For this section I’ve compiled all the questions I frequently get asked.
For the purposes of this educational page I have used the word Botox instead of Botulinum Toxin, which is medically speaking, the more technically correct term. Just like penicillin, you will only be offered this medication if the doctor feels it is clinically appropriate for you.
Click a question below to expand
Botox is a substance that is used to create relaxation of the muscles that cause wrinkles. It takes 2 weeks to work. Fillers are often like gels that plump out the skin. The effects are seen straight away. As a general rule Botox is used very well in the upper face and fillers are used in the lower face, although exceptions do exist.
Dermal filler results tend to last longer than results from Botox overall. Still, results differ depending on the exact type of filler you choose, where it is injected and the lifestyle of the patient they are used in. Both products only last a certain length of time as your body continues to age and the injected substances degrade over time. If you would like to keep your refreshed look, you may want to have regular top ups.
They are different things. It is like comparing apples and oranges. Botox is generally used to treat fine lines and wrinkles whereas dermal fillers can be used to add volume to the lips and other areas on the face. They are both very good treatments and often used together to complement each other. As to how long they last, this depends on where on the body they are injected, the doses or amount used and the lifestyle of the patient. As a very rough rule of thumb Botox lasts 3 months and fillers last 6-12 months. There are exceptions to this rule.
In UK law, medical staff cannot advertise prescription only medications such as Botox. That is why instead of seeing Botox you may read terms like: wrinkle treatments, wrinkle relaxing injections, wrinkle relaxers, aesthetic treatments, injectable wrinkle relaxers and anti aging treatments.
Oddly, even though botched dermal fillers treatments can be more catastrophic than Botox treatments, fillers are freely available over the internet. This means anyone can advertise them and inject them (just like anyone can buy and use a ball point pen). In my opinion this is why we see horror stories of when things go wrong.
Why can some clinics treat me straight away with Botox whilst in others I have to return for my treatment?
It may be that you, or your practitioner may want time to think about your treatment options and all that that entails, so agree to set up a separate appointment for treatment.
Other times it is because it would be illegal for the person to inject you with someone else’s named prescription. In UK law, only medical doctors and dentists can hold stock of prescription medications like Botox, so they are the only professionals who can inject you there and then. People like prescribing nurses and prescribing pharmacists cannot hold licensed medications as stock. This means they have to get your specific medication with your name on it from the pharmacist and this takes time. This prescription can only be acquired after a face-to face consultation with you and can not be used on another patient, otherwise it is breaking the law. People like non-prescribing nurses, paramedics, ODPs, radiographers, dental therapists and dental hygienists need to ask a prescriber to see you on their behalf, before they can inject you with Botox.
Fillers are unregulated, so anyone, and yes I mean anyone, can inject fillers into your face as it is not illegal for them to do so. However it is my view this is definitely NOT recommended as the consequences can be disastrous. Please see below ‘What can go wrong with Botox and fillers?’
I see some clinics talk about Botox, Azzalure, Dysport, Bocouture. What are these and what is the best Botox out there?
Lots of studies have been done on these brands of Botulinum Toxin and there are no conclusive studies that show one brand is better than another. We commonly refer to all types of Botulinum Toxin as Botox, just like we refer to all vacuum cleaners as Hoovers. However Dyson and Shark are considered by many as the newer and better kids on the block! The term Toxin is often used as short hand for Botulinum Toxin.
Why are Botox and dermal filler treatments so different in price? How much does Botox cost? How much does dermal filler cost?
The variation in prices and costs vary from clinic to clinic and there are many reasons for this. As a doctor you are paying for my time which takes into account the years of medical experience I have, my medical insurance, my clinic insurance, my annual medical training costs, the cost of running my clinic as well as the unit price of the product. Others may not have these overheads. Put bluntly, it is legal for anyone to buy injectables (Botox and fillers) over the internet, get a paying customer who has given permission to be injected, lift a syringe, inject the skin and plunge the Botox or dermal filler, which are potentially disfiguring substances into your face. It comes down to how much you value your appearance and health, who you trust to do a good job and who will be able to help you if things don’t go according to plan. Only you know the value of this. There is an old adage that goes "the bitterness of poor quality remains long after the sweetness of low price is forgotten". Here at Dr K’s Clinic you will find our prices for our services are competitive and fair.
