Injectable Facial Treatments
Putting your best face forward.
Fillers & Biostimulators
Our Indianapolis-based Dawes Fretzin dermatologists and physician assistants are highly trained in performing safe and effective injections of fillers, biostimulants such as Sculptra, anti-wrinkle treatments like Botox, Xeomin, and Daxxify, as well as Kybella. We are dedicated to delivering natural-looking results while ensuring your comfort throughout the process. Whether you desire to restore lost volume, reduce fine lines and wrinkles, or achieve a more youthful appearance, our personalized approach and state-of-the-art techniques guarantee exceptional outcomes.
Expert injectors at Dawes Fretzin will consult with you regarding aesthetic concerns you have that are the result of facial expression lines or volume loss, and match you to the right treatment and approach. Start with a consult with an injector physician or PA if you are unsure of what you need! (You might want to start with a consultation with an aesthetician if your main concerns pertain to skin quality or products.)
Injectable treatments include:
- Anti-Wrinkle Injections/Neurotoxins
- Volumization procedures
- Hyaluronic Acid Fillers
- Radiesse
- Sculptra
- Selphyl PRFM
- Kybella
Anti-Wrinkle Injections/Neurotoxins
Over time, lines can become imprinted in the skin due to repeated movement of underlying muscles. Commonly, such lines occur between the eyebrows (the so-called 11’s), across the forehead, or around the eyes (crow’s feet) or mouth (vertical lip lines). Try making a variety of facial expressions at yourself in the mirror (best done in private to avoid stares), and you will see what we are talking about!
When injected selectively into muscles of facial expression, neurotoxins such as Botox, Xeomin, or Daxxify block chemical signaling of the nerves that cause muscle movement, effectively relaxing or temporarily paralyzing small muscles of the face to allow skin lines to soften. Natural-looking results can be obtained, and the “frozen face” avoided with careful technique and proper understanding of facial dynamics. Your injector will discuss your goals and priorities with you prior to injecting to make sure he/she achieves a result you are happy with. Occasionally, a touch-up may be needed 2 weeks after the initial injection to get the best possible result.
Anti-wrinkle injections generally take less than 10 minutes to perform and do not generally require any numbing. There is typically no downtime, although bruising can occasionally occur. The treatment takes effect slowly, reaching its maximum effectiveness typically around 2 weeks after injection. Visible lines will begin to soften once the movement has diminished consistently for days or weeks, depending on how deep the lines are to begin with. Movement will slowly return after a variable amount of time, depending on the dose administered and your own body chemistry, but treatments are generally recommended every 3-4 months in most cases. It is generally recommended that immediately after treatment patients move their facial expression muscles a bit extra in the first hour, avoid laying down for 4-6 hours, avoid massaging injected areas, and avoid intense exercise for 24-48 hours after injection.
At Dawes Fretzin Indianapolis and Westfield, we offer the following trusted brands of anti-wrinkle injections:
Volumization Procedures
As we age, we lose both bone mass and fat in certain parts of the face that can cause the face to start to look sad and bottom heavy. In addition, some are genetically born with insuffient facial volume from a young age, for example in the tear trough, cheek, or chin area. In either case, volume can be tastefully and effectively restored through the use of fillers and/ or collagen stimulators.
“But I don’t want to look like an overdone Real Housewife!” you say. Never fear! We don’t want you to look like that either, and will in fact reel you in if you start to get carried away. Natural looking results occur when an expert in facial analysis and injection clearly identifies the key areas of volume loss (not always where you think!) and treat in a balanced way that is in harmony with the entire face and honors your natural features. Unnatural results commonly result from excess focus on one area and lack of balancing added volume in other areas (most notoriously, huge lips not supported by the rest of the face), or trying to force a look that isn’t natural to a certain person’s face. (See some examples of Dr. Shrift’s work below for work that look great.)
