Botox, Fillers and Peels – Oh My – Fighting the Aging Game

Picture 2 Generally when my husband chases the family around capturing them on his Flip Cam, I try to stay out of view. Recently, however, I saw myself on video and it turns out I am fifteen years older than I have in my head. Naturally, I cried a thousand tears (not really) and then Breezy Mama turned to my favorite derm, Dr. Vi of Comprehensive Dermatology out of curiosity (ahem) on the options that are out there. Plus, she answers questions sent in from other moms.

I look a lot older than I thought, Vi. I mean REALLY older. I’m not doing Botox. Just not (yet). But can you give me the info? Where are the best places to get injected so you can still make a facial expression?

I absolutely love Botox and Dysport — the competitor. They are quick, easy, and very satisfying to the patient. The best place to treat is the glabella- between the eyebrows. The time to start is when you have lines there, especially if you are not moving them. Other great areas are the crows feet and the forehead. You can easily treat these areas to soften the lines, but still have movement.

How much does it cost?

It ranges from about $10 per unit to $16 per unit of Botox. The glabella takes between 20 units and 40 units, depending on how deep your line is.

For moms who can’t even find the time to get their hair done, can you let them know realistically how often they have to get the Botox for upkeep?

Every 3 to 4 months.

What are the risks of Botox?

Minimal risk compared to placebo — some bruising, maybe a mild headache. Sometimes, there can be drooping of the eyebrow which does not last that long. Or uneven lifting of the forehead that can be corrected by additional Botox.

Do chemical peels help?

Depends on the type. Yes, the deeper peels such as TCA help with brown spots and wrinkles.

What are the different types of chemical peels?

Most common are Glycolic, Jessner’s and Salacylic Acid (mild, helps with texture and brown spots) and TCA (deeper, also helps with wrinkles).

Let’s go old school for a minute –what anti-aging creams do you recommend for daytime?

Sunscreen and RetinA. I also like Glycloic Acid for hydration.

What about nighttime?

31AO+ay050L._SL500_AA280_Many good over the counter creams- Oil of Olay Regenerist, Kinerase, Eucerin q10.

Retin-A has been around forever. Is it effective? Is there anything better out there? What age should I start using? What are the best Retin-A containing creams?

It is proven for antiaging. Other similar ones are Tazorac, Generic Tretinoin and Differin. I think all of these are pretty similar.

Are there any great ones available over the counter?

Retinol is over the counter and it is good- but not as good as the prescription.

What can be done to avoid a face-lift but is similar?

Fraxel repair or even fillers- but a lot of fillers.

What about to remove spots from the sun?

Sunscreen and Hydroquinone (in addition to the peels and lasers). I like Obagi, a system for bleaching based on Hydroquinone.

Sun can do a lot of damage to women’s chests, too – what can you do to tone down THOSE wrinkles?

Sunscreen and Photofacial.

My neck looks like a turkey’s. What can I do to make it look better?

Sunscreen and Photofacial. Fraxel repair would obviously help, but that is more aggressive.

Also from a Breezy Mama, “I am so tired all of the time. Is there anything I can do to minimize the bags under my eyes?”

Fillers such as Restylane and Juvederm can help. There are not many creams that really help this.

Another Breezy Mama asked, “Okay… it is too late for me… What can I do to look better and slow the process, but not do anything too drastic? In my 20’s, 30’s, 40’s and ‘ouch’ 50’s? What do I need to see a Derm for and what don’t I?”

There are things that you can do to prevent and treat wrinkles. And then there are things that you can do to just look good- but these may not prevent wrinkles in the long run.

20’s- sunscreen and start a Retinoid. These 2 things have been shown to decrease wrinkles and other signs of aging such as brown spots.

30’s- sunscreen, Retinoid. You may consider a photofacial (IPL) to improve the red and brown spots. or a chemical peel for the brown spots and fine wrinkles. Or even a deeper fraxel repair (fractionated CO2 laser) to treat the brown and red spots and the deeper wrinkles.

40’s- same as for the 30’s, but really think about the fraxel repair.

