In this month’s blog post you’ll find the answers some of the most frequently asked questions our patients have about cosmetic facial injections. The topic of injectables can be quite extensive, but for an introduction to this popular and highly-requested treatment I am answering the most commonly asked questions our Southlake-area dermatology patients ask:

Q: What is Botox?

Dr. Greer: This injectable treatment is a purified man-made protein. Some of the most popular brands include Botox & Dysport. These liquid proteins are injected directly into the muscle, which allows the muscle to relax so lines in the skin appear smoother.

Q: Why is Botox so popular?

Dr. Greer: According to a recent report by the American Society for Aesthetic Plastic Surgery Botox is the fastest-growing cosmetic procedure in the country. I believe this is because it is quick, minimally invasive, almost painless and it has little-to-no downtime. Not to mention, it works really well.  My patients are so happy with the results they get from facial injectables!

In addition to reducing the appearance of lines and wrinkles within days, it is also preventative over time. This allows us to ensure wrinkles don’t get deeper, so while it reverses the appearance of lines facial injectables also help to prevent additional creases from forming.

Q: Has the use of Botox reduced the need or demand for facelifts?

Dr. Greer: Generally speaking, yes. Using injectables can help patients avoid or delay more invasive surgical procedures. It is very dependent on the individual patient. Here in our Southlake area dermatology office, every patient is evaluated by me to create a personal cosmetic treatment plan.  Occasionally, some patients are better surgical candidates, especially if wrinkling and lines are extensive, but this is the exception rather than the rule. I can say that today, in my Dallas area practice, patients are often choosing injectable and laser procedures over surgeries.

Q: How long does it last?

Dr. Greer: In general, Botox and fillers last four to six months. It depends on the product chosen, and a patient’s own response. It is important to understand that fillers and most other injectables are not permanent. If you are happy with your result (and most are!), you will typically need to be treated two-to-three times per year to maintain your improvement.

Additionally,  I’ve learned that a handful of patients who feel nervous at their first procedure are reassured knowing that in the rare event they don’t enjoy the result, it can go away. In Southlake at our dermatology office, we are fortunate that an unhappy patient is rare.  However, the peace of mind that it is not permanent is nice for some.

Q: When should a patient begin Botox?

Dr. Greer: Speaking for myself, I started Botox when I was 27 years old.  This was partly because, as a dermatologist, it’s what I do, and I wanted to see for myself what the results were. I have treated the rare patient as young as 20 and I have also had patients who receive their first treatment in their 60s.  It’s a very personal decision. The average age for people beginning to explore these treatments is typically between 30 and 50 years old.

Q: Where is Botox used on the face?

Dr. Greer: Botox can be used in numerous areas on the face as well as the neck and jawline.  The top three most common areas we treat are:

  1. Between the brows (frown lines) also referred to as “the elevens”
  2. Horizontal forehead lines
  3. Crow’s feet (around the eyes)

Q: What are fillers?

Dr. Greer: Filler injections rejuvenate facial skin by reducing or eliminating wrinkles, raising scar depressions, enhancing lips and replacing soft-tissue volume loss.  Starting at age 30, we lose approximately 3cc of volume in our face a year.  If you stay healthy and fit, you tend to notice this volume loss at a greater rate.

At our Southlake dermatology office, we are fortunate to have multiple filler options available, the large majority are hyaluronic acids. The most well-known names are JuvedermRestylane, and Radiesse but the list continues to grow as more options are approved by the FDA.

Q: Where do you use fillers?

Dr. Greer: The areas we can treat and use fillers is never-ending but our most common are:

  1. Smile lines
  2. Chin area
  3. Lips
  4. Cheekbones
  5. Under eyes (to correct “bags”)

Q: How do I make sure I don’t look “overdone” or have duck lips?

Dr. Greer: This is where having an experienced injector is hugely important. To ensure optimal results, facial injectables should be performed preferably a board-certified doctor. All fillers cannot, and should not, be used in the same areas. I have seen patients come in with injections by untrained “friends” with terrible, and occasionally permanent bad results and they ask me to fix the issues.  Many times I cannot. You should have your face assessed by a licensed, board-certified dermatologist. This allows you to create an overall treatment plan that will give you the best results for a natural and refreshed look.

My patients typically want to look more relaxed and rested. They want their friends to wonder if a new haircut or perhaps their eye makeup is making them look so great. The purpose is to subtly refresh a patient’s appearance and not to have someone notice and ask with concern, “what have you done to your face?”

Q: Do men do these treatments?

Dr. Greer: In our Southlake area dermatology practice, I will say that the majority of our patients requesting Botox and fillers are women. However, these treatments are an amazing option for men, too. Increasingly more male patients are coming to our office wanting to learn how they can look more youthful in the workplace. Yes, men are open to trying injections. They walk away with great results.

Q: How long does it take for you to see results?

Dr. Greer: With injectables, the typical time period we expect to see maximum results is two weeks. With some patients, the visible results are faster.

With fillers, patients will typically see an immediate result however, there is also a higher chance of bruising or swelling. Due to this increased risk of bruising we recommend that our patients also consider a two-week rule to see optimum results. So, if patients are planning for weddings or big holiday parties, family photos or other special events, two weeks or more prior to these engagements is a safe window of time to schedule fillers and facial injectables.

Q: What about allergic reactions?

Dr. Greer: After having injected hundreds upon hundreds of patients, I have not personally seen any allergic reactions in my patients. These medications are very safe.

Q: Are there any side effects?

Dr. Greer:  Any time you have a shot, there is risk of bruising at the site of injection. Injections with filler have a higher rate of bruising than we see with Botox or Dysport. Additionally, fillers draw water to the site of injection so everyone has some temporary swelling.  This is typically worst the first 3 days after treatment and for most patients, it resolves within one week.  We recommend using ice packs at home to help with any inflammation. Most bruising resolves within one week. However, if patients are concerned about this, or have a tendency to bruise easily, there are a couple of things that can be done prior to a facial injectable treatment:

  1. One week prior to the procedure avoid:   fish oil, vitamin E, alcohol, aspirin, or ibuprofen.
  2. If there are additional concerns about bruising, some patients elect to start an over-the-counter supplement called Arnica three days prior to treatment. This can help prevent bruising.

I hope this has helped educate our patients about the amazing world of cosmetic injectables.  

We are proud to serve our patients in Southlake, Westlake, Grapevine, Colleyville, Trophy Club, Roanoke and the surrounding areas.  Please let us know how we can best serve you and your family.

To beautiful (and refreshed) skin,




Sara Greer, M.D.