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Cosmetic Injections: Types, Composition, and Effects

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In today’s world you’d be hard-pressed to find someone who hasn’t at the very least considered cosmetic injections. However, if you’re new to undergoing the needle (and even if you’re not), it’s completely normal to be a little confused by your options, especially when you might not be sure about the difference between filler and Botox. 

To help simplify the process, we asked four top doctors in their field to break it down. “There are so many new fillers added to the market in the US alone every year that it’s difficult to keep up with all of them,” says Beverly Hills cosmetic dermatologist Simon Ourian, MD.

What to know first is that there are two categories of injectables: neurotoxins and dermal fillers. “They’re both injectable aesthetic treatment products, but the similarities between the category of dermal fillers and neuromodulators stop there,” explains Ava Shamban, MD, board-certified aesthetic dermatologist. Botox “freezes” an area (e.g., forehead and the 11 lines between your eyebrows); fillers, on the other hand, add volume or structure—almost like a nonsurgical facelift. 

Injectables are big business, and there are five major companies that manufacture both products. Each brand calls them something different. Allergan Aesthetics and Galderma have the biggest monopoly in the industry, boasting the largest portfolios of products. But other players, like Merz Aesthetics and Revance Aesthetics, are not far behind. And while there’s only one (technically two, as of September) types of botulinum toxin, there are currently seven different types of filler (hyaluronic-acid-based formulas being the most popular). 

Ready to dive in? Here’s what you need to know about all the cosmetic injections on the market as of January 2023.

Neurotoxins

Even though most of us say “Botox,” Botox is actually the brand name of a specific botulinum neurotoxin manufactured by Allergan Aesthetics. There are currently five FDA-approved neurotoxins available in the US: Botox, Dysport (from Galderma), Xeomin (from Merz Aesthetics), Jeuveau (from Evolus), and the newest, longer-lasting peptide-powered Daxxify (from Revance Aesthetics). 

“Botulinum toxin type A acts on nerve endings in muscles to prevent muscle fibers from contracting,” says dermatologist Sheila Farhang, MD. Adds Dr. Ourian: “Neurotoxins are used to treat dynamic wrinkles that are caused by muscles that are hyper mobile, such as crow’s-feet or frown lines, and forehead lines above the brows.” They last only about 10 or 12 weeks, with the exception of the new Daxxify, which can be 6 to 12 months. 

Daxxify was just approved by the FDA in September 2022. It’s the latest toxin innovation in 30 years and is unique from the four listed above. “It is the first neuromodulator powered by a different protein—a peptide exchange free of human serum albumin or animal-based components,” says Dr. Shamban. The best part: “It has the ability to deliver up to yearlong results with as few as one to two treatments annually,” she says. 

Fillers

While Botox is pretty easy to understand, fillers are a bit more complex. As a category, fillers are composed of products that are used to add volume or structure to the lines or contours of the face. “They help in lifting sagging skin and smoothing out fine lines,” says Dr. Ourian. Says Dr. Shamban: “They last 12 to 18 months—and in some cases, 24 months—before absorption fully dissipates and next treatment is required.” They are also reversible and can be dissolved with hyaluronidase. 

HA fillers

Hyaluronic acid (HA) fillers are one of the most popular thanks to their ability to replicate a soft, natural texture and youthful results. HA is found naturally in your body, so it dissolves naturally and gradually over time. “HA binds to water, making it an ideal product for correcting wrinkles and folds, as it binds with the skin’s own water,” explains Dr. Farhang. It generally lasts between 6 to 12 months depending on the individual and the product used. 


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