The Injectables, aka The “Age Erasers”:

Botox®, Restylane®, Juvéderm™, Kybella®, Sculptra®, Fat Injection and Radiesse®

The term “injectable” is used to encompass an entire realm of products that are being used to essentially “turn back time” – to restore a more youthful appearance to skin, to erase visible signs of stress, etc. They are called “injectables” because they are injected into various sites where both patient and physician desire to see improvement. They may be natural or synthetic products.

Injectables Dallas TX Ramsey J. Choucair M.D.
Injectables Dallas TX Ramsey J. Choucair M.D.

Wrinkles and furrows, if not too deep, may be remedied with Botox® Cosmetic Injections. Botox® is purified protein toxin produced by the clostridium bacteria.

Kybella® is the first ever FDA approved injectable that permanently dissolves submental fat, often referred to as chin fat or a double chin. If you are the right candidate, in just 2 to 4 injections, fat is dissolved, ultimately restoring a more defined jaw and neckline.

Board Certified Plastic Surgeons have recognized that by using these injectables, patients may receive almost instant results (within a matter of 7 days) with little downtime. By filling skin depressions or sunken areas, or by relaxing muscles around areas where signs of wrinkles and aging appear, the injectables serve as an alternative for an individual who may not yet need facial rejuvenation through surgery. Injectables can also, however, serve as a way to enhance results obtained though surgery such as in a facelift.

What is it and how does it work? Botox® Cosmetic is a purified form of the bacteria clostridium. It is not detrimental to the body overall, because it used locally in such small amounts. The effect is achieved by causing relaxation of the muscles that produce wrinkling around the eyes and forehead. Results last anywhere from three to five months. Once the Botox® ”wears off,” more injections are necessary to assist in maintaining results. Relaxation of the muscles where the Botox®is injected causes lines and wrinkles to “fade” and it is possible to continue with this type of regimen indefinitely.

Are Botox® Cosmetic Injections safe?

They have been used for over fifteen years in the ophthalmologic field and for over 6 years in the cosmetic arena, with no unsafe side effects thus far. However, to be on the safe side, pregnant women and individuals with neurological diseases should not receive Botox® injections.

Are there other Botox® Cosmetic benefits?

Alternative benefits other than those mentioned above have been found in migraine patients, who, after receiving Botox®injections, experienced a lessening or even eradication of headache pain. It is speculated that these patients’ migraines were associated with muscular tension. Once the problem areas were injected with Botox®, their pain subsided.

The FDA recently also approved Botox® injections for the armpit areas to control excessive sweating – highly beneficial to anyone who finds this embarrassing problem interfering with their social or professional life.

Kybella® is the first FDA approved injection targeted to dissolve fat accumulation in the submental (beneath the chin) area. Successful treatment typically requires 2-4 injection sessions, spaced at least 4-6 weeks apart. The Kybella® treatment is done in an examination room where a topical anesthetic cream is applied to minimize any discomfort. The visual improvement from treatment is usually seen 4-6 weeks following injection. There is a modest amount of swelling associated with most injections and minimal bruising is seen. The swelling may last up to 3-4 days depending on the individuals’ skin type and the amount of Kybella® injected.

KYBELLA® (deoxycholic acid) injection 10 mg/mL

Important Information
Indication
KYBELLA® (deoxycholic acid) injection is indicated for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat in adults.
The safe and effective use of KYBELLA® for the treatment of subcutaneous fat outside the submental region has not been established and is not recommended.
Important Safety Information
Contraindications: 
KYBELLA® is contraindicated in the presence of infection at the injection sites.
Warnings and Precautions: 
Marginal Mandibular Nerve Injury
Cases of marginal mandibular nerve injury, manifested as an asymmetric smile or facial muscle weakness, were reported in 4% of subjects in the clinical trials; all cases resolved spontaneously (range 1-298 days, median 44 days). KYBELLA® should not be injected into or in close proximity to the marginal mandibular branch of the facial nerve.
Dysphagia: 
Dysphagia occurred in 2% of subjects in the clinical trials in the setting of administration-site reactions, eg, pain, swelling, and induration of the submental area; all cases of dysphagia resolved spontaneously (range 1-81 days, median 3 days). Avoid use of KYBELLA® in patients with current or prior history of dysphagia as treatment may exacerbate the condition.
Injection-Site Hematoma/Bruising: 
In clinical trials, 72% of subjects treated with KYBELLA® experienced hematoma/bruising. KYBELLA® should be used with caution in patients with bleeding abnormalities or who are currently being treated with antiplatelet or anticoagulant therapy as excessive bleeding or bruising in the treatment area may occur.
Risk of Injecting Into or in Proximity to Vulnerable Anatomic Structures: 
To avoid the potential of tissue damage, KYBELLA® should not be injected into or in close proximity (1 cm-1.5 cm) to salivary glands, lymph nodes, and muscles.
Adverse Reactions: 
The most commonly reported adverse reactions in the pivotal clinical trials were: injection site edema/swelling, hematoma/bruising, pain, numbness, erythema, and induration.

Restylane® and Juvéderm™ are similar hyaluronic acid products, comparable in most ways, and simply manufactured by competing companies. Hyaluronic acid is a substance that occurs naturally in the human body. It is delivered in a gel form, via injection, into various sites that you and your physician have decided need to be “filled.”

Restalyne2Restylane® and Juvéderm™ injections are often used to fill laugh or smile lines around the mouth, an area where some of the first signs of aging occur, and to soften “crows feet” around the eyes. Wrinkles occur, in general, due to the continued use of various muscles that are involved with facial expressions. Collagen, the flexible support structure just beneath the skin, begins to break down due to wear and tear. The breaking down of collagen causes mild to deep lines or wrinkles because the structure eventually “gives in.” These injectables are perfect for filling in such lines.

Additionally, as the face ages, youthful fat disappears, leaving a more angular, less youthful-looking appearance. Using an injectable filler such as Restylane® or Juvéderm™ is an excellent means of restoring what has been lost due to normal aging. Many know Restylane® and Juvéderm™ as common methods for enhancing the plumpness of lips and even ridding evidence of “smoker’s lines” around the lip area.

How long do the filling and plumping effects of Restylane® last?

The duration of results varies between individuals, however, on average, due to the body’s ability to reabsorb the naturally occurring hyaluronic acid, results are expected to last between six to nine months. At that time, more injections would be necessary to maintain the filled or plumped-up effects.

Injectable fat is a “natural” filler. Fat injections are another natural filler, derived from your own fatty deposits typically found in your abdomen or thigh areas. Since the fat is from your own body, there is little or no likelihood that it will be rejected. Fat is a natural filler and up to thirty percent of the injected volume will remain permanently. Therefore, additional injections may be needed, depending upon biological individuality.

Sculptra® (also known as “New Fill”) is a synthetic injectable material known as “poly-L-lactic acid.” It has been widely used for many years in dissolvable stitches and some types of implants. Poly-L-lactic acid is deemed biocompatible; it is a material that does not harm the body and is able to be broken down. Sculptra®works by filling in lines, wrinkles and skin depressions. It also stimulates the body to produce new collagen and underlying tissue. Results with Sculptra® may last up to two years.

Radiesse® is another long-lasting injectable used for facial contouring. It is made up of microscopic calcium particles known as hydroxylapatite. These particles, normally found in bone, are suspended in a gel. This material was previously used in dental reconstruction, for promotion of bone growth, and for certain vocal cord problems, and has been proven to be very safe and compatible with the body.