BOTOX® is a very dilute form of Botulinum Toxin. It blocks transmission of a chemical called acetylcholine from the nerves to the muscle. Acetylcholine is a neurotransmitter that sends a message to the muscle telling it to contract. With the flow of acetylcholine blocked or significantly reduced, the muscle relaxes. As a result, the wrinkled areas smooth out and soften. It takes up to two weeks following an injection of BOTOX® to see the final results, which then last for three to four months.
Fillers are various substances that actually fill in the wrinkle. Hyaluronic acid products such as Restylane/Perlane and Juvederm last about six to nine months. These require no skin tests and generally cost about $500 per syringe. Each syringe contains 1cc of product, the amount required depending on the depth of the wrinkle. These products are also very useful to enhance lips. Some of the longer-lasting fillers include Radiesse, Sculptra and Artefill. Radiesse injections consist of very small, smooth calcium hydroxylapatite microspheres suspended in a water-based gel carrier. Radiesse stimulates the body to produce new collagen, correcting facial wrinkles. It lasts for a year on average and is more expensive than the hyaluronic acid products. Sculptra is poly-L Lactic Acid, and also lasts for a year or longer. The cost per cc of Radiesse or Sculptra is $1,000-1,500. Artefill contains methylmethacrylate beads, which last for several years. Artefill prices are higher than Radiesse or Sculptra.
The most important thing about any filler (injectable) is not what the substance is, but who injects it. Going to the mall is not the same as getting it injected by a physician with a lot of experience.
Hence, the most important thing about the filler is ... the filler.
Dr. Josh Korman, M.D., is certified by the American Board of Plastic Surgery and has been a member of the clinical faculty of Stanford University for 15 years. He is also a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and the California Society of Plastic Surgery. He received national attention for his use of lasers in plastic surgery and for body lift surgery. Dr. Korman has been featured on “20/20”; CNN; The New York Times; The San Jose Mercury News; Gentry Magazine; and The Metro. Dr. Korman volunteers his services as physician in developing countries with Interplast; he has served on its board of directors. Locally he donates his time to the Community Breast Health Project in Palo Alto, Calif. He is an accomplished musician and playwright. He has been named one of San Jose Magazine's "Top Docs" every year since 2000. Send your questions to josh@smartnow.com.