At Dawes Fretzin, we rely primarily on the Juvederm family of hyaluronic acid (HA) fillers, Radiesse (which has both filling and biostimulatory properties), and Sculptra, as well as Selphyl platelet-rich fibrin matrix (PRFM) in appropriate patients.
Juvederm
In the United States, 6 different HA fillers are approved in the Juvederm portfolio. While all are made of HA, the different products are cross-linked in such a way that they have different properties, making them best suited for certain purposes. Juvederm Volux and Voluma, for example, are more firm and better suited for supporting facial structure in areas like the jawline or cheekbone. Juvederm Ultra and Ultra Plus tend to pull more water in to the tissue, so are better at plumping, while Juvederm Vollure and Volbella are great at more subtle enhancement, refinement and definition of structures such as the lip border.
Radiesse
This injectable gel is composed of calcium hydroxylapetite (CaHA), and adds immediate volume similar to Juvederm, but as the gel carrier breaks down, the CaHA microspheres stimulate your own tissues to create collagen, strengthening the skin’s structure and enhancing skin quality. It can be used in various dilutions in the face, as well as in the neck, chest, or hands.
Sculptra
Sculptra is a poly-L-lactic acid (PLLA) powder that is suspended in saline and injected under the skin to stimulate collagen. It is typically administered over 3-4 sessions initially, approximately 2-3 months apart. While this option takes more time to see results (your body will make new collagen only so fast!), it is an ideal treatment for those desiring global facial volumization as well as radiant skin, as it accomplishes both! It is also a great option for those uncomfortable with HA fillers, as it works by triggering your own body’s regenerative and collagen boosting potential.
Selphyl PRFM
Platelet-rich fibrin matrix is one of the newest regenerative approaches to rejuvenation with exciting potential in the right patient. This gel is like a filler made from your own blood. First, your blood is drawn in the typical fashion and spun in a centrifuge to separate out the platelet-rich plasma (PRP) layer. This plasma is then activated and allowed to rest in a heater while it turns into a gel form that can be injected just like a filler. It is ideal for patients seeking undereye rejuvenation but who are not good candidates for filler here. However, it can be injected most anywhere that filler is used. While the volumization it provides does not last as long as an HA filler and may need to be repeated at 2-3 months, the growth factors released by your platelets trigger additional collagen formation that may have longer lasting benefits.
What To Expect
Patients seeking volumization are scheduled in a filler spot that allows a time of at least one hour in the procedure room. Numbing cream will be applied as soon as possible to maximize its effect, and the injector will confirm and finalize the injection plan with the patient. After thorough cleansing of the face with anti-septic, injections will be performed using a combination of a needle and a cannula as needed. While some pain is anticipated even with numbing cream, most patients are able to get through the procedure with minimal discomfort. Documentation of the results with before and after photos is standard and fun to look at afterwards together!
While mild bruising or swelling may occur afterward, most patients experience minimal downtime. Preparing for your appointment, we advise refraining from NSAIDs, aspirin, alcohol, vitamin E, gingko biloba, fish oil, or bromelain several days prior to minimize bruising. After your injections, you can accelerate the reduction of any bruising or swelling by purchasing bromelain supplements and Alastin post-injection serum. Please avoid any dental appointments, even cleanings, within 2 weeks before or after your injections.
Discover the range of Fillers we offer:
Kybella
Occasionally rather than adding volume, we wish to instead decrease volume, especially when it comes to double chins! Kybella is an FDA-approved synthetic version of naturally occurring deoxycholic acid that targets and breaks down fat cells. This treatment is most effective for individuals with good skin tone and elasticity in the neck, as Kybella reduces fullness but does not typically tighten the skin. It is therefore NOT a good option if the primary problem is a saggy neck. Optimal results typically require 2-4 treatment sessions, spaced about 2 months apart. Swelling, bruising, numbness, or a feeling of lumpiness beneath the skin are common but temporary side effects. Unlike other treatments, maintenance sessions are not necessary as the destroyed fat cells do not return.