50’s- same as above, and maybe time to see the plastic surgeon.

What about facials, peels, and lasers…. what and when are their uses and how much do they really help?

Lasers can help the red and brown spots, and the wrinkles, depending on the type of laser. Peels can help the brown spots, fine wrinkles, and overall texture of the skin. Facials really help to keep you looking polished. There are no studies that facials help prevent wrinkles- but they do make you look good. I always say- there are no studies that say that pedicures prevent foot disease, but they sure do keep your feet looking good!

What is a filler? Which do you recommend? How much does it cost and how often do you need to get it done?

Fillers are really just that, they fill the lines. Well, some can also help you build your own collagen to fill the lines. There are many types of fillers and your choice depends on your lines. They range from Hyaluronic acids (Restylane,Juvederm, Perlane) that are good for the lines around mouth, the nasolabial folds, and the lips. They are also good for under the eyes, and for many other areas of the face that has lost volume (cheeks, etc). They do not last very long — from 3 months to about 1 year. But that also depends on how much you put in. A syringe of restylane costs about $600, and most patients can use 1-2 around the mouth. Again, this depends on the age of the patient as well as the desired effect. Collagen is similar to the hyaluronic acids. …The longer acting fillers such as Radiesse and Sculptra and used to fill deeper lines, such as the nasolabial folds and the cheeks. They last longer, from 1 year and longer. They are also more expensive, from about $1000 per syringe for the radiesse. …Fat transfer is also an option for a filler. It can last longer and can look natural. ….I think it is important to find a doctor that you trust and tell them what your goals are. Then you can select a filler that you will be happy with.

Dermatologists, plastic surgeons, and registered nurses can all do the peels, lasers, and fillers. I have seen all of these professionals do excellent treatments. It is really about finding one that you feel comfortable with.

I don’t want the scary plastic surgery look. If a Derm uses fillers on some of my big lines will it change my “look”?

Again, it is about conveying this to your provider. Fillers can give a very natural look. They can basically soften those lines that you know you did not have 10 years ago!

One last question that was sent in, “If I’m just a normal Breezy Mama — I don’t want to look tired and old but I probably wouldn’t consider surgery. Is it realistic to think I can slow the aging process?”

Yes- you need to do sunscreen and a Retinoid. And really take that sun protection seriously.

vi1Vishakha Gigler, M.D. is a board certified dermatologist. She enjoys practicing medical, cosmetic, and surgical dermatology, including Mohs micrographic surgery. Dr. Gigler was recognized as a “top doctor” by her colleagues in 2007 in San Diego Magazine. She prides herself in delivering the highest level of medical care. For more information, visit

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  1. Very informative…I think I will ask my doctor to take the fat from my mommy pooch and stick it in my nasolabial folds! That sounds pretty!

  2. Making am appt with her today! Gots to get me some of that Retinoid….

  3. hmmmm…. looks like I’ll be needing “the works”.

  4. Great Article! I’m starting to look younger already!

  5. HUGE fan of botox…been doing it for years. it prevents you from wrinkling your face…thus permanently wrinkling your skin…thus NOT needing a facelift down the road. at least thats what i tell myself to justify the cost. 😉 and most peels work but the second you go back into the sun, it is even EASIER to damage your skin since you had a peel. its like you create baby skin with a peel…but remember that it is more fragile and can become damamged more easily. all that said, i love a good facial, peel or filler. and as superficial as that sounds, it really is all in hopes of never “needing” a facelift as people with those scare me. just my 2 cents…

  6. Glad I found you…great post!
    I’m 63…And, unless everyone is lying to me, look at least 10 years younger…NO surgery.
    Botox, fillers, Fracional Laser Skin Rejuvenation, peels, Vitamin A, Vitamin C (antioxidant), and sunblock.
    It sounds like a lot more than it really is.
    Daily routine takes 5 minutes, max.
    Once a month, an aesthetian service.
    Check out my photo on my blog: Ageless Elaine

  7. Awesome article… Questions every 30-something-year-old has, but doesn’t know who to ask. I’m forwarding it to all my girlfriends this minute!


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