Cosmetic Injectable Services
Neurotoxins
An Overview
Years of repetitive action such as laughing, smiling, and squinting often leave facial muscles tense, which can cause skin to furrow, leading to the gradual formation of unwanted lines and leave you longing for the smoother skin of your youth. Botox and Jeuveau are neuromodulators that when injected in small doses relax the underlying contracted muscles, reducing frown lines, crow’s feet and forehead lines to give you a more youthful and relaxed appearance.
The Science
Botox is an injectable botulinum toxin type A that was FDA approved in 1989. It is an extremely effective non-surgical treatment for wrinkles and lines created from facial muscle action. Botox has been used for decades to diminish wrinkles and treat the lines on your forehead, between your eyebrows, and the crow’s feet around your eyes.
Jeuveau is also a botulinum toxin type A that was FDA approved in 2019 for glabellar lines. Studies have shown that Jeuveau is comparable to Botox for the treatment of wrinkles and fine lines. It is prepared using a unique purification process called “Hi-Pure” technology, which is a stringent purification process that vacuum-dries the botulinum toxin instead of freeze-drying the protein. This technique causes less damage to the protein so that it remains more potent. Some patients report that Jeuveau tends to last a little longer for them than Botox, up to 5-6 months.
What to Expect
During your consultation, you and your provider will start by discussing what areas on your face you would like treated. Some patients see better results with Botox, while others find Jeuveau more effective for them. You and your provider will discuss the options and determine which neurotoxin is right for you. Next, you and your provider will discuss how much product may be necessary to achieve your desired result. Our providers tend to be more conservative when injecting a patient for the first time, knowing that additional neurotoxin can be injected if needed at the follow-up appointment. We want our patients to have subtle results with a natural look and only inject what is necessary to achieve that goal.
For both Botox and Jeuveau, muscle relaxation usually begins within the first 3 days following the injection. The improvement will continue with the full effect being attained after 2 weeks. Results typically last 3-4 months for both products.
Results may vary. If there is partial improvement of a treated site, and re-treatment is desired, a second treatment may be performed no sooner than 2 weeks after the primary treatment. There is a subsequent charge for any “touch–ups” or additional product needed to achieve the desired result.
It is recommended to repeat neurotoxin injections 3-4 times per year to maintain the desired results. Keep in mind that having a follow up treatment before the product has fully dissipated tends to enhance the lasting effect of neurotoxins. If you discontinue treatment the moderate to severe lines will gradually return.
There are potential side effects for any neurotoxin which include headaches, eyelid drooping, brow drooping, bruising, swelling and pain at injection site, dry mouth, tiredness, and eye problems such as double vision, blurred vision, decreased eyesight and dry eyes. If any of these side effects occur, most will dissipate right away while the more severe may take more time.
Pre-Treatment Information
BEFORE TREATMENT
Schedule your neurotoxin appointment at least 4 weeks prior to a special event, such as a wedding, class reunion, or a vacation to allow for complete healing.
Do not schedule any social events for 3-7 days after your injection as you may have bruising and/or swelling lasting this long or longer. You can cover up bruising with makeup.
One week before treatment, please avoid the following medications and supplements: NSAIDs (ibuprofen, Aleve, Excedrin), vitamin E, gingko biloba, omega-3 fatty acids, cod liver oil, CoQ10, garlic and ginger. We do not recommend patients that are on blood thinners stop their medications in order to have any cosmetic procedures performed. You can still have neurotoxin injections, however, you will be at a higher risk of bleeding and bruising. There may be a longer healing time, so please be patient.
You can start OTC homeopathic Arnica supplements one week prior to injection to help with post-injection bruising. Arnica has been shown to rapidly relieve and even prevent bruising. Vitamin Rich Bruise Relief Cream with Arnica is available for purchase in our Brainerd and Pine River offices. Arnica is also available at most health food stores.
Do not consume alcoholic beverages at least 24 hours prior to treatment as it may thin the blood and increase the risk of bruising.
Patients prone to cold sores may need to start a prophylactic dose of an anti-viral medication prior to their injection treatment. Contact us prior to your appointment to have a prescription sent to your pharmacy or a prescription can be given to you the day of your injection.
DAY OF TREATMENT
It is not uncommon for patients to “pass-out” or get lightheaded during their injection. Making sure that you have eaten and are well hydrated will make it less likely that you will feel queasy during your treatment.
Dress in cool, comfortable clothes.
Minimize make-up in and around areas where you would like to get injections performed. Any remaining lotion or make-up will be removed prior to treatment. You can bring make-up with you to apply immediately after your treatment.
Post-Treatment Information
Remain upright for 6 hours following treatment. No lying down or bending over.
