Injectables
Injectables are really anything injected into the body with a needle. But in the cosmetic derm world we are referring to cosmetic dermal fillers (brands like Juvederm, Restylane, Sculptra and Radiesse) and neurotoxins (brands like Botox, Dysport and Xeomin). Injectables like these are the number one cosmetic procedure in the US...and for good reason! I have been injecting these products for 20 years and have gotten to know them well.
Where do the neurotoxins (Botox, Dysport and Xeomin) come from?
Botulinum toxin type A is the injectable neurotoxin that you might better recognize under the brand names: Botox, Dysport, and Xeomin.
This neurotoxin is derived from Clostridium botulinum, an organism found many natural settings, including soil, lakes, and forests. Then the resulting cosmetic injectable is created by purifying a protein that is produced by Clostridium botulinum.
It is true that botulinum toxin is historically associated with a type of poisoning that often happened from food canning and packaging issues. But rest assured! These are some of the safest cosmetic treatments you can have. The production of Botox, Dysport, and Xeomin are done in a controlled, regimented environment before getting to your derm office.
How does the neurotoxin work to lessen wrinkles?
The treatment works by blocking nerve impulses to muscles, causing them to relax. Because they only work on muscle, they smooth DYNAMIC wrinkles. These are the wrinkles created from the facial movements you make day after day ...like frowning, squinting and smiling.
How long have these injectables been used?
Botox has been the front-runner since it was officially FDA approved in April 2002. In fact, it has been manufactured and studied in the U.S. since 1985. It is the most widely used neurotoxin to date. Dysport was the next to be FDA approved in 2009. Most recently, Xeomin was FDA approved in 2013.
There is also talk about a new kid in town. A neurotoxin made by Revance Therapeutics, Inc., who released promising initial results on an injection that may last longer than Botox. But its not expected to hit the wrinkle-treatment market until around 2020. We will keep our fingers crossed for that one!
What are dermal fillers?
The world of dermal fillers for facial rejuvenation is constantly evolving and there are so many types of dermal fillers these days!
The first filler that I worked with was bovine collagen about 19 years ago. As new products have been created and approved over time I love learning the subtleties of each one. Over the past 2 decades, I have worked with multiple dermal wrinkle fillers, including: Fascian, Sculptra, Restylane, Restylane Silk, Perlane, Radiesse, Juvederm, Voluma and Volbella.
With so many types of dermal fillers they are best understood when divided into categories. For explanation, this is how I have divided them: collagen fillers, hyaluronic acid, synthetic wrinkle fillers and autologous fillers.
Collagen Fillers:
Scientists created this first type of filler by purifying collagen from cows (I know, sounds crazy!). This is one that’s rarely used anymore. Mainly because you need skin testing with it (to make sure you were not allergic to the bovine/cow components), it was very soft (not great for volume) and began breaking down as early as one month after injection. The brands out there include: Cosmoderm, Fibrel, Zyplast and Zyderm
Hyaluronic Acid:
These days the most popular dermal fillers are made with hyaluronic acid. The brands you might recognize are: Juvederm, Restylane, Hylaform and Belotero. The reason these are most often used is because of the low side effect profile and the natural softness of the results. In fact, any adverse reaction with hyaluronic acid fillers (which are extremely rare) it can actually be dissolved with a substance called hyaluronidase. And to make you feel even better, hyaluronic acid is naturally found in the human body in almost every cell (but primarily in the skin)! But the clear injectable gel that we use for cosmetic purposes is derived from a sugar molecule in the lab.
Synthetic Fillers:
This category includes the brand names of Sculptra, Radiesse, Artefill, Bellafill and Silicone. They are all made in a lab and are not related to anything found naturally in the skin. One of the big benefits of these is their long lasting results. But the downside is that any side effect you experience (though they are rare) can be permanent. So if the results are not as expected, this can lead to disfigurement that may not be able to be corrected without surgical removal of the product. Yikes!
Autologous Fillers:
These fillers are composed of your own cells or tissue. Fat is the most common in this category. When you use your own fat (only small amounts are taken - so it’s not like lipo. Darn.), it is purified in a lab before then injecting it into the facial area desired. One downside is that it can be costly with only semi-permanent results. But the upside is that it is from your own body and so there is no risk of allergic reaction.
Another autologous filler that is gaining popularity is platelet rich plasma (PRP). With this, blood is taken from your arm and then is placed in a centrifuge, where it is spun at intensely high speeds. The spinning causes the blood to separate into layers so that the platelet rich plasma and growth factors can be extracted. Your PRP can then be injected into the areas of the face you would like it. Now you know why it is also called the “vampire lift!”