2525 E. Arizona Biltmore Circle
Suite 116
Phoenix, Arizona 85016
T 602.381.0359
F 602.381.0236

120 Northview Road
Sedona, Arizona 86336
T 928.282.2888


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602.381.0318   800.521.2174

Cosmetic surgical procedures can produce profound, long lasting changes in facial appearance, but are invasive and have an associated recovery period. Many patients who are just beginning to show signs of facial aging desire improvement, but cannot justify the cost or time investment required for surgical intervention. For these patients, the rapidly expanding repertoire of injectable treatments is perfect to suit their needs. Injectables can be utilized during an office visit, rather than requiring a trip to the operating room. With some treatments, no anesthetic is necessary, as the needles utilized are so small that discomfort is minimal. With others, topical anesthetic agents or nerve blocks may be utilized, depending on the patient’s preference and the sensitivity of the region being treated.

From the standpoint of using minimally invasive techniques to treat facial wrinkles, there are two general classes of injectables:

Neuromuscular Toxins (Botox® and Dysport®)

botox injection
The first option, which is most appropriate for active lines or age associated wrinkles that are deeping, is to temporarily weaken or paralyze the muscle that is causing the wrinkle. Botulinum Toxin type A® and Dysport® are neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and thus can be artistically used to soften facial wrinkles. Botox Cosmetic® and Dysport® are widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. Other manufactures are producing variant toxins that will likely be approved for use in the near future, including Reloxin and PurTox. These toxins will take 2-3 days to start working and lasting for 3-4 months. Risks include bruising at the injection site and the possibility of unintentionally affecting nearby muscle groups. Specific risks should be discussed with your doctor when considering treatment. Soft Tissue Fillers (Restylane®, Juvaderm®, Sculptra®, Prevelle®).

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The second class of injectable treatments are the soft tissue fillers. This group is rapidly expanding, and many options are available. These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds). Fillers also restore volume to the face and can add structure and a youthful look as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (eg: nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure e.g. chin, cheek/jawline. All of these injectable fillers are placed by an injection, so the group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases local infections.

Many options are available in the filler class, with clinical differences being predominantly governed by how long the effects last, as well as how the filler “feels”. Generally speaking, very soft fillers e.g. Restylane®, Juvaderm®. And Prevelle® (that are best for locations such as the lips) tend to have a shorter duration of effect, while fillers that last longer tend to have more structure and are better suited in regions where they will not be palpable (such as the deep nasolabial folds). No skin testing is needed for the new generation of injectable fillers.

A more recent class of fillers is based on hyaluronic acid (HA) e.g. Restylane®, Juvaderm®, Prevelle®, and Perlane®, which is a sugar found naturally in human skin. When first introduced, a major benefit of this filler class is that allergic reactions are extremely rare, and no pre-treatment skin testing is necessary. These compounds bind water similar to the way a sponge absorbs water. Because of this, they hydrate the skin in the treated region and act as a cushion. Several manufacturers are coming out with versions of HA fillers, and formulations vary with the size of molecules (governed by the amount of crosslinking) and other components of the injectate (such as local anesthetic to help decrease the discomfort associated with injections). The various formulations expand the repertoire of options available to your injector, as certain products are better suited for different anatomical regions. Formulations with smaller particle sizes tend to be softer and smoother, and work well in regions such as the lips. Larger particles have more structure, and are best suited for deep folds such as the nasolabial creases and facial recontouring e.g. Sculptra® and Perlane®. Hyaluronic acids are eventually absorbed by your body, and the length of time is dependent on a multitude of factors including the patient, the location of injection, and the particular product used. Results last from 6 to 8 months in high mobility areas (such as the lips), and up to 1 year in regions such as the nasolabial folds, with most patients experiencing the desired effects for 6 to 8 months. Sculptra® will last 1.5 years but is required 2 to 3 sessions to obtain the desirable result.

A newer class of fillers has been introduced that is based on microsphere technology. Microspheres are tiny round particles of solid material that are relatively uniform in size. These products are used for volume replacement and for deep facial wrinkles (such as the nasolabial folds.) e.g. Sculptra® and Radiesse®. They are not approved for use in the lips.

Radiesse®/Sculptra® contains mirospheres of calcium hydroxylapatite and degradable synthetic materials suspended in a gel carrier. The filler is broken down by the body in two phases, first the carrier and then the spheres. During this process, collagen ingrowth occurs, which is expected to provide a long lasting effect. This prolonged degradation process and collagen stimulation makes Radiesse® a longer lasting filler than those previously discussed, with expected results lasting a year or more.

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Although there are many options available, there is no “one best product” for any particular use. Our recommendation is to consult with an ASAPS member physician to discuss your areas of concern, and to hear the options they suggest. If you are considering soft tissue fillers, it is a reasonable practice to first try short acting agents to be certain that you enjoy the effects of treatment before utilizing longer acting agents. Your physician will have their personal preference regarding a filler or neuromuscular agent that gives good results in their hands, and together you should be able to choose a treatment regime that matches your desires.

Procedures that may enhance your results may include a Facelift, Forehead Lift / Brow Lift, Eyelid Lift, Lip Enhancement, Botox® Cosmetic, and Nose Reshaping.

Please visit Dr. So's Skin Care Center for further information
The Aesthetic Skincare Institute