Expert Doctor

Fillers and Neuromodulators

Posted January 31, 2017
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David Reinstadler, MD

Newport Beach, CA

Fillers and Neuromodulators

Fillers are one of the most common cosmetic procedures administered each year. The use of injectables like Botox, Juvederm, and Restylane are so commonly accepted that many celebrities have openly admitted to using them. They can be used to solve cosmetic problems like fine lines, wrinkles, gummy smiles, and thin lips, and they can cure medical issues like overactive sweat glands and various neuromuscular conditions. However, despite their popularity, fillers are generally a mystery to patients, who often don’t know the ins and outs of what they’re injecting into their faces and bodies.



Fillers are any material that can be injected into a fold or crease in the skin. These can be either permanent or temporary. Permanent fillers include silicone and Artefill; these are seldom used, but do have their uses. Temporary fillers include hyaluronic acid fillers, like Juvederm and Restylane; calcium hydrovyapatite, which is Radiesse; and poly-L-lactic acid, which is Sculptra (another filler). Neuromodulators, like Botox, are any chemicals that inhibit a signal from the nerve to the muscle, which inhibits contractions and eliminates the corresponding wrinkle in the skin.

Choosing between fillers and neuromodulators really depends on the problem being addressed. Fillers are typically used to either add volume (like in the cheeks or lips) or in the deeper folds of the face, like the nasolabial fold. Neuromodulators are usually used to decrease active wrinkles in forehead or around the eyes, either between or on the outside of the eyes (the “crow’s feet”). Both of these treatment options are temporary, and last for varying lengths of time, depending on the specific product being used. Botox, for instance, lasts four months, and fillers last roughly six to nine months, depending on where they are injected.



For fillers, an ideal patient is someone with deep folds or hollows anywhere on his or her face. This is someone who has lost a lot of volume, which is typically a natural step in the aging process. An ideal patient for neuromodulators is anyone who wants to decrease active wrinkles in the forehead or around the eyes.

The best patients are able to clearly and specifically articulate what it is they want and what bothers them. They should be certain if the problem exists only when they move, or if it occurs constantly. They should also know that none of the treatments happen instantaneously—someone wanting full lips and a wrinkle-free complexion shouldn’t expect to be able to go out the night after the procedure.



As is the case with any procedure, fillers and neuromodulators have their own risks that patients should be aware of. Fillers, if not injected properly, can damage blood vessels and cause scarring. Overcorrection is a risk with neuromodulators, which can cause drooping of the brow and eyelid. Some patients experience flu-like symptoms after injecting neuromodulators. One of the biggest fears patients have with their injectables is loss of expression. A good way to avoid this is for patients to be very specific about their expectations with the doctor performing the procedure—a skilled doctor should easily be able to avoid this problem. Additionally, if a patient is unhappy with a hyaluronic acid treatment, they can have their filler dissolved with hyaluronidase, an enzyme that completely removes evidence of the filler within a day.

Neuromodulators generally take about a week to reach their full effects, so patients should be prepared for a bit of a wait before they can see their results. Fillers typically cause acute swelling, which goes down after a week, on average. Patients should also expect bruising in certain places, like under the eye, so it’s important for patients to plan ahead and receive their treatments well before any major events. For neuromodulators, patients shouldn’t expect to experience much (if any) pain, but should avoid heavy exercise the same day they receive the treatment. With fillers, recovery varies depending on the area being injected, but other than the standard pain caused by bruises, patients don’t have much discomfort to worry about.



Though fillers and neuromodulators are easily the most common cosmetic procedures, most patients don’t know very much about them—or the best way to take care of their results. Patients have to remember the importance of skincare overall. Even if you haven’t had injections (but especially if you have), it is crucial to remember to care for your skin. Patients should remember to use sunscreen and moisturizer daily, and to look into procedures like photofacials, which can help stimulate collagen and enhance the patient’s results. With careful skincare and  the skillful application of fillers and neuromodulators, patients can feel confident in their appearance, and enjoy a refreshed and youthful appearance.


Written by Cosmetic Town Editorial Team based on an exclusive interview provided by Dr. David Reinstadler in Newport Beach, CA.

Article Last Updated on January 31, 2017