Injectables are now a staple of ageless skin and the trend is continuing on. It is invaluable to know some basics about what is out there, even if injectables are not offered at the spa. Fillers and injectables complement a thorough skin regimen and can increase client satisfaction. New formulations even contain smoother gel formulations and come with lidocaine built in for more comfort. The problem with fillers is not the fillers themselves, usually, but rather the technique of the injector. Refer clients to someone trusted, who can give a natural look and create overall facial symmetry. Here are 10 things to know about injectables. They are safe and natural. Botox is not natural, but 90 percent of fillers on the market are hyaluronic acid (HA) based, which is almost bioidentical to what is in skin, thus needing no allergy testing. Known as nature’s moisturizer, HA is found in virtually all cells and skin accounts for half of all HA found in the body. It is a natural humectant that binds moisture 1,000 times its own weight in water and keeps skin looking plump and youthful. Recent advances in the last few years have also made HA products smoother than their predecessors to eliminate the lumpy and bumpy look, leading to an ever more natural appearance, as well. Sculptra is another natural filler made mostly from Poly-L-lactic acid (PLLA), which is naturally produced by the body following active movement, such as exercise. Also noteworthy is Radiesse. It is made of tiny, calcium-based microphones similar to the minerals found naturally in the body and, over time, the body absorbs it leaving behind natural collagen. Most fillers are 90 percent reversible. All hyaluronic acid-based fillers are reversible with a quick injection of hyaluronidase, which are enzymes that help the degradation of hyaluronic acid. That is the beauty of these fillers – results can be immediately reversed or altered it if the client is not satisfied. Fillers that are not reversible are Radiesse, Sculptra, and Bellafill. Botox is not reversible, but wears off quickly after three months. They can help acne scars. Bellafill is the first and only FDA-approved filler for acne scars lasting over a year. That said, any filler can be used, but because the amount of injection is so small, Bellafill is a lasting option. It is wonderful for those who want instant gratification, no real downtime (as in the case of many young adults or teenagers in school), or for those who cannot afford lasers. If able, the best results are to do an ablative fractional laser globally, first, then, fill in what scarring is left. They can help eye hollows and puffiness. Using really fine fillers, like Belotero or Restylane Silk, around the peri-ocular bone is preferred to avoid over volumization or bumps. It only lasts about six months but can dramatically change the tired and shadowed appearance of a person’s eyes. For under eye hollows, a more broad application of filler is used and for puffiness the filler goes into the tear trough to bulk up the depression only. They can last up to five years. They are different molecular structures and have different abilities to bulk. For those looking for a lot of volume, Voluma may be a good option. For chiseled cheekbones, Lyft may be the best choice. Radiesse is a great choice for temples and hands. Lips and nasolabial folds are great with Refyne, Defyne, Volbella, and Vollure. Also, look at how long results are desired to last. For those new to fillers, with a reversible filler that does not last as long. As experience is gained, try longer-lasting, one to two year-based fillers. When ready to commit more long-term, the best low maintenance option would be Bellafill, as it lasts five years. They can be used where volume is not needed, just fill. Many women struggle with feathered lines around the mouth, as well as fine lines near the lower cheek and chin. Small molecule fillers are needed for these areas, as they just push up the line very subtly, without volumizing the area. For example, for volume in the lips but not above the lips, just use small deposits (aliquot) in the lines. Some are stiff and some are flexible. Fillers that are more firm, like Bellafill, Radiesse, Lyft, and Voluma, are perfect for cheekbones and temples, but if you when looking for a very flexible gel formulation, for areas that have movement, like the nasolabial folds, a great option is Defyne and Refyne, as they consist of a unique XpresHAn Technology™ that moves with expression. In addition, Vollure is also one of the latest options and features a unique Vycross technology to create flexibility. They can give you back 10 years in 10 minutes. Botox combined with fillers, customized for facial shape, can instantly take 10 years off one’s face in a single session. Lines, hollows, scars, temples, sunken cheeks, deflated lips, and depressions can be filled in and the jaw can be redefined, all in a matter of minutes to an hour for instant gratification. This is also a low maintenance option for those who want to do the least minimal option in time and effort, with the most dramatic results and little to no downtime. Most HA fillers last six months to two years, depending on the area and needs of the individual, with other fillers, like Bellafill, lasting five years. They can be used to dissolve fat. Kybella is the first FDA-approved injectable to permanently destroy sub-mental fat (under the chin). It is made of deoxycholic acid, which