Are Your Injectables Safe and Effective? (Botox, Jeuveau, Dysport, Xeomin, Juvederm, Restylane, Belotero, Voluma, Bellafill)

It seems to me clients in MedSpas are folks that are either pro-injectables or anti-injectables.  For those exploring the options available, which Botox and Filler is safe and what is effective? Here’s the low-down on what works, what doesn’t, and even more, what is UNSAFE…

Neurotoxins… Botox, Jeuveau, Dysport and Xeomin (I know it sounds scary, but it isn’t)

Toxin products were originally created for medical purposes. Originally used on children with Cerebral Palsy and by Ophthalmologists for out of control eye spasms and eye twitching, it is the first protein in the Botulinum chain. Although that sounds frightening, if it were dangerous it wouldn’t have been used on children right out of the gate. The way they all work is to freeze or block nerve activity to suspend muscle movement. All toxin products work best to freeze wrinkles between and around eyes, on the forehead, above the lip and occasionally on the chin.


Toxin products are very, very safe. In my 17 years in the business I’ve literally never seen someone have an allergic reaction to them, which I can hardly say about any other product I’ve worked with. The other thing that makes them great is that they are very temporary, the average treatment holds 2-4 months. So if something is wrong with your service, it will wear off quickly.

Differences Between Toxins


Botox was the original creation in the category and has been the gold standard from the get go. It’s very safe and effective and has many fans. It is a combination of Botulinum A and a preservative protein. Most complaints about Botox come from the hands of a poor injector, not the product itself. It is very important to choose your injector wisely for optimum results, improperly placed product is what makes most folks unhappy with their results.

Additionally, there are some minor issues surrounding injecting the forehead. To get a completely tight forehead you can make the upper eyelids heavy and saggy. So for those with heavy lids already, this may not be the best product for you. The product overall has a sort of a weighted feeling to it, which some folks love and others don’t.

It also has many, many FDA approved medical uses including significantly reducing migraines, helping facial twitching, it’s used to help overactive bladders, its used to control excessive sweating, MS symptoms, crossed eyes, tennis elbow and Bell’s Palsy symptoms.


The first new neurotoxin released on the market in over decade, Jeuveau has the same molecular structure as Botox. It’s strain of toxin is slightly different than Botox’s (Botox, or onabotulinumtoxinA, is made by Allergan in Westport, Ireland; Jeuveau, or prabotulinumtoxinA, is made by Evolus and comes out of Seoul, South Korea.) The risks and potential side effects listed by the companies are also identical.

The product is injected with the same “units” and techniques as Botox and studies show it has identical longevity. It is a softer, less rigid neurotoxin that has less discomfort than Botox, plus a more natural finish. It feels less weighty in your body too and moves in slowly and gently over a 14 day period. At a lower average cost per unit it’s a great value.


Dysport works from a nearly identical molecule base as Botox. Created through a combination of Botulinum A and a preservative protein (think of this preservative as a protective coating around the toxin molecule- nearly identical to Botox but it contains a smaller protein molecule.) Because of the lower protein count, folks are less likely to become immune to it versus Botox. The science behind Dysport says it should last longer than Botox due to the same lower protein count, but in my personal experience, it seems to last nearly the same amount of time as Botox.

It also varies in that it has more spread at the site of the injection. Which means clients usually need less injection points (ie less pokes with a needle – yeah!) but it also means your injector should be MUCH MORE CAREFUL injecting it as it can have a greater potential for bigger negative side effects (ie blurry vision.) Additionally, Dysport is diluted more than Botox, so once again, you want to make sure you have a skilled injector using it!


This least well-known toxin is the newest player on the market. It contains the same Botulinum A but is injected without the protein around it. Think of it as a purer version of Botox. The company chose to remove the protein in an effort to eliminate problems of becoming immune to the product over time. It makes it a smaller overall product, and it is equally effective as Botox with some minor differences. In particular, it has far less weight than Botox and as the client you feel less heavy in the areas treated. I personally find it to be the best choice for clients who want the most natural looking effect.

Additionally, in some ways it’s safer to inject as it doesn’t spread like Dysport, so it has less risk of negative side effects. The major complaint of Xeomin is that it may not last as long, however, if injected properly it should. It is significantly cheaper than it’s competitors so even if it lasts less time, it costs considerably less. It also kicks in faster than Dysport or Botox so you see results sooner.

