Most wrinkles on the face have two components--a dynamic component, i.e. the wrinkling that comes from movement of the muscles of facial expression, and a static (at rest) component, or the "etching" or creasing of the overlying skin that results from years of folding the underlying expression muscles. The latter are often referred to as "expression lines." Improvement in wrinkles can be achieved by treating the static or the dynamic component, but are most improved by addressing both issues. Neuromodulators, such as Botox, Dysport, or Xeomin work fine for the dynamic muscular component, and fillers, particularly Belotero Balance or diluted Restylane L are particularly effective for the superficial overlying wrinkling. Belotero Balance possesses the added advantage of having little tendency to result in the bluish Tyndall effect that is sometimes seen with other hyaluronic acid fillers when they are injected superficially as they must be in order to improve very fine lines. To save time, I personally recommend performing both types of treatments during the same treatment session. However, if so desired, neuromodulators can be used first followed a couple of weeks later by the filler treatment. .
