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Beauty Alert: The Scoop on Botox and Juvederm

By Sheryl Kraft

Created: 02/04/2015
Last Updated: 02/09/2015

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I used to say that I came from a family of vain women.

My dear and very attractive grandmother, born at the turn of the 20th century, valued her beauty so greatly that she'd go off on a "vacation" and emerge weeks later looking rather refreshed and rejuvenated. As I got older, I quickly caught on that "vacation" was merely her clever moniker for "face lift."

And my mother, a beauty in her own right, followed suit when she got to be a woman of a certain age.

But now that I'm that woman of a certain age, I've come to realize that it's not vanity, really, but rather, it's taking pride in the way we look. It's even more than that. It's the desire to look as youthful on the outside as we feel on the inside—full of vigor, energy and life.

It's unfortunate that many times an observer won't look deep enough to figure out that what's on the outside doesn't always match the inside. (But that's better saved for another discussion.)

I'm hardly alone in my feelings; otherwise, why would there be a record $12 billion  spent in 2013 on surgical and nonsurgical cosmetic procedures, as reported by the American Society for Aesthetic Plastic Surgery? Of that, $5 billion was spent on nonsurgical procedures, like Botox and facial fillers.

Curious, I recently met with board-certified plastic surgeon , who has a thriving surgical and injectable practice in midtown Manhattan to get his take on the subject. He gave me the inside scoop on Botox Cosmetic, Juvederm and Juvederm Volunma XC.

All About Botox

Botox is the first FDA-approved treatment to soften dynamic lines and wrinkles of the glabella—that's the area between the eyebrows that can sometimes cause you to look angry or distressed (when you're not even close to feeling that way). Botox Cosmetic is also the only neuromodulator approved to treat crow's feet—and I think we all know what those are. Some like to call them "laugh lines," but you can get them from more things than laughing (like repeated squinting or frowning). Effects with this quick 10-minute procedure with no downtime can last most people anywhere between three to five months. The results appear gradually over a few days, softening the dynamic wrinkles around the eyes.

How Botox Works Its Magic

Botox acts to decrease the signal transduction between the nerve and muscle, softening the muscle action and thereby relaxing or smoothing the overlying skin, Dr. Shafer explained. It's been on the market for more than 12 years, and it's the number one–selling prescription treatment in the country for these areas. "Competitors (like Dysport) have a similar effect, but different dosing, different distribution once injected, with different effectiveness."

You'll see gradual results about three to five days after the injection, and there are no restrictions after the treatment except for a rather obvious one: Don't go for a face-down massage immediately after the treatment. After several hours, the product is well incorporated. Many people sneak in a treatment on their lunch hour or on their way home from work, with no disruption to their activities.

While some might feel nervous about the name "toxin," Dr. Shafer explained that the amount used for cosmetic treatments is infinitesimally small. "In fact, any medication in large quantities could be 'toxic,' so it really is just a matter of semantics," he explained. The effects are always temporary and leave no lasting effect.

All About Juvederm

Both Juvederm and Juvederm XC are fillers composed of hyaluronic acid that can add volume to your face. Why would you want to add volume? With aging, volume naturally declines, leading to sagging skin and deeper wrinkles. As the midface deflates, the loose skin starts to create folds and creases (such as those nasolabial folds around the mouth and the "marionette lines" and jowls in the lower face).

Eek—acid!!?? "This is a technical molecular classification," Dr. Shafer said. "Rest assured, there is no 'acid' effect with these products." Hyaluronic acid is a natural molecule of the skin, found throughout the entire body. And due to its biocompatibility, the chance of any reaction or allergy is very low, he assured me.

Effects can last up to two years.

How Juvederm Works Its Magic

Juvederm is most commonly and successfully used to soften the areas around the mouth and nose, thus giving the face more contour and a subtle "lift" of sorts. "A balance is achieved between adding enough volume to smooth the wrinkles, while not adding too much to look unnatural," explained Dr. Shafer. The focus is to address the 3-D structure of the face; it's not just about smoothing a wrinkle or filling volume.

Because of Allergan's manufacturing technology, there is minimal swelling after injections, and results can be seen immediately. (Nothing like instant gratification, huh?)

OK, here's what a lot of you want to know:

Is it Painful?

Because Botox uses the smallest needle available, and Juvederm uses the second smallest, "Most patients do not require any topical anesthetic. However, I offer this if they want it. An alternative is placing some ice on the area of injection immediately prior to injection." Even better, Juvederm XC products have lidocaine added to them; this locally acting anesthetic begins to work immediately upon injection.

By the way, if you haven't already figured it out, I can vouch for this: It's surprisingly UN-painful!

Yes, like the generations of women before me, I like my looks to reflect my inner zest. Now you know my secret (but not all my secrets).

But in all fairness, I will be honest and say no, I was not away on vacation. And cosmetic treatments aside, there is a lot of truth about living a totally healthy lifestyle for the whole look-good, feel-good package: "Patients also need to eat healthy, stay well-rested and well-hydrated, not smoke and have a good daily skin-care regimen," said Dr. Shafer.

I couldn't agree more. And if my grandmother were alive today, she'd be nodding her head right along with me—but keeping it still while the doctor worked his magic with the incredible tools available today, like Botox and Juvederm.


I just saw a film in which the actress playing the mother of a 20 something woman looked the same age as her screen daughter. It was hugely distracting and inappropriate. Just not a fan of this stuff.

Thanks for the information, Sheryl. I know plenty of women who got this route so this will be welcome literature for them. I plan to "let it all hang out!"

While I certainly agree that Botox and Juvederm are far safer than facelifts it is not something that I would ever consider. I am pretty much what you see is what you get and my lines or wrinkles or sags tell the story of my life.

Two of my sisters have gotten quite a few Botox injections over the years, so I've seen much of the results with that. I'd never heard of Juvaderm, though. Hmmmm... Perhaps one day I'll give it a shot. (har, har... pun intended). Thank you for the info!

What is wrong with wanting to look your best? NOTHING. I have spent a lifetime relaxing my face so it wouldn't wrinkle! I say, go for it.

I really didn't know much about these procedures. Thanks for the information.

I am ALL for supporting anyone who feels the need to look and feel better about themselves. Of course, moderation is better than over load. We have all seen the results of excess use that these treatments cause. Aging gracefully is different for all of us. Respecting each others choices is the best we can do for one another.

My sister had botox done and she loved it. I always think about trying something like this. Thanks for all of the helpful info!

I have been seriously considering both of these. Thank you so much for explaining it so well and of course letting us know it doesn't hurt.

These are great options for a lot of women but I think I will stick to my natural face, imperfections and all :)

Oh I just don't know Sheryl. Some days those lines and wrinkles just jump off the mirror at me but I am not sure I could, no matter how safe, inject something in my skin. That doesn't mean I haven't thought about it :)! Great information! Thank you!

My feeling is, if it is safe and makes you feel better about yourself, why not? I say, go for it.

Very nice post. Botox is the best treatment for getting rid of wrinkles under eyes and for get clear skin. My cousin also got botox under eyes treatment from professional plastic surgeon through Unbooked Appointments platforms and she is fully satisfied with their service.

This is great (and much needed) information Sheryl.

It's amazing to hear all the medical benefits that can be provided by botox.

Thank you so much for showing us photos! I’ve been doing some research and trying to figure out if Botox is something for me. I am terrified of needles, which is why I’ve been so hesitant, but reading your blog does help a lot about the experience and expectations of getting it done! Thank you once again for sharing


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