Keep the treatment area clean. Application of make-up is acceptable.
It is normal to have some swelling, pinpoint bleeding and bruising after injection. You may apply a small bag of frozen peas or crushed ice in a sandwich bag to gently ice the area for 10-20 minutes every 30 minutes for the first 24 hours. Avoid heavy ice bags. Bruising will resolve on its own, typically within one to two weeks.
If post-injection bruising is noticed, consider starting or continuing to use Arnica supplements or cream. Vitamin Rich Bruise Relief Cream with Arnica is available for purchase in our Brainerd and Pine River offices. Arnica is also available at most health food stores.
As always, wear at least SPF 30 sunscreen when appropriate and avoid exposure to intense, direct sunlight and heat to help minimize swelling for at least two to three days.
Move the facial muscles (frown, smile, raise eyebrows) that have been treated throughout the rest of the day. This will help the muscles absorb the neurotoxin.
Avoid vigorous exercise for 24 hours after injection to help keep the neurotoxin localized to the injection site.
Do not rub or massage the areas treated for 24 hours after injection. Wash the treatment area gently and avoid facials for one week.
Do not take NSAIDs (ibuprofen, Aleve, Excedrin) for the next 24 hours. These agents may increase bruising and bleeding at the injection site. Tylenol may be taken if a pain reliever is needed.
Do not consume alcoholic beverages at least 24 hours after the treatment as it may thin the blood and increase the risk of bruising.
Consider eating pineapples or drinking pineapple juice. Pineapples have a natural anti-inflammatory property to them that helps minimize swelling after injections.
When to Contact Us
Please notify our office immediately if you feel that you may be experiencing any of these possible complications after your neurotoxin injection:
- Hypersensitivity or allergic reactions
- Cold sore or herpes simplex virus outbreak
- Signs of infection, such as fever, redness, pain or warmth.
Dermal Filler
An Overview
Dermal fillers not only treat wrinkles, lines, and folds on your face but also restores volume that is often lost as we age. Dermal filler treatments provide a non-surgical option to reduce lines and wrinkles, restore volume, and give back your youthful appearance.
The Science
Revanasse Versa is a hyaluronic acid dermal filler that can be used to treat moderate to severe facial wrinkles and folds in adults 22 years of age and older. Hyaluronic acid is a group of sugars called polysaccharides that attracts and binds water molecules, increasing the water content of the skin. Hyaluronic acid naturally occurs in the body’s connective tissue. Hyaluronic acid fillers are clear gels that, when injected beneath the skin, can help to fill in facial wrinkles, restore volume loss, and refine your facial features.
Versa’s filler particles are spherical and uniform, which creates the ideal balance between volume and smoothness. Versa injections have less bruising and swelling as compared to other fillers on the market and is formulated to include lidocaine, which decreases the pain with injection. The results of Versa injections are seen immediately and the results can last up to 12 months.
Versa is found to have results comparable to Juvederm Ultra Plus while being more cost effective. With having the largest syringe size on the market, Versa is a better value for your money.
What to Expect
Do not over-evaluate. Do not over-evaluate the treatment area for the first two weeks. It is normal to have bruising, swelling and asymmetry. We recommend waiting two weeks for the swelling and bruising to completely resolve before you can appreciate the final result. We will get you in for a 2-3 week follow up and if there is any asymmetry it will be addressed at the visit.
Bruising. Bruises may last 1-2 weeks. Bruises can show up several days after the treatment. Bruising can be covered with full coverage concealers. Tear troughs and lips are more likely to bruise because these areas are more vascular than other parts of the face.
Swelling. Swelling may not always be even from side to side depending on pre-existing facial asymmetry, volume of filler injection and bleeding at each injection site. Initial swelling takes 2 weeks to resolve.
Asymmetry. Asymmetry can be related to swelling. We advise waiting 2 weeks to see if asymmetries are due to swelling or from the filler. Please keep in mind that once you start to analyze your face it is not uncommon to “notice” new asymmetries that have been there your entire life.
Lumps and Bumps. Dermal filler will feel firmer than your own tissue. Do not massage or manipulate the area. The feeling of lumps and bumps will usually improve within 2 weeks. After the 2-3 week follow up, you may be instructed to massage this area to improve the lumps and bumps. However, you may have bumps or nodules of filler under the skin that can last 4-8 months after the injection. If they are particularly troublesome and do not improve with massage, we can also give a small injection to help dissolve them faster.
Subtle Results. A 1 cc syringe of filler is the equivalent of 1/5th of a teaspoon in volume. After the swelling subsides there may be a need for additional filler injections if you desire increased volume. Our providers are very conservative and do not over inject patients. Our providers prefer to add volume slowly with time to achieve the desired result. Evidence shows that with the first time getting injections, the results tend to diminish faster. With repeat treatments, the results last longer as you build your own collagen around the injection sites. Keep in mind that having a follow-up treatment before the product has fully dissipated tends to enhance the lasting effect of dermal fillers.
