FILLING YOU IN: THE SCOOP ON NEUROTOXINS & DERMAL FILLERS

A few weeks ago, someone messaged me and asked if I’d do a post about Botox. She said she was 40 and was starting to think about it. She knew I was a fan of it, and she wanted some advice because she thought mine looked “natural”—it wasn’t obvious I’d had it done. I considered that to be a compliment. (My doctors would have considered it even more of a compliment!) I’ve never wanted to look overdone or fake. I just want to look more like my former, more youthful self. 

I’ve always been transparent about not fearing a few needles here and there. Some find my candor odd or uncomfortable and don’t subscribe to the same attitude and thinking, but my transparency is intentional. I’m pushing 47, and many say I don’t look it. I certainly don’t feel 47. While I have genetics to thank for a lot of it -- there’s a saying, “Asian don’t raisin”-- the fact that I’m writing this post tells you that’s not all of it. Social media can make us all our own worst enemies. We are constantly comparing ourselves to others, many who are frequently filtered (myself included sometimes) and are pumped and plumped with Botox and Juvederm. I don’t want women looking at me and thinking, “Why does she look like that and I look a lot older?” The truth is that many people would look younger and better if they had the same treatments. I never want to be the reason that another woman feels badly about themselves, and that’s why I feel it’s important to be candid.

I’ll try to lay out my advice as succinctly as possible, with a little education from the sites and my personal experience. I am not a medical doctor, so please talk to your healthcare or skincare professional about all of this. 

Neurotoxins (“Botox”)
Botox is a toxin produced by bacteria. It belongs to a class of drugs called neurotoxins, which relax muscles by decreasing nerve signals to those muscles. This medication comes in an injectable form and is injected into the muscle by a healthcare or skincare professional. Botox was the first brand of neurotoxins to launch, so Botox is to neurotoxins what Kleenex is to facial tissue. So when I say “Botox,” I’m referring to the entire class of drugs and all brands. Neurotoxins can be used to correct wrinkles, but they’re also preventative. So if you think it’s too early to begin, it’s not. If you don’t allow the wrinkles to form in the first place, you’ll have better long term results. 

All neurotoxins have a similar mechanism of action and the same effect, causing the muscles to stop moving. Other brands that doctors have used on me are Dysport and Xeomin. 

I started with Botox, but after a while, I required more frequent injections and more of it. My doctor said that sometimes people become “immune” to Botox, so we tried Dysport. And the next time we tried Xeomin to see which lasted longer. Personally, my skin seems to respond best to Dysport. But you should remember that everyone’s experience will be different.

In my opinion, the key to Botox is “less is more” to begin. You can always go back for more, but unlike dermal fillers, Botox CAN NOT BE UNDONE! If you experience a bad application of Botox, you will need to wait for it to wear off, which could take anywhere from two to six months or longer. The duration of Botox’s effect will vary and largely depends on your metabolism. If you have a high metabolism, it will wear off sooner and you will require more frequent injections. Many people ask if injections are painful. I don’t feel they are, but numbing cream can be applied to the injection site(s) to help ease any discomfort. 

The full effects of Botox won’t be apparent at the time of injection. Doctors usually advise to wait 10-14 days to see its full effect. If you find that you’re unhappy with the way you look, SOMETIMES more Botox can be injected in other places to push and pull and change your look. SOMETIMES. For about 24 hours after injection, you should try to exercise the muscles to work it in. If in the forehead, you can frequently raise your eyebrows. You may experience bruising with Botox. Taking arnica before and after can minimize this. 

