Botax and other Fillers


BOTOX and other fillers and injectibles are skin rejuvenation cosmetic procedures designed to reduce the signs of aging, offered by expert physicians at UW Health Transformations in Madison, Wisconsin.
The process of aging often leaves its mark on our faces. Sun exposure, laughing, worrying and even smiling can lightly damage the tissues that make up our faces. Our physicians help reverse the signs of aging through the use of injectibles, such as:


  • Juvederm

  • Restylane

  • Radiesse

Each of these injectibles work differently, but they all achieve the same goal – reduce the signs of aging by diminishing frown lines, forehead creases and other facial lines.

Who is a good candidate for BOTOX or other injectibles?

Almost anyone may be a good candidate for injectible treatments such as BOTOX or Restylane. These cosmetic injectibles help to temporarily reverse the signs of aging by diminishing frown lines, forehead creases and other facial lines. Studies show that BOTOX may also help to relieve migraine headaches, excessive sweating and muscle spasms in the neck and eyes.
Treatment should not be used if you are pregnant, breastfeeding, have an infection on or near the injection site, or have allergies to any formula ingredients. Individuals with neurological disorders such as ALS, Myasthenia Gravis or Lambert-Eaton syndrome are increased risk of serious side effects of BOTOX and should consider another alternative.

How does BOTOX obstruct your wrinkles?

In neurology, the term motor neuron (or motoneuron) classically applies to neurons located in the central nervous system (CNS) that project their axons outside the CNS to directly or indirectly control muscles. Motor neurons carry signals from the spinal cord to the muscles to produce (effect) movement. The neuromuscular junction connects the nervous system to the muscular system via synapses between efferent nerve fibers and muscle fibers, also known as muscle cells. As an action potential reaches the end of a motor neuron, voltage-dependent calcium channels open allowing calcium to enter the neuron. Calcium binds to sensor proteins on synaptic vesicles called synaptotagmin triggering vesicle fusion with plasmamembrane and subsequent neurotransmitter release from the motor neuron into the synaptic cleft. In vertebrates, motor neurons release acetylcholine (ACh).
It is the actual movement of these muscles under the skin that causes wrinkles in the face to appear in many cases. At first, the wrinkles are visible only when the muscles move, such as when certain facial expressions are made. Eventually, these wrinkles are visible even when the muscles are resting. These constant wrinkles are often what accounts for the “angry” or “tired” look people dislike.
BOTOX contains a protein complex purified from the bacterium Clostridium botulinum. A component of this complex, Botulinum Toxin Type A is the important active ingredient. Type A is one of the seven distinct botulinum toxins produced by different strains of the bacterium. BOTOX decreases muscle activity by blocking overactive nerve impulses that trigger excessive muscle contractions or glandular activity

How do skin injectibles work?

Injectible treatments involve a non-surgical procedure lasting for only a few minutes. During which, tiny amounts of diluted filler are injected into the skin by an ultra fine needle that minimizes discomfort. No anesthesia is necessary.
BOTOX is a purified protein injection that temporarily reduces or eliminates frown lines, forehead creases, crow’s feet near the eyes and thick bands in the neck. These lines appear over time with everyday muscle activity of the face. Botox injections soften and relax wrinkles by preventing facial muscles from contracting.
Restylane is cosmetic dermal filler that corrects moderate to severe facial folds or wrinkles. It is clear gel that contains hyaluronic acid, a natural substance that already exists in the human body.

Are injectibles safe?

Although there are some risks are associated with treatment, injectible treatments are safe for most people.

What should I expect following this procedure?

Injectible treatments are relatively painless and require little to no recovery time following procedures. Full results are usually seen within seven days of treatment.
Common side effects for Restylane include temporary redness or swelling at the site of injection. These should last no longer than seven days. Side effects of BOTOX treatments may include temporary bruising or headaches in rare cases. Headaches should subside between one and two days.
Four to six months after cosmetic treatment, you will gradually regain muscle action and notice reappearance of creases and wrinkles. Talk to your physician about re-treatment. Although the anti-aging effects of injectibles are not permanent, you may notice that with subsequent treatments, your lines and wrinkles appear less severe even after you regain facial muscle activity. This is because your muscles are being trained to relax.
Cosmetic surgical procedures can produce profound, long lasting changes in facial appearance, but are invasive and have an associated recovery period. Many patients who are just beginning to show signs of facial aging desire improvement, but cannot justify the cost or time investment required for surgical intervention. For these patients, the rapidly expanding repertoire of injectable treatments is perfect to suit their needs. Injectables can be utilized during an office visit, rather than requiring a trip to the operating room. With some treatments, no anesthetic is necessary, as the needles utilized are so small that discomfort is minimal. With others, topical anesthetic agents or nerve blocks may be utilized, depending on the patient’s preference and the sensitivity of the region being treated.
From the standpoint of using minimally invasive techniques to treat facial wrinkles, there are two general classes of injectables:

Neuromuscular toxin
The first option, which is most appropriate for active lines or age associated wrinkles that are just starting to appear, is to temporarily weaken or paralyze the muscle that is causing the wrinkle. Botulinum Toxin type A is a family of neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and thus can be artistically used to alter facial expressions. Botox Cosmetic is widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. Other manufactures are producing variant toxins that will likely be approved for use in the near future, including Reloxin and PurTox. These toxins will be differentiated by their time to onset, duration of effect (the clinical effects of Botox Cosmetic are typically 3 to 4 months), and the distance of effect from the injection site. Risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups. Specific risks should be discussed with your injector when considering treatment.
Soft Tissue Filler
The second class of injectable treatments is the soft tissue fillers. This group is rapidly expanding, and many options are available. These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds). Fillers restore volume to the face and can add structure as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (eg: nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure. All of these injectable fillers are placed by an injection, so the group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases local infections.

What to expect

The procedure only takes a few minutes. And you can choose from several locations: The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Green Spring Station and White Marsh.
Depending on what kind of filler you are having injected, there may be a few instructions you need to follow prior to the procedure. You may have to lie down for a few hours after the procedure and the doctor may give you some instructions for taking care after you go home. You won’t have any marks or scarring.
A Botox injection requires no recovery time. You may see some minor bruising, which can easily be hidden with concealer. It will take two weeks to see the full effects of the treatment and the effect lasts three to six months. Over time, you may require fewer treatments because weaker muscles atrophy and require fewer injections.
*Available fillers include: Botox, Juvederm Ultra, Juvederm Ultra Plus, Perlane, Radiesse, and Restylane.