Botulinum Toxin and Facial Fillers

Botulinum toxin injections are the most popular cosmetic medical treatment in the U.S. Many people — both men and women — choose it to refresh their appearance without surgery.

This treatment has a long history in eye care. In fact, its first medical uses were in ophthalmology and oculofacial plastic surgery. Today, oculofacial plastic surgeons are among the most skilled in using botulinum toxin to soften lines, reshape the brows or jawline, and improve facial balance.

Botulinum toxin works by relaxing the muscles under the skin. In high doses, it can weaken muscles significantly; in lower doses, the effect is more subtle. Your doctor will carefully choose where and how much to inject to treat:

• Frown lines between the eyebrows

• Crow’s feet (lines at the corners of the eyes)

• Horizontal lines in the forehead

• Eyebrow shape and height

• Lines around the lips

• Downturned corners of the mouth

• Twitching or spasm in the eyelids, cheeks, or face

The injections use a tiny needle and take only a few seconds. They may feel like a small pinch, and any discomfort is brief. Results usually begin to appear within 2–3 days, with full effect in about 2 weeks. The effects typically last 3 to 5 months.

Side effects are rare. Bruising may occur but fades naturally. In some cases, nearby muscles may be affected, causing temporary drooping in an eyelid or lip. To lower this risk, your doctor may recommend not touching the area for several hours after your treatment.

Facial fillers are another popular option for non-surgical facial rejuvenation. They can be used on their own or combined with botulinum toxin for a more complete result.

Fillers work by adding volume under the skin. This helps smooth wrinkles, lift sagging areas, and improve facial shape. Common uses include:

• Enhancing lip shape and fullness

• Smoothing lines around the mouth

• Restoring volume to the cheeks, temples, and eyebrows

• Improving the look of dark under‑eye circles

• Adding structure to the jawline or earlobes

Most fillers are made from hyaluronic acid — a natural substance found in the body. Others are made from long-lasting synthetic materials.

The filler is injected with a tiny needle. Numbing cream, ice, or a local anesthetic may be used to make the treatment more comfortable. Results are visible right away, but mild swelling is common for a few days. Bruising may also occur and fades over time.

Depending on the type of filler used, results can last from 6 to 18 months (longer for some types).

All procedures carry some risks, though serious complications are rare. Possible side effects include:

• Bruising or swelling

• Bleeding or infection (very uncommon)

• Temporary unevenness or asymmetry

• Rare allergic reactions to filler material

• Rarely, fillers can block a blood vessel, which can affect skin or even vision. This is extremely uncommon, and your surgeon is trained to take steps to minimize this risk.

Botulinum toxin may cause nearby muscle weakness, which can lead to temporary drooping in an eyelid or lip. Fillers may create lumps, bumps, or unevenness, but these usually settle or can be adjusted.

Let your doctor know if you take blood thinners, as this can increase your risk of bruising or bleeding. Your surgeon will go over all potential risks with you and answer any questions before treatment.