The two main types of injectable substances used are botulinum toxin type A (which relaxes the facial muscles that cause the lines) and dermal fillers (which plump out the wrinkles).

What is botulinum toxin type A?

The cosmetic form of botulinum toxin, sometimes referred to as "Botox" by patients, is a popular injectable that temporarily reduces or eliminates facial fine lines and wrinkles. The most commonly treated areas are frown lines, forehead creases and crow's feet near the eyes. Several other areas have been treated such as thick bands in the neck, thick jaw muscles, lip lines and gummy smiles.

Botulinum toxin is a purified substance that's derived from bacteria. Injections of botulinum toxin block the nerve signals to the muscle in which it was injected. Without a signal, the muscle is not able to contract. The end result is diminished unwanted facial wrinkles or appearance. Commonly known types of botulinum toxin type A injections include Botox®, Dysport®, Xeomin® and Jeuveau®.

Botulinum toxin can be used to

• Smooth crow's feet, forehead furrows, frown lines, lip lines and bunny lines
• Diminish neck bands
• Improve the appearance of skin dimpling of the chin
• Lift the corners of the mouth
• Soften a square jawline
• Correct a gummy smile

The FDA has approved the use of Botox® for the frown lines and crow's feet, while Dysport® and Xeomin® are approved for frown lines only. All other uses are considered "off label."

What are dermal fillers?

Dermal fillers help to diminish facial lines and restore volume and fullness in the face.

As we age, our faces naturally lose subcutaneous fat. The facial muscles are then working closer to the skin surface, so smile lines and crow's feet become more apparent.

The facial skin also stretches a bit, adding to this loss of facial volume. Other factors that affect the facial skin include sun exposure, heredity and lifestyle.

What dermal fillers can do

• Plump thin lips
• Enhance shallow contours
• Soften facial creases and wrinkles
• Improve the appearance of recessed scars
• Reconstruct contour deformities in the face
• Decrease or remove the shadow of the lower lids

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery.

What dermal fillers can't do

For some patients, surgery such as a facelift, brow lift or eye lift may be the best approach. Minimally invasive rejuvenation treatments, such as soft tissue fillers, cannot achieve the same results, but may help delay the time when consideration of a facelift becomes appropriate. It is important to remember that dermal fillers are temporary treatments for facial aging and that ongoing treatments will be needed for long-term results.