Dry Lips. Lips will also be more dry post injections. Ice the areas and keep lips lubricated with Vaseline, Aquaphor or Vanicream ointment. No more than 20 minutes of ice at a time.
Pre-Treatment Information
BEFORE TREATMENT
Schedule your dermal filler appointment at least 4 weeks prior to a special event, such as a wedding, class reunion, or a vacation to allow for complete healing.
Do not schedule any social events for 3-7 days after your injection as you may have bruising and/or swelling lasting this long or longer. You can cover up bruising with makeup.
One week before treatment, please avoid the following medications and supplements: NSAIDs (such as ibuprofen, Aleve, Excedrin), vitamin E, gingko biloba, omega-3 fatty acids, cod liver oil, CoQ10, garlic and ginger as these thin the blood and increase the risk of bleeding and bruising.
If you are taking any blood-thinning medications as directed by your doctor (such as Coumadin, warfarin, Plavix, Lovenox), do not discontinue without first consulting the prescribing physician. If you continue to take these medications the chances of developing an injection-related hematoma (collection of blood in the tissue), which can leave a dark spot if it becomes entrapped in the filler implant, is higher. The dark spot may remain until the filler is naturally dissolved. You can still have dermal filler injections, however, you will be at a higher risk of bleeding and bruising. There may be a longer healing time, so please be patient.
You can start OTC homeopathic Arnica supplements one week prior to injection to help with post injection bruises. Arnica has been shown to rapidly relieve and even prevent bruising. Vitamin Rich Bruise Relief Cream with Arnica is available for purchase in our Brainerd and Pine River offices. Arnica is also available at most health food stores.
Do not consume alcoholic beverages at least 24 hours prior to treatment as it may thin the blood and increase the risk of bruising.
Patients prone to cold sores may need to start a prophylactic dose of an anti-viral medication prior to their injection treatment. Contact us prior to your appointment to have a prescription sent to your pharmacy or a prescription can be given to you the day of your injection.
DAY OF TREATMENT
It is not uncommon for patients to “pass-out” or get lightheaded during their injection. Making sure that you have eaten and are well hydrated will make it less likely that you will feel queasy during your treatment.
Dress in cool, comfortable clothes.
Minimize make-up in and around the areas where you would like to get injections. Any remaining lotion or make-up will be removed prior to treatment. You can bring make-up with you to apply immediately after your treatment.
Post-Treatment Information
Keep the treatment area clean. Application of make-up is acceptable.
It is normal to have some swelling, pinpoint bleeding and bruising after injection. You may apply a small bag of frozen peas or crushed ice in a sandwich bag to gently ice the area for 10-20 minutes every 30 minutes for the first 24 hours.
Avoid heavy ice bags. Bruising will resolve on its own, typically within one to two weeks.
If post-injection bruising is noticed, consider starting or continuing to use Arnica supplements or cream.
As always, wear at least SPF 30 sunscreen when appropriate and avoid exposure to intense, direct sunlight and heat (sauna) to help minimize swelling for at least two to three days.
Avoid vigorous exercise for 48 hours after injection to minimize swelling and bruising.
Do not manipulate, rub, poke or massage the treatment area unless specifically advised by your provider. Wash the treatment area gently and avoid facials for one week.
Do not take NSAIDs (ibuprofen, Aleve, Excedrin) for the next 24 hours. These agents may increase bruising and bleeding at the injection site. Tylenol may be taken if a pain reliever is needed.
Do not consume alcoholic beverages at least 24 hours after the treatment as it may thin the blood and increase the risk of bruising.
You may sleep with an extra pillow if desired to minimize swelling overnight.
Consider eating pineapples or drinking pineapple juice. Pineapples have a natural anti-inflammatory property to them that helps minimize swelling after injections.
Wait at least a week (preferably 2-3 weeks) after your injection before having other procedures such as microdermabrasion, laser treatment, chemical peel, etc. done in the same anatomic area.
If there is any filler product remaining in the syringe after your injections, it must be used within 3 weeks of opening to avoid contamination. Therefore, it is imperative to get your 2-3 week follow-up appointment scheduled before you leave the clinic.
When to Contact Us
Please notify our office immediately if you feel that you may be experiencing any of these possible complications after your dermal filler injections:
- Hypersensitivity or allergic reactions
- Cold sore or herpes simplex virus outbreak
- Acne breakout
- Changes in skin sensation or ability to move parts of the face
- Signs of infection, such as fever, redness, pain or warmth