Dermatologists Say That Botox Is Actually Not Safe for Use All Over the Face
While testing out a new anti-aging eye cream or face moisturizer isn't a big decision, cosmetic facial injectables are a different story. They are more costly, longer-lasting, and require more thought and research before taking the plunge. There may not be as many choices as OTC skincare products (we've walked those Sephora aisles, too!) but there are a variety of options when it comes to what's actually in the needles. We've got the complete guide to anti-aging skin injectables from top dermatologist experts, including their benefits, cost, safety, who they're best for, and who should steer clear of them.
First, there are two main types of cosmetic face injectables: neurotoxins and fillers. Each type has different brands that function similarly, but have slight and sometimes important differences. Keep reading for all the key details to know and to choose the cosmetic injectable that's right for you.
Neurotoxins
What are neurotoxins and what do they do?
"Neurotoxins are injectable proteins that aid in the relaxation of muscles that cause wrinkles when contracted from facial expression," explains Anna Guanche, M.D., a board-certified dermatologist at Bella Skin Institute in Calabasas, California. "When the muscles are relaxed, the face looks smooth: These injectables help relax or temporarily paralyze the muscles to soften fine lines and wrinkles."
What are neurotoxin injections best for?
"Neurotoxins are best for patients who have visible wrinkles during dynamic muscle movement, but minimal or fine static lines, meaning when you are at rest," says Jessica Weiser, M.D., a board-certified dermatologist and founder of Weiser Skin MD in New York City. They can also "be used as a preventative treatment for fine lines and wrinkles as early as age 18, and used up to age 99 and above," Dr. Guanche adds.
Also known as neuromodulators, neurotoxins are not meant to be used everywhere on the face, only in certain locations. "The FDA-approved indications include the 11 lines (a.k.a. frown lines between your eyebrows), forehead lines, and crow’s feet (smile lines)," says Dr. Weiser.
What are the different types of neurotoxins?
Here are the options for neurotoxins and what they are meant to be used for, according to Dr. Guanche:
Botox is the first original cosmetic and therapeutic neuromodulator; it is approved for glabellar, periorbital (crow's feet), and forehead lines.
Dysport is approved for treating glabellar lines (between the eyebrows). The way that units are generally used, this injectable could end up slightly less expensive than other brands.
Jeuveau is the newest neurotoxin on the market and approved for glabellar lines.
Xeomin (ncobotulinumtoxinA) formula contains isolated toxin without the accessory protein that the other brands have (though it performs similarly) and is approved for glabellar lines.
How long do neurotoxin injections last?
Most neurotoxins last three to four months on average, with results occasionally lasting up to six months.
Are neurotoxins safe?
The short answer: Yes. "In experienced hands, these injections are considered very safe and undergo extremely rigorous safety testing in order to obtain FDA approval," Dr. Weiser says. "Botox and Dysport, two of the most popular brands used, are approved in over 75 countries worldwide. Botox was initially approved in 2002 in the United States, and Dysport in 2009 after being used safely in Europe for years prior."
That said, you should avoid neurotoxins if you are allergic to any of the ingredients, are pregnant or breastfeeding, or have certain neuromuscular disorders such as Guillain-Barre or Myasthenia Gravis. And you should always consult with a board-certified dermatologist first, as "some patients are not good candidates for injections based on their facial anatomy," Dr. Weiser says.
What is the average cost per neurotoxin treatment?
The cost of a neurotoxin treatment can vary significantly according to geographic location and is typically decided by the number of units of the product used in the treatment, although sometimes by the area of the muscle group treated. In general, you an expect a session to cost a few hundred dollars on average. For example, a treatment between the eyebrows can run around $250 up to $600 or more.
Are there any potential side effects to neurotoxin injections?
Yes, but they're typically mild. Side effects can range from a slight headache and pain at injection site to bruising and poor cosmetic results if the procedure is improperly performed. "The most common risk is bruising, but there can occasionally be asymmetry and, in the worst case, eye ptosis [upper eyelid drooping]," Dr. Guanche says. "But these are extremely rare in the hands of experienced injectors."
Fillers
What are facial fillers and what do they do?
"Dermal fillers are gel-like substances that are injected below the surface of the skin to help restore volume loss, smooth out and plump fine lines and wrinkles and enhance the natural contours of the face," Dr. Guanche explains. Think heightened cheekbones, fuller lips, a lifted lower face, and reduced undereye hollows.
What are fillers best for?
Facial fillers are ideal for patients who are looking to replace lost volume in the face or to enhance its contours. In some circumstances, they can also be used to improve loose or crepey skin.
What are the different types of fillers?
"There are multiple different types of fillers including hyaluronic acid fillers (the most common type), calcium hydroxyapatite, and poly-L lactic acid," Dr. Weiser says. Here are the most common ones:
Juvéderm is a reversible filler made of hyaluronic acid, a lubricating substance that occurs naturally in the body. Juvéderm Voluma XC is approved for the cheeks and chin; Vollure XC is approved for moderate to severe facial wrinkles and folds, including nasolabial folds (mouth lines); and Volbella XC and Ultra XC are approved for the lips and surrounding lines.
Restylane is a reversible hyaluronic acid filler. Restylane Lyft is approved for restoration of the mid-face and hands, Silk for the lips and mouth area, Kysse for natural-looking lip enhancement, Refyne for moderate to severe facial wrinkles and folds, and Defyne for moderate to severe facial wrinkles and the chin.
Radiesse is a nonreversible filler made of microspheres of calcium hydroxylapatite, a mineral found naturally in bones and teeth. It’s used to volumize facial wrinkles and folds as well as for hand rejuvenation, Dr. Weiser says.
Sculptra uses poly-L-lactic acid (PLLA), a synthetic compound that encourages the formation of new collagen by your body's own cells. This type of filler treats shallow to deep facial folds and wrinkles, is generally more expensive and requires a series of treatments, but lasts longer than others.
How long do filler injections last?
How long a filler lasts depends which one is being injected. Hyaluronic acid fillers typically last six to twelve months (some can last up to two years when injected in large quantities), whereas calcium hydroxyapatite lasts nine to twelve months, and a series of poly-L lactic acid treatments can last up to two years.
Are facial fillers safe?
Another resounding yes from all of our experts, but they also cautioned about choosing a highly-trained professional to perform face filler injections. Look for a board-certified dermatologist, plastic surgeon, or oculoplastic surgeon. "A deep understanding and knowledge of facial anatomy is crucial for safe injection of filler," Dr. Weiser says. "Proper training and technique are very important."
Similarly to neurotoxins, fillers should be avoided by anyone who is allergic to any of the ingredients, as well as women who are pregnant or breastfeeding.
What is the average cost per filler treatment?
There are a multitude of factors that impact the cost of a facial filler treatment: The injector, the practice and its geographic location, the type of filler being used, the number of syringes needed, and the area being injected. Face fillers can range anywhere from $500 to $2,000 per syringe.
Are there any potential side effects to filler injections?
Yes, facial fillers do have potential side effects and they can potentially be more serious. “The most prevalent mild symptoms are pain or tenderness at the injection site, bleeding, bruising and swelling,” Dr. Weiser says. “Occasionally, bumps or nodules can develop at the injection site.” Other potential risks include skin redness, discoloration, inflammation, infection, and migration of the filler from the injection site, which, though infrequent, can mean further complications.
One of the most rare yet serious side effects is when "fillers cause a vessel occlusion (blocking of a blood vessel), which can result in dying tissue due to lack of blood supply, and even blindness if injected into certain vessels," Dr. Guanche says. "For this reason, it is extremely important to choose a highly-trained professional for injections."
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