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Fillers And Injectables

Everything You Need To Know About Cosmetic Fillers and Injectables

The four major structural components of our face are skin, fat, muscle, and bone.  Did you know that many visible signs of aging can be traced back to volume loss in these structures?  Over time, age-related bone loss in the face can lead to retraction of the jawline, descent of the nose, and loss of high cheekbones. 


The facial muscles also decrease in volume and elasticity, and deflation and movement of facial fat further accentuates the signs of aging.  Overactive facial muscles, time, gravity, and sun damage are responsible for many wrinkles in the face, including crinkles around the eyes, deep lines between the eyebrows, or grooves around the mouth.  


As facial tissues thin out, lines become etched around the nose and mouth and cheeks look a little hollow. 


Injectable treatment options can help reverse these effects without invasive procedures. BOTOX®, Xeomin®, Radiesse® Volumizing Filler, and Juvederm® XC Filler are some of the most popular options.  


Dermal fillers can replace lost volume to help smooth wrinkles, plump the lips, and restore a more youthful appearance. Getting poked in the face with needles didn't use to be something considered part of one's regular beauty routine, but in recent years that's been changing. 


Injectable wrinkle fillers can give you a more youthful look for a fraction of what a traditional facelift costs.  Most will fill hollows, lines, and wrinkles in less than 30 minutes with results that can last from 4 months to more than a year.

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There Are Three Main Types Of Fillers and Injectables 

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Fillers And Injectables - Type 1 - Neuromodulators

The first category consists of neuromodulators, which are used to weaken and paralyze the muscles in the face. The most common one is Botox®, but other options include Xeomin®, Dysport, and Jeuveau. These fillers are commonly used to smooth wrinkles on the forehead and around the eyes.


BOTOX® is perhaps the most widely known of the injectable treatment options.  That’s why we put it first here, even though it is not our first choice. It is ideal for treating frown lines as well as creases in the forehead.  BOTOX® works by reducing contractions of the muscles, leaving the treated area soft, smooth, and youthful.


Treatment with BOTOX® typically takes less than fifteen minutes, beginning with a brief examination of the area to be treated. Injections are tiny, with minimal side effects, and patients are able to quickly return to regular activities.  Maximum results are visible within a few days, and the effects last for up to four months. Click for more detailed information on BOTOX®.  



Much like BOTOX®, Xeomin® decreases the appearance of fine lines and wrinkles around the mouth and in the forehead.  Ideal results with Xeomin® are seen shortly after treatment, but to maintain results, just as with BOTOX®, you will need to repeat treatments every three to four months. 


For some, Xeomin® might be a better choice than BOTOX® as it contains no additives. The only side effects may include short-term, minimal bruising and numbness.  In addition, unlike BOTOX®, you will not ever build up a resistance to Xeomin®. This is because it is lacking a carrier protein.


Xeomin incobotulinumtoxinA is FDA approved and does not contain additives. This natural option helps lower the possibility of patients experiencing negative side effects. 


Xeomin®  is a clinically proven injectable that removes frown lines while leaving facial expressions looking natural.  Xeomin® relaxes your muscles, smooths away wrinkles and fine lines by blocking chemicals in the muscle so lines are smoothed and softened. 


Xeomin®  can be used to eliminate fine lines, wrinkles around the forehead, brow furrows, forehead, bunny lines in the nasal area, crow’s feet, on eyebrows, on vertical muscle bands in the neck, for pore reduction,too diminish frown lines between the glabella lines, droopy brow lines, and reduce the size of the masseter muscle (jaw).


Fillers And Injectables - Type 2 - Dermal Fillers

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Dermal fillers sit under the skin to provide volume and support in multiple areas of the face—like lips, for instance. The ones you'll see most commonly are based on hyaluronic acid (yes, the same ingredient often used in your favorite hydrating serums): Restylane, Refyne, Defyne, Juvederm, Vollure, Volbella, and Belotero. 


