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Botox is a drug made from a neurotoxin produced by the bacteriumClostridium botulinum called botulinum toxin. It is used medically to treat certain muscular conditions and cosmetically remove wrinkles by temporarily paralyzing muscles.

Botulinum toxin is sold commercially under the names:

  • Botox, Vistabel, Botox cosmetic (OnabotulinumtoxinA or botulinum toxin type A)
  • Dysport (AbobotulinumtoxinA or botulinum toxin type A)
  • Bocouture, Xeomin (IncobotulinumtoxinA or botulinum toxin type A)
  • Myobloc (RimabotulinumtoxinB or botulinum toxin type B).

Botox and Dermal Fillers

A Comparison of the Most Popular Dermal Fillers

Dermal fillers are an increasingly popular way to help reverse the visual signs of aging and restore a youthful appearance. As we age, our outer most layer of skin gradually loses three of its most important components: collagen, elastin andhyaluronic acid, leading to the appearance of lines and wrinkles. Dermal fillers help stop and even reverse this process by injecting collagen, hyaluronic acid or other important substances back into the skin. All dermal fillers do not work the same way, though, so no single filler is suited for use in every area of the face.

Absorbable (temporary) materials

  • Collagen: Collagen is a type of protein that is a major part of skin and other tissues in the body. Sources of purified collagen used in soft tissue fillers can be from cow (bovine) or human cells. The effects of collagen fillers generally last for 3-4 months. They are the shortest lasting of injectable filler materials.
  • Hyaluronic acid: Hyaluronic acid is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell when in gel form, causing a smoothing/filling effect. Sources of hyaluronic acid used in dermal fillers can be from bacteria or rooster combs (avian). In some cases, hyaluronic acid used in dermal fillers is chemically modified (crosslinked) to make it last longer in the body. The effects of this material last approximately 6 – 12 months.
  • Calcium hydroxylapatite: Calcium hydroxylapatite is a type of mineral that is commonly found in human teeth and bones. For wrinkle filling in the face or for the hand, calcium hydroxylapatite particles are suspended in a gel-like solution and then injected into the wrinkle in the face or under the skin in the back of the hand. The effects of this material last approximately 18 months. While in the body, calcium hydroxylapatite will be visible in x-rays and may obscure underlying features.
  • Poly-L-lactic acid (PLLA): PLLA is a biodegradable, biocompatible man-made polymer. This material has wide uses in absorbable stitches and bone screws. PLLA is a long lasting filler material that is given in a series of injections over a period of several months. The effects of PLLA generally become increasingly apparent over time (over a period of several weeks) and its effects may last up to 2 years.

Juvederm contains a smooth gel made of hyaluronic acid, a naturally produced substance that absorbs water and adds volume to the skin. Juvederm is used to smooth moderate to severe wrinkles, especially those around the nose and mouth, by temporarily adding volume to facial tissues. Juvederm also is commonly used to soften acne scars and augment lips and chins. One treatment of Juvederm can last for up to one year; however, some people need a follow-up treatment after six months. Since Juvederm is not derived from animals, allergic reactions are rare.

The active ingredient in Restylane is also hyaluronic acid. It is generally used to reduce the appearance of moderate to severe facial wrinkles, such as laugh lines, worry lines, crow’s feet and marionette lines. Restylane also can be used for lip and chin augmentation, filling in under-eye hollows, softening acne scars and creating temporary eyebrow lifts. One treatment generally lasts for approximately six to eight months, although this depends on the area treated. Since Restylane is not derived from animals, allergic reactions are rare. One study estimated that Restylane treatment causes less than one allergic reaction for every 1,600 treatments.

The active ingredient in Evolence is collagen, which works with the body’s own collagen to provide greater structure and support to the skin and to smooth moderate to deep lines and wrinkles. The most common area targeted by this treatment is nasolabial folds (laugh lines), which extend vertically from the outside of the nose to the outside of the mouth. One treatment of Evolence generally last for six to 12 months. Because this product is derived from pigs, and pig skin it is very similar to human skin, allergic reactions are rare. Johnson & Johnson has recently stopped, manufacturing Evolence® due to financial reasons at this time. The product is still FDA approved and might be picked up by another manufacturer in the future.

Sculptra, a stimulatory filler, contains a synthetic substance derived from fruit acids called poly-L-lactic acid. When injected, Sculptra stimulates the body’s natural production of collagen, which in turn smoothes wrinkles and folds. This is slightly different than traditional dermal fillers, which plump the targeted area with the product itself. Because of this different mode of action, Sculptra requires multiple treatment sessions over a period of two to three months, but then can last for one to two years. Sculptra is generally used for full face volume augmentation. Because Sculptra is synthetic, allergic reactions are rare.