “Drought Over, Botox Is Back” once a new batch received FDA approval.
2000
Botox got the FDA’s approval for the treatment of cervical dystonia (neck and shoulder spasms);
2002
Botox Cosmetic (the frown-line fixer) got its official government go-ahead, greenlighting Allergan to begin a multi-million-dollar marketing campaign to boost its already healthy Botox sales, which had reached $310 million by the end of 2001.
2003
The drug had been profiled in nearly 14,000 TV and print stories (in the U.S. alone), end-of-year sales had reached nearly $440 million and Allergan had proclaimed Botox Cosmetic one of the most successful pharmaceutical brand launches in the company’s 53-year-history.
2004
Allergan received yet another FDA approval, this time for the treatment of severe underarm sweating (hyperhidrosis).
2006
Botox sales had soared past the $1 billion mark, with cosmetic uses accounting for about half of sales.
2009
Marked the 20th Anniversary of Botox.
2010
In 2010 the FDA approved Botox ® therapy to treat increased muscle stiffness for upper limb spasticity. Botox ® was studied to treat the prevention of recurring headaches in adults diagnosed with chronic migraines, and approved by the FDA.
2013
Allegan's sales amounted to almost $2 billion.