By: Katharine Griffiths
Created on 20th September 2011
Do you know the difference between a filler and a volumiser? Are you confused by references in the media to celebs looking ‘over-filled’ with Botox? Well worry no more, because here's the definitive guide to what’s what in the world of injectables
Botulinum Toxins
We’ve all heard of Botox, but do you know how it works? And did you know that Botox is actually just the name of one particular brand, which has – like Hoover – become synonymous with a whole category of wrinkle eradicators. That category should really be titled ‘botulinum toxins’.
There are three major players in the botulinum toxin market place: Botox, Dysport and Xeomin. It is entirely possible that even your aesthetic practitioner is using, for example, Xeomin, but referring to it as ‘Botox’, so deeply has the brand penetrated our consciousness.
Let’s get one thing clear: you can’t use a botulinum toxin to fill a wrinkle. What a botulinum toxin does is to relax the muscles beneath the skin, preventing the formation of ‘dynamic wrinkles’ – wrinkles that are caused by certain facial expressions.
The only licensed cosmetic use of botulinum toxin is the prevention of, glabellar lines – the number 11 shape that forms between your eyebrows when you frown.
It is common, however, for practitioners to offer off-licence indications – to simulate a neck lift, for example – although they may well not advertise this fact.
Botulinum toxins can also be used to treat hyperhidrosis (excessive sweating), to numb the balls of the feet for women who spend long periods of time wearing high heels, and are widely used in the medical arena to treat migraines, tension headaches, back pains, spasticity and prolonged muscular contraction conditions, called dystonia.
Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium botulinum. This bacterium makes several different types of protein which are called type A to type F. All three of the brands mentioned above are type A botulinum toxins.
Did you know that Botox itself is not even licensed for cosmetic use? It's cosmetic application is called Vistabel, which was licensed in 2006. In 2009, Dysport received a cosmetic licence as Azzalure. The most recently approved is Xeomin, whose cosmetic application, Bocouture, received its licence in 2010.
Bocouture is an innovative botulinum toxin type A formulation, in which the complexing proteins have been removed by an extensive purification process.
Studies show that these proteins, which are present in the other botulinum toxins on the market, can cause a reaction from the body’s immune system, resulting in a loss of effect and a reduction in the duration of the products’ activity.
This means that Bocouture, without these proteins, is able to provide similar results to those achievable with the other products, without the risk of antibody formation and so provides continual long-lasting effects.
The regulations about marketing botulinum toxins to the consumer are strict, as they are classified as drugs, so you are unlikely to see ‘Vistabel’, ‘Azzalure’ or ‘Bocouture’ advertised on a clinic’s website.
If you are interested in experiencing the benefits that these products have to offer for yourself, the phrase to look out for is ‘wrinkle (or muscle) relaxing injections’, and you would then need to speak to the practitioner to find out exactly which product they use.
Temporary dermal fillers
Dermal fillers, as the name would suggest, are used to fill in lines and wrinkles.
The original dermal filler was made from collagen derived from a bovine source, which was highly effective but had some fairly major limitations – the main issue being that patients needed to come in for a skin test four weeks prior to treatment to check for allergic reactions, so it wasn’t exactly a walk-in, walk-out procedure.
Collagen also had a very short duration of action, with the effects wearing off after two to three months.
Then, in 1996, a non-animal hyaluronic acid (HA) based filler called Restylane was launched, and since then a whole wealth of fillers have appeared on the market, each one more technologically advanced than the last.
One of the most popular fillers of recent years is Belotero, distributed by Merz Pharma UK. Launched in the UK in 2007, Belotero is a monophasic double cross-linked HA filler. It is created using Cohesive Polydensified Matrix technology, a unique process which gives it unusual elasticity.
“For me, Belotero is the very best HA dermal filler,” says top cosmetic doctor Michael Prager (www.drmichaelprager.com). “When it was first launched it was critizised for being too thin, but that actually makes it much smoother. Thickness was linked to longevity which is actually not such a major criterium for cosmetic treatments.
“Comfort and, ultimately, the cosmetic result are what matters most. With Belotero my patients have very little discomfort, the results are never overdone, I never have to worry about lumps or blue HA residue (often a problem of biphasic products, such as Restylane or Juvéderm) and patients are camera-ready fifteen minutes post treatment.
“This has revolutionised my practice because I can now offer fillers just like I would botulinum toxins: as a maintenance every six months, rather than a one off with doubtful results and a proposed effect of up to two years.”
There are several big temporary filler brands on the market today and most of them will have two or three different products for different applications.
