By Dr. Wyble //
Two of the most popular noninvasive cosmetic procedures are Botox and use of fillers. Which one or both is best for you?
In general, Botox, a neuromuscular blocking agent, works by “relaxing” the muscles causing wrinkles and is used in the upper third of the face. Areas include the frown lines, (between the eyebrows), forehead, (horizontal lines), and crow’s feet or laugh lines around the eyes.
Fillers, on the other hand, are used mainly in the mid and lower face where we develop either volume loss or fine lines around the mouth area. They can also be used together to maximize the effect of each.
There are now three neuromuscular blocking agents on the market: Botox, Dysport, and Xeomin. Clinical studies demonstrate that the three products have similar effects, although some clinicians would argue that time of onset and durations may vary based on the anatomical area used. This does give the physician more options in targeting different muscle areas of the face.
Botox, Dysport, and Xeomin are mainly used in the upper face, but they can also be used in the lower face. Examples include improving the fine lines of the upper lip, diminishing the fullness of the jowls, and softening the playtysma bands of the neck. Botox, Dysport, and Xeomin can also improve asymmetries of the lower face if muscle imbalance is present.
Fillers have shown incredible improvement since the days of collagen injections in the 1980’s and 1990’s. Generally, fillers can be used to restore volume to areas where we lose fat and collagen/elastin. Examples would be the use of Juvederm “Voluma” and Restylane Lyft in the mid-face. Tear trough deformity and loss of volume over the cheek bones can be restored or enhanced. Both fillers are FDA approved for use in the mid-face.
In dealing with nasolabial folds and marionette lines (the pronounced creases which run from the corners of the mouth to down along the chin), Restylene and Juvederm work very well for mild loss of volume. For more prominent nasolabial and marionette areas, Radiesse, a calcium hydroxylapatite gel, allows greater improvement with lesser volume and lesser cost than Restylene and Juvederm. Radiesse has also been shown to stimulate your own collagen and elastin production.
For fine lines around the mouth Belotero or newly FDA approved Restylene Silk work very well. For lips enhancement or augmentation, Restylene Silk works well to improve and eliminate the fine lines that may cause lipstick to “bleed,” while use of Restylene or Juvederm off-label can achieve more dramatic fullness for patients that want or need more volume to the lips.
In areas where there are loss of volume and fine lines of the skin, fillers targeting both can be used in a layering effect. The filler for volume is first placed deeper where needed, and the fine lines are then corrected with the appropriate filler after the deeper foundation is placed. Additionally Botox can be added to target certain muscles to enhance the above effect.
By adding Botox and fillers to skin tightening devices, such as Thermage, or skin resurfacing devices such as the three different Fraxel lasers, a comprehensive nonsurgical approach to the face can be tailored to your needs.
With the holidays and family events approaching, now is a great time to look in the mirror and decide what is best for you!
Dr. Wyble has been in practice on the Mississippi Gulf Coast for 23 years and is Board Certified in plastc surgery. Contact him at (228) 865-7299.