There is a wide variety of fillers available today, and more are on the horizon. Each filler has its own specific set of characteristics that makes it more apt for a particular use. I use my fillers similar to the way an artist uses different paint brushes and I combine them with different injection techniques to obtain the desired results. With so many different fillers and injection techniques available, how is a patient supposed to know what they want? Well, the real answer is that patients should not be burdened with this choice. We don’t go to a hair stylist and ask them to use a specific scissor, rather we ask them for a certain type of haircut, a specific length, or style that we are looking to achieve. In the same way, you should be able to tell your injector the effect you hope to accomplish, or the area you would like addressed and trust them to advise and achieve your desired outcomes. That desire can be as simple and broad as “I want to look more attractive” or as specific as “I want a better jawline”.  This is why it is so important to choose a qualified injector. You are not simply choosing someone to inject a product into your face, but you are choosing someone that is able to understand your desires and the proper (and safe) way to achieve them. 

Common Cosmetic Uses for Botulinum Toxin and Facial Fillers

The uses for botulinum toxin and facial fillers can be broadly separated into two categories; Enhancement and Rejuvenation. The enhancement category uses are those that alter specific aspects of a persons face in order to achieve a more favorable aesthetic appearance. The rejuvenation category targets signs of aging with the goal of restoring youthful features to one’s appearance. Below are 5 of the most common applications of botulinum toxin and facial fillers in each category.

Botulinum Toxin (Botox, Xeomin, Dysport)

ENHANCEMENT:

1.       Raising the eyebrows:

A small elevation of 1mm to 3mm can be achieved with botulinum toxin. This creates a more “open eye” appearance and gives the brow a subtle arch that the human eye finds attractive.

2.       Elevating the corners of the mouth to correct Frowning rest face

Some individuals have a mild drooping of the corners of the mouth. This makes them appear upset and interpreted as less pleasant. By decreasing the activity of the depressor muscle that pulls down on the corners, and a more pleasant and attractive appearance can be achieved.

3.       Correcting chin pruning from mentalis strain

If you try to close your lower lip tight against the top lip, you’ll notice that the chin dimples and prunes. This is from the mentalis muscle, which functions to help close the mouth. Some individuals have this pruning as a habit or compensation, creating an unfavorable pruned appearance, which can be relieved with botulinum toxin.

4.       Preventing the nose from drooping when smiling

Most people will notice that the tip of their nose droops down slightly when smiling. However, some have an exaggerated droop, which creates an aesthetically unfavorable appearance, deterring them from smiling in photos. This can be minimized with a small injection of botulinum toxin.

5.       Prophylaxis and Reducing pore size

Preventing forehead and frowning wrinkles has become very popular amongst the younger crowd. Even though many do not have wrinkles, they will still often notice an improvement in their skin quality. That is partial because botulinum toxin helps shrink pores and decrease sweat gland activity.

6.       Reducing a widened lower face

The masseter muscles are one of our main chewing muscles and can become significantly enlarged, giving the lower face a bulky and wide appearance. Botulinum toxin weakens the muscle and promotes it become smaller, giving a more tapered feminine appearance to the lower face.

REJUVENATION:

1.       Crow’s feet

The price we pay for smiling or squinting is a set of wrinkles at the corners of the eyes. These fine wrinkles can occur in a variety of patterns but always produce a more aged appearance. Treatment with botulinum toxin is very effective for this area.

2.       Forehead wrinkles

The forehead is an active area of movement for facial expressions and one of the primary areas exposed to the sun, thus signs of aging are quick to appear in the form of horizontal wrinkles. Botox is a great way to alleviate these lines, leading to a smoother, more youthful appearance.

3.       Angry 11 Lines

This is another active area of movement during facial expression that is prone to forming deep-seated wrinkles. Angry eleven lines, as the name suggests, can give the appearance and impression of an angry or upset facial expression. This can be treated with botulinum toxin, with the added benefit of a very slight elevation of the brow.

4.       Smokers lines

These can be seen even in those who have never smoked. They are the result of repeated lip pursing, loss of volume, and loss of elastin in the skin. A very small amount of Botox is used to help treat these lines, many times in combination with a filler.

5.       Neck Bands

If you strain your neck, you will notice long vertical bands running along the neck. These can become prominent even at rest in some individuals but can be treated with botulinum toxin injections. 

FILLERS:

ENHANCEMENT:

1.       Lip injections for definition or size.

The lips are a very prominent aesthetic component of the face and come in many shapes and sizes. We can use filler to add volume to specific areas, or simply to add definition. The goal will depend on what the patient desires, what is realistically achievable, and what is aesthetically balanced with the individual’s facial features.

2.       Facial Contour: Getting the feminine heart shape face

Attractive faces come in many different shapes. It is not so much the shape and size of the face, but rather it’s proportions that create an aesthetic harmony. The cheek area is a popular site for filler because it helps create the aesthetically appealing S-shaped curve called the ogee line, and heart shape, where the face gently tapers down from the cheeks into to lower face.

3.       Jaw Line definition

A defined jawline is a very prominent aesthetic feature of an attractive face and can be seen on many celebrities.  

4.       Chin Augmentation

As previously mentioned, the face is all about relative proportions, aesthetic harmony, and balance. The is an important component of this harmony. A deficiency in chin projection or height can make other features (ie the nose) appear larger. A more refined chin is often more balanced in a female, while a slightly broader chin is more desirable on a male. These features can be augmented with filler.

5.       Non-Surgical Rhinoplasty

Fillers can be used to create a smooth nasal bridge by disguising “the bump” that most seek to remove. More advanced techniques can be used to refine, elevate, and rotate the tip, and even to make the nose appear more narrow.

REJUVENATION:

1.       Restoring Cheek Volume

With age, facial volume is depleted and the soft gentle fat pads that give it structure descend. The cheek is one of the most notable areas of volume loss and can make a very significant impact when filler is used to rejuvenate their volume.

2.       Under eye, tear trough filler

This is perhaps one of the earliest areas to show signs of aging and creates an overall look of fatigue.

3.       Marrionette Lines

Volume depletion around the corners of the mouth creates a hollowing and creasing, giving the impression of a marionette puppet, thus labeled the marionette lines.

4.       Lip lines and Lip Volume

Lip lines are partially from overuse, but also a result of volume loss. The lips become flat and lose their youthful shape and volume. Filler is a great treatment for this area.

5.       Nasolabial Folds

These become more prominent as the cheeks lose volume and begin to descend. Some level of correction can be obtained by replenishing cheek volume, but we sometimes need to inject the folds themselves to obtain that smoother youthful appearance.

The following list includes on-label as well as off-label uses for botulinum toxin and filler products.