March 2022 | Elite Medical & Aesthetics

When to Consider Botox vs Dermal Filler

March 17, 2022/in Botox, Fillers /by Mary Beth Martin

Introduction

It is not uncommon for people to get confused when they go in for an injectable appointment thinking they need Botox, when really they might need dermal filler, or vice versa. Sometimes misinformation can be given from social media, the internet, or even other injectors.

This blog will help you understand the differences between what Botox is intended for, and what filler is intended for.

Watch our YouTube video below for a visual representation of information that this blog will cover, too.

How does Botox work?

Botox, or Botulinum Toxin, is a prescription medication used to treat fine lines and wrinkles. Botox, or other brands of neurotoxin like Xeomin and Dysport, work to stop muscles from creating a repetitive movement that lead to unwanted lines and wrinkles. Botox injections are also preventative, to keep lines from worsening.

For more information about Botox injections read our blog “Botox for Dummies” below.

How does filler work?

Most dermal fillers are made of a gel-like substance called Hyaluronic Acid (HA) that are used to restore lost volume, fill lines and wrinkles, sculpt areas of the face, and plump. When filler is injected properly into the desired areas, it instantly plumps or fills the areas of volume depletion, giving you a refreshed, natural, and youthful appearance.

If you are curious about filler injections, and want to learn more, be sure to click on the pink button!

What areas can I get Botox injections?

The most common areas for Botox injections, or Botulinum ToxinA, are the glabella (11’s), forehead, and crows feet. There are several other areas that are considered “off label” that can be treated with neurotoxin, too, such as:

Bunny lines: lines on either side of the nose when you scrunch
DAO’s: depressor anguli oris muscle (around the mouth)
Platysmal bands: neck bands
Masseter muscle: jaw muscle
Lip Flips

What areas can I get filler injections?

The most common areas for filler injections are probably the lips and the cheeks but other areas include:

Under eyes
Jawline
Temples
Chin
Nasolabrial folds
Marionette lines

Certain types, like Radiesse, can also be used to help create collagen in the face, neck and body.

Remember, filler is considered much more dangerous than Botulinum Toxin injections because the gel like substance is more like an implant (usually lasting around a year) and can also occlude vessels. Some areas are higher risk than others and you want to go to an injector that knows the risks and how to treat them.

Does Botox or filler help forehead lines & wrinkles?

Botox helps with forehead lines and wrinkles, and is our recommendation here over filler due to to less risk (see below). When you inject neurotoxin into the forehead muscles, it stops the repetitive muscle movement that causes lines and gives a refreshed appearance.

Forehead lines treated with neurotoxin

Can you inject filler in forehead lines?

We do not recommend injecting filler into deep forehead lines, because there is a risk for vascular occlusion (filler that gets into an artery) that can lead to blindness.

Vascular occlusion can happen anytime filler is injected but in high risk areas such as the forehead, glabella, and nose blindness or even a stroke could occur. As far as we know there are no cases where the blindness was able to be reversed when it was caused by filler.

Some clinicians will do these injections, and if you decide to have it done, make sure you ask about their experience doing it and what they would do in case of emergency.

There are several other treatments that can help with forehead lines and wrinkles such as Botox, microneedling, laser treatments or a surgical referral.

Does Botox or filler help with Glabella (11's) lines?

Botox is recommended for Glabella lines over filler. This is because when you continually scowl or frown, the glabella muscles are activated to move, and over time those constant movements cause lines. Botulinum toxin injections, once injected into the muscle, stop the constant scowl or frowning and thus softens the lines and wrinkles.

11’s treated with neurotoxin

Can you inject filler in the Glabella (11's) lines?

Technically, you can inject filler in the 11’s, but we do not recommend it. Like mentioned above, injecting filler in this area has a high risk for vision complications. Safety is a priority when it comes to injectables. If you have deep 11’s lines that are there at rest, and Botulinum Toxin injections have not worked for you, book a consult to see what else can be done.

Can I get Botox injections for my smile lines?

No, you should not get Botox injections in your smile lines because it could cause your face to look distorted or drop your top lip.

Specifically in the nasolabrial fold area, there is a muscle called the levator labii superioris alaeque nasi (LLSAN) that is injected intentionally for people with a “gummy smile” to drop the top lip. If you don’t have a gummy smile, you don’t want to inject this area or it can lengthen your philtrum column (more below).

Getting Botox injections in your smile lines can cause a ducky lip.

As above, if you inject Botox into the smile lines, it’s possible to cause the philtrum column (the distance between the bottom of nose and mouth) to lengthen. A longer philtrum column can create a ducky upper lip appearance with or without lip filler.

Ensure you are going to an experiened licensed injector so these types of side effects/risks are avoided. However, Botox is not permanent, so side effects will wear off in 3-4 months.

Can I get filler injections for my smile lines?

