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Guide to Reducing Visible Signs of Aging

The Role Botox, Fillers & PDO Threads Play In Reducing Visible Signs Of Aging

By Brian Sidella, President & Founder – Forever Young MedSpa

This article was put together to assist our patients in making good, informed decisions on the role BOTOX, Fillers & PDO threads play in getting and then keeping your appearance youthful and vibrant.

Our goal was to take away the medical mysteries of how/why we age and remove much of the “medical speak” that often confuses patients with medical language.

While Botox, Fillers & PDO threads play a significant role in reducing lines and wrinkles and replacing volume lost due to the aging process, they don’t address visible signs of aging in the skin itself and that’s where Lasers & RF treatments come in. If you’d like to know about the role Lasers and RF treatments play, please check out our Guide to Facial Rejuvenation and the Role of Lasers & RF.

Am I a good candidate for BOTOX & Dermal Fillers?

First, no one needs Botox or fillers. If someone wishes to keep lines and wrinkles on their face as a badge of aging, that’s great and a personal choice. For many others though, looking younger through the use of Aesthetic Treatments such as Botox, Fillers, and Laser treatments to look & stay Forever Young is a great option.

As you will read below, the use of Botox is a treatment option that corrects dynamic lines/wrinkles in common areas of the face while fillers replace volume or fat lost during the aging process. Botox & Fillers are markedly different however and we explain those differences below and how/why they are used often in combination.

What is BOTOX & how does it work?

Botox belongs to a class of neurotoxins called Botulinum Toxin A and there are currently four FDA-approved versions in Botox, Dysport, Jeuveau, & Xeomin. We will use the term Botox in this article, however, Jeuveau, Dysport & Xeomin are in the same class of drug & interchangeable.

Many patients are surprised to learn there are three additional options and we will cover the differences later below. How all three work is exactly the same. When injected properly they simply “relax” opposing dynamic muscle groups that cause deep lines and wrinkles. Let us look at some examples:

Before and after photo showing results of aging linesWhen you squint and bring your eyes together the wrinkles that form are called the LL’s.

Left untreated the LL’s get deeper and wider until they become permanent even when resting or not making that expression.

Patients in Sun Belt states like Florida tend to develop very strong muscles in this area.

You can see the differences in the after photographs.



Before and after photos showing wrinkle reductionNow, let’s look at the forehead. When you furl or raise your brow you can see lines/wrinkles that form. These muscles tend to get very strong over time and eventually, yes… they will become permanent unless treated. In the photo, you can clearly see how defined or strong these muscles are.

The next image below is one minute after, without treatment, you can still see the lines are beginning to set in & on their way to deepening and becoming permanent.

The last photo is 10 days after her treatment.



Showing crows feet wrinklesThe 3rd area is called Crow’s Feet. When smiling these lines form & through repetition, these lines become more pronounced & eventually, permanent. As you can see in all these before and after images, the results are more youthful, restful & very natural in appearance.

Are there any other areas that Botox is used in?

Three other often treated areas include as depicted in the photos below, Dimpled Chin, Gummy Smile & Eyebrow Treatments and those pictures are below.

Dimpled chin

Gummy smile

Eyebrow treatments

What is the difference between Botox and Facial Fillers like Restylane & Juvederm?

As described above, Botox treatments treat dynamically caused lines/wrinkles by relaxing the muscles. Fillers serve an entirely different purpose as they replace the fat or volume lost during the aging process. Botox & Fillers are very often used together to provide the best clinical results.

Illustration showing fat distribution in faceTo see how we lose fat please look at the chart. At the far left at about age 35, a person’s face begins to lose volume or fat and skin begins to drop.

As we age further, the fat thins & separates, the laws of gravity cannot be denied & your face begins to sag. You look more tired, sadder, & older than you did in your recent past.

Male patients describe this aging process as looking angry even when they are not, due to this loss of volume.

Depiction of mother and daughter with facial agingLooking at the Mother/Daughter picture to the left these changes can be clearly seen.

The Daughter’s face features high cheekbones, a rounder more youthful face with nice volume throughout her entire face. Mom has reduced volume, especially in the mid & upper face which results in a more angular and a less youthful appearance.

How do Fillers Work?

We have many tools in our tool chest when it comes to fillers that are used in different areas of the face, hands, chest, and even buttock area to replace the volume of fat loss over time. Often different fillers are combined to achieve the best results. Fillers today include Restylane, Restylane Silk, Juvederm, Juvederm Ultra, Juvederm Voluma, Belotero, Restylane Lyft, Restylane Refyne, Restylane Defyne, Restylane Kyss, Radiesse, Volbella & Sculptra with more approved every year.

