At a Glance
Four things to know before deciding- Relaxing a muscle: reduces wrinkles that movement deepens; the effect generally lasts three to four months and varies from person to person.
- Restoring volume or hydrating: a hyaluronic acid gel is used for smoothing or adding volume; its effect can last from six months to a year or more, depending on the area and the product.
- Stimulating collagen: prompts the skin to make its own collagen rather than adding immediate volume; how long the effect lasts has not been established.
- Exosomes: their effectiveness has not been established, and no exosome product is approved in the United States.
Where to Start, Depending on Your Concern
You look in the mirror: the crease between your eyebrows that remains visible even when you are no longer frowning, the fold that runs from your nose down to your mouth, skin that is less firm than it used to be. These concerns are not treated with the same injection, and the treatments also known as injectables, facial injections or anti-aging injections fall into very different types. Here are the injection treatments offered by CARE MD, organized by what they target.
- Relaxing a muscle
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- Frown lines: causes of the crease between the eyebrows and treatments
- Crow's feet: wrinkles at the corners of the eyes and treatments
- Masseter injection: a wide jaw and teeth clenching
- Nefertiti lift: bands that become visible on the neck
- Excessive underarm sweating: causes and treatment
- Restoring volume or hydrating
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- Hyaluronic acid lip injections: restoring volume to the lips
- Nasolabial folds and marionette lines: correction with filler injections
- Skin booster: injectable skin hydration
- Stimulating collagen production
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- Collagen biostimulators: how they work and who they are for
- Exosomes
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- Exosomes for hair: what can be said about thinning hair
Injections That Relax a Muscle
This injection, a neuromodulator such as Botox® or Dysport®, blocks the ability of the facial muscles to contract, with the aim of reducing wrinkles that are already present. It is not limited to wrinkles: jaw clenching, bands that become visible on the neck or excessive underarm sweating are also concerns addressed by this type of injection.
- Acts on
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Movement, not an existing hollow; it does not change tissue volume.
- Who it is for
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An adult whose wrinkle deepens when the muscle is active—on the forehead, between the eyebrows or at the corners of the eyes—as soon as they make a facial expression.
- Duration
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According to Health Canada, its effect generally lasts between three and four months, with variations from person to person; it is therefore not permanent.
- Risks
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If the injection is poorly placed, it can cause a drooping eyelid when the forehead or the area around the eyes is treated, or, in the neck, muscle weakness with difficulty swallowing. Spread of the product away from the injection site is a serious but rare effect, mainly associated with non-cosmetic uses.
- Precautions
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Extreme caution is required in the case of neurological disorders, difficulty swallowing or breathing problems; the injection is not performed on inflamed or infected skin, or in the case of hypersensitivity.
Seek care right away
If you have difficulty swallowing, speaking or breathing.
Hyaluronic Acid Injections and Dermal Fillers
Here, the product injected is a hyaluronic acid gel, a gel that holds water. It is a medical implant designed to smooth or fill areas including the nasolabial folds, cheeks, chin and lips, and it is the most widely used filler material in Canada. The list of areas that can be treated is confirmed during the assessment.
A dermal filler is not chosen only for what it does, but also for what can be done if it does not suit you. Some fillers are permanent, and removing them can be difficult or even impossible; hyaluronic acid offers more leeway, with no guarantee.
- Acts on
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Contours and volume, not movement.
- Who it is for
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A loss of contour or a hollow to be filled.
- Duration
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From six months to a year or more, depending on how the skin has aged, the area and the product.
- Skin quality
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The same gel can target hydration rather than volume, which is the principle behind a skin booster; in a review of studies, the hydration, firmness, texture and radiance of facial skin improved, but the quality of the evidence is low.
- Common risks
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Pain, bruising, redness and swelling; these are generally temporary but can last several months.
- Bluish tint
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A gel injected too close to the surface can discolour the skin: this is the Tyndall effect. This discolouration is not urgent, even though it can persist for a long time, and it can be corrected with an enzyme that breaks down the gel, at the doctor's discretion.
