Look as Young as You Feel—A Review of Fillers and Neurotoxins

Cyndi Yag-Howard, MD, FAAD

The Face as Living Art

When you look at yourself in a mirror, do you ever think about how you could go back in time and reverse a few years? As a board certified dermatologist who specializes in facial sculpting, that is one of the most common things people ask me every day. There are many safe and effective, non-surgical ways to improve how you look. So before you consider going under the knife let me give you a few tips.

Facial sculpting is an art. It requires a thorough understanding of facial anatomy from the inside and out, an artful eye that appreciates the importance of contour and the ability to listen carefully to patients in order to appreciate their desired look. As a facial sculptor, I believe it is important to see the human face as living artwork. Let’s explore some of the newest methods to help you look your best.

Facial Fillers and Toxins

I use Injectable fillers predominantly on the lower half of the face to compensate for loss of volume, due to loss of fat, muscle and bone that occurs naturally as we age. Injectable neurotoxins are used predominantly in the upper half of the face to prevent muscle contraction from causing wrinkles.

The four most common types of fillers are: hyaluronic acid, calcium hydroxyl apatite, poly-L-lactic acid and collagen. There are many brands in each of the filler types to choose. How and why to select a specific one is where the art of facial sculpting becomes important.

Hyaluronic acid exists naturally in our bodies and it can be injected into the cheekbone area, the smile lines, pucker lines around the mouth, the lips as well as the folds beneath the mouth around the chin called marionette lines. The hyaluronic acid fillers can also be injected to “fine-tune” other areas, such as the folds between the eyebrows (to make you look less angry) and just beneath the side of your eye brow to give the brow a beautiful and natural appearing lift. The results are seen immediately and can last for 6-12 months depending on several factors that may include your metabolism. The newest hyaluronic acids to enter the market, can last longer (up to 2 years with a touch-up per the manufacturer). but they are only indicated for use in the cheekbone area to give lift and minimize sagging that occurs with age.

Calcium hydroxyl apatite exists naturally in our bodies. When it is injected into the cheekbone area, smile lines, and marionette lines it can increase collagen. This gives your cheekbones an excellent lift, making you look younger . The results are immediate, and can last for about 9-12 months before a touch-up is necessary.

shutterstock_126008561-2 (5)Poly-L-lactic acid is made of a powdered form of absorbable suture material and allergy testing is not necessary. Like calcium hydroxyl apatite, the body slowly replaces poly-L-lactic acid with collagen. This is an outstanding product used to compensate for sagging skin. The aging process results in facial volume loss that is due to decreasing amounts of collagen, elastin, fat and . The products in this group help to create a more natural, healthy look and a beautiful glow to the skin. It is injected deep into the cheekbone and cheek area, temples, smile lines, marionette lines and jawline and requires a good degree of expertise and experience. Results take about two months to be visualized, and can last for about two years, which is significantly longer than other common fillers.

Collagen, once a common filler, has fallen out of favor largely because it is made from animal sources and requires allergy testing prior to injection. It is used predominantly in the smile lines and marionette lines, but not the lips. Results last from two months to five years depending on the type of collagen used. This is not a product that I recommend in my practice.


Neurotoxins are made of variations of botulinum toxin, which has been used in other countries for more than three decades. They are very safe when used correctly and do not require allergy testing before injection. The neurotoxins work at the level of the junction between the nerve and the muscle to prevent contraction of the muscle and can give you a beautifully relaxed look.

The most common areas to treat with neurotoxins are the forehead creases, the anger lines between the eyebrows, the crows’ feet and the chin (to reduce dimpling). Side effects can include temporary headache or drooping of the eyelid, but these conditions are extremely rare if the product is injected appropriately. In fact, these toxins have been used to treat headaches in some people. Results are noticeable in four to seven days and last for three to four months.

What to Expect

In my office we begin by talking about what your goals are. You look in the mirror, and we discuss what areas bother you most. Many people say that they don’t like the lines around their mouth or the lines between their eyebrows, but they don’t realize that these areas are treated entirely differently. It is important to address each of these areas to give you the best possible aesthetic outcome.

Amazing Results

A typical treatment begins by applying a topical anesthetic to decrease discomfort. Throughout the session, we discuss the treatment and make any adjustments as needed. You can watch the whole process of transformation as it takes place. Tears of joy are not uncommon as the process is truly amazing. When we have completed your session you will see yourself “years” younger.

The art of facial sculpting requires a high degree of expertise and experience. It is wise to make sure your doctor has obtained the proper training and certifications.

Don’t be afraid to ask. In the proper hands non-surgical facial sculpting is a wonderful way to help you look younger.