5 Things to Know about Botox and Fillers

While I was training in plastic surgery at Stanford, one of my professors told me, "No one will notice your best work." That's true with surgery, but it's also true with injectables, such as Botox and fillers. The goal is to look better, not to look done. Here's a little primer to help you get the results you want. First let's discuss wrinkles of the face. Did you ever wonder why lines of the forehead are horizontal? Or crow's feet emanate from the sides of the eyes like rays of the sun?

The secret is in our facial muscles. The muscles work like the elastic in a waistband, wrinkling the fabric. They contract in a predictable direction, creating wrinkles in a predictable pattern. Weakening the pull of the muscle with a neurotoxin like Botox or Dysport is like cutting the elastic. The lines soften or disappear. So if you don't like your frown lines, your crow's feet, or your forehead lines, you'll want to consider Botox or Dysport. On the other hand, if you're looking to fill in a deep line or plump up an area, fillers can help. The most widely used fillers are made of hyaluronic acid, a substance produced naturally in our skin and our tissues. As we age, our tissues thin, lines deepen, our faces lose their fullness, and our lips lose their plumpness.

Products like Juvederm, Voluma, and Restylane plump up and fill in where needed. Fear of looking like a duck or having an expressionless face are what keep many people from venturing into the world of injectables. Here's a little secret: You don't have to look like that. It is possible to look better, not just different. Below are five tips to help you get the results you want:

  • Get enough Botox/Dysport injected. Some patients come in with a limited budget for Botox, but they want their forehead, crow's feet, and frown lines treated. They purchase half the number of units they need and spread them all around. Later they call saying, "The Botox didn"t work.? If we compare photographs before and after their treatment, we can see the Botox did work, but the results are too limited to notice. Solution: either treat one area completely or don't have any Botox at all. Don't throw away your money on undertreatment.
  • Don't get too much Botox/Dysport injected. Some patients focus on erasing every whisper of their wrinkles. While they might accomplish that mission, their forehead is masklike and heavy. Don't be too tunnel-visioned when assessing the results you want. Some wrinkles may be better than a completely smooth brow.
  • "I had one treatment, and I'm never coming back." While the skill and artistic eye of the doctors and nurses who inject vary, no patient is exactly alike. Sometimes it takes one or two treatments to figure out that you might need a little more or a little less Botox than someone else. If you need a touch-up, that's often an indication that you'll need more Botox next time; if your face is frozen, you'll need less.
  • "I don't want to look like a duck!" Patients who have lines of their upper lip are often focused on one thing: making them disappear. While some patients have laser resurfacing and maybe a little bit of Botox, some patients get so much filler that their upper lip expands like a balloon. True, the lines are gone, but this is a change that is different, not better. A little bit of filler can soften the lines and still look good. Far better to look like a human with softened lines than a duck with a smooth bill!
  • Botox/Dysport + filler = synergy. Often our best results are when we combine the muscle-relaxing actions of Botox with the detailed sculpting of filler, sometimes called the Liquid Lift. Like Goldilocks, you don't want to underdo or to overdo. You want to get it done just right!

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.