Neuromodulators and dermal fillers are two broad categories of injectables that are used around the face for multiple purposes. The first indication that most people generally think of is the treatment of wrinkles. Yes, they are both used for that purpose but the wrinkles each product can help are quite different. Wrinkles such as crow’s feet, the transverse wrinkles of the forehead, and the vertical glabellar lines (or the ”11’s” as many people refer to them) are dynamic wrinkles or facial lines caused by the motion of the underlying muscles.
The neuromodulators such as Botox, Xeomin, and Daxxify are used to treat dynamic wrinkles. These neuromodulators are all very, very similar as they are all forms of the molecule botulinum toxin type A. When shipped from the manufacturer to your doctor’s office, the molecule is basically a “dry powder” in a closed bottle or vial. As the botulinum toxin type A molecule is unstable in this form, an accompanying protein is used to protect or stabilize the molecule. For most of the neuromodulators, this protein is HSA or human serum albumin. The most significant exception to this is Daxxify. Daxxify’s stabilizing protein is a proprietary protein that does not have any human or animal components. The molecule has a slight charge which helps localize the botulinum toxin type A to the end of the nerve for an extended period of time. This accounts for the increased time of duration of Daxxify compared to its competitors. Prior to injection all forms of the neuromodulator are reconstituted with normal saline solution. The liquid product is then drawn up into syringes for injection.
Dermal fillers can encompass a spectrum of products and tissues. The use of the adjective dermal in this case is a bit misleading as although these fillers are injected within the dermis, they are placed deep to the dermis in the majority of cases. This group of “dermal” fillers is used to treat static wrinkles, loss of facial volume, and depressed scars. What are static wrinkles? These are wrinkles that are secondary to the aging process and not to the action of underlying muscles. As we age, the loss of facial volume and the effects of gravity, lead to the development of these static wrinkles. Examples of these are the lines around the mouth known as marionettes lines and the nasolabial folds.
The most commonly used dermal filler products at RothausMD and HausMD include hyaluronic gel fillers, biostimulatory fillers, and the patient’s own fat (microfat and nanofat). The hyaluronic fillers used in our practice include products from 3 different families of hyaluronic gels: Restylane, Juvederm and RHA. Each manufacturer has many types of fillers within their product line. For example, the Galderma products we commonly use includes Restylane Defyne, Restylane Kysse, Restylane Contour and Restylane Refyne. The Revance products are RHA 4, RHA 3, RHA 2 and Redensity. Our Allergan (or AbbieVie) products are Voluma, Volbella and Volux. The hyaluronic gel fillers are usually injected in a single session and the results are immediate.
An example of a biostimulatory fillers is Sculptra. At RothausMD and HausMD we use Sculptra in patients who need volume correction in multiple areas and over large sections of the face. Sculptra does require a series of treatments and the patients must massage the area as instructed over a period of 5 days. Over a period of time, the Sculptra is replaced by the patient’s own collagen. While most of the hyaluronic fillers last up to one year, Sculptra will last for approximately twice as long.
Microfat which is used for volume correction is prepared from the patient’s own fat. This is obtained under a local anesthesia using a small syringe for suction. The microfat is prepared from this harvested fat. Microfat is injected during the same visit. As the microfat has to establish a blood supply from the area into which it was injected, there is always some loss of injected fat. For that reason, a greater volume than required for correction is usually placed.
Naturally, an in-person or virtual consultation is required to determine what is the best neuromodulator or filler product to address a patient’s needs. These consultations can easily be scheduled through our online form or by calling or testing us at 212-737-1424.view all blogs
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