Neuromodulators - "botox" & Fillers

Neuromodulator injections is a cosmetic treatment designed to relax muscles and reduce lines and wrinkles on your face. Some wrinkles and lines are caused by overactive muscles. Neuromodulators relax these muscles, allowing for fewer unwanted expressions.

The following is a list of common indications for neuromodulator therapy:

• Forehead wrinkles
• Bunny lines
• Gummy smile
• Lateral canthal rhytids (Crow's Feet)
• Lower Eyelid (Jelly Roll)
• Nose tip lift
• Vertical ip lines (smoker's lines)
• Marionette lines
• Dimpled chin
• Platysmal bands in the neck
• Frontal (Migraine) Headaches
• Hyperhidrosis (excessive sweating)
• Blepharospasm - abnormal contraction or twitch of the eyelid
• Masseter muscle (face slimming) / Bruxism (grinding of the teeth)

What are common complications?

If injected properly, neuromodulator side effects should be minor. Some patients experience redness immediately after the injection lasting maybe 10 minutes, rarely is there any bruising. This can be minimized by holding pressure over the areas injected if a bruise or immediate swelling occurs.  Some people have reported getting headaches following injections; this is a rare side-effect and usually resolves within 24hrs. Acetaminophen (Tylenol) can be safety taken if a headache occurs.

You cannot eliminate all risks of any medical device or procedure, but the chance of you individually getting a serious side effect is exceedingly small. However, potential neuromodulator complications may occur. Some rare side effects include temporary diffusion of the medication which can cause a drooping eyelid (ptosis), a crooked smile, crooked eyebrows, or similar complications. Each treatment plan is tailored to the individual. 

The following serious complications are exceptionally low, however have been reported:

• Dysphagia and trouble breathing: Neuromodulator diffusion into deep muscles in the neck can result in difficulty swallowing (dysphagia) or breathing, which in severe cases may require a feeding tube or medical support.
• Systemic effects (Botulism-like symptoms): In extremely rare cases, the toxin can spread throughout the body, causing generalized muscle weakness and symptoms similar to botulism.
• Severe allergic reactions: While uncommon, patients may experience a systemic allergic reaction, including hives, diffuse edema (swelling), and anaphylactic shock, which is a life-threatening emergency.
• Infection: As with any injection, there is a risk of infection at the injection site, which in rare but severe cases can lead to serious complications if not properly managed.
• Vision problems: Though typically a less severe, technique-dependent issue, vision changes like blurred vision, double vision (diplopia), or dry eyes can occur, occasionally requiring ophthalmologic consultation. 

Injector knowledge and skill are key to minimizing side-effects and possible complications.

1. What are dermal fillers? 

Dermal fillers are substance/gels injected beneath the skin’s surface to smooth wrinkles and add volume and contour. The products are composed of stabilised hyaluronic acid (HA) which occurs naturally in the cells of the skin, or calcium hydroxylapatite (Radiesse) - also naturally found in the body. HA works by drawing in water and therefore augmenting the skin, thus reducing the wrinkle treated. It is by no means permanent and is totally biodegradable. Depending on what type of dermal fillers, results can last between 4 to 18 months.  

Radiesse is made of calcium hydroxylapatite (CaHA) gel microspheres that work immediately upon injection. CaHA is made up of phosphate and calcium ions, which occur naturally in the human body.  The injectable gel initially does all the work of filling in the volume you want. As time goes on, though, the CaHA stimulates your naturally-occurring collagen, allowing your skin to produce more of its own natural filler. The hydrogen, oxygen, and carbon in the gel help to create a structure that mimics connective tissue.  Eventually, the CaHA absorbs back into your body, leaving your collagen in its place. Because of the science behind Radiesse, treatment results can last for well over a year.

2. What areas can dermal fillers be used for? 

The face loses volume and contour as we age, the bones resorb and the soft tissue dissolve and contribute to the appearance of sagging. Dermal fillers may be used to replace this volume loss and restore the structural support, giving the patient a more youthful appearance. The aim is to make the face more harmonious and rejuvenated.  For instance, the lips may be injected to improve their shape, size, symmetry and proportion. The cheeks may be injected to make a face more defined and attractive. An underdeveloped chin may be injected to make it appear more projected and proportionate. The nose may be injected to improve the shape and its contour.  

