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Botulinum Toxin Injections

Botulinum toxin injections (BTX), often referred to by the product names Botox or Dysport, are biological toxins (botulinum toxin) transformed into a therapeutic agent.
Work with BTX began in the late 1960s to treat neurological disorders.
Today, BTX is used for the treatment of frown lines, forehead furrows, "crow? feet," lines and wrinkles of the lower face, and even nasal muscles (to decrease nostril flaring).
BTX injections have proven to be a very popular nonsurgical cosmetic procedure.
Aesthetic plastic surgeons have found that the type of lines and wrinkles that respond to BTX injections are those caused by the muscles-specifically those muscles that contract during facial expressions such as frowning or squinting.

The patient is asked to contract the muscles in the area being treated so the surgeon can determine the proper location for injection.
In most cases, BTX is injected directly into the muscle with a tiny needle.
It takes a few days to realize the effect of BTX injections.

No downtime.
Patients can immediately resume normal activities.
Long experience has proven BTX to be safe.
To date, no systemic complications associated with BTX injections have been documented.
Treatment is reversible within several months.

Other Considerations:
BTX injections are a temporary solution for the treatment of wrinkles. The effects last from 3-4 months and require repeat treatments.
Possible side effects include local numbness, swelling, bruising, or a burning sensation during injection. Some patients have reported temporary headache and nausea.
Most complications are of short duration and can be avoided with proper injection techniques.
A small percentage of patients are reported to experience no improvement at all.

Patients who show early signs of aging, as well as those who may not be suitable candidates for more extensive aesthetic facial surgery, may be good candidates for this procedure.
Certain medications (some antibiotics, anti-inflammatories, or aspirin) and even some vitamins and herbs may increase the potency of BTX and may increase bleeding and bruising at the time of injection.
Therefore, patients should be candid with their surgeon about all medications and supplements. Pregnant or nursing women should postpone undergoing this procedure.

Filler for facial asthetic usen

Many people confuse filler with Botox because both Botox and filler are used concomitantly to erase wrinkles and are not permanent treatment.
But they have different indication and action.
Botox paralyze local muscle which make wrinkles but filler raise or puff up that area
Filler injections is also used to make the lips fuller and to augment nose or chin. Different fillers last different lengths of time and different pros and cons. So, you should know about different filler material to choose prudently.
Of course, good doctors can choose instead of you because they know better about filler.

Various Filler Material

  1. Human or bovine collagen (CosmoDerm, CosmoPlast, Zyplast, Zyderm, Cymetra):
    The effect lasts less than 3 months and bovine collagen needs allergy test 4 weeks before the treatment.
    It is not used nowadays.
  2. Hyaluronic acid (Restylane, Juvederm, Perlane):
    The hyaluronic acid draws fluid to the treated area and its effect lasts 3 to 6 months.
    According to the size of particle, the lasting period and the recommended area are different.
    Small particle hyaluronic acid like Restylene and Juvederm is good to use remove thin wrinkles under eye and its effect lasts shorter(3-6 months).
    Large particle hyaluronic acid like Perlane is good to use remove deep wrinkles like nasolabial fold and to augment lip & nose and its effect lasts longer (6 to 9 months).
    Hyaluronic acid can be resolved by hyaluronidase.
  3. Calcium hydroxylapatite (Radiesse):
    The composition is very similar to large particle hyaluronic acid but the effect lasts longer (6 to 12 months).
    This doesn’t leave any remnant but can’t be removed easily.
    Recommended in using to erase thick wrinkles like nasolabial fold and to augment nose.
    It should not be used on lips because it can be calcified and feels hard.
    It should not be used on forehead because it can compromise vessels and produce necrosis.
  4. Biodegradable polymer (Bio-Alcamid, Interfall, Aquamid, Sculptra):
    This is composed of 95% water and 5% of polymer.
    As times go by, water can be absorbed and polymer can be degraded, but not completely.
    The effect lasts 1 to 5 years.
    The one contains monomer (Interfall & Aquamid) was reported to be able to cause severe granuloma and prohibited in some countries and I don’t use those.
    Bio-Alcamid which doesn’t contain monomer can be removed by aspiration.
    Softer than Artefill or Artecol.
    Recommended in using to augment lips, nose and to correct deep wrinkles like nasolabial fold.
    Not recommended in using to erase thin wrinkles like periorbital and perioral wrinkle.
  5. Microscopic plastic beads and bovine collagen (Artefill, Artecol):
    The plastic beads are made of poly methyl methacrylate (PMMA).
    The collagen goes away over time, but the plastic beads remain under the skin permanently:
    The effect lasts more than 5 years.
    It feels like hard lump and can’t be removed eventhough the patients want to remove for any reasons after injection.
    Not recommended to use to augment soft area like cheek or lips.
    The filler of choice for correction of congenital anomaly like hemifacial microsomia.
    I usually don’t recommend this for aesthetic use because it is impossible to remove.
  6. Fat cells harvested from your body (autologous fat):
    60% are remained after 6 months of injection, but the survived fat cells last forever.
    Usually needs repeated injection.
    Because it is soft, it is hard to augment pressure bearing area like nasolabial fold, nose.
    Because it can cause calcification after injection, it is not recommended to augment lips and breasts.
    The filler of choice for cheek augmentation for hollow cheek and forehead augmentation for depressed forehead.
  7. Silicone:
    Because it can move to other areas and can cause severe complications like skin necrosis and granuloma.
    It is strongly prohibited to use it as facial aesthetic filler evenif the product is permitted to use in eyeball as medical use.
    It is soft, lasts forever, can’t be removed.

