Botox™ and Filler Injections

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Botox™, Dysport™ and Filler Injectables

Non-Surgical Facial Rejuvenation

Dr. Goldman has one of the largest injectable filler practices in Northern Ohio. As a result, he has been chosen as a physician trainer by Medicis Aesthetics and  Ortho-Neutrogenia/Johnson and Johnson, to train other physicians in injection techniques. He has also spent extensive time training the nurse injectors that work with him at our offices. Both Dr. Goldman and our nurses continue to expand their knowledge and techniques with advanced training courses and at plastic surgery meetings throughout the year.

He uses the injectable fillers as part of a full spectrum of options for facial rejuvenation. He believes in a graduated approach to facial rejuvenation, starting with non-surgical techniques, including Botox™, Dysport™, injectable fillers, and medical-grade skin care as first-line treatment. The second treatment tier involves treatments including CO2 laser resurfacing with the Fraxel Re:pair™ laser and more involved injection techniques using fat injection (with the patient’s own fat) or layering of multiple different fillers concurrently.

Dr. Goldman’s extensive experience with facial surgery gives him a thorough understanding of facial anatomy, allowing him to use more advanced techniques than other physicians less experienced in surgery and injection techniques. Feel free to email or call with any questions about injectables such as Restylane™, Botox™, or about facial surgery.

Botox™ and Dysport™

Botox™ and Dysport™ are both composed of a neurotoxin, specifically Botulinum toxin, that can be injected directly into muscles of facial expression to temporarily paralyze them. While Botox™ and Dysport™ are made by different companies (Allergan and Merz respectively) they act in the same way and have mostly subtle differences between them.

Dr. Goldman also  commonly uses Botox™ and Dysport™ in combination with injectable fillers (like Restylane™ and Radiesse™) and medical grade skin care (like Obagi™). These injections and other non-surgical therapies can compliment surgical procedures like facelifts, browlifts, blepharoplasties, and laser resurfacing with the Fraxel Re:pair™ CO2 laser.

Where do you inject Botox™ and Dysport™?

If injected with precision into the appropriate muscles, Botulinum toxin will reduce or eliminate wrinkles that are caused by muscle contraction. Botox™ and Dysport™ are both FDA approved for injection between the eyebrows (into the corregator supercilii muscle); this will reduce the so-called “elevens” or vertical frown lines that form when someone scowls. Both Botox™ and Dysport™ are commonly injected off-label into other sites, like the forehead and Crow’s feet.

Dr. Goldman believes there is a difference between just injecting into the typical sites versus using Botox™ and Dysport™ to shape the face, especially the brows and eyes. Dr. Goldman uses his knowledge of facial plastic surgery and the anatomy of the facial muscles to achieve this goal. Dr. Goldman integrates the newest techniques promulgated at national Plastic Surgery meetings with his own personal experience.

How long do the results last?

This is one area where our patients report a slight difference between Botox™ and Dysport™. Once injected, Botox™ typically takes about 72 hours to take effect and could take up to a week to see full results. Our patients experience Dysport™ taking effect in less time, seeing results as soon as 36 hours but can take several days for full results.  Both Botox™ and Dysport™ last for approximately 3-4 months but some patients will experience a longer effect. This is could be due to a behavioral change: if someone has not used a muscle in 3-4 months, they may tend not to use it much for a few weeks after it has become functional again.

What are the risks?

In large series or studies, approximately 1% of patients developed droop of the upper eyelid from diffusion of Botox™ or Dysport™ injections into the muscle that elevates the eyelid. In Dr. Goldman’s practice, the incidence is well under 1%. In most patients, droop lasts 1-2 months (less than the cosmetic effect). This can be treated with eye drops. Patients who have a history of myasthenia gravis or some other neurodegenerative disorders are more at risk for eyelid droop, so these disorders are a relative contraindication to getting injections.

Bruising is the most common side effect of getting Botox™ or Dysport™ injections and occurs rarely between the brows and a small percentage of the time, perhaps 5%, at other sites like Crow’s feet, forehead, or mouth. Any bruise can take 2-3 weeks to resolve. Generally these are small and easily covered with makeup, but occasionally are more noticeable. Most patients return to work the same day or the next day.

How often are injections necessary?

