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“Liquid Face Lift”: Neurotoxins and Fillers Examined

The “liquid face lift” is the current buzz phrase for non-surgical facial rejuvenation. It combines two different aesthetic treatments to provide a lifted or firm appearance of the facial skin. It’s becoming very popular for women in their mid-30s and older, causing a growth in media attention which has led to greater demand for aesthetic practitioners offering “liquid face lifts”.

Liquid Face Lift Wrinkles are caused by both repeated muscle contraction and aging skin. The “liquid face lift” treatment combines the use of neurotoxins to temporarily relax muscles, and dermal fillers injected into the skin to smooth wrinkles and restore lost volume due to aging.


Neurotoxins (specifically, the Botulinum Toxin Type A) treat facial muscles. Over time, repeated muscle contraction causes wrinkles to appear, particularly around the eyes and across the forehead. Injecting small amounts of Botulinum Toxin Type A directly into specific muscles blocks the nerve impulses that trigger muscle contractions. The muscle relaxes, and the wrinkles smooth away. This is a temporary effect, lasting from three to six months.

First used to treat uncontrolled blinking, the neurotoxin BOTOX® Cosmetic was then developed to treat moderate to severe frown lines between the eyebrows.

Botulinum Toxin Type A is approved for temporary improvement in the appearance of moderate to severe glabellar lines. It’s also safely used for several “off-label” treatments.

Neurotoxins include:

  • BOTOX® Cosmetic (onabotulinumtoxinA)
  • Dysport® (abobotulinumtoxinA)
  • Xeomin® (incobotulinumtoxinA)

Dermal Fillers

There are several types of dermal fillers. Dermal fillers are gels or compounds injected into the mid to deep dermis to correct moderate to severe facial wrinkles and folds, such as the nasolabial folds. Some dermal fillers, such as Restylane®, are also approved for lip augmentation.

In addition to temporarily reducing or eliminating the appearance of lines, wrinkles and folds, injectable fillers are used for facial contouring by adding volume to facial tissue. Dermal fillers can even correct asymmetries.

Over time, these dermal fillers are absorbed by the body.

Hyaluronic Acid

Hyaluronic Acid fillers are probably the most popular treatment option. Hyaluronic Acid occurs naturally in the skin, so there’s no need for skin testing, and minimal risk of allergic side effects. They last from six, twelve, 18 or 24 months. Examples include:

  • Juvederm®
  • Restylane®
  • Perlane®
  • Belotero®
  • Voluma® FDA approval pending

Collagen Fillers

Collagen breaks down quicker than other dermal fillers, and is no longer a popular treatment option. But as with all facial augmentation products, new research and developments could lead to new product breakthroughs. Collagen fillers last for about 3-4 months. Examples include:

  • Evolence Collagen Filler

Synthetic Dermal Fillers

Synthetic fillers consist of synthetic gels. Radiesse, for example, is an injectable calcium hydroxylapatite implant, which adds volume to facial tissue. It lasts about 18 months. Examples include:

  • Radiesse®


There are products that do not provide immediate filling by adding volume through its own composition, but gradually add volume to the injected sites by triggering a stimulation of collagen production.  This new collagen results in a thickening of the dermis and a volumized appearance. Examples include:

  • Sculptra®
  • Radiesse®

Permanent Synthetic Fillers

There is a new, non-absorbable synthetic dermal filler. Polymethylmethacrylate beads (also known as PMMA microspheres) are not absorbed by the body. These beads are made from a synthetic polymer, biocompatible and non-biodegradable. The microscopic beads are suspended in a gel which contains bovine collagen, and injected. The only FDA approved permanent synthetic dermal filler is:

  • ArteFill®

Facial anatomy

Aesthetic practitioners must of course have a thorough knowledge of facial anatomy and physiology. Understanding facial musculature as well as skin is necessary before offering safe & effective facial contouring treatments.

In conclusion, effectively combining Botulinum Toxin Type A and dermal filler treatments means clinicians really can offer patients a “liquid face lift”.

Sources used in researching this article include theU.S. Food and Drug Administration’s Wrinkle Fillers site and the U.S. FDA’s neurotoxin page.