Before and after showing volume restorationLet’s look at some before and after pictures.

On the far left you can see the loss of volume throughout her cheek and mid-face & some jowling taking place.

By restoring that lost volume her entire area is lifted & refreshed. Her jawline is more defined, and she looks years younger.



Before and after showing facial fillersNext is an early 30’s patient who looks very good to the casual observer. On closer inspection, you can see a loss of volume in her mid and upper face.

The after pictures show a subtle, natural, and jaw-dropping difference that occurs when properly and skillfully replacing the reduction of volume or fat with facial fillers such as Sculptra. Note however that her skin also really needs Laser/RF treatments to correct her uneven skin tone, texture, pore size, and sun damage.

Male patients show a more relaxed and rested look with fillersAs you can see in the before picture, this 47-year-old patient lacks lower, mid, and upper face volume & the after picture speaks for itself.

Men come in for different reasons than women. Men are not as worried about looking their age. They want to look more
relaxed, less angry or irritated, and more rested.

If you’ve heard “I’m tired of looking so tired” once, we’ve heard it 500 times!

As you can see in all the after pictures, once proper deep and superficial volume has been restored, the results can be truly amazing. This patient also received laser & RF treatments and the improvement in skin tone/texture, laxity, and pore size is easily seen.

How many syringes of filler and how many units of Botox will I need?

Spoons demonstrating amount of fillers needed - 1 syringe vs 4.As described in the early part of this article, patients lose on average 6 cc’s every 11 years past the age of 30. The silver spoon on the photo below shows what 1 syringe looks like inside a teaspoon. The last teaspoon on the far right shows 4 full syringes easily fitting inside a teaspoon.

Most patients when asked how many syringes of filler will fit inside a common teaspoon believe that only one will fill a teaspoon. The correct answer is 5.8 syringes will fit onto just one teaspoon.

Forever Young MedSpa offersOn the subject of BOTOX, as no two patients opposing muscle groups are exactly the same strength the required dosage varies from patient to patient and especially males who typically require a stronger correction dosage.

Have you ever wondered why when receiving Botox, we ask you to make all those strange faces? We are actually analyzing the strength, length, location & depth of those muscles so we may target the specific areas more precisely.

We don’t simply inject units of Botox. We specialize in Natural Look Aesthetic Medicine and provide the best results possible for our patients using tools like Botox & Fillers to accomplish them. The artistry & expertise required to achieve outstanding results cannot be overstated.

Our policy with Botox is that we treat the areas rather than the price per unit. Why? We’ve seen the Botox Groupon “deals” with ridiculously low per-unit prices and we have retreated countless patients over the years from those types of offerings. Many centers that lower the cost per unit will over dilute their Botox and where an area calls for 20 units you are in fact receiving more Saline Units than Botox Units because to advertise low prices, they overdilute far past the 2.5ml Allergan requirement.

Every practice regardless of size pays exactly the same price for Botox so how can the national average be $16.00 per unit some practices with Groupon deals offer $8.00 or even per unit which is actually well “below” our cost to provide the treatment.

At Forever Young MedSpa, all we do each and every hour of every single day is specialize in the field of Medical Aesthetics and we don’t cut corners on anything.

What are PDO threads and how do they work?

PDO Threads are made of a very common substance called Polydioxanone and go by the tradenames of Novathreads, MINT & MIRACU Threads. They have been used in surgical procedures for decades and patients commonly know them as self-dissolving sutures. FDA-approved PDO Threads are used to gently pull your skin up providing a lifting action that fillers alone cannot achieve.

These threads are fully absorbed within 4 to 8 months but during that period of time, a lot is taking place. The placement of the threads stimulates collagen synthesis & the skin structure created will hold for another 12 to 15 months providing you a lifted, younger, and more vibrant results than we can achieve with just fillers alone.

In most cases, a patient would need to have both Fillers and PDO threads as one is not a substitute for the other. The combination of Fillers & PDO Threads provides not only volume to replace fat but also a lifting effect that cannot be achieved with just fillers as well. PDO threads come in many different sizes, shapes, smooth or barbed, and thickness and can be used almost anywhere on the face or body such as necks, jawline, decollate, butts, c, and lifting of skin just above the knees.

What’s the difference between Botox, Jeuveau, Dysport & Xeomin?