3. What does the procedure entail and is it painful? 

Generally, basic dermal filler procedures require no anaesthetic as the dermal filler contains local anaesthetic. It is simple and straight-forward, involving a few tiny injections directly into the skin. Most patients tolerate the procedure without any issue. We take steps to help make the treatment tolerable. Make-up can be applied 3-4 hours after the procedure to allow the injections sites to close and avoid possible infection.  

4. How soon will I see any result and how long does it last? 

Results are typically seen instantly after the treatment, although this gradually improves over the course of the following 2-4 weeks. Results can last between 9-18 months depending on product used, although optimal results can be maintained over a long period of time through regular repeated treatments. The longevity varies from person to person and factors such as individual metabolism, lifestyle habits (like sun exposure and smoking), the specific treatment area, and overall health can influence how long the results last. 

5. Are dermal fillers safe? 

Dermal fillers are generally safe when administered by a trained health professional using Health Canada approved products, but they do carry risks such as bruising, swelling, and infection. Serious complications, though rare, can include accidental injection into a blood vessel (VO = vascular occlusion), which may lead to tissue death, blindness, or stroke. A product called hyaluronidase can be used to help dissolve fillers if needed.

6. What are the key benefits of having my treatments at Lips N Lines Plus? 

We only use market-leading brands. We will not compromise on our standards and use the highest grade dermal fillers. Consultation and treatment plans are customized to the patient and based on desired outcome. Treatments are typically very tolerable – we use anaesthetics to numb the area being treated for increased patient comfort. We are well known for our methods of achieving beautiful yet incredibly natural cosmetic results with minimal discomfort, bruising and down time. 

7. Are there any side effects? 

Today’s dermal fillers have come a long way since the first-generation of hyaluronic acid fillers. Advanced injection techniques, coupled with the use of micro-cannulas (blunt needle) and improved product safety means that significant side effects are extremely uncommon but may include:  

Injection-related reactions: These reactions may include redness and sometimes swelling at the injection site immediately after the treatment. 

Bruising: Occasionally bruising can occur. However the use of micro-cannula (blunt needle) dramatically reduces the risk of bruising. Contour irregularities can and do occasionally occur. Massaging can usually smooth out any ‘lumpiness’ however if persistent the filler can be easily and rapidly dissolved. 

Infection: As with all injections, this procedure carries a risk of infection. The syringe is sterile and standard precautions associated with injectable materials are taken. 

Necrosis: This is one of the worst possible complications of dermal filler, fortunately, this is extremely rare. It happens when the dermal filler is accidentally injected into a blood vessel and it subsequently blocks the blood supply to the skin/tissue in that area. 

Blindness: This is a very rare complication. The reporting of this statistic varies in the literature, however upwards of 350 cases have been reported in recent years, likely related to the uptake in cosmetic treatments globally, number of new injectors, and lack of standardized training, especially in some foreign countries. This occurs when dermal filler is accidentally injected into a blood vessel that blocks flow to the eye's optic nerve. Treatment for this rare but serious complication requires immediate specialized intervention and is very time sensitive. Knowing what to watch for and immediate follow up with specialized intervention are paramount. 

8. Are there any after-care instructions? After your treatment, we will again go through with you any after care advice in order to maximise your treatment benefits and avoid any undesirable side effects.  You can resume normal activities, drive yourself home or return to work immediately after the treatment. As with any type of injection there may be some slight redness immediately afterwards. The results seen immediately after the treatment is not necessarily the final results. This is because over the following 1-2 weeks, the treated area(s) will gradually improve. For 1-2 weeks after the treatment you are advised to avoid extreme heat (sun bed, sunbathing, saunas) or intense cold.

 HYPERDILUTE RADIESSE

Hyperdilute Radiesse offers several benefits, including stimulating natural collagen and elastin production for firmer, tighter skin, which helps improve skin texture, tone, and elasticity. It is used for skin rejuvenation in areas like the neck, décolletage,  arms, legs, and knees, as well as hands. It provides a natural-looking, long-lasting results without adding significant volume. The procedure is minimally invasive with little to no downtime, and can help with skin laxity, fine lines, and crepiness. 

A recent study by Dr. Pecora (2024), published an article in the Journal of Cosmetic Dermatology about using hyperdilute Radiesse along with a neuromodulator and an HA filler all blended together and injected for neck rejuvenation called the Gold Protocol. Follow up evaluation after 4 months showed significant improvement in 93.3% of patients with high patient satisfaction.

COST:

Hyperdilute Radiesse alone $750

Radiesse GOLD Protocol $1300

Package pricing available as typically 3 treatments are recommended for longer term results.