During the procedure, patients may experience a burning sensation shortly after the injection. However, the area is numbed before and after the treatment using ice to minimize discomfort. The injections only take a few minutes once the area is numbed, and most swelling resolves within 3-5 days. A consultation with our physician will determine if you are a good candidate for Kybella.
Fillers & Injections F.A.Q.s
Approximately 94% of millennials are considering Botox treatment. The most common area treated is the glabella, commonly known as the “11” lines between the brows.
Patients of different ages consider Botox for various reasons.
- Consider Botox in your 20’s if you’re interested in delaying fine lines from forming.
- Patients in their 30’s begin to develop dynamic lines and wrinkles and may botox to treat these dynamic lines of facial expression.
- Patients over 40 usually consider Botox to achieve a “less tired” look and to maintain a youthful appearance.
Botox has an excellent safety record, especially in the hands of a trained and experienced dermatologist. While any cosmetic procedure has inherent risks, most side effects with Botox are temporary. Some of the complications of Botox include:
- Redness due to the pinpoint swelling at the injection site and from the application of the ice packs. The redness typically lasts about 30 minutes.
- Swelling is usually mild and looks like little bug bites that disappear on their own in about 15 – 30 minutes.
- Bruising can occur at the injection sites and can rarely persist for about a week. Patients on blood thinners, aspirin, and specific vitamins are at a higher risk. Drinking alcohol, especially red wine, within 24-48 hours of treatment may also increase bruising. It is not recommended to stop any prescription medication solely for the use of Botox.
Asymmetry can occur and is most apparent two weeks after the procedure. Botox touch-up appointments are scheduled two weeks after the initial procedure to address any mild asymmetry and follow up on the progress.
- Brow drop can occur when excess Botox is injected into the forehead or when Botox is injected too low on the forehead. Brow drop is more common in men due to the shape of their brows. This self resolves as the Botox wears off, usually within 4-6 weeks. Your injector may be able to treat the muscles that pull down on the brows with additional Botox to help speed resolution.
Ptosis is eyelid droop and rarely occurs when diluted Botox spreads into other muscles around the eye or when Botox is injected at an incorrect depth. Medicated eye drops can offer some improvement, but it should resolve on its own within a few months at most. Avoidance of massaging injection sites in the hours following your injections is important to minimize risk of ptosis.
- Headaches are reported in some patients within 24 hours of their procedure. This is temporary and typically resolves with acetaminophen (Tylenol).
Two to three million dermal filler injections are performed in the United States each year, and complications occur relatively infrequently. While some swelling and bruising are to be expected, uncommon side effects such as inflammation or infection around injected filler or very rare blockage of an artery of the face or eye can occur. We use the safest techniques possible when injecting, including sterilization of the skin prior to the procedure, cautious injection technique, and use of cannulas when appropriate. In addition, most fillers can be dissolved with injection of hyaluronidase in the case of serious or persistent complications.
We also recommend avoidance of filler treatment within 2 weeks of any dental procedures or other invasive procedures that may resulting bacteria entering the bloodstream.
We have all seen images of people who had cosmetic procedures performed to intentionally exaggerate certain facial features, such as the lips. While this is a desirable look in the eyes of some, others prefer a more natural result that simply restores volume to levels present at a younger age or adds volume where perhaps it was not present due to inborn factors, such as in the case of genetically deep hollows beneath the eyes, flattened cheeks or very thin lips. The degree of volumization achieved is up to you, and depends on the amount of filler injected and its placement. It is absolutely possible to have a natural looking result and we make it our priority if it is important to you.
No, injectable treatments do not disrupt the skin surface or make you more sun sensitive, so no additional sun avoidance is required.
Treatment Pricing
Botox treatments average $200-300 for per treatment area. Treatment with fillers can range from about $500-2000 depending on how many syringes are injected. Discuss your budget with your injector at the time of consult.