I get Botox in my forehead and more recently around my eyes for crow’s feet. Here are a few watchouts. Don’t get it too close to your eyebrows, otherwise you can end up with droopy eyelids. I recommend about a finger-width above, but your doctor will decide. Sometimes a forehead application can lead to overly arched eyebrows, but this can usually be remedied if it happens. More will be added to bring that area down a bit. For crow’s feet, my doctor puts three dots outside of each eye (where my crow’s feet are)—slightly above, aligned with the center, and slightly below. The other area where Botox can be applied is in between the eyebrows at the frown line/crease. But BE CAREFUL HERE. Too much and/or poorly injected Botox in this area can cause an angry look and/or a beady eye look. If you want to know what I’m talking about, do a google search for a recent photo of Maria Shriver. It can also cause your eyes to appear too wideset. So I tend to ask for “very little” if I have an injection in this spot.

Outside of my forehead, crow’s feet, and in between my eyebrows, I have not used Botox. In other areas of my face, I’ve had dermal fillers injected.

There are many different brands of dermal fillers. And for each brand, there are different types for different indications (uses). Their duration varies, ranging from about six months to two years. A few brands I’m familiar with are Juvederm, Restylane, and Radiesse. I’ve personally had Juvederm. Here are the various types of Juvederm, along with their indications (uses), from their website. 

JUVÉDERM® VOLUMA™ XC injectable gel is for deep injection in the cheek area to correct age-related volume loss and for augmentation of the chin region to improve the chin profile. 
JUVÉDERM® VOLLURE™ XC and JUVÉDERM® XC injectable gels are for injection into the facial tissue for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds.
JUVÉDERM® VOLBELLA™ XC injectable gel is for injection into the lips for lip augmentation and for correction of perioral lines. 
JUVÉDERM® Ultra XC injectable gel is for injection into the lips and perioral area for lip augmentation. 

Dermal filler is hyaluronic acid that is injected to replace the volume in your face that is lost with aging. It can be injected into your lips. I’ve never had that done. I’ve heard it’s the most painful application, but again, numbing cream can be used to minimize discomfort. 

Dermal filler can be used to fill and lift. For me, I didn’t think my “laugh lines,” nasolabial folds, were very funny anymore. And my jowls started to be more noticeable. So I had a small amount of Juvederm injected into my nasolabial folds. That pulled up the jowls and my mouth (frown) a bit. I recently had Juvederm Voluma injected into my cheeks and the tops of my cheekbones high on my face between my eyes and ears. This will pull up the face, minimizing the appearance of sagging jowls. Filler fills, so you’ll also see a bit of projection out of your face. If you overdo it, you can look a bit like Frankenstein, and I actually felt that way until I got used to it. My hair covers most of that, and I seem to be the only one who notices. Dermal fillers are said to give a non-surgical facelift due to their ability to lift.

Another area that women often ask for filler is the undereye area. As we age, the skin under our eyes thins. This creates bags and dark circles. Filler can remedy this. Filler can be injected directly into that area, or a cannula can be used. When using a cannula, the entry point is on the outside of the face/cheekbone area, and the needle goes under the skin to the undereye area to inject. The purpose of this is minimize bruising and swelling directly under the eyes.

Which leads to my next point. Injection of dermal fillers can cause bruising and swelling. After the injection, it’s best not to engage in any vigorous exercise for the time period advised by your doctor. Apply ice 20 minutes on and 20 minutes off as much as you can. 

Like Botox, the “less is more” approach is best with dermal fillers. When I had Juvederm injected into the upper part of my cheekbone, the doctor started small. I actually wanted more, and he refused to give it to me, saying he wanted to see how my face would settle in before injecting more. Some immediate effect is seen with dermal fillers, unlike with Botox. But dermal filler attracts and binds to water, so over the few weeks after the initial injection, the volume will change a bit and you’ll see volume increase and wrinkles filled. In my personal experience, it takes a good three weeks for your face to settle in and not seem puffy and pulled. Give it time. Don’t freak out.

 If an application of dermal filler goes awry, it can be removed/dissolved with the injection of an enzyme called hyaluronidase. It breaks down hyaluronic acid (dermal filler) to basically reverse the effects of the procedure. 

