What’s for Lunch—Botox, Pico Laser, or SkinVive?

Neuromodulators

There’s nothing quite like the wrinkle-reducing effects of a neuromodulator, such as Botox, Dysport, Jeuveau, Xeomin, Daxxify, or Letybo. But regardless of the brand name, all neuromodulators work to temporarily relax muscles that create static and etched-in lines and wrinkles from repeated movements, giving the skin a smoothing effect that reduces the appearance of wrinkles and helping prevent new ones from forming. “The different types of toxins work at different receptors on the same nerve terminal,” says board-certified dermatologist Divya Shokeen, MD. “When botulinum toxin is absorbed into the nerve terminal, it leaves behind a protein called SNAP-25, which is essential for releasing acetylcholine, the neurotransmitter that tells muscles to contract. Without the release of acetylcholine, the muscle simply doesn't fire.”  

“The goal is a refreshed, natural result so that you still look like yourself,” says Dhrumi Mody, FNP-C, a board-certified nurse practitioner at Ject. While wrinkle reduction is typically the main objective, these products can also be used (sometimes off-label) to create a subtle lifting effect in certain areas of the face, such as the brows, the tip of the nose, the upper lip, jawline, and neck.

Mody adds that neuromodulators are also popular for their skin-enhancing benefits, such as minimizing the appearance of pores, reducing oil production, and creating a glowy complexion. Microdoses of your favorite neuromodulator (aka baby Botox), which are about half the normal dose, help maintain natural, nearly full expression without the risk of looking too frozen.

While neuromodulators work for pretty much anyone and everyone, Mody likes them for “someone who comes in saying they feel tired or look angry,” which is “the perfect candidate for wrinkle reducers.” Neuromodulators take about 10 to 20 minutes to inject and come with virtually no downtime. The results can start to show as soon as three days post-treatment and generally last three to four months (some last up to six months) depending on the type of toxin used, the dose, and the injection site.

Pico Laser

Ideal for wiping away unwanted pigmentation, stubborn melasma, acne marks, and even unwanted tattoos, Shokeen calls picosecond lasers, which you may recognize as PicoSure, Pico Genesis, or PicoWay, one of the most versatile options. "They are safe to use across various skin tones, making them accessible across diverse patient populations," she says. "Pico laser is short for picosecond laser, a category of advanced laser treatments that deliver energy in trillionths of a second." Unlike traditional lasers, which use heat and longer pulses, Shokeen explains that pico lasers work through a non-thermal, photoacoustic effect that quickly delivers energy to break down pigmentation and stimulate collagen without creating excess heat that can cause unwanted side effects.

Oftentimes, pico lasers, which are primarily used for correcting pigment, are layered with other treatments, including microneedling, radiofrequency, PRP, chemical peels, or fractional and CO2 lasers. “For example, using a pico laser with a CO2 laser or another laser, helps produce new collagen and elastin and resurface the skin,” says double-board-certified facial plastic surgeon Lesley Rabach, MD. Since the picosecond laser targets uneven skin tone and texture and boosts clarity, pairing it with another modality can help tighten the skin for a comprehensive rejuvenation strategy.

However, this is not a one-and-done laser: At least two or three minimal-downtime sessions (some people may experience downtime that lasts up to six days) are recommended to achieve maximum results. There may be minor redness or inflammation for a few hours, but the results can be well worth the $500 treatment. “Depending on the intensity of the treatment, results can last years with proper skincare and protection,” Rabach adds.

Microneedling Stacking

One of the most popular treatments du jour is microneedling stacking. Microneedling, which relies on ultra-thin needles that are stamped into the skin to create controlled micro-injuries that trigger the skin’s natural wound healing to stimulate collagen, works well on its own. But when combined with a regenerative treatment—like Vamp Advanced, a medical-grade PDRN solution to revitalize the skin; platelet-rich plasma (PRP) to jumpstart collagen and elastin production and reduce healing time; or exosomes to improve elasticity and redness—the benefits are amplified. Microneedling also pairs well with lasers, which is Rabach’s favorite stacking combination: “When I use multiple modalities at the same time, it’s one numbing time, one downtime, and much better results.”