- Rare and serious risk
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Accidental injection into a blood vessel can cause necrosis, vision problems, blindness or a stroke, and it requires immediate treatment.
- Postponing treatment
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A filler treatment is postponed if the skin is inflamed or infected, or if you have a bleeding disorder. During pregnancy and breastfeeding, and under the age of 22, safety is unknown, which does not mean that it is harmful.
- Missing evidence
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The safety of repeated use over a long period, and of combining it with an injection that relaxes a muscle, has not been evaluated in a controlled clinical study; this does not mean that a risk is known.
Seek care right away
After an injection, if you experience unusual pain, if your vision changes, if the skin near the injection site turns white, grey or bluish, or if you notice signs of a stroke.
Injections That Prompt the Skin to Rebuild Its Collagen
Hyaluronic acid is generally considered a product that fills a space. Other materials—poly-L-lactic acid (Sculptra®), calcium hydroxylapatite (Radiesse®) or polycaprolactone—trigger a controlled foreign-body reaction, and it is the skin itself that then makes collagen. The goal is therefore not to add immediate volume, but to prompt the skin to remodel itself.
- Who it is for
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Skin that seems to have lost its firmness, with no specific hollow to fill.
- What studies report
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A review of 22 clinical studies reports improvements in wrinkles, skin quality and volume. These studies differ greatly from one another and are mostly non-comparative: they cannot be used to promise a result or to say which product works better.
- Duration
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How long the effect lasts has not been established for this type of injection.
- Timing
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With poly-L-lactic acid, an expert consensus indicates that results become visible after the third monthly session, which makes it less suitable for someone looking for an immediate result; this timing has not been established for the other products.
- Risks
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The side effects reported are mostly mild and temporary. Nodules, small lumps under the skin, are the most notable with poly-L-lactic acid, and their frequency varies widely from one study to another; that frequency therefore cannot be applied to another product.
Exosomes: What Can Be Said for Now
- Approval
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In the United States, no exosome product is approved by the FDA, and those intended to treat a disease or condition are regulated there as drugs, with approval required before they are marketed.
- Effectiveness
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The effectiveness claims made by some clinics are not substantiated: no effectiveness has been established.
- Scope of this notification
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This notification does not describe the situation in Canada, for which we do not have equivalent data.
- Adverse events
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Serious adverse events have occurred in patients treated with unapproved products presented as containing exosomes.
- What to ask
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If they are offered to you for thinning hair, ask what the product is and whether it is approved.
The Medical Assessment Before an Injection
Your mirror does not tell you everything. An injection is a medical procedure: at CARE MD, on Montreal's North Shore, it is performed by a doctor or by a nurse injector supervised by a doctor. The purpose of the medical assessment is to check that the type of injection matches your concern before any product is discussed; it must come before any choice when you are unsure which type to choose, when you have a medical history or previous treatments to discuss, or when you do not know which type matches what you see.
During the assessment, the doctor reviews your allergies, bleeding disorders, history of heart problems, previous cosmetic treatments, whether you are pregnant or breastfeeding, and all your medications and supplements, including aspirin, ibuprofen, warfarin, vitamin E, St. John's wort, garlic and ginger. Never change how you take a prescribed medication without advice from the professional overseeing your prescription.
This examination may lead to postponing an injection, switching to another type, considering another approach, including one that does not involve a needle, such as fractional CO2 laser, CO2 laser resurfacing or focused ultrasound, or forgoing the injection. No result is guaranteed. It depends on the person, the area and the product, and discomfort is possible; what you hope for should be discussed before treatment, along with what the product being considered can and cannot do.
To prepare for the consultation, write down what you want to change, then schedule an assessment and bring these questions with you:
- Is the product permanent or temporary?
- What are the side effects?
- What is the risk in your case?
- Is the product approved?
- What experience does the person performing the injection have?
Ask Us About Injections
Frequently asked questions
What is the difference between an injection that relaxes a muscle and an injection that adds volume?