Belotero is no exception: Belotero Basic is made of long strands of HA and is injected into the mid dermis to treat lines like the nose to mouth lines or to frame the lips, to prevent lipstick bleed. Belotero Soft is injected into the upper dermis to fill superficial wrinkles such as smokers’ lines and crows’ feet and even to smooth the décolletage, while Belotero Intense is injected into the deep dermis to treat deep lines and is ideal for plumping the lips.
Having this choice of products under one umbrella means that once you have found a filler you are happy with, your aesthetician can treat all the imperfections on your face using the same brand, giving you confidence in the outcome from the start.
Hyaluronic acid micro-injections
If you’re not quite ready for Botox or fillers, but could do with a complexion booster, hyaluronic acid micro-injections might be the treatment for you.
Foremost in the market place is Restylane Vital, which leapt onto the scene in 2010. Administered using a specially designed pen, the treatment injects tiny amounts of hyaluronic acid through micro-injections just below the skin’s dermis, to boost hydration and promote a radiant, dewy complexion.
“In the 1990s, Botox changed dermatology and cosmetic medicine forever. In my opinion, the development of Restylane Vital in 2010 will come to be seen as similarly significant for people seeking to arrest the effects that ageing has on our skin.
“As we age, our bodies start to slow down the production of
collagen; Restylane Vital induces your body to produce new
collagen, thereby leading to your body starting to rejuvenate its
own skin again.” – Dr Ariel Haus, www.drhausdermatology.com
Volumising fillers
Volume loss is one of the biggest giveaways of ageing – the old adage that you have to choose between your figure and your face after forty is sadly truer than you might like to think.
Thankfully, however, modern science has given us some wonderful gifts, and volumising fillers provide a cunning tool that allows you to stay svelte in the body and youthful in the face, well beyond your fortieth birthday.
Most of the big dermal filler ranges contain a volumising product, containing larger molecules of the same substance, which are injected deeper into the dermis – Belotero Intense, for example, can be used to create an impressive volumising effect.
However, there are some products which have been developed specifically for the purpose of restoring lost volume. Radiesse (www.radiesse. com) is a biocompatible volumising filler that stimulates the growth of your own natural collagen over time, but with an immediate volumising result.
Cosmetic doctor Beatriz Molina (www.medikas. co.uk) has been using it since 2006. “Radiesse is unique in the sense that it’s made from synthetic calcium microspheres. It’s biocompatible, so you don’t need any allergy testing, and it’s very versatile – you can use it just to fill in a wrinkle, like you would with a normal dermal filler, you can go deeper to create volume, and you can even inject it into the mid dermis in a vector to create a non-surgical facelift.
“It is a dermal filler, but it also has a fantastic lifting effect, as it has the highest G-force of any product on the market (the ability to push back against a force, like the dermis), and it’s perfect for volumising and contouring. It lasts longer than most fillers, too – between 12 and 18 months.”
The other big name in the volumising market is Sculptra, a ‘tissue simulator’, made from poly-L-lactic acid, which is injected deeper into the dermis to stimulate collagen production, and the effects of which can last for up to 25 months.
“We do offer Sculptra as well as Radiesse,” says Dr Molina, “but I have to say we don’t do an awful lot of it at the moment. Because with Radiesse you can do with one treatment what with Sculptra would need three, and also you see the effects straightaway, whereas with Sculptra you have to wait for several months to see whether it’s worked.”
For cosmetic doctors, the exciting thing about Radiesse is its versatility and the opportunities that presents. Dr Molina has produced a thread lift effect on some of her patients, by injecting the product in very thin strands, to give a lifted appearance.
“And in France, last year, some doctors started doing a neck lift with this product,” Dr Molina enthuses. “You inject just behind the earlobe and beneath the jaw line to create a smoother neck. That’s what is so great about it – you can use it just about anywhere in the body to create the effect you desire.”
Body fillers
For women considering breast or buttock augmentation but nervous about going under the knife, the introduction of body filler Macrolane in 2008 was a godsend.
Using the same patented technology as its sister product Restylane, Macrolane is a thicker, more viscous hyaluronic acid gel, which can be injected in larger volumes into the breasts, buttocks or calves to create a subtle and temporary volumising effect.
“Macrolane, while not widely
understood or used in the UK
is extremely popular in Brazil
and patients there appreciate
the results it can achieve and
it is used to enlarge breasts,
chests and buttocks. It is
seen as a safer alternative
to implants with less trauma
to the body and minimal
downtown by comparison.” –
Dr Ariel Haus
CS&AG