Ideal for treating a host of skin-related concerns, such as pigmentation, mild laxity, and rough texture, microneedling first creates microscopic wounds, allowing whatever is used in conjunction to better penetrate the skin so it heals faster.

Mody adds that a series of low-downtime microneedling treatments will typically deliver the best results, as collagen production progressively builds with each session. “Some people may notice improvement after one treatment, but multiple sessions allow for more significant collagen and elastin stimulation, leading to smoother texture, firmer skin, softening of acne scars, and improvement in fine lines and pores over time.”

Sculptra

With age, the face loses collagen and overall structure, and one way to rebuild and restore what’s lost is with Sculptra. As Mody explains, the poly-L-lactic acid (PLLA) collagen biostimulator injectable, which is not a traditional filler, stimulates the body's collagen production over time, volumizing deficient areas like the cheeks and nasolabial folds, as well as improving fine lines and wrinkles.

Results are not immediate like with hyaluronic acid fillers, nor are they dissolvable. Rabach shares it takes one to three months to see the restored volume because collagen must build around the Sculptra particles: “It’s the best for total volume rejuvenation for patients with large amounts of skin thinning, facial deflation, and age-related volume loss.” It’s also a great, quick-to-administer option for those experiencing facial volume loss from GLP-1 medications to restore a softer, more youthful appearance in a natural-looking way.

A series of Sculptra injections (usually three, spaced about every four to eight weeks) doesn’t come cheap. At Ject New York, one vial of Sculptra costs about $1050, and the rule of thumb is to inject one vial for each decade of life. But while the treatment can get pricey, it offers long-term benefits that far outweigh the cost.

SkinVive

In less time than it takes to make a salad for lunch, your injector can administer a vial of SkinVive—an injectable hyaluronic acid skin booster—for plumper, smoother, more hydrated skin. Unlike traditional hyaluronic acid fillers, Mody explains that SkinVive improves overall skin quality rather than adding significant volume or contour. It’s also a fast fix for minimizing dryness in areas like under the eyes or the mid-face.

Mody says that superficial injections of SkinVive into the cheeks enhance hydration by increasing water retention in the dermis. “While the results, which typically start to appear after about two weeks, can last up to six months, you can expect the skin to look smoother, more radiant, and refreshed,” she says. “Because SkinVive focuses on improving skin quality and hydration, it has quickly become one of the more popular ‘undetectable’ aesthetic treatments, so you can get a healthy, glowing look that isn’t overfilled or obviously injected.”

Laser Facial

When a quick skin refresh is in order, skincare experts often turn to laser facials to induce a healthy glow and gently resurface the skin without major downtime, redness, or peeling. “Most laser facials refer to Intense Pulsed Light (IPL), but they could also include a fractional laser, something like Clear + Brilliant, or a gentle resurfacing laser,” Rabach says. “Laser facials are usually gentler because they’re more superficial, so there’s not that much downtime, but that also means that there may not be as much bang for your buck.” Most laser facials are non-ablative and don’t damage the outermost layer of skin. According to Rabach, the skin’s tone and texture may be a little more even, and there may be a reduction in age-related spots.

A variety of different laser combinations (aka laser stacking) can also be used in a single session, which usually takes less than an hour, Mody prefers pairing Moxi, a non-ablative fractional laser, with BBL (broadband light). “Moxi focuses on improving skin texture and stimulating collagen production, and BBL uses pulses of light energy to target unwanted discoloration while reducing redness caused by rosacea and vascular pigmentation.” One of the main benefits of this duo, Mody says, is that it can target pigment and texture in a single treatment with minimal downtime (expect mild redness and dark, small ‘coffee grind’ spots that last for a few days as part of the normal healing process), leading to brighter, smoother, firmer, and healthier-looking skin.

