This article has been medically reviewed for accuracy by Plano, TX facial plastic surgeon Dr. Vu Ho on March 11, 2022.
Botox and hyaluronic acid filler injections are minimally invasive, require little to no downtime, and deliver consistently predictable results—what more could you ask for? One could say there’s no need to mess with a good thing, although a growing trend of using both Botox and fillers more superficially, “stamping” or microneedling them into the skin via treatments such as Aquagold and SeruGlow MD, is increasing in popularity. Turns out, these (off-label) uses can offer some very real benefits different from those that come with traditional injection techniques. Here’s what you need to know.
The benefits of superficial neurotoxin are wide-ranging and extensive
Traditionally, neurotoxin is injected deep into the muscle, where it inhibits the neurotransmitters that cause muscle contractions and, ultimately, wrinkles. With Aquagold, SeruGlow MD, or manual superficial Botox injections, you’re injecting into the intradermal layer, right above the muscle, says Dr. Amelia Hausauer, a board-certified dermatologist in Campbell, California. This won’t have an effect on facial movement or wrinkles but will do several other things, including decreasing oiliness and constricting blood vessels that cause redness, she explains. The same mechanism of action is responsible; it’s just happening in a different place in the skin. The Botox acts on the neurotransmitters that are responsible for vasoconstriction and weakens the muscle connected to the pilosebaceous unit, to decrease oil production, says Dr. Hausauer.
And while the almost immediate wrinkle-smoothing effects of traditional Botox injections are well known, some data indicates that superficial use may have some long-term effects on skin quality as well. Dr. Hausauer cites one study that found it increases the activity of fibroblasts, to stimulate collagen production. Similarly, she’s found superficial Botox injections to be beneficial for her patients dealing with hypertrophic scars and keloids. “It’s changing cell signaling and helping to control genes, for proper cell organization and function,” she says.
Superficial hyaluronic acid filler is already widely used in Europe
New York City board-certified dermatologist Dr. Paul Jarrod Frank says the entire concept of using injectables more superficially started in Europe, where there’s already a product dedicated for this purpose; Profhilo is a very dilute form of hyaluronic acid that’s injected into the top layer of the skin, and it should eventually be making its way to the U.S. market, he says. Dr. Hausauer adds that Juvéderm Volite, a similar injectable that’s already widely available in other parts of the world, will also likely be approved by the U.S. Food and Drug Administration (FDA) soon.
As is the case with neurotoxin, the results of superficial hyaluronic acid filler injections are very different from the traditional ones. “Hyaluronic acid is a natural humectant that plumps the skin. By placing it into the very top layers, it can improve skin quality and create more of a reflective glow,” explains Dr. Frank. “We’re not talking about volumizing or building structure—we’re talking about complexion enhancement,” adds Dr. Hausauer. “It can help with hydration, creating a suppleness and pillowiness to the skin.”
There are different ways to microdose these injectables
The most common—and widely available—option is Aquagold, a brand-name treatment that utilizes a microneedling device to deliver different products into the skin. Most commonly, it’s a combination of neurotoxin and hyaluronic acid filler, diluted with saline to create a watery mixture that can easily flow through the superfine needles. Some doctors also perform these types of superficial injections manually. For example, Dr. Hausauer says she often uses Botox to treat redness in rosacea patients, injecting it superficially into areas such as the cheek and nose. (It bears mentioning that the Botox has to be much more dilute than usual; this dilution, coupled with the particular injection technique, is what gives it these different properties and allows it to diffuse into broader areas, she says.) Dr. Frank often concocts what he calls a “slurry” of neurotoxin and hyaluronic acid filler for superficial injections, noting that he finds it works especially well to address skin texture around the lower mouth and chin.
“I like to add PRP/PRF to get even more skin-boosting benefits,” says Plano, Texas facial plastic surgeon Dr. Vu Ho. “The beauty of this simple treatment is that it allows me to customize the ingredients to tailor-fit my patients’ needs.”
Doctors note that it’s also possible to deliver products via a traditional microneedling device—so long as the depth of the needles is properly adjusted. Traditional microneedling needles are between 2 mm and 2.5 mm, whereas you would want them to be less than .5 mm in order to ensure the neurotoxin and/or filler won’t go too deep into the skin and cause any side effects, notes Dr. Hausauer. (More on side effects in a moment.) It’s part of the reason experts sing the praises of the Aquagold device as compared to any other delivery method. “The microneedles are all at a fixed depth, so you’re going to get a very consistent result,” notes Dr. Frank. Dr. Hausauer adds that the density of the needles makes it easy to much more effectively treat the entire face because it’s not possible to manually inject that many points.
There are potential side effects
“You really have to make sure you’re delivering the product at the right level,” cautions Dr. Hausauer. Injecting neurotoxin too deep means it can end up affecting the facial muscles, resulting in muscle distortion and what Dr. Hausauer calls a “stroke-like” appearance. As far as fillers go, the incorrect technique and/or depth of penetration can leave the skin with a bluish hue, says Dr. Frank. To that point, he strongly advises against Aquagold, or any type of microneedling procedure, being performed in a spa.
“People who aren’t physicians are using their own microneedling devices and putting all kinds of products into these concoctions. For example, they might put in a type of hyaluronic acid that’s more akin to a serum than a filler and microneedle it into the skin, causing irritation and an allergic reaction,” he warns. “Never let aestheticians microneedle skin to the point where it causes bleeding—and never let them infuse products into or onto open skin. Any kind of treatment where there’s a wound and pinpoint bleeding is a medical procedure that needs to be performed by a healthcare provider.”
Who is a candidate for superficial Botox and filler?
Pretty much anyone—so long as you’re aware of the limitations of the effects. Dr. Frank says it’s a great option for an emerging audience of younger patients, who don’t yet need muscle modification or volume. For more mature patients, this won’t do much as a stand-alone treatment; rather, it’s a nice complement to either traditional injection methods and/or other procedures, such as lasers. “This can be the icing on the cake, offering a skin-quality result that they may not get from deeper injections,” he adds.
And while the results aren’t necessarily very long lasting—anywhere from about three to six months—they do kick in fairly quickly, within a week for neurotoxin and pretty much instantly for filler. For this reason, something such as Aquagold is a great treatment to do before a big event, says Dr. Frank.
