Q. Can you explain the difference between Botox® and fillers such as Restylane® and Juvederm®?

A. That is a good question and one that I am frequently asked in my practice.  Each of these materials are designed to treat wrinkles, but they work in very different ways and have very different indications.  Botox is a neuromuscular blocker, meaning it blocks the nerve impulse to a muscle, thus making the muscle unable to contract normally.  Certain muscles can cause skin wrinkles, however if the muscle is relaxed, the wrinkle will disappear.   Neuromuscular blockers (Botox®, Dysport®, and Xeomin®) are all derived from the Clostridia Botulinum bacteria, and when injected in small doses, are very safe.

Botox® is used for wrinkles that are caused by muscle activity, such as crow’s feet, frown lines between the eyebrows, and the deep furrows on the forehead.  When the neuromuscular blocker is injected in very tiny quantities directly into the offending muscle, the muscle relaxes and the overlying wrinkle will either disappear or be significantly less noticeable.  After using Botox®, you will see the effects last anywhere from 3-4 months.

Fillers, such as Restylane® and Juvederm®, are an injectable hyaluronic acid gel (hyaluronic acid is a normal constituent of human skin) designed to fill out a wrinkle or crease.  The wrinkles that respond best to fillers are ones that are static lines, meaning unrelated to muscle activity.  Lines on the face that respond well to fillers include the nasolabial fold, which runs from the edge of the nose to the corner of the mouth, the marionette lines which run from the corners of the mouth down to the jaw line, the lip lines above and below the lips, and some deep lines on the forehead.  The fillers are injected directly into the wrinkle or crease, which fills the line and smoothes it.  One big advantage of hyaluronic acid fillers, such as Restylane® is that they are reversible, so that in the unlikely event you do not like the results, the filler can be dissolved and its effect removed from the site of the injection.  Fillers and neuromuscular blockers are FDA approved and are very safe when injected by an experienced and qualified person.

Q. I have a 16 year old daughter who has very large breasts.  She now wears a DD bra and she is very embarrassed and will not participate in any physical activities.  At what age can she have a breast reduction?

A. The key to treatment of juvenile breast hypertrophy (large breasts in teenagers) is to wait until there has been no growth of the breasts for at least a year.  In rare instances, early surgical intervention (ages 12-14) for giant breasts is warranted when the symptoms of the large breasts are intractable.  If early surgery is chosen as the course of action, the patient and the family must be aware that the breasts may continue to grow after surgery and that a repeat breast reduction may be necessary.  My personal experience is that if the patient is over 16, it is uncommon that the breasts will re-grow enough to warrant another breast reduction.  Your daughter needs to know that she will have scars on the breasts, reduced nipple sensitivity, and have a reduced chance of successfully breast feeding.  This knowledge can sometimes be very troublesome for a teenage girl.  I would suggest a consultation with a board certified plastic surgeon to discuss the options for your daughter.

William Byron Barber II, M.D.

has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com