Please have a look at the dermal fillers page which details a picture diagram of all the areas that can be treated. Fillers are a gel-like substance that is injected into different parts of the body to alter the appearance of the skin. They can be used almost anywhere on the face; forehead, temples, under the eyes, cheeks, nose, lips, jawline and chin. They can also be used in the neck, earlobes, décolleté, under arms, hands, feet and in the bottom. They are used to help to smooth out wrinkles, plump and hydrate the skin making it look less aged and haggard.
Please have a look at the Botulinum Toxin page which details a picture diagram of all the areas that can be treated. It is used extensively for aesthetic purposes but also for medical and health purposes. We all are aware of treatment for forehead lines, crows feet and frown lines. But it can also be used to soften wrinkles on the nose, around the lips, create a lip flip, reduce a down turning mouth, dimpled chin and neck bands. The medical purposes include treatment for migraine, eye twitching, teeth grinding, excessive sweating of forehead, top lip, under arms, hands, groin, under breasts and feet. There are multiple more areas that it is injected but are mechanically more invasive than those mentioned above. It is reassuring to say Botox is used extensively for many years and is proving to be a very safe injectable treatment in the right hands.
There is no way of accessing the under surface of the skin without the use of a needle to pierce the skin and so create the possibility of a bruise. The good news is that there are some areas that are less prone to bruising, like cheek, chin and jawline. However there are also areas that are very prone to bruising like lips (they are red because of all the blood vessels lying superficially) and around the mouth. Please read the Botulinum Toxin and Filler sections to find out how you can minimise your chance of bruising like stopping alcohol and anti-inflammatory medications. It is also worth nothing that fillers can be injected using a cannula.
A cannula is a blunt tube that deposits filler underneath the skin and can be used to treat most parts of the face e.g. tear troughs, cheeks, jawline or lips. A needle needs to puncture the skin so the blunt cannula can be inserted into the needle hole to get access to the under surface of the skin. Cannulas are considered a safer option than needles, as these blunt tubes tend to push vessels and nerves to one side and leave them intact. A needle will skewer through blood vessels and other facial structures. This means cannulas create less bruising and less complications.
You may well ask this as the papers and social media highlight those who have been disfigured. I too shake my head and despair as to why they choose to have this done and who is it that is disfiguring these people especially young women! In the right hands and with expert technique it is possible to achieve a beautiful rejuvenation without any tell tale signs of ‘work done’. Aesthetic treatments can be so life enriching for people. When patients and their injectors keep adding filler over numerous sessions until their results look disproportionate and unnatural is when things go wrong. You may ask "but why?" and the answer is not simple. Some people enjoy the process of change, some may have lost the ability to objectively assess their appearance, others may not be clear on where they can draw the line between self-expression and risk to their health. In such cases it has to be the responsibility of the practitioner to guide their patient away from treatments that will give poor aesthetic or clinical results. That is why I feel you need an ethical injector who will say no to the vulnerable and enquiring patient.
The best filler to use will depend on the area to be treated, each brand have several grades of filler. Your aesthetic doctor will talk to you more about these mechanical properties like viscosity and elastic capacities of the filler and how it is suited to the area being treated if asked. Most dermal fillers are made of hyaluronic acid however there are also bio-stimulating types as well. There isn’t a single filler that is best for every area of the face, indeed one often needs at least 2 types of filler for the lips alone. For example an injector needs; a lifting type to lift the cheekbone or emphasise the chin, a soft type to get rid of a crease or super fine line, a soft and elastic type for natural looking hydrated lips, a hydrostatic type that doesn’t cause puffiness in the tear trough and a runny type to simply boost the hydration levels in the skin. To get the most natural effect you have to use a variety to treat the various skins concerns.
