What you need to know about botox, lasers and fillers

By: Andrea Karr
This will make you re-think nonsurgical skin-care

<p>Alexander Straulino/Trunk Archive</p> Author: Andrea Karr


What you need to know about botox, lasers and fillers

By: Andrea Karr

We lift the veil on the world of nonsurgical anti-aging procedures—what they can do, whether they'll hurt and how much of a dent they'll put in your wallet.

We all get older; it's a fact of life. But do we need to look older? The answer is no. Nonsurgical cosmetic procedures such as laser treatments and Botox injections can minimize wrinkles, remove excess fat and plump up and tighten skin. But they're also a bit taboo, because isn't it frivolous to want to "fix" your hard-won lines and sun-darkened brown spots? Our advice: Do what makes you feel good—you're the only one who gets to have a say about your appearance. We offer a breakdown of your treatment options, just in case your curiosity (or your frown lines) gets the better of you.


If you see an exhausted face looking back in the mirror every single day, the culprit is probably your peepers. "The eyes are the very earliest place affected as we age," says Toronto-based plastic surgeon Dr. Jerome Edelstein. In order to brighten your appearance, you'll need to minimize dark circles, frown lines and crow's-feet. 

To deal with wrinkling in the upper part of the face, try injections of botulinum toxin (a.k.a. Botox or Dysport), which relaxes the muscles that allow wrinkles to form and reduces the appearance of lines. It's possible to customize the number of units and injections so that your upper face will be completely frozen, be able to move slightly or be fully capable of movement, though more movement means less overall improvement.

Next, try a dermal filler to restore volume in your tear troughs, the areas under your eyes, which can appear dark and hollow. Dr. Andrea Herschorn, who works with Dr. Edelstein, recommends starting with half a syringe of soft, fluid Emervel, or Teoxane's Teosyal or PureSense Redensity II.

Pain and downtime: Injections of botulinum toxin feel like minor pinpricks. You might have a slight headache for a few house or days.

$$$: $12 per unit of Botox or Dysport. Forehead treatment costs between $300 and $600.

Lasting effects: Three to four months.


There are two main reasons for jowls and sagging in the lower part of the face: skin laxity (due to loss of collagen and elastin) and decreased volume in the cheeks (caused by fat atrophy and thinning of the cheekbones). All of these changes are a natural part of getting older.

Usually, a two-pronged approach is best for treatment. The first step is dermal filler being injected into the cheeks. "I call it building a foundation," says VIctoria-based dermatologist Dr. Mark Lupin. "You start deep and work toward the surface." Adding volume back to the cheeks with one to six syringes of filler will lift the skin in the lower part of the face.

Then, your doctor or medical esthetician will likely recommend a skin-tightening treatment that uses radio-frequency technology. Thermage and ReFirme, for example, heat the collagen deep in the skin, prompting it to contract and tighten and kick-starting the skin's natural renewal process.

Pain and downtime: Pain is minimal, though some patients will take an oral analgesic.

$$$: $1,500 to $2,100 for one Thermage treatment. Most people require one treatment, but some may opt for a second treatment three months later. Meanwhile, each ReFirme treatment costs $250 to $500. Six treatments, each one or two weeks apart, are required.

Lasting effects: Up to two years for Thermage, and about a year for ReFirme.


Most of us spend so much time focusing on our mugs that we forget another important area: the neck. Your neck requires just as much love as your face, and many of the aforementioned treatments can be used to make it look slender and elegant. Botulinum toxin injections can correct vertical lines (also known as vertical banding or turkey neck) and create a more defined jaw line, and radio-frequency technology can tighten sagging skin. Meanwhile Fraxel laser treatments can smooth fine lines and correct papery texture.

One procedure that's exclusive to the region between your chin and your collarbone is Belkyra, a brand-new injection that uses deoxycholic acid (a bile acid that emulsifies fats for absorption in the intestine) to destroy fat cells responsible for the look of a double chin.

Pain and downtime: Belkyra is relatively painful. It will feel like burning in the neck for five to 10 minutes. There will be swelling and slight bruising that typically last for about a week but can last as long as a month, so winter is a great time to try this treatment (hello, scarves and turtlenecks).

$$$: Approximately $1,200 to $1,500 per treatment. Two to four treatments, each eight weeks apart, are required.

Lasting effects: Belkyra's effects will last forever; fat will never deposit in your double-chin region again—even if you gain weight. Can we get some of that for our thighs? Health Canada says no...for now.


"As we age, volume loss makes us look older, and most of that volume loss happens as a result of fat atrophy," says Dr. Cory Torgerson, a facial plastic surgeon based in Toronto. The loss of fat, in addition to increased skin laxity and repetitive muscle movements, can cause defined lines in certain areas of the face—especially above the lips (known as smoker's lines), along the sides of the nose to the corners of the mouth (nasolabial folds), and from the corners of the mouth down the sides of the chin (marionette lines). 

For plumping up, all deep lines will need dermal filler injections, though each type of wrinkle requires a slightly different treatment process. There are several brands (for example, Juvéderm, Restylane, Emervel and Teosyal) that use the go-to ingredient hyaluronic acid. Doctors will have their preferred brands, depending on their personal experience, but each line has a full range of density options, such as a thicker, more structured filler for cheekbones and a thinner, fluid one for under the eyes. And if you don't like the results of your injections, don't worry; the hyaluronic acid fillers can be broken down with an injection of the enzyme hyaluronidase.

Pain and downtime: Dermal fillers are one of the more painful nonsurgical treatments available. However, most offices order syringes that also contain lidocaine, which numbs the tissue and minimizes pain.

$$$: $600 to $800 per syringe. As a ballpark, one to four syringes can usually treat the nasolabial folds in a single appointment, with each syringe containing only one cubic centrimetre, or one-fifth of a teaspoon, of product.

Lasting effects: Six to 18 months.


Before considering a visit to the doctor's office, try these recommendations for a better at-home regimen.



Eye spy: Look for an eye-care profuct that contains a vitamin-A derivative, such as tretinoin or retinol, which will stimulate collagen production and target skin laxity. Olay Pro-Retinol Eye Treatment, $40,

Here comes the sun: Protect your skin by applying a sunscreen with SPF30 or higher to ensure the results from your procedures last. SkinCeuticals Physical Matte UV Defense SPF50, $44,

Bright idea: Look for a serum or oil packed with vitamin C. The antioxidant helps brighten, repair and protect from free radicals. Ole Henriksen Pure Truth Vitamin C Youth Activating Oil, $56,

In the neck of time: What did we say about taking care of your neck? That means moisturizing! StriVectin TL Advanced Light Tightening Neck Cream, $99,

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What you need to know about botox, lasers and fillers