Novel uses for Botox and filler

By now, we all know that Botox helps improve the look of fine lines and wrinkles, and filler can plump our pout and restore volume to the face. What's left to talk about? As it turns out, plenty!

There are FDA-approved and tried-and-true uses for Botox and filler products, but innovations are pushing the envelope of what these products can do, and not all applications are aesthetic. These injectables, Botox in particular, are being used to treat pain, excessive sweating and other conditions that can leave people feeling insecure or on the sidelines of life.

While indeed "novel," perhaps a better word would be "innovative" or "cutting edge." Contemporary uses for these products are not a flash-in-the-pan fad. They are quickly gaining popularity and becoming mainstream.

What's new and novel for Botox?

The word "Botox" has become almost synonymous with wrinkle reduction. Beyond being on wrinkle patrol, Botox seems to be expanding its aesthetic empire by branching out into other aesthetic avenues.

"One popular off-label use is the brow lift, where Botox is strategically injected into the lateral brow depressors to create a subtle lift, opening the eyes and creating a more youthful, refreshed look," said Lara Devgan, MD. "Similarly, the 'Nefertiti neck lift' involves injections along the jawline and platysmal bands (neck) to refine the jaw contour, providing a lifted and more elegant appearance. Another sought-after treatment is trapezius slimming, where Botox is injected into the trapezius muscles (at the top of the back) to reduce bulk, elongate the neck and even relieve tension caused by stress or poor posture."

Sara Dickie, MD, is also seeing more patients ask about other novel Botox procedures.

"I have also seen a big increase in Botox for 'lip flip' procedures as people are starting to get away from filler in the lips," said Dr. Dickie. "It offers a more refined and subtle effect on the lip aesthetics and is excellent for people with thin lips, where filler can end up looking unnatural."

Don't think that the creative uses for Botox stop there.

"Perhaps one of the most intriguing emerging applications of Botox is its ability to adjust facial microexpressions," said Dr. Dickie. "Skilled injectors can subtly modify eyebrow positioning, lip tension and even the corners of the mouth to create a more pleasant, approachable appearance. For example, adjusting the cant of the eyebrows can reduce a perpetually angry or sad look, making the face appear happier and more relaxed. Similarly, Botox can soften the appearance of a downturned mouth, reducing an unintentional 'resting frown.' Another novel use is calf slimming, where Botox injections in the gastrocnemius muscles create a more sculpted leg contour, particularly popular in parts of Asia where a lean calf aesthetic is desired."

The mechanism that makes Botox a powerful wrinkle-fighter also lends itself to other medical applications, and people are starting to take notice.

"I would say that people are starting to learn about alternate uses for Botox and filler products from the social media and aesthetic education outlets, so more people ask about them," said Dr. Dickie.

What are they asking about specifically?

"I have had clients coming for axillary hyperhidrosis for many years," said Dr. Dickie.

The paralytic effects of Botox can treat hyperhidrosis, or excessive sweating. The drug blocks nerve signals that tell sweat glands to activate, stopping sweat at the source. Even more novel is that Botox for sweat is not just for the underarms.

"By injecting Botox into the underarms, palms, soles of the feet or even the scalp, sweat production can be significantly reduced, improving comfort and confidence," said Dr. Devgan.

Another non-cosmetic use for Botox is called "masseter Botox."

"Masseter Botox is another powerful treatment that serves both cosmetic and medical purposes," said Dr. Devgan. "By reducing the size of the masseter muscles, Botox creates a slimmer, more V-shaped facial contour while also alleviating jaw clenching, teeth grinding (bruxism) and TMJ (temporomandibular joint) dysfunction. Many patients experience relief from chronic headaches and jaw pain, making this treatment both an aesthetic and quality-of-life enhancement."

Dr. Dickie has also seen more patients taking an interest in masseter Botox.

