To inject or not to inject… that is the question on many women’s minds as they age. Whether you’re frowning about laugh lines, or concerned about thinning lips, it’s likely that your girlfriends are pondering the same thing: should I go for it? And which of my friends already have? If you’ve thought about talking to your girls, or even if you’ve already discussed the idea, there are a few important questions you’ll want to consider together… Neurotoxins vs. Fillers — What’s the difference, and which is right for me? This is one of the more common questions dermatologists get asked. As we age, our faces naturally lose subcutaneous fat (found just beneath the skin), and the skin tends to stretch. This can cause a loss of volume and make wrinkles, like smile lines and crow’s feet, more apparent. Lips may lose plumpness and under-eye circles may deepen. Heredity, sun exposure and lifestyle can also affect our skin, and some people turn to neurotoxins or cosmetic fillers to help capture a more youthful appearance. These do some similar things, but they work quite differently. Neurotoxins work by temporarily weakening the facial muscles. This helps prevent the development of those lovely creases in your forehead or around the eyes—and over time, it can help permanent creases start to relax. The effects can last from 3 to 6 months, depending on the number of treatments. Cosmetic fillers (also called dermal, soft tissue or facial rejuvenation fillers, or injectable implants) are injected into the skin to add volume to the area and smooth out wrinkles. Results can last from six months to more than two years, depending on the type of filler and where you inject it. Fillers may also: Plump thin lips Correct nasolabial folds (those “laugh” or “marionette” lines) Create a smoother and/or fuller appearance in the face Enhance shallow contours Improve the appearance of recessed scars Augment the cheeks Correct under-eye hollowness Camouflage lower-face jowls Reverse aging of the hands What’s in fillers? Most fillers are made from absorbable (temporary) materials, such as highly purified cow or human collagen, hyaluronic acid gel (a lubricating substance produced naturally by the body), calcium hydroxylapatite (found in human teeth and bones) or Poly-L-lactic (a biodegradable, biocompatible, man-made synthetic material). The FDA has approved only one non-absorbable (permanent) filler material—it’s made with polymethylmethacrylate (PMMA) beads. PMMA is a non-biodegradable, biocompatible, man-made polymer, and the beads sit in a gel-like solution that contains cow (bovine) collagen. The collagen adds fullness and the PMMA beads stimulate your own collagen to produce at the same time. What’s the procedure like, and does it hurt? A physician injects fillers in his or her office and the procedure typically takes about 30 to 45 minutes, depending on the number of areas being treated. Many fillers are combined with a local anesthetic and/or the use of a topical numbing cream to help with any discomfort. You may have some bruising and swelling for a few days after the procedure, but you should be able to continue with your normal makeup and skincare routine. Before scheduling a procedure, arrange a consultation to determine which products to use, and which areas of the skin would respond best. Many women initially opt for the simplest, shortest-acting product to gauge results. If satisfied, they’ll consider more long-lasting solutions. Since it is a medical procedure (not a cosmetic one), be sure to choose a specialist in dermatology or plastic surgery, and ask about his or her experience, as well as any risks involved with the recommended treatment. What are the risks? Most side effects with fillers happen shortly after injection and go away within two weeks. These may include: Bruising Redness Swelling Pain or Tenderness Itching, rash Difficulty performing activities (if you had a hand treatment) Less common side effects include infections, lumps and bumps, changes in skin color, and an allergic reaction. Allergy testing is required for certain filler materials, such as those taken from animals (e.g., cows, rooster combs). Rare side effects include a severe allergic reaction, development of hard nodules, skin or lip damage, migration or leakage of the filler material, problems with vision or blood supply, and stroke. If any of these occur, you may choose to have the filler removed through surgery, though this is sometimes difficult. One type of filler, hyaluronic acid, can be easily and quickly dissolved with an enzyme injection. What will it set me back? So the big question… the cost. Health insurance typically does not cover elective surgical procedures, such as lip plumping, wrinkle correction, or hand volume augmentation, but many plastic surgeons offer patient financing plans. Costs vary, but according to 2014 statistics from the American Society of Plastic Surgeons, they can average anywhere from $500 to $1,800, depending on the type of filler. So do your research, and talk it over with your girlfriends. Hopefully one of them has already been down the road of cosmetic fillers and can share her experience and insights with you.