‘FDA approved’ is an American ‘gold stamp’ on fillers. Filler companies have to spend thousands/millions on making sure they jump through hoops to be authenticated as FDA approved. This then allows doctors in the US to inject these products as dermal fillers. Restylane (Restylane Lyft, Restylane Defyne, Restylane Refyne), Teoxane (RHA range), Juvederm (Volbella, Voluma, Vollure, known as the Vycross Range), Juvederm Ultra range, Belotero Balance, Radiesse and Sculptra are the ones more commonly used in the UK.
In the UK we look at CE marking, this means these fillers have been approved for the European market. There are more fillers CE marked than FDA approved. In May 2020 there are new rules coming into force that ensures more checks are done on fillers used in Europe. See below for more details.
How do I know my dermal filler is safe? What regulations are there in the UK that makes sure dermal fillers are safe for facial injections?
Fillers that are placed in UK market for medical purposes need a CE marked, which means checks have been performed on them that they are suitably produced for medical standards. Currently dermal fillers that are advertised for aesthetic injections do not require a CE mark. This effectively means that practitioners are able to import unknown fillers, offer them at low prices and inject within UK law. This puts vulnerable patients at risk. But from May 2020 under European Medical Device Regulations (that the UK government say they will continue to adhere to) all dermal fillers will be regulated as medical devices. This is great news and a good step to make the industry safer and protect patients.
How do I choose an aesthetic injector? How do I know if my aesthetic injector is legitimate and safe?
First and foremost the simplest thing I would suggest is look at your injector! If your injector, male or female, has enlarged cheeks and stiff duck lips, chances are they will inject you to look the same. If this is what you want then read on to find out crucial safety details. If this isn’t what you want, move on immediately and continue your visual research for your injector.
In the rest of Europe you have to have a medical licence (be a practising medical doctor) to inject fillers, but in the UK it is legal for anyone to inject you, if you have given consent for them to do so. This makes it very hazardous for UK patients to find a legitimate and safe injector.
Check out if the injector is a member of a validated professional body that will insist on ethical and professional standards of care. You can be safe in the knowledge that they will be effectively ‘kicked off’ the professional register eg General Medical Council (GMC), if the doctor’s care of you is substandard. Other professional registers like the GDC and NMC have similar stringent standards. Make sure you fully research your practitioner before committing to an injectable treatment with them, ask to see before and after photographs of real patients and make sure you discuss how realistic your results will be. Ask what product will be used, the reasons for the product choice, how much will be injected, the technique of injection (needle or cannula), how long the results are likely to last and if there are any risks and side effects possible. It’s also worth asking about alternatives to filler treatment, as a good practitioner should be able to discuss alternative treatment options with you.
Above all else, do not make your decision based on price, please see the above question ‘Why are Botox and dermal filler treatments so different in price?’
Where can I find Botox near me, dermal fillers near me, PDO threads near me and double chin reduction near me?
Please have read of ‘How do I choose an aesthetic injector?’. This will give you honest advice on how to choose the best aesthetic practitioner near you.
What can go wrong with Botox and dermal fillers? What are the side effects of Botox and dermal fillers? What will happen if my Botox or dermal fillers do go wrong? What treatment will I need?
Any number of things ranging from dropped eye brows to more disfiguring consequences. Having a surgical nose job or surgical eye bag removal have significant risks including blindness and disfigurement. Non- surgical means less risk but there are still risks. These should be discussed in detail with you by your medical practitioner, if they are not, run a mile. Allergic reactions are very uncommon due to the new modern formulas. If dermal fillers are administered incorrectly, the worst-case scenario could be blindness. This is caused when a small amount of filler is accidentally injected into or around a blood vessel that then blocks the blood supply to the eye. This is why you need to go to an experienced medical professional as you will have taken steps to minimise these risks.
