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Don J. Fontana, MD, PA
Botox and Fillers, When and Why?
Don Fontana, MD

Botox and Fillers, When and Why?

Nearly eleven million cosmetic procedures were performed in the United States in 2006, a 7% increase from 2005 according to the American Society of Plastic Surgeons. The trend is believed to continue as the aging population seeks less invasive procedures to lessen the signs of aging.
Minimally invasive procedures including Botox injection and skin fillers have risen sharply. In 2003, 2.8 millions Americans received Botox for facial wrinkles while in 2006, 4.1 million did the same. Again skin fillers are becoming increasingly popular among patients of all age groups. Botox and fillers workthey are effective and reasonably priced. There is little or no down time with very few risks. In addition, the American population is showing a preference for the quick fix without the recovery and down time associated with some surgical procedures.
Many patients however are confused and uncertain about the use of Botox and fillers, thinking that they are essentially interchangeable. The reality is that frequently both may be used together to get the best results.
Botox prevents a muscle from contracting, thereby preventing the skin from wrinkling which normally occurs when a facial muscle contracts. The sites where Botox is best suited are the forehead, frown lines between the eyebrows, and the crows-feet areas. The deep lines between the eyebrows associated with frowning are a perfect example of increased muscle activity resulting in deep furrows. Thus Botox is wonderfully suited to prevent these muscles from contracting, The effect can be dramatic and lasts three to six months. So-called crows feet around the outer eyes are also ideal for Botox treatment.
Areas of the face that are sure signs of aging are the deepening of the folds from the nostrils to the jaw line and the so-called marionette lines from the corners of the mouth. These folds are not a result of facial muscle activity, but a result of sagging skin. In order to lessen the depth of these folds, a skin filling agent is best suited. Botox would not be applicable to treat these areas. Fillers have different varieties and viscosities. One must select the appropriate filler for the particular facial region. Incorrect injection of filler can result in an unsatisfactory appearance, lumpiness or more serious problems. Each of the fillers Restylane, Juvederm, Hylaform, Radiesse, Captique have specific sites for use. Your treating surgeon should be familiar with all of these agents to offer you the best option at the most reasonable cost.
It is important to differentiate between wrinkling that is present only on animation versus wrinkles that are present in repose, without any muscle activity. In this particular situation, using both Botox and filler in a staged treatment is most effective. For example, I typically treat deep frown line furrows present in repose and worsened with facial animation first with Botox. Thus, the muscle no longer is active. Approximately two weeks after the Botox treatment, I will fill the remaining residual furrow with Restylane, Juvederm, or Hylaform. The advantage of this technique is that the longer the muscle is inactivated, the longer the filler will last. This is meaningful to the patient since the filler is usually the more expensive part of the treatment, and the longer is lasts, the greater the benefit to the patient. It is not uncommon to have the improvement last months beyond the usual expected period.
If you are seeking a quick, low risk, no down-time treatment for facial aging and wrinkling, consider either a Botox or filler combination treatment. Consider a consultation with a plastic surgeon. You may be delighted with the results, over 4,000,000 Americans tried it in 2006 and the number is rising.

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