While fillers and neuromodulators often target the same problem (wrinkles), they work very differently. Neuromodulators offer a temporary relaxation of the muscle, which in turn will soften lines and wrinkles. Fillers, on the other hand, are used to restore the volume and add structure below the skin, which will, in turn, plump the skin and smooth wrinkles. 

Neuromodulators take up to 2 weeks to take effect and are only active in the body for approximately 3 months before needing re-treatment, whereas you see the results of your filler immediately, and they can last up to 9 months-2 years. 

In most cases, fillers and neuromodulators work great together as they target different areas and work in different ways. When done well, both can provide very natural-looking results.

Most people find the injections to be only mildly uncomfortable. Topical anesthetics are used prior to injection, and the fillers themselves often have lidocaine mixed in, meaning they will continue to offer numbing as we go along. At the end of the day, it varies from person to person – a needle will be inserted into your skin, so rarely does that go completely undetected.

I recommend avoiding alcohol and NSAIDs (i.e. ibuprofen, aspirin, etc.) for about 48 hours prior to and after treatment to minimize bruising. Keep in mind that bruising and swelling are likely, so plan accordingly around important events – ideally, giving yourself at least 2 weeks of recovery time. – If you are concerned with bruising, you can take Arnica tablets for 2-3 days prior to your appointment. These are available over the counter. 

– We can not perform filler injections if you are pregnant or nursing. 

– If you have a history of cold sores, it may be beneficial to take a prophylactic antiviral prior to injections as the trauma may re-ignite that virus and cause cold sores.  

– If you are feeling unwell in any way, please reschedule your filler appointment, as I do not recommend an invasive treatment while sick. 

– Importantly, if you have had dental work (including a cleaning) in the last two weeks or plan to in the following two weeks, we will need to reschedule either your filler or dental appointment.

You may feel a minor pinch as the needle passes through your skin, followed by a minor burning sensation that lasts 1-2 seconds as the medication is injected; however, these are only seconds of discomfort that immediately disappear when the treatment is completed. Most people don’t find any discomfort at all.

Most people find that they start seeing or feeling some difference within a few days, though it does take approximately 2-3 weeks for the toxin to fully settle into the muscle to judge your results.  You do need to keep in mind that if you have deeper wrinkles or have never treated yourself before, you will not see an instant disappearance of wrinkles. Our first goal is to minimize muscle movement; in time, that lack of movement will allow those wrinkles to fade away.

There are several reasons your Botox/Jeuveau/Dysport/etc. might not be lasting as long as you’d hope. Some of these reasons to consider: illness or recent vaccines, frequent exercise, high metabolism, breastfeeding, and lower dosing of treatments are all common reasons that your tox might not last as long as you’d like. If you have concerns, I always welcome you to bring them to my attention, so we can try to find a solution.

The toxin will gradually fade away, and the aging process will continue on. This means your wrinkles will return, but there is no other downside to stopping treatment.

One of the most common side effects of a neuromodulator in the upper face is a brow ptosis – this means that your brow(s) sag a little lower and look/feel heavy on the eye. While this can also happen to the eyelid, it is less common than with the brow. Alternatively treating the lower face, it can potentially alter the appearance of your smile or cause some asymmetries in the face. These are typically cosmetic side effects (rather than true dangers), but unfortunately, they cannot be reversed. Some asymmetries can be corrected by strategically injecting more toxin, but others will simply take time to wear off.  

There are other more severe risks, such as difficulty breathing, but these are extremely rare and are most often associated with injecting neuromodulators into a patient with an underlying neuromuscular disease. 

While these side effects can certainly happen, take comfort in the fact that they are very uncommon and are most often avoided by a deep understanding of anatomy by your injector.