Superficial Botox and Filler Injections: Unveiling the Benefits and Precautions
This article has been medically reviewed for accuracy by Plano, TX facial plastic surgeon Dr. Vu Ho on March 11, 2024.
Botox and hyaluronic acid filler injections are minimally invasive, entail little to no downtime, and provide consistently foreseeable outcomes – what else could one desire? One might assert that there's no need to tamper with a successful approach, yet a rising tendency of using both Botox and fillers in a more superficial manner, “stamping” or microneedling them into the skin through treatments like Aquagold and SeruGlow MD, is gaining traction. It turns out, these (off-label) applications can offer some truly substantial advantages distinct from those associated with traditional injection techniques. Here's what you need to be aware of.
The Profound Benefits of Superficial Neurotoxin
Traditionally, neurotoxin is injected deep within the muscle, where it inhibits the neurotransmitters that cause muscle contractions and, ultimately, wrinkles. With Aquagold, SeruGlow MD, or manual superficial Botox injections, the injection occurs in the intradermal layer, precisely above the muscle, as stated by Dr. Amelia Hausauer, a board-certified dermatologist in Campbell, California. This won't have an impact on facial movement or wrinkles but will accomplish several other tasks, including reducing oiliness and constricting blood vessels that cause redness, she elaborates. The same mechanism of action is at play; it's merely occurring in a different area of the skin. The Botox acts on the neurotransmitters responsible for vasoconstriction and weakens the muscle linked to the pilosebaceous unit, to diminish oil production, Dr. Hausauer clarifies.
And while the nearly instantaneous wrinkle-smoothing effects of traditional Botox injections are widely recognized, some data suggests that superficial utilization might have certain long-term impacts on skin quality as well. Dr. Hausauer references a study that discovered it enhances the activity of fibroblasts, stimulating collagen production. Similarly, she has found superficial Botox injections to be beneficial for her patients dealing with hypertrophic scars and keloids. “It's altering cell signaling and aiding in the control of genes, for proper cell organization and function,” she remarks.
Superficial Hyaluronic Acid Filler: A European Prevalence
New York City board-certified dermatologist Dr. Paul Jarrod Frank asserts that the entire concept of using injectables in a more superficial manner originated in Europe, where there's already a product specifically designed for this purpose; Profhilo is an extremely diluted form of hyaluronic acid that's injected into the top layer of the skin, and it should eventually enter the U.S. market, he says. Dr. Hausauer adds that Juvéderm Volite, a comparable injectable that's already widely accessible in other regions of the world, is also likely to be approved by the U.S. Food and Drug Administration (FDA) shortly.
Just like with neurotoxin, the results of superficial hyaluronic acid filler injections are markedly different from the traditional ones. “Hyaluronic acid is a natural humectant that plumps the skin. By placing it in the very top layers, it can enhance skin quality and create a more reflective sheen,” explains Dr. Frank. “We're not discussing volumizing or constructing structure – we're referring to complexion improvement,” adds Dr. Hausauer. “It can assist with hydration, creating a suppleness and softness to the skin.”
Diverse Methods for Microdosing These Injectables
The most prevalent – and widely accessible – option is Aquagold, a brand-name treatment that employs a microneedling device to deliver various products into the skin. Commonly, it's a combination of neurotoxin and hyaluronic acid filler, diluted with saline to form a watery mixture that can effortlessly flow through the ultra-fine needles. Some physicians also carry out these types of superficial injections manually. For instance, Dr. Hausauer mentions that she frequently uses Botox to treat redness in rosacea patients, injecting it superficially into areas such as the cheek and nose. (It's worth noting that the Botox has to be much more diluted than usual; this dilution, combined with the specific injection technique, is what confers it these distinct properties and enables it to diffuse into broader regions, she states.) Dr. Frank often concocts what he refers to as a “slurry” of neurotoxin and hyaluronic acid filler for superficial injections, noting that he finds it particularly effective in addressing skin texture around the lower mouth and chin.
“I prefer to add PRP/PRF to obtain even more skin-enhancing benefits,” says Plano, Texas facial plastic surgeon Dr. Vu Ho. “The charm of this straightforward treatment lies in its allowance for me to customize the ingredients to precisely meet my patients' needs.”
Doctors point out that it's also feasible to deliver products via a traditional microneedling device – provided the depth of the needles is appropriately adjusted. Traditional microneedling needles range between 2 mm and 2.5 mm, whereas they should be less than.5 mm to ensure the neurotoxin and/or filler don't penetrate too deeply into the skin and cause any adverse effects, notes Dr. Hausauer. (More on side effects shortly.) This is part of the reason experts extol the virtues of the Aquagold device compared to any other delivery method. “The microneedles are all at a fixed depth, so you're bound to obtain a highly consistent outcome,” notes Dr. Frank. Dr. Hausauer adds that the density of the needles simplifies the treatment of the entire face much more effectively as it's impossible to manually inject so many points.
Potential Side Effects to Consider
“You truly have to ensure you're delivering the product at the correct level,” cautions Dr. Hausauer. Injecting neurotoxin too deeply can result in it affecting the facial muscles, leading to muscle distortion and what Dr. Hausauer describes as a “stroke-like” appearance. Regarding fillers, the incorrect technique and/or depth of penetration can leave the skin with a bluish tint, as Dr. Frank explains. At this point, he strongly advises against Aquagold, or any type of microneedling procedure, being conducted in a spa.
“People who aren't physicians are using their own microneedling devices and introducing all sorts of products into these mixtures. For example, they might incorporate a type of hyaluronic acid that's more similar to a serum than a filler and microneedle it into the skin, causing irritation and an allergic reaction,” he warns. “Never allow aestheticians to microneedle the skin to the extent that it causes bleeding – and never let them infuse products into or onto open skin. Any form of treatment where there's a wound and pinpoint bleeding is a medical procedure that needs to be carried out by a healthcare provider.”
Who is Suitable for Superficial Botox and Filler?
Just about anyone – as long as you're cognizant of the limitations of the effects. Dr. Frank states that it's an excellent choice for an emerging group of younger patients who don't yet require muscle modification or volume. For more mature patients, this won't be highly effective as a standalone treatment; rather, it's a favorable complement to either traditional injection methods and/or other procedures, such as lasers. “This can be the final touch, offering a skin-quality result that they might not obtain from deeper injections,” he adds.
And while the results aren't necessarily very long-lasting – ranging from approximately three to six months – they do take effect rather quickly, within a week for neurotoxin and almost immediately for filler. For this reason, something like Aquagold is an ideal treatment to undergo before a significant event, according to Dr. Frank.
