The history of facial injectables stretches back to the late 1800s, when substances such as paraffin were experimentally used as dermal filler to address facial deformities. Since then, injectables have evolved into highly specialized formulas that can be used to enhance almost any aspect of the face, with many dermal fillers relying on hyaluronic acid, a substance that naturally occurs in our bodies. Here, I will recount the storied history of facial injectables and highlight my innovative techniques as well as the products that have stood the test of time.
The invention of the modern syringe
The syringe has become an invaluable medical tool in all specialties, as well as being critical to the artistry of facial injectables. Syringes were used for thousands of years before they evolved into what we see today. The earliest syringes did not have needles and were used primarily for suctioning fluid or debris from small areas or dispensing liquids. Scottish doctor Alexander Wood is credited with the invention of the hypodermic syringe in 1853. Made of glass, the contents could be accurately measured and dispensed, ensuring patients were receiving the correct dosage.
Early formulas, failures, and successes
After the modern syringe made its debut, it didn’t take long for doctors to begin experimenting with injectable facial fillers. Paraffin wax was the first injectable filling agent, though its use was short-lived after complications like migration, embolization, and granulomas were reported. Silicone replaced paraffin wax in the early 1900s and achieved a smoother, more youthful appearance, though it too caused similar complications and was consequently banned by the FDA for this type of cosmetic use.
Doctors began testing animal collagen as a potential filler in the 1970s. Bovine collagen seemed promising and was the first agent to be approved by the FDA for cosmetic injections in 1981—Dr. Terry Knapp (my Chief Resident at Stanford University) and four other physicians were a part of this legacy. Unfortunately, results were not long-lasting and a number of patients suffered swelling and allergic reactions after treatment.
The FDA approved hyaluronic acid for injectable cosmetic use in the early 2000s and, as a highly-effective, long-lasting filler, it has since become a mainstay. Patients are less reactive to hyaluronic acid as it occurs naturally in the body.
The FDA approved hyaluronic acid for injectable cosmetic use in the early 2000s and, as a highly-effective, long-lasting filler, it has since become a mainstay.
Bacterium clostridium botulinum has been studied for well over 100 years. During that time, several strains have been isolated and studied independently for various medical uses. Originally approved by the FDA for eye muscle disorders, experimentation with botulinum toxin type A as a wrinkle eraser began with “off label” use of the drug in the 1990s. By 2002, the injectable neurotoxin known as Botox was being widely used for cosmetic purposes and finally gained specific FDA approval for treatment of frown lines.
In the beginning, Botox was controversial as many could not see past the word “toxin.” Additionally, as with any treatment, those who went overboard with Botox dosages were more likely to be noticed, leaving many concerned that treatment would always result in a “frozen” face. In time, both physicians and patients learned that excellent results were possible with nuanced application and quickly adopted the product, with over 2.8 million Botox injections administered in its first full year as an FDA-approved wrinkle treatment.
Since then, more neurotoxins have joined the market, yet all rely on a similar methodology of temporary muscle paralysis. Injection placement and dosages have also become highly refined, allowing experienced providers to achieve natural-looking cosmetic improvements throughout the face.
Choosing the right facial injectable in Honolulu
Botox and dermal fillers are both effective, long-lasting, and almost-instant solutions to enhance the face but there are marked differences in formula and function.
Neurotoxins including Botox and Dysport temporarily relax dynamic muscles, preventing lines and wrinkles caused by repeated movements. Neurotoxin can also be used for shaping facial features, as is done with the Botox lip flip, in which the lip muscles are relaxed to increase the visible height of the upper lip. With 43 muscles in the face, it is critical that Botox be expertly administered to avoid negative side effects. A highly-skilled surgeon will ensure proper placement and dosage so you love your results, which can last up to four months.
At my Honolulu plastic surgery practice, I use Botox to:
- Address frown lines, forehead wrinkles, crow’s feet, and other expression-based wrinkles
- Subtly elevate the eyebrows by balancing forehead musculature
- Treat platysmal bands in the neck
- Improve lines around the lips
- Treat a gummy smile
JUVÉDERM® VOLUMA is an injectable hyaluronic acid-based gel specifically designed to restore volume in the mid-face. It was the first filler approved by the FDA to treat the cheek area. Using JUVÉDERM VOLUMA through the upper cheeks can create a lifting effect as we see with a surgical facelift, with no incisions or downtime. This injectable is often my choice to:
- Restore volume in the mid-face
- Create definition through the cheekbones
- Build up the chin
- Sculpt the jawline
- Augment the lips
- Smooth marionette lines
Restylane is available in different, targeted formulations to address specific improvements to the face or for different age groups. Administered in small doses, results are almost immediate and last up to six months—or as much as 18 months if patients seek a follow-up injection. I prefer this filler to:
- Smooth moderate to severe lines and facial folds
- Soften acne and surgical scarring
- Fill fine lines and wrinkles
- Add definition to the lips
- Fill spaces between tendons and veins to reduce their appearance in the hand (known as a hand lift or hand rejuvenation)
Restylane Lyft is used as an anti-wrinkle treatment and dermal filler to restore the youthful fullness that can diminish with age. Similar to Restylane, noticeable results are seen within hours and this formulation can last between 12 and 18 months. Restylane Lyft can be used to:
- Fill deep wrinkles
- Volumize sunken cheeks
- Shape and/or fill the lips, cheeks, and chin
Sculptra® is an injectable lactic acid approved by the FDA to restore facial volume by activating the skin’s natural collagen production. Sculptra achieves a more youthful appearance with a series of treatments over a few months. The gradual approach to boosting the body’s natural collagen stores can last up to two years. Sculptra is eventually absorbed by the body, making this filler one of the safest options. I often choose Sculptra to:
- Gradually improve skin firmness
- Promote collagen production in the face to reduce the appearance of fat loss
- Non-surgically increase volume in the buttocks, mitigating the risks and prolonged recovery time that accompany surgical options like Brazilian butt lifts
JUVÉDERM® VOLBELLA® XC
JUVÉDERM® VOLBELLA® XC is an injectable hyaluronic acid gel specifically designed for lip rejuvenation. This formula’s smooth consistency allows the lips to move naturally and poses almost no risk of adverse reactions since hyaluronic acid occurs naturally in the body. Results are fully evident after 1-2 weeks and can be enjoyed for 12 months after treatment. This is an effective option to:
- Fill lip lines and wrinkles
- Add definition to the lips
- Reduce vertical lines around the mouth
- Enhance lip volume and improve symmetry
Liquid Face Lift
A liquid face lift is a tailored combination of dermal fillers and Botox or Dysport to treat multiple areas of the face at once. This personalized technique achieves what was once only possible with a surgical facelift. Patients can experience dramatic results in one convenient office visit with no significant recovery time needed. I will customize a treatment plan with a series of injections to fully rejuvenate the entire face.
Honolulu Facial Injectables
Dr. S Larry Schlesinger is a board certified plastic surgeon who has performed more than 20,000 procedures over the course of his career. Highly-regarding for his published articles on techniques and procedures, Dr. Schlesinger has also shared more than 70 of his personal publications with the plastic surgery community. He is also a verified plastic surgeon on RealSelf, an online advisory platform for plastic surgery and cosmetic procedures. Dr. Schlesinger and his team of experts at the Breast Implant Center of Hawaii invite you to contact us online or call our office at 808.597.8835 to schedule a consultation. With over 40 years of experience, Dr. Schlesinger provides natural, long-lasting results his patients rave about.