Patients may prefer to get Botox™ or Dysport™ injections every 3-4 months, as soon as the temporary paralysis wears off or they may wait longer. It’s up to the patient’s preference.

Restylane™

Restylane is currently the best selling injectable filler in the United States. It is a clear gel made of hyaluronic acid, which is a component of human skin and joint fluid. Hyaluronic acid binds water, so when it is injected into wrinkles, it adds volume, or fills them. This makes the wrinkles less deep, smoother, less noticeable. Restylane, like Juvederm, Elovesse, and Perlane, the other popular hyaluronic acid fillers, is purified from bacteria, so no human or animal proteins are present, eliminating risk of allergic reactions.

Where Do You Inject Restylane?

Restylane is FDA approved to be injected in the lower half of the face.  This includes the naso-labial folds, marionette lines and melomental fold (lines around the mouth). Restylane is the only filler FDA approved for use in the lips. Restylane can be injected ‘off label’ in other areas of the face.

How Long Do The Results Last?

Restylane typically lasts 6-9 months in most individuals.  Some patients report longer satisfaction especially with repeated treatment.

 What Are The Side Effects?

Side effects include mild swelling, redness, tenderness at the injections site, and bruising.  These side effects from the injections can last from a few hours to a week-pending on how the individual heals.  Anyone with a lidocaine allergy should make this known to a provider and should not receive the filler that has lidocaine already infused in it.

Other factors in receiving filler injections are discussed in greater detail on the Informed consent for cosmetic injections and during consultation prior to injection.

Pregnant or breast feeding mothers should not obtain a filler injection.

Perlane™

Perlane is made by Medicis, the same company that manufactures Restylane and Dysport. Perlane and Restylane are both made of hyaluronic acid, but the particle size is larger in Perlane, making it thicker. Both products are clear gels. Hyaluronic acid is a component of human skin and joint fluid. Hyaluronic acid binds water, so when it is injected into wrinkles, it adds volume, filling them. This makes the wrinkles less deep, smoother, less noticeable. Perlane, like the other popular hyaluronic acid fillers is purified from bacteria, so no human or animal proteins are present, eliminating risk of allergic reactions.

Where Do You Inject Perlane?

Perlane is FDA approved to be injected in the lower half of the face and is typically used in deeper creases than other hyaluronic acid fillers.  This includes the naso-labial folds, marionette lines and melomental fold (lines around the mouth). Perlane can be injected ‘off label’ in other areas of the face.

How Long Do The Results Last?

Perlane typically lasts 6-9 months in most individuals with some patients reporting longer satisfaction especially with repeated treatments.

 What Are The Side Effects?

Side effects include mild swelling, redness, tenderness at the injections site, and bruising.  These side effects from the injections can last from a few hours to a week depending on how the individual heals.  Anyone with a lidocaine allergy should make this known to a provider and should not receive the filler that has lidocaine already infused in it.

Other factors in receiving filler injections are discussed in greater detail in the Informed consent for cosmetic injections and during consultation prior to injection.

Pregnant or breast feeding mothers should not obtain a filler injection.

Feel free to email or call with any questions about injectable Perlane, Botox, or facial surgery.

Radiesse™

Radiesse is a long-lasting injectable filler made of hydroxyapetite, which is a calcium-containing compound found in bone. It is synthesized chemically and is therefore not a human or animal byproduct. 

Radiesse looks like a thin white paste in contrast to hyaluronic acid which looks like a clear gel. Radiesse comes in a 1.5cc syringe, which is more than any other injectable filler. Because of its volume and thick consistency (paste-like compared to the gel texture of most of the other fillers), Radiesse is useful in deep creases and folds. For fine, superficial wrinkles, Dr. Goldman prefers to use other fillers, like Belotero, Restylane, and Juvederm. Dr. Goldman also prefers Radiesse for the non-surgical rhinoplasty.

Where Do You Inject Radiesse?

Typical sites that are injected with Radiesse include Naso-labial folds (smile lines), corners of the mouth, pre-jowl, milomental fold (chin) and cheeks.  Dr. Goldman also used Radiesse when he performs a non-surgical rhinoplasty

How Long Do The Results Last?

Radiesse as a thicker filler has been known to last anywhere from 9 months to 1 year after being injected, although there is much variability in the longevity of all the injectable fillers from patient to patient.  Radiesse also helps stimulate your own body to build new collagen, thus softening the folds of your skin even more.