"Last year, I definitely saw an increase in people asking for masseter Botox," said Dr. Dickie. "Mainly, these were people who grind their teeth and get tension headaches from this. Many of them enjoy the aesthetic effect of the treatment, but mostly they get it for relief of symptoms."

Filler rounds out its aesthetic role

The use of filler is also having an innovative moment. While the power of the plump hasn't diminished, there are novel ways that a skilled plastic surgeon can use filler to treat a new variety of aesthetic concerns.

"Fillers have evolved far beyond their traditional use for wrinkle reduction, now playing a crucial role in facial micro-optimization – the subtle enhancement of facial proportions to create a more harmonious and balanced appearance," said Dr. Devgan. "Unlike traditional volumizing techniques, micro-optimization focuses on refining small details, such as enhancing cheekbone projection, defining the jawline or correcting minor asymmetries. This approach allows injectors to sculpt a more naturally attractive facial structure without an 'overfilled' look. Another cutting-edge application is nonsurgical rhinoplasty, where hyaluronic acid fillers are used to straighten dorsal humps, refine the nasal tip or improve bridge height, offering an alternative to traditional surgery with minimal downtime."

Dr. Dickie also uses filler in exciting ways, especially for patients suffering from significant scarring as a result of acne, surgery or injuries.

"For filler, I use it a lot on scars," said Dr. Dickie. "Acne scars, trauma or surgical scars of the face are often amenable to filler, which can help flatten and smooth out scars that are depressed or tethered to the deeper tissues. In my experience, filler treatment provides excellent results and often lasts years."

The list of applications for filler is growing, according to Dr. Devgan.

"Another innovative use of filler is tear trough augmentation, which addresses hollowness and dark circles under the eyes, instantly refreshing a tired appearance," said Dr. Dickie. "This technique restores lost volume in the under-eye area, reducing the shadowed effect that can make patients look exhausted or aged. Moving beyond the face, filler is now commonly used for dorsal hand rejuvenation, where aging-related volume loss exposes tendons and veins. Even more unexpected is nipple filler, an emerging trend where small amounts of filler are injected to create a fuller, more projected appearance, particularly popular among those who experience flattening due to breastfeeding, weight loss, or aging."

Is new and novel good?

What's new is always exciting. However, it is always in the patient's best interest to do their research and talk to their plastic surgeon about innovations in the industry and what type of result they can expect. Some uses and procedures remain off-label, and patients need to understand what that means.

"Off-label means that the FDA has not approved the product to be used in a certain area for a certain indication," said Dr. Dickie. "So, when a product is used off-label by a physician or other licensed practitioner, the expectation is that the practitioner understands the physiology of the product they are using and the anatomy of the treatment area and, therefore, is able to explain and defend the expected outcome. They are using their expertise to provide treatment, but there may not be sufficient data to support this or enough widespread use for a manufacturer to obtain FDA approval. So, having off-label treatments, it is much safer to go to a practitioner who is fully licensed and board certified in plastic surgery. This provider should provide insight as to whether the treatment will work as expected, for how long and what they will do if the treatment doesn't work as anticipated or there are complications."

Trends also come and go, sometimes for a good reason. You may like the look specific novel treatment options can provide, but again, it pays to talk to your plastic surgeon about the reality of maintaining those results.

"I've seen a lot of trends in Botox come and go, and mainly, it is due to the high doses needed for effect," said Dr. Dickie. "Think of 'Barbie Botox,' which is a treatment of the trapezius muscle. 'Calf Botox' to slim down thick calves. A Nefertiti lift, which is Botox in the jawline and platysma. To get the effects of these treatments, upwards of 60+ units of Botox is necessary, which is in the high hundreds of dollars if not a thousand. The Botox in these areas is still temporary, and the results are subtle, so patients see results they may like, but the maintenance is often out of reach financially."

Consider whether you are looking for a sustainable treatment option or are chasing a trend. Talking to a board-certified plastic surgeon who is an ASPS member can help uncover whether a novel Botox or filler treatment is worth the hype and the cost.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.