Others are non-H.A., which feature different consistencies and typically last longer. These include Sculptra (poly-L lactic acid), Radiesse (calcium hydroxyapatite and one of our favorites), Belafill, and silicone.


Hyaluronic Acid (HA)

Hyaluronic acid is a naturally occurring substance that is already found in your skin.  It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The results are temporary, lasting 6 to 12 months or longer before the body gradually and naturally absorbs the particles. Most HA fillers are infused with lidocaine to help minimize discomfort during and after treatment.  FDA approved HA fillers include:


Poly-L-lactic Acid

Poly-L-lactic acid is a biocompatible (meaning it is safe to use in the body), biodegradable synthetic substance.  It has been used for many years in medical devices, such as dissolvable stitches. 


Poly-L-lactic acid products are technically classified as “collagen stimulators,” as their main mechanism to smooth fine lines is by helping your skin rebuild natural collagen—the filler gel itself dissipates a few days after treatment.  


Poly-L-lactic acid is typically used to treat deep facial wrinkles, and results can last more than 2 years. FDA approved Poly-L-lactic acid fillers include Sculptra® Aesthetic.



Juvederm® XC Filler works by replacing nourishing, hydrating hyaluronic acid in the skin, a substance that is naturally lost over time. Sunlight, time, and other factors all contribute to the lost of hyaluronic acid, causing a reduction in elasticity and volume. The result is most noticeable in the creases around the nose and mouth. 


Juvederm® XC Filler is a smooth gel, approved by the FDA, used to fill in these grooves, providing smoother and younger looking skin.  A single treatment can last for up to a year, and Juvederm is formulated with lidocaine, a common anesthetic, to allow for minimal pain and discomfort.


Treatment with Juvederm® XC Filler takes less than half an hour, using a thin needle. Injections are made directly into the creases and wrinkles, and results are visible immediately.  Because Juvederm® already contains lidocaine, recovery time is negligible.

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Calcium Hydroxylapatite (CaHA)

Calcium hydroxylapatite is also a naturally occurring substance, found primarily in our bones. When used in a filler, the calcium particles are nearly microscopic and suspended in a smooth gel. 


The consistency of a CaHA filler is typically thicker than that of a hyaluronic acid filler and typically last longer as well, about 12 months for most patients. 


Calcium hydroxylapatite is also reported to help stimulate natural collagen production, and it is typically used for deeper lines and wrinkles. FDA approved CaHA fillers include Radiesse®.



Radiesse® Volumizing Filler not only replaces lost volume, but also stimulates your body’s natural collagen production. This gives it double power, which is one of the reasons we like it so much.  


Radiesse® has the added benefits of being FDA approved for use with the local anesthetic, lidocaine, allowing for the least amount of pain during your injections.  Radiesse® is also clinically proven to last for a year or more in the majority of patients.


Not only does Radiesse® add volume, lift, and tone to reduce signs of aging, it also provides structure for your body’s natural collagen production to rebuild.  The combined effects allow Radiesse® to be long-lasting and to work with your body’s natural mechanisms.


If you have a deficit in the cheek area, this is usually due to a loss of volume. By volumizing the cheek area, we can get a nice lift and fullness. It is more effective to use the product Radiesse® to volumize the cheeks. 


This will give a nice lift and take some of the weight off the lower face where we begin to see deepening of the nasolabial lines and formation of the marionette lines.


Radiesse® has calcium-based microspheres and gel that help to provide structure and stimulate the production of new collagen. It has been clinically proven to last 10-12 months and will give immediate results.


If the nasolabial lines are significant without a loss of volume in the cheek area, then this area can be treated with either Radiesse® or Juvederm® Ultra Plus. Radiesse® is used if the lines are very deep and fairly long in the region, extending into the lower face area. 


If the lines are deep but not requiring as much product, Juvederm® Ultra Plus is a good choice. It is clear, soft, and easy to massage into this area.


