Photo: Craig Cutler
Botulinum ToxinStar Power: Injections of botulinum toxin (brand names Botox, Xeomin, and Dysport) smooth away wrinkles by blocking the nerve impulses that cause muscle movement. When Botox was approved for cosmetic use in 2002, many patients wound up trading wrinkles for immobile eyebrows. In the years since, doctors have mastered how to smooth lines without making people look petrified or poker-faced. In fact, doctors now inject less toxin with each treatment than they used to. Expect results to last about three months at first. "After you've used botulinum toxin for a couple of years, it will last closer to six months," says Cheryl Karcher, MD, a New York City dermatologist. "And I have some patients who need only yearly touch-ups."
Who Might Benefit: Anyone who wouldn't miss her expression lines. Botox, Dysport, and Xeomin are FDA approved to treat frown lines (the "11s" between the brows) but are frequently used "off-label" to uncrinkle crow's-feet and horizontal forehead lines. Some doctors also use botulinum toxin for trickier applications: to soften vertical lines in the neck or between the breasts, to smooth puckering around the lips, and to lift the corners of the mouth.
You Should Know: Toxin injections can cause bruising. If injected incorrectly, they could also leave you with a droopy eyelid or—when used around the mouth—a drooling problem. "There are no long-term adverse effects caused by FDA-approved botulinum toxin," says Arielle Kauvar, MD, clinical professor of dermatology at NYU Langone Medical Center, "but an unskilled doctor can create some pretty embarrassing, if mercifully temporary, side effects."
Hyaluronic Acid FillerStar Power: When applied topically, hyaluronic acid subtly plumps the skin for hours. When injected, it dramatically plumps the skin—for months. In the decade since Restylane, the first hyaluronic acid filler, was approved by the FDA, doctors have learned to use these injectables not only to soften the lines that can't be smoothed with Botox (the nasolabial folds) but also to replump the contours of the face that gradually lose definition (the cheekbones) or become hollow (the temples). Research has now shown that hyaluronic acid fillers can even help reverse aging by encouraging the skin to produce more collagen. Also appealing: If you think you've overdone it, these fillers can be completely dissolved with injections of the enzyme hyaluronidase. "I've never had to reverse a hyaluronic acid filler," says Karcher. "But patients love knowing that I can."
Who Might Benefit: If you want to plump your lips or smooth your nasolabial folds, consider Restylane or Juvéderm. Perlane and Juvéderm Ultra Plus are a bit thicker (and sometimes last longer) and are ideal for restoring volume around the cheekbones, along the jawline, or in the hands. Belotero was FDA approved in 2011 and is favored for filling the hollows under the eyes: It won't create the bluish tinge that other hyaluronic acid fillers can leave when injected beneath thin skin.
You Should Know: Restylane, Juvéderm, and Perlane can include lidocaine to ease the pain of injection, but it still stings. (Belotero doesn't include lidocaine, but many doctors mix it in before injecting.) You may bruise and can expect some swelling for about 24 hours after an injection.
Next: The treatment for fine lines and roughness
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