Q. I am almost fifty and have been using both Botox and fillers for my facial wrinkles for almost 8 years. I love the effect as it smooths my forehead lines and the fillers fill in the lines around my mouth. I am just a little concerned that I have been using these injectables for so long and I cannot find any information as to whether it is dangerous to be on these products for a long time. What is your opinion?
 

A. Great question, and one that we do not get asked about very often. The simple answer to whether long term use of neuromodulators such as Botox Cosmetic® and Dysport is safe is yes, they are. There are many patients who have been using these products for more than 20 years for the treatment of blepharospasm and strabismus. These patients have to be retreated every 3-4 months to control the spasms of the eye muscles, and many patients have done this regularly for more than two decades. The neuromodulators that are used for cosmetic purposes such as wrinkles on the forehead, are the exact same formulation of Botox® that has been around since 1989, and the product has a very solid safety profile. So you can be comforted by the fact that the product that you have been using for the last eight years is safe to continue to use, as long as it is providing the results that you are looking for.

As for the long-term safety of fillers, you were not specific as to which filler you are using, but I assume it is one of the hyaluronic acid products such as Restylane or Juvederm. These products have been around for more than ten years and also have a very safe record with respect to complications. The injectable is a non-protein based product so it does not stimulate the immune system. Hyaluronic acid occurs naturally in our skin cells and helps to keep our skin youthful and smooth, but unfortunately its natural production in our skin slows down as we age. The injection of these filler products is simply restoring some additional hyaluronic acid in the area of the wrinkle, which attracts water to the site and binds to the filler. This produces a plumping and smoothening of the wrinkle or line. These filler products have been around since about 2005 and have gained in popularity. I have many patients who have been using fillers for more than ten years to try to avoid the need for surgery, and I have not seen any issue with its long-term use.