 What Are The Side Effects?

Radiesse has had long clinical testing in many countries for years, thus proving its safety and efficacy.  It was FDA approved to use in the United States in 2006.  Very few allergic reactions were reported during the trials, therefore it is not necessary for an individual to obtain allergy testing prior to receiving the injection.  Side effects include bruising, swelling, redness, and localized discomfort to the injections sites that usually resolve within a short period of time.

Other factors in receiving filler injections are discussed in greater detail on the Informed consent for cosmetic injections and during consultation prior to injection.

Pregnant or breast feeding mothers should not obtain a filler injection.

Juvederm™

Juvederm is another hyaluronic acid that is utilized as a facial injection to correct or soften moderate to severe facial folds.  Hyaluronic acid is natually found in everyone’s body, usually the joints.  The hyaluronic acid found in facial fillers is manufactured in a lab and works by plumping and drawing water to the area which assists in softening the facial fold.  Juvaderm was FDA approved in 2006 to be utilized as an injectable filler in the United States. 

Where do you inject Juvederm?

Juvederm is typically injected in the naso-labial folds, corners of the mouth, jawline and melomental fold.

How Long Do The Results Last?

Typically studies and individuals report results lasting 6 months to 1 year. There is variability from patient to patient depending on the frequency and volume of injections.

 What Are The Side Effects?

Risks include mild swelling, redness, tenderness at the injections site, and bruising.  These side effects can last from a few hours to a week depending on how the individual heals.  Anyone with a lidocaine injection should make this known to a provider and should not receive the filler.

Other factors in receiving filler injections are discussed in greater detail on the Informed consent for cosmetic injections and during consultation prior to injection.

Pregnant or breast feeding mothers should not obtain a filler injection.

Sculptra™

Sculptra is often referred to as a re-volumizer of the face and not a filler of folds and wrinkles.  This injectable is based on poly-L-lactic acid.  Sculptra is best utilized in individuals who have facial hollowing that maybe genetic, caused by illness or weight loss.  It is especially helpful to individuals who are in the 40-60 age range although particular applications do vary. Sculptra works by stimulating collagen growth and while results are not immediate they can last longer than the other fillers.

Sculptra was FDA approved to be utilized for cosmetic use in the United States in 2009.  It is manufactured in a laboratory and contains no animal products or human DNA. IT has been utilized in Europe, Canada and many other countries for over 10+ years.

 Where Do You Inject Sculptra?

Sculptra is able to be injected in areas that the other fillers may not be best utilized. As a volumizer these areas include hollow cheeks, Naso-labial folds, melolabial fold (chin to mouth), hollow chin, defining jawline, and hollow temples.

How Long Do The Results Last?

Upon completion after a series of injections (typically 3-4 sessions) every 6 weeks, results should last up to 2 years.  After injection, it can take 45-90 days to see the full results.  Before and after photos are taken to show the re-volumizing change that occurs in the face.  Maintenance injections are usually performed after the 2 years have passed as an annual procedure. There is variability knowing that everyone’s body is different.

 What Are The Side Effects?

Individuals who should not receive the re-volumizing injectable of sculptra include those who are pregnant, nursing, are allergic to lidocaine or have auto-immune diseases such as Lupus, Rheumatoid Arthritis, or Sjogren’s Syndrome.  Side effects of receiving the treatment include bruising, swelling, redness, discomfort at the injection sites.

Other factors in receiving filler injections are discussed in greater detail on the Informed consent for cosmetic injections and during consultation prior to injection.

Pregnant or breast feeding mothers should not obtain a filler injection.

Voluma™

Voluma is a product made by Allergan (also manufactures Juvederm) and was approved by the FDA in 2013.  It is another injectable that is composed of hyaluronic acid (HA).  HA is a naturally occurring sugar in the body that assists in plumping the skin and is a cushion between joints.  The HA for Voluma is manufactured in a laboratory and includes other cross linking molecules to give it a more sturdy scaffold to re-volumize an area. It is designed to replace volume loss of the mid-face, not to fill or soften folds.

Where do you inject Voluma?

This injectable is FDA approved to be injected in the mid-face only.  Specifically the cheek bone and cheek area.

How Long Do The Results Last?

