Injectables & Fillers
by Nicole Spaeth MSN, FNP-c
Areas most commonly treated by Botox include crow’s feet (lines around the eyes), worry lines between the eyebrows, and the lines across the forehead. In just a few minutes, these facial paralytics can temporarily weaken facial muscles beneath the wrinkled area to relax the skin and restore its youthful appearance.
$10 per unit
Standard treatment per area begins at 20 units
What is BOTOX?
BOTOX Cosmetic is an injectable with an active ingredient that has been used medically for many years to treat numerous medical conditions, including muscle spasms. The ingredient, a purified form of a protein produced by the Clostridium botulinum bacterium, hinders or decreases a muscle’s ability to contract.
How Does BOTOX Work to Smooth Wrinkles and More?
In a cosmetic setting, BOTOX can be used to “quiet muscles working overtime” or prevent motion in facial muscles associated with what are known as “dynamic wrinkles.” These folds and lines appear when certain expressions are made, especially when these expressions cause the same wrinkles to form over and over again in the same places.
It can also relax muscles that play a role in facial contouring. Additionally, BOTOX is often used in combination with dermal fillers to extend the longevity of the fillers in certain areas of the face
What Can BOTOX Address?
BOTOX Cosmetic is ideal for addressing fine lines and wrinkles between the brows (frown lines), fine lines and wrinkles around the eyes (crow’s feet), horizontal forehead wrinkles, and fine lines around the mouth. It is also a treatment of choice for eyebrow shaping and enhancement, brow lifting, facial sculpting, and diminishing underarm sweating.
Because it forces muscles to stay at rest, it can also be used for the prevention of lines by relaxing muscles early so that they cannot contribute to deeper wrinkles in the future. At ReFresh, we call this “prejuvenation.”
How Long Does BOTOX Last?
BOTOX results typically last three to four months, depending on where it is injected. The ideal time for another treatment is when muscle activity has begun to return, but wrinkles have not yet begun to be visible again. Many people choose to receive treatments at least three times a year.
After your injections, you will see gradual improvement for up to two weeks, with most of the beneficial effects visible within the first week. This allows the effects to be subtle, so that all anyone will notice is that you look ReFreshed.
What is Recovery After BOTOX Injection?
You can go back to your daily life immediately after you have had a BOTOX treatment. You can even apply makeup right away. In some cases, mild tenderness or bruising may result for a day or two after an injection. The only precaution we recommend is to avoid touching or manipulating the injection areas for a couple of days. While no procedure is without risks, this injectable has been used successfully for many years, and BOTOX side effects for aesthetic uses are very rare.
IMPORTANT SAFETY INFORMATION & APPROVED USES
BOTOX® Cosmetic may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX® Cosmetic :
- Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months.
- Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.
BOTOX® Cosmetic dosing units are not the same as, or comparable to, any other botulinum toxin product .
There has not been a confirmed serious case of spread of toxin effect when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines, crow’s feet lines, and/or forehead lines.
BOTOX® Cosmetic may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX® Cosmetic. If this happens, do not drive a car, operate machinery, or do other dangerous activities.
Serious and/or immediate allergic reactions have been reported. They include: itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.
Do not receive BOTOX® Cosmetic if you : are allergic to any of the ingredients in BOTOX® Cosmetic (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.
Tell your doctor about all your muscle or nerve conditions, such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of BOTOX® Cosmetic.
Tell your doctor about all your medical conditions, including: plans to have surgery; had surgery on your face; have trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® Cosmetic can harm your unborn baby); are breast-feeding or plan to (it is not known if BOTOX® Cosmetic passes into breast milk).
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using BOTOX® Cosmetic with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® Cosmetic in the past.
Tell your doctor if you have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin-like products or blood thinners.
Other side effects of BOTOX® Cosmetic include : dry mouth; discomfort or pain at the injection site; tiredness; headache; neck pain; and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids and eyebrows, swelling of your eyelids and dry eyes.
BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to temporarily improve the look of moderate to severe forehead lines, crow’s feet lines, and frown lines between the eyebrows in adults.
Xeomin is the latest FDA approved injectable. It is different from Botox in that it does not contain any protein additives. The potential benefit of this is mainly for the patient who stopped responding to Botox treatments because of the development of antibodies to the proteins.
$8 per unit
Standard treatment per area begins at 20 units
Xeomin is the latest cosmetic injectable approved by the FDA to treat facial lines and wrinkles.
What is Xeomin?
Xeomin is a medically derived sub-unit of botulinum toxin type a called incobotulinum toxin a. Xeomin weakens the muscles into which it is placed, improving the appearance of fine lines and wrinkles. Xeomin, like Botox, is commonly used to treat dynamic wrinkles. Dynamic wrinkles include the forehead lines, fine lines around the eyes, and the furrows between the eyebrows. Xeomin works by targeting the wrinkle causing facial muscles in order to eliminate these dynamic lines. Xeomin can provide a very natural appearing and dramatic improvement in your appearance.
What is the difference between Xeomin and Botox?
On a molecular level, Xeomin is different from Botox in that it does not contain any protein additives when packaged which is commonly referred to as the “naked injectable”. The potential benefit of this is mainly for the rare patient who stopped responding to Botox®treatments because of the development of antibodies to the proteins so the human body is less likely to become resistant to it.
How does Xeomin work?
Xeomin works by weakening the muscles of facial expression that insert onto the surface of the skin. Weakening the pull of these muscles on the skin causes the visible wrinkles to flatten out. Over time, cumulative benefits are observed as the skin remodels without the negative influence of the wrinkle-creating facial muscles.
What areas can be treated with Xeomin?
Xeomin is used to treat dynamic facial wrinkles. Areas most commonly treated by Xeomin include crow’s feet (lines around the eyes), worry lines between the eyebrows, and the lines across the forehead.
XEOMIN® (incobotulinumtoxinA) IMPORTANT CONSUMER SAFETY INFORMATION
Read the Medication Guide before you start receiving XEOMIN® (Zeo-min) and each time XEOMIN® is given to you as there may be new information. The risk information provided here is not comprehensive. To learn more:
- Talk to your health care provider or pharmacist
- Visit www.xeominaesthetic.com to obtain the FDA-approved product labeling
- Call 1-866-862-1211
Uses XEOMIN® is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary).
It is not known if XEOMIN is safe and effective in children under 18 years of age.
XEOMIN® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems anytime (hours to weeks) after treatment with XEOMIN®:
- Problems with swallowing, speaking, or breathing can happen within hours to weeks after an injection of XEOMIN®if the muscles that you use to breathe and swallow become weak. Death can happen as a complication if you have severe problems with swallowing or breathing after treatment with XEOMIN®.
- People with certain breathing problems may need to use muscles in their neck to help them breathe and may be at greater risk for serious breathing problems with XEOMIN®.
- Swallowing problems may last for several months, and during that time you may need a feeding tube to receive food and water. If swallowing problems are severe, food or liquids may go into your lungs. People who already have swallowing or breathing problems before receiving XEOMIN®have the highest risk of getting these problems.
- Spread of toxin effects. In some cases, the effect of botulinum toxin may affect areas of the body away from the injection site and cause symptoms of a serious condition called botulism. The symptoms of botulism include: loss of strength and muscle weakness all over the body, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing.
These symptoms can happen hours to weeks after you receive an injection of XEOMIN®. These problems could make it unsafe for you to drive a car or do other dangerous activities.
Do not use XEOMIN® if you are allergic to XEOMIN® or any of the ingredients in XEOMIN® (see the end of this Guide for a list of ingredients in XEOMIN®, had an allergic reaction to any other botulinum toxin products such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX® COSMETIC), or abobotulinumtoxinA (DYSPORT®) or have a skin infection at the planned injection site.