I have to reiterate that your injector makes a HUGE difference in the look and effect of all of these toxins… do your homework on your technician or get referred by a friend! The only thing that makes a toxin unsafe is your injector… any issues I’ve ever seen have been at the hand of a “cowboy” injector (someone taking risks they shouldn’t with your injection) or an inexperienced injector.

Dermal Fillers

Dermal Fillers are primarily used to “fill” lines and wrinkles in the face. Where?


There are 3 main types of Dermal Fillers… Hyaluronic Acid Fillers, Lab Made or “Permanent” Fillers and Collagen Based Fillers.

How do they work?

Which are the best? Which are the safest?


Hyaluronic Acid Fillers… Juvederm, Versa, Voluma, Belotero, VolBella, Restylane

If you’re interested in the SAFEST fillers then this is the category you should focus on. Hyaluronic Acid Fillers use something that’s already inside of you to fix your sagging face! What is it? WebMD explains it well:

“Hyaluronic acid is a substance that is naturally present in the human body. It is found in the highest concentrations in fluids in the eyes and joints.

These types of fillers are soft and natural looking, they work inside your body to improve collagen formation in the most effective way. They dissolve effectively over time and can be easily broken up if your injector places it incorrectly. All fillers have a risk of allergic reaction but this group has the lowest chance of that happening. They all have differing thicknesses and placement is determined by that. How do they run?



These fillers are primarily used to help with the super fine lines around the mouth and above the lips. They are additionally used to enhance lip volume as well. In this use, they are a great solution!


Occasionally injectors use it under the eyes, BUT I PERSONALLY FIND THIS A RISKY PRACTICE. I’ve seen it go wrong with the following negative side effects:

  • Permanent “bruising” look under the eyes (comes from pressure from the filler)
  • Uneven semi-permanent swelling on one side or the other
  • A high risk of hitting critical capillaries under the eye area causing permanent damage

There are far better results using lasers under the eyes, I would recommend a different solution in this area…

The thinnest, well-known (and safest) fillers are VolBella, Belotero and Restylane Silk. I find the performance of all of them pretty satisfying when injected properly, the biggest difference is price so make sure you ask!!

Medium Weight Fillers

These fillers are slightly thicker than the ones listed above. They are also silky in texture. Medium weight fillers do a great job of filling deeper lines in the face, such as the “parentheses” around your mouth, softening the jaw line and plumping up cheeks. Lasting 8-14 months after a single visit, with the right injector they create a soft, subtle reduction in those lines. These are all the safe locations to use these. The safest fillers for this area are Versa, Juvederm and Vollure.


There are a few UNSAFE spots to inject these fillers, even though the fillers themselves are safe. Filling the line that can occur between your eyes is a very risky and potentially dangerous spot. Filler is placed much deeper than Botox or Xeomin and has a big risk of your injector hitting an important vein there. If that happens… it’s really, really bad… perhaps leaving a hole of dead tissue between your eyes. This is a serious risk and I therefor recommend staying away from there.

Thickest Fillers

The last category of Hyaluronic Acid Fillers is the thickest category. These fillers are primarily used for cheek filler. You need more weight to the product to fill a cheek with significant fat pad loss and these fillers are the best for that AND they last the longest of all fillers. The best ones for this area is Voluma (actually called Juvederm Voluma) and Restylane.

Cheek filler can be done well or terribly based on your injector!! Placement of your cheek product determines the effectiveness and look of your filler and if placed incorrectly can make you look like a chipmunk… it’s usually mis-placed filler that is making your favorite celebrity (or your best friend) look bizarre! Too much filler in the lower face makes them look fat. Too much cheek filler in the wrong spot gives someone weird round apples in the cheeks. But proper placement looks beautiful and natural!

Bad filler:

Too much filler in apples of cheeks


Too much filler in the lower face

Beautiful filler:

Man-Made or “Permanent” Fillers

I hope you made it all the way down to this part of the article because this was the inspiration for writing it in the first place! Man-Made or Permanent Fillers is the category where the greatest filler risk exists. These products do not naturally occur in the body NOR do they belong there.

