Consumers' Questions

Use of Artefill

Is it safe to use Artefill above the lip or other parts of the face? I have heard pros and cons and am totally confused.

Artefill is approved by the FDA for the treatment of nasolabial folds. These are the creases that run between the nose and the corner of the mouth. It is not approved for lip augmentation. Surgeons may use Artefill, like other fillers, in other areas of the face in an "off-label" manner. Surgeons may use Artefill on other areas of the face if they wish. Some report good results, but there are no published trials to document this. You should consult with an experienced injector and determine the best course of treatment for you.
Ira D. Papel, MD, FACS

Injectable neck lift

I read about a Botox neck lift. What is this and does it work? I thought Botox was for frown lines?

The Botox® neck lift refers to the use of Botox® Cosmetic to relax muscular bands (Platysmal bands) located immediately under the skin of the neck--not a true neck lift. You are correct, Botox® Cosmetic is only approved for the forehead frown lines. The use of Botox® Cosmetic to lift the neck is off-label and has some risk. In general, cosmetic use in the neck has been reserved for people with little fat under the chin and mildly hanging skin and muscle bands. By relaxing the muscle band, the skin appears to droop less. If a botulinum, like Botox®, is injected too deeply, the ability to swallow or move the head normally may be affected.
Julius Few, M.D.

Treating migraines?

My doctor said he can treat my migraines at the same time I get my cosmetic Botox injections. Is this true?

The use of botulinum toxin (Botox®) for the treatment of migraine headache disorders has been publicized in both the lay press and the medical literature. This represents a novel and sometimes effective approach to treating this disorder, as opposed to other types of drugs. Botox® used in such treatments would constitute an off-label use of the product. Allergan, the maker of Botox® has several approved indications for the product, both for functional disorders (Botox®) and cosmetic use (Botox® Cosmetic). If you are seeking treatment of migraine headaches with Botox®, you need to have a complete discussion with your physician regarding your medical history, including other conditions that could be producing headaches. Also, your health insurance may not cover the costs of this treatment.
Mark L. Jewell, M.D.

What is Sculptra?

I thought Sculptra was for people with HIV. My doctor said it could help me look younger, that I have fat wasting in my face. I don't have HIV, I don't know what fat wasting is. Is this safe?

Sculptra® is approved by the FDA for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus. It is used "off label" in non-HIV patients. It is my preferred filler for patients like, as you describe, have lost fat in their face and either don't have any fat for transfer or would rather not undergo that procedure. Fat wasting is mere loss of fat in the face or anywhere else for that matter this can occurs with aging. Sculptra® is a safe product that relies on your body's reaction to it to "fill". It also causes thickening of the skin. It is important to realize that it usually takes a couple of treatments to get to the desired result (which may take 3-6 months). Once the endpoint is reached, it may last up to 2 years.
Jeffrey M. Kenkel, M.D.

Restylane for the Feet?

Can Restylane really make it more comfortable to wear heels? My fitness trainer said that would help me a lot.

I don't have any experience injecting Restylane to the feet and I expect the same is likely to be true of most aesthetic surgeons who regularly inject Restylane for facial aesthetic purposes. It would be prudent to "rule out" functional problems before this type of injection and therefore, I would suggest that this done after examination by an orthopaedic, foot and ankle surgeon or podiatrist. If Restylane or a hyaluronic gel injection then appears to be the best solution, it should be performed by a physician with experience in this area of the body.
Roger Dailey, MD

Acne Scars

I have horrible acne scars, and a friend suggested that injections of collagen could help? How expensive it this? Will it work and does it last?

Acne scars are the result of long time infection and inflammation of the skin’s glands; the result is an uneven surface with peaks and valleys. There are many treatments for acne scars, and filler injections such as collagen are often helpful. Fillers help to raise the valleys so that there is less of a depression around the peaks. This means less shadowing and therefore the appearance of a smoother skin surface. Collagen fillers, which can be of either human or bovine (cow) origin, are safe and effective to use if there is no patient allergy present. The injections usually last from 3-6 months, and can be repeated when necessary. Other fillers such as hyaluronic acid, calcium hydroxylapetite, and polymethylmethacrylate beads are also available for this purpose. The duration of these fillers is from 6 months to permanent. Each substance has its own advantages and disadvantages. Still other treatments for acne scars include dermabrasion, laser resurfacing, and chemical peels. A qualified physician, with experience in all of these methods, should examine your scars before helping you choose the appropriate course.
Ira D. Papel, M.D., F.A.C.S.