After the injection, if you see any lumps, you can press or massage to try to smooth them. In fact, your doctor will do this at the time of injection, but you may need to do a little at home if instructed and as instructed. Dermal filler can move, so you should avoid heavy exercise, facials and massages for a time period after the injection as advised by your doctor. You should also avoid skin therapies and devices like the gua sha tool that may move the filler.

I am obviously not a healthcare professional. This is my personal experience, and by sharing it, I hope it has helped you understand what procedures you may want to consider and discuss with your healthcare or skincare professional. Feel free to message me with any questions. When looking for a doctor or skincare professional, I would advise asking to see some of their before and after patient photos. Begin with a consultation about your goals to understand their recommendations, any bruising or side effects to expect, the cost of the recommended procedures, and how long the effects are expected to last. Again, go slowly. Don’t get any injections if you have an important event in the next two weeks. And you should probably allow at least a day or two where you don’t have any meetings, just in case you bruise and swell a lot.

SEARCHING FOR THE FOUNTAIN OF YOUTH

“Growing old gracefully.” Not something I am personally embracing at the age of 46. For those who choose to do so, hats off to you. I’m not judging. I’m just not there yet. Because none of us have to be. For me, I want my outside to match my inside, and I don’t feel 46…unless you count how I feel when I have to get out of bed too early.

Procedures from the dermatologist help. I have never been shy about admitting that I enjoy a healthy dose of Botox or Dysport in my forehead. But during this pandemic, getting to the dermatologist was not an option. My last Botox touch-up was on January 9. Timing probably couldn’t have been worse. But thankfully, I believe a few things I was putting on my face and inside my body (tequila was not one of them!) helped to maintain a more youthful appearance. A friend asked me what I felt was most effective, but it’s difficult to say. I just know that this combo is working, so I’m going to continue, and I’ll share it all with you. This post will focus on the skincare piece. And I have fallen in love with Neostrata.

Rather than plagiarize and take credit for brilliantly summarizing what makes these products different, here is a graphic from their site.

I used to work in skincare. But that’s not necessary to understand it. Regularly exfoliating to slough away the dead and dull skin to reveal fresh new layers is a key step in the anti-aging process. As a teenager, I used to slather granular facial scrubs all over my skin, hoping to clean those pores and remove all of the dirt and grime from the environment. But harsh mechanical exfoliants are not good for your face. They’re too rough, and they aren’t really as effective as other options. Which leads me to the first product I’ll share from this line.

Exfoliating Facial Wash - I use this before bedtime and in the morning. It contains Polyhydroxy Acids that effectively remove debris from pores…because nothing is more unattractive than large pores. And clogged pores lead to skin problems like acne. This product sloughs away dead skin cells to reveal healthy new skin with fewer visible lines. Sometimes I worry that exfoliants will leave my skin dry or rough, but this product actually refreshes the skin with a blend of aloe, cucumber, and rosemary extracts. It helps balance the pH in your skin, making it ready to receive whatever you apply next. Just don’t get the product in your eyes because it does burn them a bit.

Pigment Controller - This brightening treatment helps to brighten the appearance of skin, making it more luminous, and it diminishes the appearance of dark spots. It’s formulated with stabilized Vitamin C, NEOGLUCOSAMINE® 0.1% Retinol, and a potent antioxidant found in turmeric. I use this all over my face at bedtime every night and in the morning most days as a light and silky moisturizer. My skin feels very smooth, and the tone seems much more even. In the photos in this post, I am not wearing any foundation. I applied this product all over, used concealer under my eyes, and Laura Mercier Secret Camouflage on dark spots.

Dermal Replenishment - Only at night do I use this product instead of the Pigment Controller. I use for it for its benefits, which I’ll get to, but not in the morning because it has a bit more of an oily look and feel and sort of flakes off if you rub your skin a bit later. That doesn’t bother me at night. I feel as though this product has helped tremendously with the firmness and plumpness/fullness of my skin. That makes sense because Neostrata’s proprietary AMINOFIL® works with Maltobionic Acid and NEOGLUCOSAMINE® technology to provide a firmer appearance and reduce the look of wrinkles. This product also works to strengthen the skin’s moisture barrier and hydrate, which is key because dehydrated skin is a major factor in aging.