Before receiving XEOMIN®, tell your doctor about all of your medical conditions, including if you
- have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig’s disease], myasthenia gravis or Lambert-Eaton syndrome)
- have had any side effect from any other botulinum toxin in the past
- have a breathing problem such as asthma or emphysema
- have a history of swallowing problems or inhaling food or fluid into your lungs (aspiration)
- have bleeding problems
- have drooping eyelids
- have plans to have surgery
- have had surgery on your face
- are pregnant or plan to become pregnant. It is not known if XEOMIN®can harm your unborn baby.
- are breastfeeding or plan to breastfeed. It is not known if XEOMIN®passes into breast milk.
Tell your doctor about all of the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Talk to your doctor before you take any new medicines after you receive XEOMIN.
Using XEOMIN with certain other medicines may cause serious side effects Do not start any new medicines until you have told your doctor that you have received XEOMIN in the past.
Especially tell your doctor if you
- have received any other botulinum toxin product in the last four months
- have received injections of botulinum toxin such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX®COSMETIC) and abobotulinumtoxinA (DYSPORT®) in the past. Be sure your doctor knows exactly which product you received. The dose of XEOMIN® may be different from other botulinum toxin products that you have received.
- have recently received an antibiotic by injection
- take muscle relaxants
- take an allergy or cold medicine
- take a sleep medicine
Ask your doctor if you are not sure if your medicine is one that is listed above.
Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.
Possible Side Effects
XEOMIN® can cause serious side effects that can be life threatening including
Headache was the most common side effect of XEOMIN® for treatment of glabellar lines. Other possible side effects include:
- dry mouth
- discomfort or pain at the injection site
- neck pain
- muscle weakness
- eye problems, including: double vision, blurred vision, drooping eyelids, swelling of your eyelids, and dry eyes. Reduced blinking can also occur. Tell your doctor or get medical help right away if you have eye pain or irritation following treatment.
XEOMIN® may cause other serious side effects including allergic reactions. Symptoms of an allergic reaction to XEOMIN® may include: itching, rash, redness, swelling, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing or asthma symptoms, or if you get dizzy or faint. See “Warnings.”
The most common side effect of XEOMIN in people with glabellar lines include:
These are not all the possible side effects of XEOMIN®. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
General information about the safe and effective use of XEOMIN®
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or doctor for information about XEOMIN® that is written for health professionals.
Active Ingredient: botulinum toxin type A
Inactive Ingredients: human albumin and sucrose
JUVÉDERM, provides you an advanced solution to remedy the effects of aging without the risk of going under the knife. JUVÉDERM is a family of injectable, hyaluronic acid dermal fillers, used to provide up to one year of correction in moderate to severe facial wrinkles and folds, including lip augmentation.
$500-$700 per syringe
Standard treatment per area begin at 1 syringe
First, What Is Juvederm?
Juvederm is a non-surgical cosmetic treatment that is also known as an injectable or a dermal filler. Its main ingredient is hyaluronic acid, a naturally occurring material found in the human body. That’s one reason that Juvederm and other fillers are usually tolerated well, unlike procedures that introduce foreign substances into the body.
Approved by the FDA in 2006, Juvederm has become one of the most popular non-invasive procedures in the United States. Over 2.4 million people opted for a hyaluronic acid-based filler treatment in 2016.
Why Choose Juvederm?
As we age, our faces begin to show signs of stress as well as normal “wear and tear.” Think about it: the facial muscles are used day in and day out and can take a significant toll on the skin.
People who have spent a lot of time in the sun or who were cigarette smokers, often find that their faces look much older than they are. However, everyone’s face will show signs of aging sooner rather than later. Quite simply, Juvederm stops the hands of time and makes people look young and vibrant.
Those who have severe marionette lines, facial creases, or wrinkles might benefit from Juvederm UP XC or Juvederm Volbella XC, Juvederm Vollure XC. Don’t worry; our medical provider will discuss the differences between these fillers with you. Together, we will determine the most appropriate treatment plan for your individual needs.
What Areas of the Face Can Juvederm Improve?
