Botox and Fillers: The Most Common Questions Answered
Thinking about getting Botox or dermal filler? We asked Aesthetic Practitioner and Dental Surgeon, Dr. Ayah to answer some of the most common questions she gets asked about the popular cosmetic treatments. Read on for the answers…
Before we start, let me briefly explain the anatomy of the face as when you understand what is happening at the various layers, you can then better understand the treatments used to target the changes that occur.
Our face is made up of 4 basic layers: bone, muscles, fat and skin. Over time there are changes within each of the layers which lead to the physical signs of ageing. These changes are as follows:
Facial bones recede and shrink
Muscles shrink and lose their tone
Fat will reduce in the upper half of the face and increase in the lower half, collecting together and falling south with gravity
Skin will lose its elasticity and thickness and become more textured and wrinkled
Now, let’s move on to the questions I get asked the most…
What is Botox?
Botulinum toxin (brand name Botox) is a drug used to make muscles relax. Repetitive movement of certain muscles can cause creasing of the skin, leading to what we see as wrinkles. There are 3 main brands used in the UK, the most common is the brand ‘Botox’.
Think of a piece of paper, if you continually fold it, it will eventually crease and once this happens no matter what you do you cannot restore it back to its original smoothness.
This is what Botox stops and why we use it frequently in the upper face. As you move your facial muscles and as your skin thins, lines start to form. When you are younger these lines are not as visible because the skin is thicker, and you haven’t had years of movement. Botox will relax the muscle, thereby reducing your ability to ‘crease your skin’ and leading to fewer wrinkles.
When should you have it done?
This is a tricky one to outline. Let’s go back to what I was saying about folding the paper analogy. If you never fold a piece of paper, it won't crease. This is why people often talk about preventative Botox. If we reduce the muscle movement, it won't lead to lines. However, some people will have treatment once a few lines appear and they’re beginning to stay. If wrinkles are very deep, Botox won’t be enough to smooth them completely.
But what if I like my lines and just don’t want them to be as prominent?
Good news! This is what we call ‘baby Botox’. As clinicians, we have the ability to tailor how much we want the muscles to relax. With baby Botox, we use small doses to soften and relax the muscle rather than eliminate the ability to move it completely. Hence why good Botox can’t be detected and doesn’t leave you frozen!
How long does it last?
Typically, around 3 months. Botox works gradually, initially showing results around week 2 which gets better up to week 6-8 and then gradually wears off.
Can’t I use skincare instead?
This is where the anatomy of the face is important to keep in mind. Skincare works on the skin, whereas wrinkles form through the movement of muscle. Yes, the better your skincare, the more resilient the skin is and the less Botox you may need, but skincare cannot replace Botox as they work on different layers of the face.
What are fillers?
Fillers are gel-based treatments we use to augment facial structures. The most common ones are made of hyaluronic acid and last between 6- 18 months depending on which area is treated.
As we age, our bone starts to recede. This means there is less support for the facial tissue and so it falls south. This is where fillers come in. We can use them to replicate and add structure to the face to help support the tissues for a more youthful appearance.
Can fillers give me facelift?
Unfortunately not. They can’t work to literally lift tissue, but what they can do (and are fantastic at!) is softening the hills and valleys of your face by filling areas that need it. If you want to feel refreshed or a little tweak, they’re the best.
What about dark circles and eye bags? Can I fix these with skincare or aesthetic treatment?
Treatment will depend on what the eye issue is. If you have skin pigmentation, skincare can really help. If you have thin skin which is leading to wrinkles, a retinol eye cream can work fantastically.
If, however, you have hollowing under or around your eyes, then unfortunately this is a bone / fat issue and therefore will need the appropriate treatment. This is often tear trough or cheek filler.
Can I have Botox or filler when I am breastfeeding or pregnant?
While there is no evidence to suggest any specific complications during pregnancy or breastfeeding, most insurance companies do not support having treatments during this time and the products are not licensed to be used in breastfeeding or pregnant women.
For pregnancy, there is a 100% no treatment policy across the board. There are thoughts that fluctuating hormones can cause changes in blood flow and lead to possible complications for the mother (not the baby!). However, if you have had filler treatment and you've not realised you're pregnant, I wouldn't worry too much. Fillers are made of hyaluronic acid, so the safety profile is great and if you accidentally had your wrinkles treated, the amount of botulinum toxin for cosmetic procedures is far less than therapeutic and carries a very small risk of absorption into the body. Lastly, the actual molecule size of either Botox or fillers makes it incredibly unlikely for them to be excreted into breast milk.
The main issue is due to the ethics involved; there are no large studies (and won't be) so there is no evidence to refer to. As always, most clinics will discuss on a case-by-case basis. Some clinicians do not mind treating clients that are breastfeeding, following a transparent discussion and gaining informed consent.
What advice would you give to someone interested in Botox/filler?
I think the best piece of advice I can give is to understand that aesthetic medicine is as much of an art as it is a science. The same filler in two different hands yields very different results, as does Botox. When filler or Botox is done well, it is subtle and helps you to look like the best most refreshed version of you.
Always seek out a reputable, qualified clinician and have a consultation prior to treatment to understand which treatment is best for you.
Words by Dr Ayah Siddiqi, Aesthetic Practitioner and Dental Surgeon specialising in Cosmetic Dermatology and Aesthetic Medicine
Qualifications - BSc Hons in Medical Sciences, Diploma in Aesthetic Medicine and Bachelor of Dental Surgery