is a natural substance in the body that breakdowns and absorbs fat. Two to four treatments are needed, five weeks apart, depending on the amount of fat to be dissolved. It can also be used off label to dissolve pockets of fat on the body. The only downside is there will be a good amount of swelling, post-treatment, for a week and more minor swelling for two to three weeks. Injectable filler is now in thread lifts. Instalift is the next big thing to a facelift. It is two procedures in one – as people receive a lift and re-volumization in one treatment. FDA-approved to last up to two years, the dissolvable thread has cones of Sculptra filler along it which will create neocollagenesis. Instant gratification, long-term lifting and volume, and a great safety profile make this a household name. Research has shown that hyaluronic acid, collagen, and elastin are key to staying youthful. Higher levels of hyaluronic acid in the body leads to more hydration in skin, lubrication of the joints, more protection from free radical damage and inflammation, better immune regulation, and more. It is easily and safely administered though injectables. There are many choices out there, so seek a competent professional who can assist clients. The Skin Saint’s™ Quick Reference Guide for Injectables: Botox FDA-approved for moderate to severe frown lines and crow’s feet Gets muscle induced lines in the skin Only approved injectables for headaches and excessive sweating (hyperhidrosis) Belotero Hyaluronic acid filler that lasts 6 months (only filler we carry NOT containing lidocaine) Very fine filler for smaller corrections like vertical lip lines, fine lines, under eyes Versatile enough to handle moderate nasolabial folds, and an option for treating delicate areas such as etched-in smile lines and vertical lip lines Juvederm Ultra XC and Ultra Plus XC Lasts up to 6-9 months Hyaluronic acid (exists in the skin as a natural moisture-binding agent (holds h20) Ultra Plus (a little thicker so lasts longer) Versatile (good in lips for full or softening) Restylane Defyne Hyaluronic acid gel with a high lifting capacity FDA approved injectable with XpresHAn Technology™ to help smooth out deep laugh lines (nasolabial folds and marionette lines) Lasts 12 months Restylane Refyne Hyaluronic acid gel with a moderate lifting capacity Lasts 12 months Designed with XpresHAn Technology™ and is FDA-approved to help with subtle lip augmentation and soften subtle laugh lines (nasolabial folds and marionette lines) Restylane Lyft Hyaluronic acid that lasts 1 year Firm (great for cheek bones) FDA-approved for the correction of age-related mid-face contour deficiencies Restylane Silk Hyaluronic acid filler that lasts 6+ months First FDA-approved product specifically designed for lip augmentation and the smoothing of wrinkles around the mouth Very fine filler for smaller corrections like vertical lip lines, fine lines, under eyes Radiesse + (plus version contains lidocaine and creates more lift) Calcium based filler lasts 1 year or longer The only FDA-approved dermal filler for face and hands Thicker (good builder, may have 10% reduction after 8 weeks) Helps natural collagen growth Volbella XC HA filler that lasts 12 months First and only FDA-approved filler proven to increase lip fullness and soften the appearance of vertical lip lines Vollure XC First and only hyaluronic acid dermal filler FDA-approved for the correction of moderate to severe wrinkles and folds (such as nasolabial folds) Lasts 18 months Developed using proprietary Vycross technology, and formulated with an innovative combination of low and high (90/10) molecular weight HA technology Voluma XC Hyaluronic acid but thickest and longest lasting HA filler- up to 2 years FDA indicated for cheekbones Also more expensive than other Hyaluronic fillers as it lasts longer Bellafill Only FDA-approved filler to last 5 years The only FDA-approved filler for acne scars lasting 1 year Proven safe in the longest and largest prospective dermal filler study ever 20% PMMA microspheres (same substance in contacts, knee replacements, etc.) 80% bovine collagen gel Sculptra Made of PLLA (Poly L-Lactic Acid) which is naturally produced in the body. Lasts about 2 years FDA-approved for HIV associated facial fat loss (lipodystrophy) Takes weeks to months to see results over multiple treatment visits Instalift Made of Sculptra and dissolvable suture threads FDA-approved to last up to two years Lifting and Filler in one Used for lifting the mid-face and creating neocollagenesis Holly Cutler, celebrity medical aesthetician, also known as America’s Skin Saint™, rebuilt her own skin disfigured from cystic acne, almost two decades ago, and has since created one of the most extensive rejuvenation clinics in the country, FACE Skincare~Medical~Wellness. Her multiple award-winning clinic offers over 35 laser and facial machines, injectables, non-surgical facelifts, body makeovers, and wellness treatments by renowned naturopathic physician Dr. Doug Cutler. She has been a featured expert on FOX, CBS, NBC, ABC, The Doctors, and several national publications. Cutler has now launched her own highly anticipated and innovative skin care product line, The Skin Saint™, and the first national virtual skin care consulting company to help people all over the country who may not be able to access the services at her clinic. Want to read more? Subscribe to one of our monthly plans to continue reading this article.