Neuromuscular Toxins
The first option, which is most appropriate for active lines or age associated wrinkles that are just starting to appear, is to temporarily weaken or paralyze the muscle that is causing the wrinkle. Botulinum Toxin type A is a family of neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and thus can be artistically used to alter facial expressions. Botox Cosmetic® is widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. Other manufactures are producing variant toxins that will likely be approved for use in the near future, including Reloxin and PurTox. These toxins will be differentiated by their time to onset, duration of effect (the clinical effects of Botox Cosmetic® are typically 3 to 4 months), and the distance of effect from the injection site. Risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups. Specific risks should be discussed with your injector when considering treatment.muscle groups. Specific risks should be discussed with your injector when considering treatment.Soft Tissue Fillers
The second class of injectable treatments are the soft tissue fillers. This group is rapidly expanding, and many options are available. These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds). Fillers restore volume to the face and can add structure as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (eg: nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure. All of these injectable fillers are placed by an injection, so the group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases local infections.
Many options are available in the filler class, with clinical differences being predominantly governed by how long the effects last, as well as how the filler “feels”. Generally speaking, very soft fillers (that are best for locations such as the lips) tend to have a shorter duration of effect, while fillers that last longer tend to have more structure and are better suited in regions where they will not be palpable (such as the nasolabial folds). In the past, the most widely used fillers were based on collagen, with sources ranging from bovine to human. For some collagen formulations, skin testing before injection is necessary to confirm that you will not have an allergic response to the filler. Collagen based fillers tend to last 3 to 6 months, and for some indications have a very natural feel.