When you meet your aesthetic injector ask what can be done if things go wrong and what can go wrong. Can your practitioner diagnose and treat filler complications? Are they able to dissolve your filler with prescription medications and will they charge you for this? Is there an emergency help line you can contact them on? If not, consider another injector.
Make sure you are asking sometimes seemingly awkward questions about validated qualifications, training and experience as these are good ways of sussing out if your practitioner is someone who is able to put you at ease and can deal with any untoward events. Avoid someone who will ask you to see your GP if an infection or worse occurs. Whilst your GP will have at least 10 years of specialist and generalist medical training before they can see you and independently treat you, they are unlikely to have had training in this new specialty. I know this as I am a member of the Royal College of GPs with 20 years of NHS training so I know it is unlikely your GP, even excellent ones, will know what may be happening and what to do to treat you.
It’s not the end of the world there are aesthetic hacks that can help you. Return to your injector (assuming you chose an expert prescribing injector) and they will help you. If it is Botox you don’t like at worst it takes a few weeks for unwanted effects to soften. However if your injector injected too much Botox into your forehead and you have dropped eyebrows, then you have to wait for 3 months for your brows to lift again. Eyelids can be temporarily lifted with prescription eye drops.
As dermal fillers take about 2 weeks to settle into your skin, it’s best to wait and see how you feel then. Again, make a follow-up appointment with your practitioner. In most cases you can have it adjusted or dissolved altogether with a prescription enzyme but this depends on the type of dermal filler used. This is where a prescribing injector is a must. Or you could wait it out, as hyaluronic acid fillers are naturally broken down within 12 months but this depends on the filler used and area treated.
We know a lot about these products and as your aesthetic doctor I have regular professional updates about the long-term safety of these products (this is certainly the case with the GMC as you can only be registered if you have proof of keeping your knowledge up to date and your patient’s health is your utmost concern). We have been using Botox for licensed medical purposes since 1988. We have extensive data on the benefits and risks. Children with cerebral palsy often have 7 times the upper limit of Botox used for aesthetic treatments on the face. We have plenty of data showing safety, albeit in the right hands.
Hyaluronic acid, the most common type of dermal filler, is a natural substance found in the body. At the time of writing this piece (Jan 2020) there is no evidence to suggest that long-term use is at all damaging. In fact, long-chains of hyaluronic acid such as those found in fillers are anti-oxidant and anti-inflammatory. It is certainly from my experience those who have repeat filler treatments tend to look fresher, even when their filler would have disappeared. They appear to have pressed the pause button on the aging process.
This is a common question and the answer is absolutely not. I wonder if this is a myth, spread around by injectors with questionable ethics. If you have only had one or two treatments, then over time as it disappears, you will just look as you did before. However, if you have been having treatments over two-three years, then your skin can look younger than before you started because some treatments help to permanently rejuvenate your skin over time.
If I come in for one treatment, will I decide I want something else too? I’m afraid I will become addicted to Botox and fillers. Are the treatments addictive?
Firstly, ageing is inevitable and there is no one-off treatment that freezes time forever. Our signs of ageing develop continually and present themselves as wrinkles, pigmentation changes, loss of elasticity and thinning of tissues such as skin, fat, muscle and bone. There are different types of treatments to address each one of these issues. A holistic approach is to use different treatment options to get an overall balanced result. In my opinion it is best to have top ups on a regular basis as it keeps your collagen and elastic active so you continue to look well with slow gradual improvements. If you wait for it all to go, then you will often need a financial splurge to get things back on track.
Secondly, treatments can make you feel great so it is understandable you want to repeat it. I liken the feeling to how you feel after a visit to the hairdressers or if you bought a new luxury item. But this is why you need to find an ethical professional who will say no if you want unnecessary or disfiguring treatments. Believe me there are plenty of unscrupulous injectors out there who wont say no to your money, without a care for you as a patient.