A Beginner’s Guide to Injections

With all the information available at our fingertips, it is sometimes daunting to truly understand a certain phenomenon, such as the one of injections and fillers. Non-surgical cosmetic procedures have become increasingly accessible. What used to be something that only the rich and famous would do, has now become a treatment available to everyone. Here is a beginner’s guide to injections!

We discussed with renowned Montreal plastic surgeon Dr. Edouard Coeugniet to learn more about injections. His practice is in Nun’s Island and on Dr Penfield ave and he is trusted for his extensive expertise, passion and compassion.

Lip Injections

Types of injections

While there are many different types of injectables, we finally understood that there are three major categories – fillers, paralyzing agents and lipofilling (fat grafting).

Fillers and paralyzing agents like botulinum toxin (what Botox is made of), are the most popular ones. Botox, a toxin, contains a purified toxin (molecule) secreted by bacteria that freeze muscles. The appearance of lines and wrinkles caused by facial expressions, but also the normal contracture at rest of the face, which is in fact in a major part responsible for wrinkles at rest, can be minimized with Botox.

On the other hand, dermal fillers contain ingredients that add fullness to areas that have thinned due to aging, but are also acting on deep creases by filling them. This thinning is common in the cheeks, lips, and around the mouth. The third major type is lipofilling, which consists of injecting your own fat. More specifically, after having harvested the fat under local anesthesia from areas such as the abdomen and thighs, desired areas such as the face are injected. Lipofilling is known to last longer (forever actually as it is a transfer of your own bodyfat) but is less popular due to its greater invasivity.

Once I begin getting injections, how often do I have to get touch ups?

Toxins and paralyzing agents such as BOTOXr (“Botox“), require regular injections (every 3 to 6 months). After this period, the effect wears off. Minor touch ups can eventually be done 10 days after the initial injection to even potential asymmetries, if any.

On the other hand, filling agents are usually injected every year or year and a half. Just like for BOTOXr and the like, touch ups may be necessary to correct minor asymmetries after the initial injection.

Will getting injections prevent me from facial muscle movement (smiling, frowning, etc.)?

Usually not, but this depends on the amount of toxin injected and the patient’s desire. Some patients wish a maximal effect, while others a more natural one. 

How do doctors assess which injections and treatments are right for me?

Plastic surgeons posses the proper training to assess beauty and understand the patients’ desires according to well-established beauty criteria and facial proportions. This expertise is entirely part of a plastic surgical training. Dr Edouard Coeugniet

What are potential side effects? Any risks?

There is no major risk for toxins (BOTOXr, etc.). Wrinkles may persist if the dosage is too low. On the other hand, in case of over-injection, transient palsies of mimic muscles may occur in the face. In other words, you may temporarily loose facial expressions. However, “temporarily” is the key word; all side effects wear off in time. The most common side effect is minor asymmetry, which is easily and quickly fixed in the long term. On the other hand, too much Botox may lead to skin atrophy.

As for fillers, the major side effect is also facial asymmetry. Over-injection leads to visible lumps and under-injection may lead to an unsatisfying result. Both results can respectively be corrected or wear off in time.

Rare major complications such as blindness or skin necrosis have been reported due to injections performed into an artery of the face. Unfortunately, theses major problems do not have a real cure. Hence, expertise of facial anatomy is important and these treatments should only be administered by professionals with proper training in the matter, such as certified plastic surgeons.

Once I hop on the injection band wagon is it possible to stop? What if it’s not for me?

Each type of injection has its own indication- they are not a universal treatment. These indications have to be selected properly. Satisfying results generally lead to patients wanting to continue getting injections regularly. Unfortunately, naturally and realistically, aging results in progressive relaxation of the face, which will ultimately require rejuvenation surgery (such as face lifts). Injections should only be administered for a limited period of time, before resorting to more invasive treatments. It is important to have a professional assess the patient’s needs because injecting when the indication is not ideal or over due may lead to dissatisfaction and facial deformities.

When we think injections, we often think facial injections. Are there any other body parts that can benefit from injections, and why?

Indeed, there are other anatomical regions like the neck and hands that can be injected. In general, injections such as fillers and paralyzing agents are sought after to enhance appearance by volumizing and resurfacing. One can also surgically re-inject fat in other body parts such as breasts or buttocks. Some patients suffering from hyperhidrosis (excessive sweating) also resort to Botox injections under the armpits.

Why is it important to have injections performed by a doctor rather than a beauty expert?

As previously mentioned, a formal training in beauty, ideal facial proportions and exact knowledge of the anatomy are mandatory for acquiring perfect results. The ability to manage complications is also required. After-care is of the utmost importance. All these elements seem to me quite difficult to be acquired without a proper medical and plastic surgical training. Injections may seem easy to perform but bad results and dramatic complications may occur. The proper knowledge and care is necessary.

Before/after facial injections Kylie Jenner

How much do injections cost?

Prices vary and depend on each practitioner. Toxins are generally billed per unit; the price ranges from  9-15 $ per unit for plastic surgeons and in general, one treatment requires 50-100 units. As for fillers, the pricing has a very broad range according to the type of filling substance and the required quantity. There also exists “low cost” fillers, which I personally would not recommend.

What are some misconceptions about injections that exist that you’d like to debunk?

One may think it gives you an artificial and disproportionate appearance; this occurs only if they are not properly administered according to good and natural indications. Medical professional advise is very important. In addition, several patients may also think that injectables are a miraculous solution for everything and enhance appearance under all circumstances. Unfortunately, they can only help with specific needs. This is dependent on the facial anatomy, the patient’s proportions and wishes. Unrealistic expectations need to be settled with adequate advise. On the other hand, it is important to stop injections in situations where surgery (such as a face lift) begins to be more appropriate. In such cases, continuing injections will only contribute to alter the apparence in a non-natural and undesired manner.

Call 514-736-7792 to reach Dr Coeugniet‘s practice to book a consultation.

Happy Me-Time,


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