Wrinkle treatments are best done by professionals
Like any medical procedure, Botox and dermal fillers can come with risks, especially if they are done by someone who is inexperienced or has minimal training. That means that having these increasingly popular minimally-invasive treatments done at a spa or in a home “party” setting might not be as safe as if you had the same procedure by a trained medical professional.
The risks of these two injection-type treatments are different.
“Botox is relatively safe,” said hand and plastic surgeon Julian D’Achille, MD, MPH, at Cape Cod Healthcare Plastic Surgery in Mashpee. “The danger of fillers is significantly higher than Botox.”
Botox is botulism toxin. It works by temporarily paralyzing muscle, he said. It inhibits the release of acetylcholine from the nerves that feed those muscles. When used for cosmetic reasons, the effects are temporary. When done with the actual brand name drug, Botox, it lasts for an average of three months. There are some newer formulations that last longer, he said.
“Botox works to reduce the appearance of wrinkles, primarily on the face, but it works better for wrinkles that are ‘action’ wrinkles, wrinkles that are activated when you move the muscles on your face versus ‘static’ wrinkles which are present all the time,” Dr. D’Achille said. “It does help smooth out the static wrinkles as well, but it doesn’t necessarily eliminate them.”
Dr. D’Achille explained that the dosage of Botox you need to actually be fatal is so high that no one would ever inject that much. But that doesn’t mean there are no issues that can arise when someone isn’t properly trained.
“Knowing the anatomy and where you are injecting Botox is key, so if you are not trained on how to do it, if you are not trained on the anatomy, then it is a question of are you going to put it in places where you’re going to end up with a side effect that you don’t necessarily want,” he said.
Overtreatment Risks
One of the most common unpleasant side effects is being overtreated, causing the eyebrow to droop so one side is higher or lower than the other. The other thing that can happen if the injection is in the central forehead above the nose and eyes, is that it could spread and paralyze the muscle that lifts the eyelid, causing it to droop.
If that happens in a plastic surgeon’s, dermatologist’s or other trained medical provider’s office, there are eyedrops physicians can prescribe to mitigate the problem.
The most common side effects of Botox injections include bruising and small red marks that go away in about 10 to 15 minutes.
Filler Dangers
“Filler is used for almost exactly what it sounds like,” Dr. D’Achille said. “You use it in spots where folks have what they would call wrinkles, but more accurately are areas of volume loss with aging. The nasolabial fold is probably the most common area that we use it for.”
The nasolabial fold is what people commonly call “smile lines.” The other common areas are the ‘marionette lines’ at the corners of the mouth and the cheeks. Some people use filler to plump up the temples, if they lose volume there.
The brand names Juvederm and Restylane are hyaluronic acid-based fillers. Sculptra is also hyaluronic acid-based but it is a different formulation. Radiesse is a calcium hydroxyapatite filler. Juvederm lasts around a year and Sculptra last about two years.
“Then, even within those brands, there are different formulations of the fillers, based on how thick they are,” Dr. D’Achille said. “They range from being very thin, almost like water, to being on the thicker side. The different formulations are used in different locations. For example, I like to use a really thin version for the ‘smoker’s lines’ that people get around the lips.”
The most common side effects of fillers include bruising and bleeding. Infections are rare but they do happen. Scarring is also a risk because some people have a reaction to the filler itself where the body tries to wall if off. Nodules can occur for the same reason. If the person injecting the filler puts too much in one spot and not enough in another, you end up with facial asymmetry.
Wrong Injections and Allergic Reactions
One of the most dangerous things that can happen is vascular occlusion, Dr. D’Achille said. If someone inadvertently injects the filler into a blood vessel, it can travel from where it was injected to the artery that feeds the retina, which can cause blindness.
“This is where someone doing filler at a party at somebody’s house can be potentially really dangerous because you don’t have quick access to an ophthalmologist,” he said.
If something goes wrong with a filler that is hyaluronic acid-based, the patient needs access to a medication called Hylenex. It is an enzyme that can break down the hyaluronic acid in both Juvederm and Restylane. A physician would inject Hylenex into the site where the filler was injected to try to break up the hyaluronic acid.
Dr. D’Achille has seen a patient have an allergic reaction to a filler where her face swelled up “like a balloon.” Steroids reduced the swelling and the patient was fine, but it still required a doctor able to prescribe steroids. Nerve damage is another worry with improperly injected filler.
“If you inject too close to the infraorbital nerve, a nerve that comes out near our cheekbones, the pressure from the hyaluronic acid can actually put pressure on the nerve and that can cause the nerve to become paralyzed,” Dr. D’Achille said. “It’s not a motor nerve; it’s a sensory nerve, so you end up with a numb area on your cheek for potentially as long as the filler is there. These last for about a year so that can be a huge problem.”
Timing is Important
In addition to plastic surgeons, dermatologists are also trained to inject Botox and fillers. Ear, nose and throat specialists who do plastic surgery are also qualified, and many oral surgeons are trained to do injections. It’s always a good idea to ask whoever is doing your injections how much training and experience they have had and what their backup safety plan is if something goes wrong.
“Particularly if you are someone who easily bruises, this isn’t something you want to do right before you have a big event,” Dr. D’Achille said. “I have people that come in and say, ‘I want to get filler before my wedding next week.’ Absolutely don’t do that.”
It takes three to five days for Botox to take effect so Dr. D’Achille recommends getting the injections at least two weeks before any big event. Filler looks better two weeks after it is injected than it does on the day you have it injected. He recommends waiting about a month after the filler injection.
“If you know that you bruise a lot, then play with that timing a bit,” he said.