Yes, filler injections are an appropriate treatment for smile lines. Smile lines can become static and more defined as we age, and people tend to dislike these lines. Filler is the best option because we want to fill the lines and wrinkles with volume to restore a natural look in the area.

Full face filler, including smile lines

Can I get Botox injections in my cheeks?

No, getting regular Botox injections in the cheek region can cause unwanted side effects. These side effects cause face distortion to your smile and talking movements. Sometimes microtox or “baby botox” can be used to smooth the skin but it can still cause unwanted side effects.

What happens if Botox is injected into cheeks?

If Botox was injected into the cheek muscles, there is a risk that your smile will look as if you had a stroke or Bell’s Palsy. This is because the muscles in the cheek connect to the corner of the mouth to lift it when you smile. If these muscles are disabled, you will not be able to lift the corner of your mouth.

These risks should be discussed in a consultation with your provider, along with other treatment options intended for cheek wrinkles. Book Consultation Now!

To learn more about specific areas to avoid injecting Botox in, watch our YouTube Video here. Our NP injector, Ali, demonstrates a visual representation of what could happen if Botox is injected into unintended muscles.

Can I get filler injections in my cheeks?

Yes, it is very common to get filler injected into the cheek region. Filler can enhance the appearance of lost volume in the cheeks, contour the cheeks for definition, and add structure to the cheek for other areas of concern to be treated such as under eyes.

What does Botox treat that filler doesn't?

Botox treats the muscles that lead to wrinkles, where as filler treats deep lines/wrinkles that need to be filled to restore volume

What if I don't know if I need Botox or filler?

Do not worry! Being unsure of what treatment may be best for you is not uncommon. In most cases, we recommend scheduling a consultation to talk with a trusted provider about your concerns and gather information about what treatments you are a candidate for.

What can I expect in an aesthetic consultation?

The goal of a consultation is to provide you with as much information as possible for you to make an informed decision on which treatment you want to do. Areas of conversation may include:

Addressing concerns
Goals of the patient
Anatomy assessment
Risk factors with treatments
Are you a candidate for the desired treatment?
Pricing and packages
Any other questions you may have

For more information about what you can expect in an aesthetic consultation, read this article.

Conclusion

If you are in the Lone Tree, CO area, be sure to stop by our office or schedule a consultation by clicking on the pink “book now” button below. Our trusted providers will ensure they are there for you every step of the way. If you are not located in the area, make sure to schedule a consultation with a licensed injector whom you trust.

Inside a Lip Filler Appointment

March 1, 2022/in Fillers /by Mary Beth Martin

How to prepare for a lip filler appointment

If you’re considering lip filler know that it is normal to be nervous, but we hope that after reading this article you’ll be more excited instead! Most commonly, people are concerned about pain from the needles, looking over-done or having “duck lips”, or maybe not knowing what to expect at all.

Rest assured that these appointments are very thorough, and should be comfortable when you go to a licensed injector who follows all safety precautions.

Before actually getting the injections, it is recommended that you consult with your provider about what your desired results are. They will assess, and ensure that you are a good candidate and go over realistic expectations of lip filler and known risks. Continue reading this blog to answer all of your questions about what you can expect from a lip filler appointment.

What is a lip filler consultation like?

First, your injector will talk to you about what you’re looking to achieve, what brought you in, and what questions you may have to better understand your goal with lip filler. Then they will assess your specific anatomy, and talk to you about the realistic expectations that can be achieved on you. Once you and the injector have agreed upon the treatment plan, they will go over benefits of the treatment, risks, and potential side effects (informed consent).

Informed consent is crucial, and mandatory, for all medical procedures. This is where the provider goes into depth about risks, potential side effects, and even alternatives to the treatment. The goal here is to give you all of the information so you can make an informed decision if the treatment is right for you. Some people aren’t even a candidate for lip filler so it’s good to talk first!

If you are in the Lone Tree, CO area and are interested in booking a consultation to see if lip filler is a good treatment option for you, click here.

If you’re not local, here are some good sample questions to ask when you go in for a consult:

What are your credentials? I.e. RN, PA, NP, Physician
What kind of training did you do to learn these kinds of injections?
Do you have photos of your work?
What are the risks and how would you treat them?
What are the side effects of the procedure?
What product will you be using and why? Is it FDA approved in the U.S.?
Can the product you’re using be dissolved?
How can I reach you or your office on a Saturday in case of emergency?

How do I prepare for lip filler?

Once all of your questions and concerns are answered, the injector will start the numbing process. This is to ensure you are as comfortable as possible during the treatment. There are two option with numbing specifically for lip filler. You and your injector should discuss which option would be best for you, but read below for a description of both.

2 Types of Numbing Options

1. Topical Numbing Agent

This is a topical medication that is compounded to combine local anesthetics such as lidocaine and tetracaine. Once this is placed on the lips, it starts working by blocking nerve signals in the body to reduce discomfort from initial injections.