ArteFill Safety

I heard a doctor on TV say that Artefill was risky, but my friend had it injected and it looks really good. Is Artefill safe? Does anything last as long, like maybe silicone?

I have not personally injected ArteFill® but am told the advantages include more volume and research documents longer lasting results than other presently FDA-approved dermal fillers. Silicone in not FDA approved as a dermal filler, nor is it recommended. Longer-lasting fillers like ArteFill, (approved to treat the nasolabial folds or lines from the nose to the outer corners of the mouth) offer some advantage: The duration of results means that you do not have to inject regularly. However because of the longer duration, may doctors approach correction conservatively and it may require re-injection to achieve the desired shape and volume replacement. A disadvantage is that it is difficult to remove the filler or correct enhancement in the event the patient does not like the effect or has complications including granuloma formation (small bumps that can be felt under the skin). Complication is generally more likely with off-label use, and so the risks associated with off label uses should be thoroughly discussed with a qualified doctor before treatment.
Mark A. Codner, M.D.

Scalp Injections

My husband is bald and it looks great on him, but he has a ridge on his scull that looks odd. I've had Radiesse, Restylane and Juvederm in my face. Can these be used to smooth out the ridge on his skull?

If the ridge is due to the soft tissue on his head, yes, a soft tissue filler will help to smooth the area and could be very helpful to improve the overall contour. However, if the depression is due to a bony defect (resulting from accidents, surgery, tumors, etc.) then he may need more of a reconstructive procedure to specifically contour his skull and the bony deformity. My recommendation is for you to visit with a board certified plastic surgeon that can better evaluate the condition and advise you on the options to treat it.
Renato Saltz, M.D.


You state that hyaluronidase can more rapidly break down fillers in face. Does it break down natural acids in face, too? Can it cause perminant holes or scars in face?

Hyaluronidase is an enzyme which accelerates the absorption of hyaluronic acid based dermal fillers. When used in small quantities it can help to smooth bumpy areas after cosmetic filler injection. When restricted to overfilled areas, the response can take a few days to be noticeable. It does not seem to cause any degeneration of the surrounding normal tissue when used in this manner. It is not FDA approved for this purpose as no clinical trials have ever been conducted. This is an off label use for a drug which has been used for other purposes for decades.
Ira D. Papel, M.D., F.A.C.S.

Lazy Eye after Botox

I recently moved to New York, and have had Botox previously with great results. But on my first visit to a new doctor, I got “lazy eye”. Did the doctor do something wrong? I told him where I had been injected before.

What you describe as a “lazy eye” is technically called ptosis. Although complications from injections of Botox Cosmetic® are rare, ptosis is the most common complication reported. It results from a combination of the injected dosage and your own anatomy’s response to treatment. Ptosis is benign, meaning it does not affect your health or present any danger to you. Your appearance will improve over time as the effects of the injection begin to diminish, within 90 days.
Mark L. Jewell, M.D.


You don’t have much information on mesotherapy on your site, but the doctor I saw said it is FDA approved and showed me pictures of people who looked so much younger when they had it injected in their faces. They really looked good! You say it isn't FDA approved and you don't have much more information. Is your site up to date?

There is no conclusive, authoritative information that exists (such as unbiased, peer-reviewed clinical studies that meets the standards of an accepted medical journal) that measures both the efficacy and safety of mesotherapy. Some doctors will tell you mesotherapy is FDA approved because the individual ingredients that are compounded (mixed together) to make mesotherapy may be FDA approved for unrelated purposes, but the FDA hasn't approved mixing and then injecting these ingredients. Mesotherapy or any compounded substance, whether it is comprised of medications, supplements or both, is unsafe and should not be injected into your body for any reason.
Mark L. Jewell, MD

Lip discoloration

I had Juvederm in my lips, and see little white "pimples" under the skin on my lips. I never had those before. You can't feel them, but up close you can see them. What is this?

Juvederm is a clear gel, and is commonly injected into the lips. This is likely the natural appearance of the skin of your lips, it is simply now more visible since the lips have been augmented. Follow-up with the doctor who performed your injections to be certain the condition is benign, and not an unrelated viral or other skin condition.
Mark Jewell, M.D.