An injection that relaxes a muscle blocks the ability of the facial muscles to contract, with the aim of reducing existing wrinkles that movement deepens. A dermal filler is a medical implant designed to smooth or fill folds, the cheeks, the chin or the lips: it acts on contours, not on movement. Biostimulators, for their part, prompt the skin to produce collagen rather than providing immediate volume.
Which injection should you choose for a natural-looking result?
No injection, on its own, guarantees a natural-looking result. Expectations need to be discussed together with the possibilities and limitations of the product being considered, depending on the concern, the area and the person. The medical assessment may lead to considering another option or to postponing treatment.
How long do the effects of cosmetic injections last?
There is no single duration. The effect of an injection that relaxes a muscle generally lasts a few months and varies from person to person. For dermal fillers, how long the effect lasts depends on the material and the area: some effects are temporary, and some products are designed to remain in place. For biostimulators and exosomes, no duration has been established.
Are cosmetic injections painful?
A filler injection can cause pain, bruising, redness and swelling, which are generally temporary but can last several months. The sensations you may experience and the aftercare instructions need to be explained before you decide on treatment. Unusual pain or a change in vision after a filler treatment requires immediate medical care.
What precautions should you take before an injection?
Mention your medical history, allergies, bleeding disorders, medications, supplements and previous cosmetic treatments, and whether you are pregnant or breastfeeding. Inflamed or infected skin or a bleeding disorder may lead to the treatment being postponed. Never change how you take a prescribed medication without advice from the professional overseeing your prescription.
Are exosomes an established option?
The effectiveness of exosomes has not been established. No exosome product is approved by the FDA (United States). In its safety notification, the FDA also reports that serious adverse events have occurred in patients treated with unapproved products presented as containing exosomes. This notification does not describe the situation in Canada: ask which product is being proposed and what its status is before you decide.
Are there treatments that do not involve an injection?
Yes. CARE MD offers three options that do not involve a needle: fractional CO2 laser, CO2 laser resurfacing and focused ultrasound. The choice between an injection and one of these options is based on your concern, your skin and your medical history; which one suits you should be discussed with the doctor. Not all wrinkles call for an injection.
Sources10 references+
- Health Canada — Cosmetic injections (opens in a new tab)
- FDA — Dermal Fillers (Soft Tissue Fillers) (opens in a new tab)
- AAD — Fillers: Preparation (opens in a new tab)
- PubMed 35486036 — Evaluation of the biostimulatory effects and the level of neocollagenesis of dermal fillers: a review (opens in a new tab)
- PMC13214704 — Mechanisms of Cytokine Modulation and Inflammatory Cascade in Bio-stimulatory Skin Rejuvenation (narrative review) (opens in a new tab)
- FDA — Public Safety Notification on Exosome Products (opens in a new tab)
- Dissolving hyaluronic acid gels: situations and limitations — JMIR Dermatol, 2024 (opens in a new tab)
- StatPearls — Poly-L-Lactic Acid (NCBI Bookshelf, 2024) (opens in a new tab)
- J Cosmet Dermatol 2023 — Consensus recommendations on the use of injectable poly-L-lactic acid in Asian patients (opens in a new tab)
- Clin Cosmet Investig Dermatol 2023 — The Effectiveness of Injectable Hyaluronic Acid in the Improvement of the Facial Skin Quality: A Systematic Review (opens in a new tab)
Before Any Injection: Limitations, Contraindications and Precautions
At CARE MD, have your options, benefits, limitations, contraindications and risks assessed: they depend on you and on the treatment. These guidelines do not replace a consultation with a qualified professional.
Limitations and precautions
Medical history, allergies, medications and supplements
Before treatment, share your medical history, allergies, medications and supplements.
Inflamed or infected skin
If your skin is inflamed or infected, or if you have a bleeding disorder, postpone the filler treatment.
Neurological disorders
If you have a neurological disorder, difficulty swallowing or a breathing problem, extreme caution is required before an injection that relaxes a muscle.
No guaranteed result
Your result cannot be guaranteed.
Repeated long-term use
The safety of repeated filler treatments over the long term has not been evaluated in a controlled clinical study.
Exosomes
The effectiveness of exosomes has not been established.