Juvederm is used in the face, primarily in the cheeks, the lips, and the area around the mouth. More specifically, this injectable targets:
- the nasolabial folds, also known as “smile lines,” that extend from the sides of the nose down to the outer corners of the mouth
- the “marionette” lines, which surround the mouth
- the vertical lip lines, which appear above the lip
- Lip volume & cheek volume
Can Everyone Benefit from Juvederm?
In short, yes! This treatment works on men and women of all skin tones.
The only reason you might not be a good candidate for Juvederm is if you have an active infection of any kind at the injection site. Juvederm can also be safely combined with other fillers, such as Restylane and Radiesse.
Do Juvederm Injections Hurt?
There is very little pain associated with Juvederm injections. Our medical provider will apply a numbing cream to the area of the face being treated about 10 minutes before the treatment. You won’t even feel the needle.
Juvederm is introduced into the face through a series of injections with a very thin needle. The area will be massaged with care to ensure the proper distribution of the hyaluronic acid gel. You will also be asked to ice the affected area, on and off, for the remainder of the day.
Are There Any Side Effects?
Expect minor swelling and bruising. The most common side effects may also include:
- lumps or bumps
- minor pain
If you do experience these side effects, they will lessen and subside within one to two weeks.
To lessen the possibility of an adverse effect, Juvederm patients should avoid strenuous activity, sun exposure, and alcohol consumption for at least 24 hours post-treatment. It’s also best if you can avoid wearing makeup during that period.
In very rare cases, injectable fillers can result in complications such as permanent scarring, visual impairment, or stroke. These complications can occur when the injection is placed into a blood vessel. To ensure your safety, make certain that the medical prvided who performs your Juvederm procedure is trained, certified, licensed & insured.
How Long Does Juvederm Last?
You will see the effects of Juvederm almost immediately. How long it lasts depends on which Juvederm product is used, as well as what area of the face has been treated. Generally, you should expect the Juvederm to last between six months and one year.
Over time, the hyaluronic acid filler will dissolve and be excreted by the body. As it does so, your face will gradually re-assume its previous appearance. Your face won’t look stretched out, and there will be no loose skin or sagginess.
JUVÉDERM® INJECTABLE GEL FILLERS INDICATIONS AND IMPORTANT SAFETY INFORMATION
JUVÉDERM VOLUMA® XC injectable gel is for deep injection in the cheek area to correct age-related volume loss in adults over 21. JUVÉDERM VOLLURE™ XC injectable gel is for injection into the facial tissue for the correction of moderate to severe facial wrinkles and folds (such as nasolabial folds) in adults over 21. JUVÉDERM® XC injectable gel is for injection into the facial tissue for the correction of moderate to severe facial wrinkles and folds (such as nasolabial folds). JUVÉDERM® Ultra XC is for injection into the lips and perioral area for lip augmentation in adults over the age of 21. JUVÉDERM VOLBELLA® XC injectable gel is for injection into the lips for lip augmentation and for correction of perioral lines in adults over the age of 21.
IMPORTANT SAFETY INFORMATION
Are there any reasons why I should not receive any JUVÉDERM® injectable gel formulation?
Do not use these products if you have a history of multiple severe allergies or severe allergic reactions (anaphylaxis), or if you are allergic to lidocaine or the Gram-positive bacterial proteins used in these products.
What precautions should my doctor advise me about?