Juvederm® is definitely the product of choice in treating the lips for volume loss. Generally the Juvederm® Ultra is thick enough to give a nice fullness and shape to the lips.  If someone is looking for a more extreme look of fullness or the Juvederm® Ultra hasn’t lasted at least 6 months, then Juvederm® Ultra Plus is a good choice. Either product will last 6-9 months in the lips.


Fillers And Injectables - Type 3 - Deoxcholic Acid

Finally, there's Kybella, a deoxycholic acid that dissolves small quantities of fat. It's currently approved for use beneath your chin.

 Fillers And Injectables - What To Expect

Although most patients have few side effects, some will experience mild redness, swelling, tenderness, bruising, or itching.  These side effects usually fade quickly, and the positive results are visible immediately. 


Regardless of which treatment you choose, downtime is usually minimal, and most patients return to their everyday activities the same day they receive treatment.


All fillers involve the use of injecting the product into the tissue.  It is important that the patient has stopped all use of blood thinners, such as aspirin, aspirin-containing products, vitamin E supplements, and other supplements. This will help decrease the risk of bleeding, bruising, and swelling.

Fillers And Injectables- Choosing The Right Provider

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When selecting a provider for injectable treatments, give your decision the same level of care and scrutiny that you would for a surgical procedure.  Non-surgical filler treatment is still a “medical” procedure that requires specific training, knowledge and skill to ensure safe treatment and natural-looking results. 


Choose a provider with an extensive knowledge of facial anatomy, a well-developed aesthetic eye, and an expert’s skill and precision.


Whomever you choose, make sure your provider has a proven background in cosmetic medicine as well as training and substantial experience performing filler injections.  Ask to see before & after photos of a potential provider’s patients. If an R.N. or physician’s assistant will be performing your injections, that person should be working closely under the supervision of a qualified physician, preferably a board certified cosmetic surgeon.


The consultation should cover a few key things.

Make sure you and your aesthetician are on the same page about what you're trying to achieve. While you can do a lot with injectables, they still need to work with the proportions of your features, go for a gradual approach and adding more later only if needed.


Feel comfortable about changing your mind. If you don't feel like doing it, don't do it. If you do, make sure you take this time to get any remaining questions or concerns addressed. 


Avoid black market dermal fillers

Dermal filler procedures can be expensive, which has prompted some consumers to turn to the online black market to purchase do-it-yourself fillers.  In the last few months, there have been multiple reports in media outlets and in the medical literature of dangerous complications resulting from self-injection of fillers by non-health professionals.


Ultimately, if it sounds too affordable to be legitimate, it probably is.  If in doubt, get a quote from several clinics near you. This is one case in which you should definitely stick to reputable professionals.  You just don't want to risk it.


One risk is that fillers purchased online can contain a variety of nonsterile substances, such as hair gel.  When injected, these substances can cause allergic reactions, infections, and the death of skin cells.  


Another risk is that improper injection technique can lead not only to swelling and lumpiness, but also more serious side effects such as death of skin cells, and embolism leading to blindness. The FDA has issued an official warning urging consumers to “never buy dermal fillers on the internet. They may be fake, contaminated, or harmful."


Dermal fillers are safe and effective in the right hands

So where does this leave the savvy consumer interested in noninvasive treatments to reduce the signs of aging?  Finding the right person to perform your dermal filler procedure is key.  Don’t be afraid to ask about training and certification to ensure you’re receiving care from someone who is both board-certified and experienced.


With the right preparation and communication between you and your provider, you can achieve natural, beautiful, and safe results.  We are always happy to answer questions, call us: 951-735-5570 

Want to learn more about Xeomin® and Radiesse®?  Click below to watch the video where Nahid, Nurse Practitioner, explains it all. 


Tags: fillers, injectables, facial fillers, cosmetic fillers, Xeomin®, Botox®, Radiesse®, get rid of wrinkles