This category contains the following products: Bellafill, Radiesse, Sculptra and Silicone

All of these substances were derived in a lab and CANNOT be broken down if something goes wrong or if they are mis-placed. The least dangerous of these is Radiesse, as the company has a protocol to break down the product, but I don’t personally know what success rate that has.


The least scary of the man-made fillers is Radiesse. It is an injectable hydrogel that contains tiny particles of calcium hydroxylapatite (a substance that occurs naturally in human bones and teeth). Even though it is man-made, it is effectively based on a natural substance in the body and therefor the body accepts it well and naturally breaks it down over time so it is not considered a “permanent” cosmetic. I do find it to be the only acceptable man-made filler.

The only reason it isn’t as nice as other filler is that the body swells significantly after being injected, so it has more downtime than most fillers and takes awhile to look natural. But it lasts significantly longer than other fillers so for those who break down their filler quickly, it is a better solution.

I want to speak the most about the scariest injectables though: Bellafill, Sculptra and Silicone.


Bellafill is a product that has been around for years but has recently been re-branded and re-released after years of bad publicity under the name Artifill. It is made from a combination of bovine collagen (vegans beware!) and polymethylmethacrylate. It’s the last ingredient that is scary… Encyclopedia Brittanica explains this product to be:

“A transparent and rigid plastic, PMMA is often used as a substitute for glass in products such as shatterproof windows, skylights, illuminated signs, and aircraft canopies. It is sold under the trademarks Plexiglas, Lucite, and Perspex.”

Ummmm… none of this should be injected in your face, ever! I have personally seen a number of terrible results from this product. Picture an injector placing product in the wrong spot and never being able to remove it. But worst of all, I’ve seen the body reject the product and literally force its way out of the skin leaving holes in the face which are impossible to fix, even by the best plastic surgeon!

Filler being pushed out of skin

You can see more scary pictures about this going wrong at: https://www.realself.com/review/kansas-city-mo-bellafill-safe


Sculptra is a man-made filler made from Poly-L-Lactic acid. It sounds safer because lactic acid naturally occurs in the body, but it usually used medically on pins, plates, screws, intra-bone and soft-tissue implants. It isn’t designed to be an effective filler for the face, it’s actually a polymer, another product that shouldn’t be injected in the face. The National Institute of Health explains it as:

“The L-isomer of polylactic acid is a biodegradable, biocompatible, biologically inert, synthetic polymer.”

Sculptra is a sneaky filler as it looks beautiful after being injected and doesn’t show it’s nasty side effect till much later. What happens with it is that on some patients, it begins to harden and become lumpy over time. I worked with a woman who had it harden under her eyes and in her hands right before her daughters wedding. When she called the company for help they told her it had to be surgically removed to get it out!! This great risk makes it a filler to stay far away from!

Sculptra hardening under the eye


Silicone injections are a scary, underground cosmetic procedure. Used lightly in the face or illegally as a heavy fill in the butt has proven to have seriously frightening side effects, including death. Used in the face, the product hardens and as you age, it can show and permanent rivers under the skin. In an NPR article:

“Newberger describes one patient who had injections when she was in her 40s. As the patient reached her 60s, her skin started to thin, a normal process of aging. “But the silicone didn’t thin,” says Newberger, “so the patient was left with ridges where she had wrinkles.” The permanent raised ridges of silicone became discolored and now, Newberger says, the patient looks like a “klingon.”

Once silicone hardens, it can also migrate to other parts of the body. Newberger has a number of patients who have lumps and bumps on their cheeks and other parts of their face as a result of the silicone moving away from the initial site of injection.”

So let’s just stay away from permanent fillers!

Collagen Based Fillers

These fillers were the first ones to enter the filler marketplace but at this point they are hardly used. The body metabolizes these fillers so quickly (2-6 months) that they quickly disappeared from use. They are generally made from bovine collagen but hardly worth discussing anymore. There was a high risk of allergic reaction to them as well.

Final Thoughts

Whew! That was a lot of information, I hope you digested it well and learned what’s safe and what isn’t. So do your homework on what’s being put in your face AND your injector as well. An informed client is a safe client!

Jennifer Warmann-Bloss

-Jennifer is a blogger, mom and owner of Elemental Esthetics in St Louis, MO










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