Xerf

K-beauty treatments have been all the rage for years, and now there’s a new skin-firming treatment, Xerf, that’s painless and downtime-free. As Shokeen explains, Xerf is the first-of-its-kind multifrequency monopolar radiofrequency (RF) treatment that gently warms the deeper layers of skin, where collagen and elastin are produced. “Technically, we are hitting shallow, middle, and deep layers simultaneously, including the SMAS layer, which is the same foundational layer targeted during a facelift.”

Xerf’s main draw is that it works deep within the skin without causing pain. “Other skin-tightening treatments, such as Ultherapy, which has been the gold standard for a long time, are quite painful, even with the use of numbing,” Shokeen says. Xerf also uses Wave Fit technology to deliver energy in a single pulse. “This matches the skin's natural impedance, combined with a highly advanced cooling system to prevent the ‘heat spike’ that causes pain in older RF generations,” she adds

While the treatment is said to feel like a warm sensation, even without numbing, XERF also delivers cooling bursts for tolerability. However, she says treatments at deeper settings can cause mild discomfort, which the cold bursts offset.

Concerns about potential fat loss have made many people skeptical about radiofrequency treatments. “This is the biggest point of contention, because we are coming off the heels of procedures like RF microneedling that can melt fat at high temperatures,” Shokeen explains. "But XERF monitors the distributed heat and usually does not reach above 44 degrees celsius. When done correctly, the device carefully controls the temperature with a feedback monitor to stay within a range that stimulates collagen but remains below the level that destroys fat cells, so that it tightens the skin without causing volume loss.”

Cadaver-Derived Fat Injections

If you’re looking for an alternative to more invasive, downtime-heavy fat transfer procedures, consider cadaver fat injections, aka “Zombie Filler.” This of-the-moment injectable treatment is especially beneficial for people who don’t have enough of their own fat to harvest and graft, or who are opposed to the idea. While the fat is processed from human donor tissue or fat-related extracellular matrix from a deceased tissue donor, as Rabach explains, it's then sterilized and turned into a special injectable substance.

The two main injectable products are Alloclae, for volumizing the breasts, butt, or hips via tissue regeneration, as well as Renuva, which restores volume in the face by gradually encouraging the body to grow fat cells. “The injection process from cadaveric fat doesn't require harvesting fat from the patient, and often doesn’t contain living donor fat cells, thereby primarily acting as a structural scaffold and possibly stimulating collagen formation,” Rabach says.

While the results take time (expect full results at the three-to-six-month mark for both), there’s no regular maintenance plan to follow with Alloclae or Renuva since the effects can last for a few years. With Allolclae treatments, there may be some redness, bruising, and minor swelling, but some experts feel it’s well worth the tradeoff. “These are next-generation treatments to restore volume without surgery or liposuction to harvest the fat,” Rabach says. “It's great for someone doesn’t have a lot of body fat, or someone on a GLP-1 who lost a lot of weight and their fat cells aren't as sturdy.”

Microinfusion (Aquagold)

Although microinfusion uses tiny needles stamped across the skin, Dr. Rabach says it's much more superficial than microneedling because the delivery method is direct. “The beauty of Aquagold (a microchannel micro injector) is that it uses tiny, hollow needles to deliver a customized blend of ingredients directly into the skin,” she shares. A mix of known skincare ingredients, including vitamin C, Botox (it won’t paralyze muscle movement), gluthatione, and hyaluronic acid fillers (there’s no volumizing effect due to how it’s delivered) are delivered to the skin with a micro-dosing application that can enhance the skin’s glow factor, refine the skin’s overall appearance, improve skin hydration, and reduce the appearance of enlarged pores and decrease oil production with little downtime.

In the days following a microinfusion treatment, which typically takes 30 minutes, skin emerges glowier and more even-looking, with a highly desired, glass-skin effect that Rabach says can last for one to three months. It’s also an excellent option if you’re looking to refresh the skin but aren’t ready to commit to fillers or regular injections of a neuromodulator, although both can work in tandem with microinfusion treatments to do the heavy lifting.