    Are there too much kinds of filler material ?
    Is this confusing ?
    So, I made a diagram to compare each material briefly.
  Longevity Advantages Disadvantages Recommended usage Contraindication
Human,Bovine collagen 2-4 months     No longer used  
Hyaluronic acid (small particle) 3 to 6 months Complete degradation
Easily Removable
Short action Thin wrinkle  
Hyaluronic acid (large particle) 6 to 9 months Complete degradation
Easily Removable
Relatively short action Thick wrinkle
Thin wrinkle
Calcium hydoroxyapatite 9 to 18 months No remnant
Relatively long effect
Thick wrinkle
Augmentation except lips
Thin wrinkle
Lips, Forehead
Biodegradable polymer 2 to 5 years Long effect
Left polymer Thick wrinkle
Thin wrinkle
Microscopic beads and collagen 5 years Long effect
Hard Irremovable Congental defect Thin wrinkle
Fat graft Forever Own body material Repeated injection Cheek and forehead augmentation  
Silicone Forever Cheap, easy Severe complication Prohibited  

Are you still confusing ?
Then, let’s choose the appropriate filler according to the effect you want.

The choice of filler or Botox according to the area to be treated

  1. Thin wrinkle around eyes
    Small particle hyaluronic acid (Juvederm, Restylane) is the choice.
    Do not use large particle HA, Calcim hydroxyapatite, biodegradable polymer.
    Botox is the procedure of choice for Crow’s feet.
  2. Thick wrinkle like nasolabial fold, frown line, Marionette line
    If you prefer completely degradable, easily removable filler, large particle hyaluronic acid (Perlane) is the choice evenif its effect lasts only for 6 to 9 months.
    If you prefer completely degradable filler, Calcium hydroxyapatite (Radiesse) is the choice evenif it is not easy to remove until it is degraded spontaneously.
    If you prefer longest acting filler, biodegradable polymer is the choice evenif it left some polymer in our body.
  3. Forehead wrinkle
    Botox is the procedure of choice for transverse forehead wrinkle.
    Concomitant use of filler and Botox is the procedure of choice for severe frown lines.
  4. Augmentation of lips
    If you prefer completely degradable filler in spite of short action, large particle HA (Perlane) is the choice.
    If you prefer long acting filler in spite of remnant polymer, Bio-Alcamid is the choice.
  5. Augmentation of nose, chin
    If you prefer completely degradable filler in spite of short action, you can choose between large particle HA (Perlane) and Ca Hydroxyapatite (Radiesse) according to longevity and ability to be removed.
    If you prefer long acting filler in spite of remnant polymer, Bio-Alcamid is the choice.
    I prefer surgery than filler injection because surgery is safer, more effective, permanent.
  6. Cheek or forehead augmentation
    Of course, these areas also can be augmented with synthetic fillers like HA, Ca HA, Polymer.
    But it is not effective because filler is too expensive and large amount of filler injection is always not recommendable.
    So, most plastic surgeons prefer fat graft to augment forehead and cheek.

Filler injection can lead to problems. Possible complications include:
• Infection: rare but deadly complication. Call your doctor if you have new redness, swelling, or pain after the first day. You may need antibiotics right away.
• Bleeding or bruising. Before a filler injection, avoid alcohol use and stop taking any blood-thinning medicine like aspirin and vitamin E.
• Allergic reaction such as rash, hives, swelling, or flu-like symptoms can be resolved spontaneously.
• Lumpy skin surface after treatment.
There are rare reports of serious or life-threatening complications after filler injection including anaphylactic shock, sepsis, skin breakdown (necrosis).


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