- Tell your doctor if you are pregnant or breastfeeding. The safety of these products for use during pregnancy or while breastfeeding has not been studied
- The safety of JUVÉDERM VOLUMA® XC in patients under 35 years or over 65 years, the safety of JUVÉDERM® XC and JUVÉDERM® Ultra XC injectable gels in patients under 18 years, and the safety of JUVÉDERM VOLLURE™ XC and JUVÉDERM VOLBELLA® XC in patients under 22 years has not been studied
- The safety and effectiveness of JUVÉDERM VOLUMA® XC in areas other than the cheek area, JUVÉDERM® XC and JUVÉDERM VOLLURE™ XC for areas other than facial wrinkles and folds, and JUVÉDERM® Ultra XC and JUVÉDERM VOLBELLA® XC in areas other than the lips and perioral area have not been established in clinical studies
- Tell your doctor if you have a history of excessive scarring (eg, hypertrophic scarring and keloid formations) or pigmentation disorders, as use of these products may result in additional scars or changes in pigmentation
- Tell your doctor if you are planning other laser treatments or a chemical peel, as there is a possible risk of inflammation at the treatment site if these procedures are performed after treatment
- Patients who experience skin injury near the site of injection with this product may be at a higher risk for side effects
- Tell your doctor if you are on immunosuppressive therapy used to decrease the body’s immune response, as use of these products may result in an increased risk of infection
- Tell your doctor if you are using medications that can prolong bleeding, such as aspirin, ibuprofen, or other blood thinners, as this may result in increased bruising or bleeding at the injection site
- Minimize strenuous exercise, exposure to extensive sun or heat, and alcoholic beverages within the first 24 hours following treatment
What are possible side effects?
The most commonly reported side effects with JUVÉDERM® injectable gels included injection-site redness, swelling, pain, tenderness, firmness, lumps/bumps, bruising, discoloration, and itching. For JUVÉDERM VOLBELLA® XC, dryness was also reported. For JUVÉDERM VOLUMA® XC, most side effects were moderate and lasted 2 to 4 weeks. For JUVÉDERM® XC, JUVÉDERM VOLLURE™ XC, and JUVÉDERM® Ultra XC injectable gels, most side effects were mild or moderate and lasted 14 days or less. For JUVÉDERM VOLBELLA® XC, most side effects were mild or moderate and lasted 30 days or less.
One of the risks with using these products is unintentional injection into a blood vessel, and while rare, the complications can be serious and may be permanent. These complications, which have been reported for facial injections, can include vision abnormalities, blindness, stroke, temporary scabs, or permanent scarring.
As with all skin injection procedures, there is a risk of infection.
To report a side effect with any JUVÉDERM® product, please call Allergan at 1-800-433-8871. Please visit Juvederm.com or talk to your doctor for more
Xeomin vs. Botox
Aesthetic medicine now uses botulinum toxin regularly in treating a variety of skin and muscle problems. Botox and Xeomin are two commonly used preparations.
- The main difference between Xeomin and Botox, is that Xeomin contains just one ingredient: botulinum toxin A. This neurotoxin acts by blocking the neuromuscular junction and has an effect on the skin and muscles it is injected into.
- The manufacturing process is slightly different with the 2, which leads to some potential, subtle differences in clinical practice.
- Xeomin is a “naked injectable,” meaning that it does not contain any additives. A benefit of a pure-form injectable is that the human body is less likely to become resistant to it. Some patients have developed antibodies to Botox.
- Xeomin is the only one injectables that does not need to be refrigerated before use, due to its lack of additives.
- Xeomin might have the slowest “onset” of action (Botox onset in 72 hours, and Xeomin onset in 4 days.). Both Xeomin and Botox exert their effect in around 7 days after it has been injected, with the effects lasting up to 6 months. The overall effect that results from Xeomin and Botox are the same.
- Xeomin may be “mildly more convenient” than Botox, as the “product’s lack of complex proteins will help prevent antibody formation, or resistance to neuromuscular treatment with botulinum type A toxin, in patients being treated for neuromuscular conditions.”
- Neurotoxins diffuse differently, in part because Botox has protective proteins clustered around the active part of the molecule, while Xeomin has no protective proteins.
- The cost of Xeomin and Botox are comparable, making the administration of either drug a choice that can lie with the physician or the patient.
- Xeomin is manufactured by Merz Pharma while Botox is manufactured by Allergan.
Botox Party =
Girls Night Out!
Host your own Botox Party at Indiglo Med Spa!
Parties must include at least 5 friends + the Host
$10 per unit (20 unit minimum per person)
$9 per unit (30 unit minimum per person)
Party Host gets their treatment 1/2 Off!
We provide the refreshments, you may bring the hors d’oeuvres