Results have been proven through clinical trials to last up to 18 months.  Individuals who have a significant amount of volume loss may receive more than one syringe to replace and restore the mid-face volume.

 What Are The Side Effects?

Risks include mild swelling, redness, tenderness at the injection site, and bruising.  The side effects from the injections can last from a few hours to a week depending on how the individual heals.  Anyone with a lidocaine allergy should make this known to a provider and should not receive the filler that contains.  Any individual who has suffered a anaphylactic reaction should notify the physician.

Other factors in receiving filler injections are discussed in greater detail on the Informed consent for cosmetic injections and during consultation prior to injection.

Pregnant or breast feeding mothers should not obtain a filler injection.

Belotero™

Belotero was FDA approved in the United States as a cosmetic dermal filler in 2011 and is manufactured by Merz (also makes Radiesse).  It is utilized in the deeper dermal layers as well as more superficial layers to assist in filling deep folds and softer lines.  Belotero is primarily made up of Hyaluronic Acid (HA) which is a naturally occurring substance in your body.  The HA draws water to the area where the filler was injected and assists in softening the folds and lines.

Where do you inject Belotero?

Belotero is FDA approved to be injected into the nasolabial folds, vertical lip lines, corners of the mouth and marionette lines.

How Long Do The Results Last?

Research reveals this filler lasts 6 or more months, but iIndividual results may vary.

 What Are The Side Effects?

Risks for this filler as similar to other injectables and include mild swelling, redness, tenderness at the injection site, and bruising.  The side effects from the injections can last from a few hours to a week depending on how the individual heals.

Other factors in receiving filler injections are discussed in greater detail on the Informed consent for cosmetic injections and during consultation prior to injection.

Pregnant or breast feeding mothers should not obtain a filler injection.

The Liquid Facelift

Liquid Facelift is term to describe a non-surgical, minimal invasive technique that addresses the aging face.  A combination of injectable fillers and muscle immobilizing products (Botox or Dysport) are utilized to assist in softening the folds & fine lines, restore lost volume, create a more rested & energetic appearance, as well as restore your natural curved facial contours.

Liquid Facelift injectable fillers include: Sculptra, Juvederm, Voluma, Radiesse, Restylane, Belotero and Perlane. Muscular paralytics include Botox, Dysport and/or Xeomin.  Each of the injectables are FDA approved to be utilized in certain areas of the face in order to provide the best results possible.  Please refer to the website pages that explain each product for more detailed information.  Upon scheduling a consultation, you will receive a completely customized consult in order to utilize the most appropriate injectables to give you the results you are looking for.

In addition, resurfacing lasers and other non-surgical techniques like Ulthera can be utilized in combination with fillers to provide a more youthful appearance and counteract the aging effects.

Please contact our office at 216.514.8899 or email at info@drgoldman.com for more information or to schedule a personal consultation.

Non-Surgical Rhinoplasty

Non-surgical rhinoplasty refers to using injectable fillers to correct nasal imperfections. When these fillers are injected with precision by an experienced physician the fillers can make subtle changes to the appearance of the nose, often mimicking surgical rhinoplasty. The main advantage of the nonsurgical rhinoplasty technique is the lack of significant down-time, which is an advantage of the injectable fillers in general.

How is nonsurgical rhinoplasty performed?

Dr. Goldman uses Radiesse™ most commonly for this procedure as this filler is made from  a building block of bone tissue and tends to be more firm than hyaluronic acid (HA) fillers and lasts longer in most patients.

Fillers can only add volume to an area, not take away. When the filler is injected just above a bump on the bridge of the nose, it will make the bump look smaller or even eliminate it in some patients. Filler injected properly into the tip will make it look elevated and refined. The tip may look smaller and less bulbous even though filler has been added to it. Depressions or asymmetric areas can also be filled and smoothed.

What is the recovery?

Down-time is similar to that of injectable fillers used elsewhere on the face. Most patients have mild swelling and skin discoloration for 2-3 days. Most men do not find the need to cover this. Most women use their regular makeup. Almost all patients return to work the next day. A small percentage of patients (perhaps 10% in our practice) will have more significant bruising that requires (if patient wants to conceal the bruise) cover-up makeup. Such bruises can take 2-3 weeks to resolve, like a bruise from any cause.

Read more detailed information here or email us at info@drgoldman.com.