Intensive Eye Therapy - I LOVE this eye cream. My biggest issue is dark circles, followed by wrinkles and that under eye bag. This is something that my dermatologist said a filler like Juvederm can resolve. But again, we are in the midst of a pandemic, so I had to try something else. I use this product at bedtime and in the morning before applying my concealer. It plumps and firms around the eye area, reducing the appearance of wrinkles and crow’s feet. Caffeine helps diminish the appearance of dark circles, and it also works with hyaluronic acid to deflate puffiness. I swear by this stuff!

Brightening Eye Cream - Sometimes in the morning, I alternate and use this eye cream instead of Intensive Eye Therapy. If you have dark circles as your primary eye concern, this is a great product. It brightens and firms using antioxidants, peptides, algae extracts, and stabilized vitamins C and E and polyhydroxy acid blend of gluconolactone and lactobionic acid. Gluconolactone is wonderful for sensitive skin under the eyes and works really well with vitamin C in anti-aging. Lactobionic acid is a patented antioxidant derived from natural sugars and is known as a "Bionic Acid.” It keeps the under eye area hydrated, which is key because nothing says “tired eyes” more than a dry under eye area.

Triple Firming Neck Cream - One day while I was editing and choosing blog/Instagram photos, I noticed that my neck seemed to be aging faster than the rest of me. YIKES! I used to watch a soap opera (before kids when I had time to watch TV) and remember noticing how youthful an actress’ face looked while her neck looked old and saggy. I could not become that woman. Three ingredients — NeoGlucosamine, NeoCitriate, and Pro-Amino Acid — work together to firm and lift sagging skin in the neck and décolletage and to diminish deep creases and “crepey” texture (when it looks and feels like crepe fabric). I have seen a dramatic difference since using this product at bedtime and in the morning. I have only been using it on my neck, but I’ve just begun using it on the décolletage area because I notice a few lines when I wake in the morning. Don’t worry about this product ruining clothing or caking in your neck creases because it’s formulated with that consideration in mind.

Perfecting Peel - And finally, a once a week at-home chemical peel. I recently asked my dermatologist about something stronger and more aggressive for hyperpigmentation/dark spots. While the products above are working well and I’ve seen great improvement over time, I’m a bit impatient. I asked about microneedling, and she is only “meh” on it, especially since I don’t have a lot of acne scarring. She suggested a chemical peel. I may end up there, but I’m not sure I’m ready just yet because your skin does actually peel and turn red after an office treatment. The degree to which it does that depends on the person. So I’ve tried this at-home product twice, and I like the results because I see an improvement without any burning, peeling, or scary red face. It’s formulated with a potent blend of Alpha Hydroxy Acids (AHAs) — Glycolic and Citric Acids — and visually improves skin imperfections such as fine lines, wrinkles, and uneven pigmentation. So if you’re a baby steps kind of gal like I am, this is likely the product for you. I felt a little tingly but no burning or irritation at all.

Purchasing new skincare products without experiencing them in person can be daunting. So thankfully, Neostrata has a 30-day money back guarantee. That said, I don’t think you’ll need it. At the time of this post, all products ship free. Their Instagram profile says they offer 20% off your first purchase, but I signed up for the newsletter with a new email address and couldn’t seme to make it work, nor did I see the offer appear in my inbox. But give it a shot, and it’s likely worth messaging them to get a code if it doesn’t. After all, it is advertised. If you try them, let me know what you think. As with any new skincare product, it’s best to ease into it. Use once daily for a week to two, or even every other day if you have sensitive skin, and then increase usage to twice daily where directed. Consistency is key, as it giving it a fair shot. Don’t call it quits if you don’t look 25 after two weeks.