Everything You Ever Wanted to Know About Injectables

From what they are and who to get them from to avoiding the dreaded ‘frozen face’

Just over 30 years ago, Vancouver-based doctors Jean and Alastair Carruthers discovered that botulinum toxin (Botox), a substance they were injecting to control eye spasms, was also getting rid of wrinkles in patients.  

Cut to 2019, where multiple other injectables have been developed for lifting, plumping and getting rid of wrinkles, and Botox is a household name, with the number of injections given each year increasing by 36 percent between 2014 and 2018.

Despite their popularity, there’s still a lot of skepticism, fear and secrecy, so we chatted with two doctors who specialize in aesthetic medicine about all things injectable. 

What kind of injectables are there today, and what can they achieve?

“The main types currently used in aesthetic medicine are neuromodulators, for example, Botox, and dermal fillers, such as Juvederm,” says Dr. William McGillivray, medical director of Project Skin MD. “Neuromodulators relax certain muscles that cause wrinkling of the skin. Dermal fillers are used to replace volume that has been lost during the aging process. Research has shown that dermal fillers also stimulate collagen on a long-term basis.”

Who is legally allowed to administer injectables, and what do you think about that? 

“In Canada, every province regulates who is legally allowed to administer injectables. In B.C., medical doctors and nurses under the direct supervision of a medical doctor can legally administer injectables. Dentists are legally allowed to inject neuromodulators, and specifically trained naturopathic doctors who are cleared by their College are allowed to administer injectables,” says Dr. McGillivray.

Dr. Amanda Lau, medical director of Skinfolio, believes our province could stand to be a little more rigorous. “Naturopaths are delivering dermal fillers and Botox injections, but they don’t have medical degrees or the training in anatomy that’s required to do these things well,” she says. “Even someone like me, a medical doctor and a trained physician, I will leave certain things like nose fillers to my plastic surgeon colleague. All of these things are actually quite safe, but in the wrong hands, it can be risky.”

Dr. McGillivray agrees that these treatments should be given by medical doctors or nurses under the supervision of doctors. “Medical doctors by and large have the most experience with these treatments, and they have to follow the guidelines of the College of Physicians and Surgeons of British Columbia, which gives a reassurance of safety,” he says.

How do you usually advise people who are just beginning to think about injectables?

“Unfortunately, there can be misleading information on the Internet, including social media,” says Dr. McGillivray “Ideally, a prospective patient should research with regard to good clinics and respected practitioners in their area, and have an individual consult tailored to their personal needs.”

What’s the biggest myth you know about injectables?

“I think it’s that you can always tell someone has had them and that they make people look unnatural,” says Dr. McGillivray. “That clearly does happen, and those people are obvious to everyone, but well done injectables have quite the opposite outcome.”

How can people avoid that ‘frozen face’ look?

“People are turned off by that,” says Dr. Lau. “These days, they’re not here for drastic interventions to look younger—they want to appear like they’ve had nothing done. Part of my approach and my clients’ approach is that I often inject less than other providers. I tell people they can always build up—one week after treatment when things have settled down, we can add some more. Most physicians take a corrective approach, where it’s a one-time treatment, but I see it as a gradual process.”

Dr. McGillivray says there’s an art to aesthetic medicine, as well as a science. “Some practitioners may be using a cookie-cutter approach and thus giving too much or too little,” he explains. “There are ethical decisions with aesthetic medicine, just as in other areas of medicine, and that means doing the right thing for the patient at all times. Some younger patients may not need much help in keeping their skin youthful, while some older patients may not be getting enough in the way of treatments.”

Where does skin care fit in? Can we skimp on that if we invest in injectables?

This is a subject Dr. McGillivray is very passionate about. “All patients, no matter their age, need a skin-care program,” he says. “This starts in infancy with sunscreen for life. My ‘trifecta’, or minimum skin-care advice that I give everybody is sunscreen, including sun awareness, a good vitamin C serum in the morning and a vitamin A dervative (retinol or retinoid) in the evening. Other patients may need additional products. Aging is a comprehensive issue and deserves a comprehensive approach.”

And Dr. Lau says it’s really just being smart about where you spend your beauty budget, investing in good quality, whatever you do. “To me, it’s about quality ingredients in pure forms that deliver with fewer side effects,” she says. “When you get medical-grade skin care, you find you use less product to achieve that healthy, glowing skin that’s naturally beautiful.”