Botox and hyaluronic acid are absorbable products, that is to say, they are degraded naturally by the skin over time. The result is therefore transitory, but it is a guarantee of security. The risk of reaction is much lower than with a product that remains permanently in the skin. However, these two injected products do not obey the same regulations.
Botulinum toxin is a drug
This medicine has a marketing authorization. Used since the 1970s, it is a safe product. In France, three brands of this localized muscle relaxer are used in aesthetics. Only surgeons (maxillofacial surgery, face and neck surgery, and reconstructive and aesthetic plastic surgery), dermatologists, and ophthalmic are authorized to inject it.
Contraindication : it should not be used in people suffering from certain muscular diseases (myasthenia gravis, etc.).
Hyaluronic acid is a medical device
This large moisturizing sugar molecule, which corrects volumes, falls under the medical device, in the same way as breast prostheses or dressings. This invasive device (because it is injected into the skin) is therefore not considered to be a drug. It is subject to CE marking, which only guarantees the sanitary quality of the formula.
In France, around 100 products are marketed by 35 manufacturers; they are regularly checked by the National Agency for the Safety of Medicines and Health Products (ANSM), with the help of external experts. Any doctor can inject it into the face.
Contraindication: it should not be used in people who have been injected with permanent products, suffering from active autoimmune diseases, and in those with keloid scars, an inflammatory scar condition.
Choosing the right practitioner
It is not always easy to choose your doctor, especially as aesthetic medicine is not recognized by the National Council of the Order of Physicians. Prefer a practitioner with specialized training. “The anatomy of the face being little studied during medical studies, certain diplomas allow doctors to learn injection techniques”, explains Dr Cécile Winter.
The practitioner should ask you about your medical history, current treatments (if you are taking anticoagulants, these injections are contraindicated). He must be informed of any previous aesthetic treatment: the injection of an absorbable product on a non-absorbable, even several years later, can cause undesirable side effects.
The practitioner should also provide a quote indicating the doctor’s qualification, his registration number with the Order Council, and the references of the products injected. This estimate must be accompanied by informed consent to sign, but also oral explanations of the precautions to be taken and any side effects.
On D-day (after 15 days of reflection), the doctor must put on gloves before pricking you, use sterile equipment, remove make-up from the skin and disinfect it. He is obliged to tell you what he has injected (name, manufacturer, batch number), and must provide you with the syringe label. If not, ask for your injection book.
“The doctor must be reachable within two or three days following the operation,” adds Dr. Martine Baspeyras. If in doubt about a reaction, send them a selfie. ”
Absorbable anti-wrinkle products: what are the risks?
As with any medical act, there are some. First of all aesthetic risks, if the result does not suit. But also medical risks. According to the ANSM, side effects related to hyaluronic acid injections would affect 0.1 to 1% of people.
The most common – edema, small bleeding, or bruising – subside in a few days. Rare, theallergy to hyaluronic acid exists, causing a localized inflammatory reaction such as urticaria. In some women, nodules may appear and create a small lump in the injected area, sometimes several months after the procedure. White blood cells attack hyaluronic acid to digest it and die. This nodule is treated by anti-inflammatory treatments based on corticosteroids and massages, or punctured.
It can also happen that hyaluronic acid is injected into an artery and mouth. ” It’s here complication the most serious ”, underlines Dr Ludovic Lievain. It can cause skin necrosis or vascular emboli (kinds of clots). Injection with a cannula with a round tip avoids this phenomenon. These problems remain extremely rare and can be resolved if the doctor reacts right away by injecting hyaluronidase, an enzyme that dissolves hyaluronic acid. Subject to Marketing Authorization, it is authorized exclusively in the event of a vascular complication. Only surgeons, dermatologists, and ophthalmologists have this antidote. “Pain, skin that turns white or blurred vision should be warning signs,” recalls Dr. Lievain.
On the side of the botulinum toxin, there are no cases of side effects linked to the molecule itself.
To find out what it really is about the different techniques aimed at reducing wrinkles, plumping the skin, and stimulating cell regeneration, listen to this episode of Hypercondriac, Santé Magazine’s prevention podcast. Aline Perraudin, the editorial director, receives Pr Brigitte Dréno, head of the dermatology-oncology department at the Nantes University Hospital and member of the health magazine scientific committee.