Is an Injectable Cosmetic Treatment Right for You?

This article is for women who may be interested in injectable cosmetic treatments for the face, or anyone who wants to learn more about injectable cosmetic treatments. The goal of this patient education activity is to help patients engage in shared decision-making with their doctor about injectable cosmetic treatments.

You will learn about:

• Your skin and how it changes as you age

• Factors that can change your skin

• Types of injectable cosmetic treatments

• When to get treatment

• What to do before and after treatment

In addition to being part of your appearance, your skin protects you from outside microbes and the environment.

Your skin has 3 layers:

• Epidermis, the top protective, waterproof layer

• Dermis containing follicles for hair growth, oil and sweat glands, and tough connective tissue that supports other tissues

• Hypodermis, deeper tissue made of fat and connective tissue

Skin also contains substances that help give it its shape, such as:

• Collagen to provide firmness

• Elastin, elastic tissue that helps skin stretch and bounce back

• Glycosaminoglycans (GAGs) that keep skin hydrated (moist)

Aging is a natural process that happens to skin over time. As adults get older, the body makes less collagen, elastin, and GAGs.

Skin changes that happen during aging include:

• Slackness or looseness from less elastin

• Fragility and thinness due to less collagen

• Transparency as the epidermis thins

• Easier bruising due to thinner blood vessel walls in the skin

As a result of these changes, skin becomes rougher and wrinkles begin to form.

Aging also causes changes in the tissues and structures underneath the skin, such as:

• Loss of fat below the cheeks, temples, chin, nose, and around the eyes that causes loose skin, sunken eyes, and a "skeletal" look

• Bone loss around the mouth and chin that can cause skin puckering

• Cartilage (tough, flexible connective tissue) loss in the nose that causes drooping

Many skin changes are due to genetics (traits you inherit from your parents). But because your skin is your outermost layer, it's exposed to the sun, weather, and pollution. Over time, this also causes changes.

Sunlight is the biggest external factor in skin aging. Ultraviolet (UV) light damages elastin, which causes skin to sag, stretch, and lose its ability to bounce back.

Skin changes also depend on your lifestyle and diet, stress, gravity, daily facial movements, obesity, your sleep position, and if you smoke.

Cosmetic injections are prescription treatments given by a doctor to improve appearance. Most provide temporary changes. The 2 main types are neuromuscular blocking agents and dermal fillers.

Neuromuscular blocking agents reduce wrinkles and creases. Tiny amounts are injected to temporarily relax the muscles under a wrinkle.

Dermal fillers are gel-like substances injected beneath the skin to fill in hollows and wrinkles. They may also be used as "volumizers" to plump and lift areas.

Neuromuscular blocking agents -- such as Botox®, Dysport®, Xeomin®, and Jeuvea ® -- work by temporarily blocking signals from nerves to injected muscles so the muscles can't contract (tighten). This softens the wrinkles on top of and around those muscles. The main ingredient is a neurotoxin made by the bacterium Clostridium botulinum.

These treatments are usually used for forehead lines, crow's feet (lines around the eye), and frown lines. They won't help with wrinkles caused by the sun or gravity.

Dermal fillers smooth lines and soften creases by filling in areas under wrinkles. Some may also plump and lift cheeks, chins, jawlines, and temples; enhance facial contours; and plump lips.

Types of fillers based on their main ingredient include:

• Hyaluronic acid (HA), such as the Juvéderm® and Restylane® families of products and Belotero Balance®

• Calcium hydroxylapatite (CaHA), including Radiesse®

• Poly-L-lactic acid (PLLA), including Sculptra® Aesthetic

• Polymethylmethacrylate (PMMA), including Bellafill®

• Autologous fat taken from another part of your body. This treatment requires surgery

As you age, changes in and below your skin can affect your appearance. Some changes can begin and be noticed as early as age 20.

The best time to start treatment can be different for everyone. But it's important to remember that injectable cosmetic treatments are only available by prescription and are only for use in adults.

Before treatment, discuss your goals and any questions or concerns with your doctor. Together you can find the treatment that's best for you.

Be sure to tell your doctor about:

• Any medical conditions and allergies

• All medicines you take, including those you get without a prescription, and herbals and supplements

• If you smoke, or drink alcohol or caffeine

Ask your doctor if there are any precautions you should take before having treatment.

Depending on the treatment, it may take several days to see the full effect. Ask your doctor how to care for the treated area and if you have any restrictions, such as strenuous activity or exercise.

All treatments can have side effects. After injection, some people may have mild redness, bruising, swelling, or tenderness that often goes away after a few days. Other side effects with neuromuscular blocking agents include headache or weakness in nearby muscles. Dermal fillers may also cause allergic reaction or tiny bumps under the skin.

All side effects are not listed here -- ask your doctor about possible side effects and how to manage them.

Congratulations!

You have successfully completed the program: Is an Injectable Cosmetic Treatment Right for You?

View Additional Materials

View Additional Materials on this topic that you may find useful:

Botulinum Toxin

Botox-Type Injectables Guide

Filling in Wrinkles Safely

Dermal Fillers (Soft Tissue Fillers)