2. Dental Block

A dental block refers to injecting an anesthetic agent, such as lidocaine, (typically) into the infraorbital nerve and mental nerve through the mouth. This provides the client with complete numbness of the lips prior to injection.

How long does it take to become numb for lip filler?

For topical numbing, it usually takes 5-30 minutes for the effects of the numbness to work (depending on the compound). The area continues to remain numb for 30 minutes to 1 hour after removal. Dental Blocks immediately start numbing the lips and the effects of this numbing process may remain for several hours hours post injections.

Pro's & Con's of numbing medications for lip filler:

Pro's of topical numbing

This works quickly, allows patient to move their lips easier during injections (for better assessment), and wears off quicker for patient to go about their day

Con's of topical numbing

Patient is not 100% numb, some formulations can cause blanching (whitening) of the lips making the assessment difficult for the provider

Pro's of dental block

Complete numbing for overall patient comfort

Con's of dental block

Initial dental injections go deep into gums and are painful. This can also make assessment difficult when moving mouth, because patient can be too numb. Numbness lasts for hours after treatment.

What is lip filler treatment set-up like?

While the desired numbing agent is working, the provider will start to set up for the treatment using industry standards. This includes washing hands, placing sterile drape onto tray, using gloves, properly preparing the filler products, and cleaning the injection site(s) on the client. This step is especially important because lip filler injections are a medical treatment that needs to be administered safely. Going to licensed providers that have a clean and sterile environment is crucial to lower any potential risk, and ultimately to keep you safe.

How long do lip filler injections take?

This is the quickest part of the appointment. The actual lip injections only take 10-15 minutes. You can expect that your injector ensures you are comfortable throughout the injecting process, giving you breaks where needed. From here they will start to inject the filler by building the lips to fit the patient’s specific features. Overall, the goal should be to harmonize the lips and create balance to the face by subtly enhancing the lips. You should not feel anxious or worried about getting “duck lips” from this filler procedure. With the right injector, you will gain a boost of confidence, instead.

For more on how to avoid “duck lips” with lip filler read this!

Will I swell after lip injections?

Swelling and bruising is normal, and your injector should disclose this part of the treatment with you at the consultation and assessment step, that way you are aware and can plan for social down-time. For initial downtime, the first 24 hours is the worst, then swelling subsides day by day and can be covered by makeup.

It is also recommended to not plan this appointment on (or too close to) any important social gatherings, pictures, or work presentations.

Generally we tell people not to “love them or hate them for 2-weeks” but give them 30 days to fully settle. Ultimately, the treatment should be done at least 4-6 weeks before any big event.

Click on the pink “read this” button to learn how you can reduce swelling and bruising post lip injections.

Photos of Before & Immediately After injections

From these photos, you can see there is initial swelling right after the injections. Keep in mind, this is normal and to be expected. Do not be surprised either, if swelling gradually increases throughout the day into the night.

What do providers put on lips after injections?

Once the provider is finished with injecting, they will finish the procedure with these steps:

1. Massaging the filler to ensure it is even and smooth

2. Applying post-injection cream to prevent biofilm

3. Apply medical grade anti-bacterial ointment on top to prevent infection

These 3 simple steps make a big difference in treatment outcomes! As mentioned earlier, it is crucial to get dermal filler from a licensed provider who is well-educated and takes all necessary precautions to keep you safe.

What is lip injection aftercare like?

After the injections, your provider will recap what to expect following the appointment, and any precautions to take. This is to ensure you are confident in what to expect with the healing process after the appointment and avoid any risks. At Elite Medical & Aesthetics we often tell patients:

No tongues on their lips for 24 hours (theirs, their significant other, children or pets)
No touching for 24 hrs
No make-up on the injection area for 24 hours
Avoid straws for 72 hours, or forever 🙂 !!!
Avoid alcohol and any medications that can increase bruising
Only ice for short periods as needed and wash ice pack between use
Avoid any harsh or irritating products
Contact us with any questions or concerns!

Be sure to talk to your injector to know what they recommend post treatment if you’re not an Elite Client. We also remind people that the first 24 hours of swelling can look crazy! It will get better quickly.

Click on the pink “read here” button to learn about the lip filler roller coaster for emotional reassurance!

" I always make sure my patients have my contact information in case of questions or concerns, especially if going into a weekend"

Ali Wagstaff

Nurse Practitioner

Viola!

Even though it can be intimidating getting lip filler (especially if it is your first time) be reassured that at Elite Medical & Aesthetics we will be with you every step of the way!

Regardless of where you go, we cannot emphasize enough the importance of going to a licensed medical provider that you trust and knows how to keep you safe, while also giving great results.This is a medical procedure and needs to be treated as one.

If you are in the Lone Tree, CO area come see us for a free consult so we can decide together if lip filler is right for you. Ali Wagstaff is a double board certified Nurse Practitioner with a fellowship in aesthetic medicine. She is also an artist and takes a holistic approach to patient care. Click the pink “book now” button below to book.