As stated above they are all the same class of drugs. Think of the brand Advil or the generic Ibuprofen. Same exact class of drug, one the original and the other a generic. For the Botox class of drugs, however, there are some differences.

Botox, Jeuveau & Xeomin inject unit for unit exactly the same while Dysport requires 2.5 times more units for the same result. Botox, Jeuveau & Xeomin come in 100 unit vials and Dysport comes in 300 unit vials because again, Dysport simply requires more units which for patients does not really matter as we take care of proper dosing. Many patients are fooled with advertisements of 50 units of Dysport for $299 because they are unaware that 50 units of Dysport are equal to just 20 units of Botox.

There are some real differences in the products that have been seen both in studies and in our own practice as well. Dysport has a much faster onset of action (begins to work faster) than Botox, Jeuveau, or Xeomin and more studies have found a slightly longer duration as well.

Combine this with Dysport costing on average about 15% less and that’s why over 90% of our patients have switched over to Dysport. Dysport, as you can see in the chart below also has the highest concentration of active toxin as compared to all others in this group.

Screen cap of video demonstrating active toxin content by brand

What about Xeomin & Jeuveau? Both are good products with their own niche. Over time some patients develop a resistance to Botox or even Dysport. Not to the actual Botulinum Toxin A but rather to the proteins used as additives in both products. Xeomin & now Jeuveau is the purest form of Botulinum Toxin A available and is often used on patients who have developed a resistance to Botox & Dysport or for patients who simply want the purest form available or those that may have an allergic reaction to the additives in Botox or Dysport however, that is pretty rare. Longevity is reported to be just a bit shorter than Botox or Dysport.

I’m concerned about bruising, swelling & pain associated with needles!

First, know that our Certified Aesthetic Practitioner Injectors are supremely qualified & certified with all our injectable procedures. That said, no one “likes” injections, especially on their face. Forever Young Medspa is very proud that we’ve introduced some cutting-edge pre-treatments that make the experience unique from other centers. It begins with a kind & gentle touch combined with the skillful art of having performed countless thousands of injections over the years along with a prescription-strength topical numbing cream.

Image showing placementNext, we use a vein imaging system that allows us to look under your skin and avoid all the major veins and larger vessels.

While bruising can still occur, it is typically minor & greatly minimized by using this vein imager.



Woman receiving oxygen / nitrous oxide mix - ProNox.We also offer for a slight additional fee the ProNox system that provides a 50/50 mix of oxygen and nitrous oxide. This takes the edge off & helps with anxiety, especially for newer patients.

Many of our patients LOVE the ProNox experience. The effects are very quick to wear off and patients can resume normal activities in minutes.

For Botox injections, we also use The INViSIBLE NEEDLE which has a 14% thinner diameter than the other 33G needles and most practices still use much larger 31G needles, and compared to 31G needles, our is over 50% thinner! These needles cost far more than the industry standard but patient safety, minimizing bruising and comfort for our patients are all equally important.

You won’t find systems like these in most other centers in South Florida or the entire USA. Forever Young MedSpa has a long history (Since 2005) of excellence and market leadership.

Our patients appreciate that while the price is always important, patient safety – results – technologies & practitioner qualifications matter most of all.

Besides Laser, RF, PDO Threads, Botox & Fillers what else should I have done?

That depends on what’s important to you and your budget. The great news is that we offer almost everything possible. We stress the importance of all our patients having monthly DiamondGlow or Frozen C facials. Proper exfoliation, deep pore cleansing, and removal of that tired, dull-looking top layer of skin are all critical to your overall skin health.

One of our other core specialties is a non-surgical body shaping and muscle enhancement. Few centers anywhere in the world offer all these treatments such as the all-new CoolSculpting Elite, EMSCULPT, Vanquish ME, Exilis Ultra, Venus Freeze & Venus Legacy all under one roof!

Lastly, while we have millions of dollars and all the latest and best FDA-approved systems in the world, they are secondary to our staff of wonderful, kind, loving & caring medical aesthetics professionals.

Over the past 16 years, we’ve developed our own success protocols and techniques born from having performed more than 65,000 procedures.

Our patients understand that one does not simply wake up one morning, look in the mirror and suddenly realize they have aged 30 years. Aging and anti-aging is a process that typically requires months to achieve and then follow-up treatments are necessary to maintain the look. There is no such thing as a one-and-done treatment protocol, at least not yet…

We LOVE what we do and look forward to helping you on your journey towards looking and then staying, Forever Young.

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