Treating Smokers Lines

I have smokers lines, and my sister-in-law had Restylane to treat this and it looks good. I went to a consultation and the doctor suggested Botox. I didn’t think Botox was for the lips?

Vertical lines around the lips represent changes brought about by loss of volume in the skin and tissue beneath, as well as the constant muscle action which creases the skin. Treatment of these lines may involve replacing volume, such as with dermal fillers like Restylane, or by decreasing muscle action with botulinum toxin. At times both remedies are used together. Botulinum toxin is most frequently used in the upper face, but has been utilized for lip creases in small doses. When placed carefully botulinum toxin can help reduce these lines for months at a time. At times the effect may not be equal, leading to a crooked smile or difficulty with speech or drinking liquids.
Ira D. Papel, M.D., F.A.C.S.

Sculptra use

If Sculptra is approved for HIV positive people, why can healthy people be treated with it?

Sculptra is FDA approved to treat lipoatrophy or facial wasting in HIV positive individuals. It is used by many physicians off-label to restore volume to the dermal tissues of healthy individuals for cosmetic reasons. Off-label means that a use similar, but not specific to a defined FDA use, that is an accepted practice among many physicians. Similarly, hyaluronic acid fillers like Restylane or Juvederm are not technically FDA approved to be injected into the lips. However, the use of these dermal fillers to augment the lips is a widely accepted off-label use.
Renato Saltz, M.D.

Salon safe?

My hair salon has a cosmetic doctor come once per week to do injections. Is this safe?

Injections are medical treatments, and should only be provided in a properly equipped medical setting. Equally important are the qualifications of the doctor performing the injections, and that you are being injected with genuine, U.S. FDA approved cosmetic injectables.
Renato Saltz, M.D.

Cosmetic Injections to the Breast

I’ve read about fat injections to get bigger breasts, but what about using Restylane?

Restylane injection for breast enhancement/enlargement has not been studied in a significant manner. It would take a large volume of Restylane or hyaluronic acid to make the breast significantly larger, making the use of Restylane too expensive to be practical for temporary breast enlargement. The only FDA approved way to augment the breast is with silicone or saline breast implants. Silicone or saline breast augmentation is safe, effective, and it is permanent. For more information, view or
Julius Few, M.D. FACS

Permanent Lip Fillers

I had collagen in my lips and I loved it, but I cannot afford to keep having injections. I saw a web site that suggest Artecol or silicone. Do they do the same thing?

The largest experience with Artecol and silicone injections are outside the US. Neither is FDA approved in the U.S. for cosmetic indications. ArteFill is similar in principle to Artecol and is U.S. FDA approved, it is used for filling deeper static facial creases, but is not recommended for the lips. The use of these products for lip enhancement has been described, but there have been several warnings for using these products in the lip enhancement area. Over time, these products have been shown to be associated with a risk for "angry bumps" that develop and are difficult to correct. These bumps can cause difficulty for the patient, both in terms of their appearance and their ability to use the lips. I currently have two patients in my practice, who had silicone injection to the lips years ago and now have a deformity that will require surgical correction. Fat injection is a safe and effective alternative to non-permanent fillers. Fat injection is very effective, lasting years in many cases, and without significant risk. Consult for more information.
Julius Few, M.D., F.A.C.S.

Cheaper Botox

My friend’s doctor offers really cheap Botox. He says it comes from Mexico and it is real Botox, just lower price because it comes from Mexico. Is he for real?

Only Botox from Allergan, Inc. is approved by the Federal Drug Administration (FDA) for use to treat glabellar wrinkles in the United States. This also permits doctors to use the injectable for "off label uses" such as the crow's foot area. Use of non-FDA approved substances is illegal and history has shown that it can also be dangerous.
Roger Dailey, M.D.

Restylane for Under Eye Hollows

I will be having Restylane injected for my under eye hollows. I am so afraid. I worry about retinal occulusion, and blindness. I also worry about long term effects. Can you give me your opinion about the procedure under the eyes? Thank you.

Restylane has become a common material for the treatment of nasojugal grooves, along the bony orbital rim beneath the eye. When performed by a qualified injector it is considered very safe and effective. I have not heard of any incidences of blindness, or other serious complications. This is possible but highly unlikely with a qualified physician. The effect should last 6-9 months. If you are deeply concerned, you should discuss this with your physician. Cosmetic procedures are elective, so don't feel compelled to have a procedure if you have great worry.
Ira D. Papel, M.D., F.A.C.S.