Injectables (Botox/Fillers)

San Francisco BOTOX®/Dysport®

No matter what age you are, it’s never fun to look in the mirror and notice a new wrinkle on your face. Whether you have a few fine wrinkles just while smiling, or deeper ones which are present all of the time, being treated with neurotoxin alone or in combination with fillers will help to soft or remove completely any of those annoying wrinkles.*   

BOTOX® Cosmetic was the first FDA-approved prescription treatment that diminishes the appearance of moderate to severe glabellar frown lines (wrinkles between the eyes) and crow’s feet (wrinkles than fan out laterally from the corners of the eyes) that tend to appear with age.  However, now there are more medications on the market (Dysport® and Xeomin®) with the similar properties. 

There’s no single factor that determines the time and severity of the appearance of these lines, but factors include cellular changes, collagen and elastin depletion, and damage caused by the sun. Certain facial gestures and expressions like squinting and frowning prompt your facial muscles, particularly those between your brows or around your eyes, to contract, creating wrinkles. These medications work by targeting the muscles that create these lines, temporarily minimizing their activity which results in smooth skin over the muscle.* 

Whether you have had neurotoxins before or if this is your first time, Dr. Sieber will work with you to understand which areas you want to see some improvement.  

Improvements with Neurotoxins:*

  • Lines between the eyes (glabella)
  • Lines in the glabella (area between the brows)
  • Horizontal forehead lines
  • Crow’s feet (lines on the outside of the eye)
  • Masseter hypertrophy
  • Improvement in downturned corners of the mouth
  • Cobblestone appearance or dimpling of the chin
  • Movement of the nasal tip with smiling
  • Nasolabial folds
  • Gummy smile
  • Hyperhidrosis (excessive sweating)


It used to be thought that facial aging was all about gravity and its downward pull on the skin and muscles of the face. As it turns out, that’s not exactly true. Facial aging is also about volume loss which is why fillers have completely changed how plastic surgeons approach facial rejuvenation. As we age, our face naturally begins to lose fat in areas such as the temples, the cheeks, around the eyes, the lips, and around the mouth. Facial fillers, typically composed of hyaluronic acid which is a natural forming substance in our bodies, can “pump up the volume”, plumping up fine lines and wrinkles, and providing a temporary “lift” to areas such as the cheeks and mid-face.* Patients with subtle asymmetries on their noses can even be treated with fillers for a non-surgical rhinoplasty.*

One of the most confusing things about fillers is knowing which filler is right not just for you, but also for which specific area of your face. Dr. David Sieber teaches courses on filler injection technique and safety to other practitioners so he has extensive, advanced training in all of the latest fillers, and he brings this knowledge to every patient that he sees. Each year, the FDA approves new fillers for use in the United States. With so many fillers already on the market, the best way to think about them is to divide them into three distinct categories:

  1. “Soft” fillers such as Vobella, Restylane Silk, and Belotero are best used for superficial lines such as those around the mouth, lips, forehead and in tear troughs.
  2. “Medium” fillers such as Juvaderm Ultra/Ultra plus, Vollure, and Restylane are thicker and best used to correct intermediate depth lines in the forehead, the “11” area between the brows, under the eyes, the nasolabial folds, and for non-surgical rhinoplasty.
  3. “Firm” fillers such as Voluma, Restylane Lyft, and Radiesse are used deeply against bone to provide support and volume in areas such as the temples, cheeks, jawline, and chin.

During your initial consultation, Dr. Sieber will go over all of your options in detail, using his expertise and artistic eye to recommend the ideal combination of fillers to best achieve your desired outcome. His goal is to create a more youthful, brighter, but still totally natural looking you.* Fillers typically last anywhere from 12-24 months depending on the type of filler used as well as how your body reacts.* In general, Dr. Sieber prefers hyaluronic acid based fillers due to the fact that the results can be reversed with a substance called hyaluronidase if, for any reason, you’re not happy.

Fillers Can Improve:*

  • Forehead wrinkles
  • Lines in the glabella (area between the brows)
  • Sunken appearing eyes
  • Hollowing of the temples
  • Lost volume in the cheeks
  • Irregularities in the nose
  • Fine lines along the mouth
  • Lost volume in the lips
  • Droopy corners of the mouth
  • Early jowling
  • Nasolabial folds
  • Jaw definition
  • Small chin

To find out more about fillers with Dr. David Sieber at Sieber Plastic Surgery, call us today at: 415-915-9000 or schedule a consultation here.

Quick Facts

  • Length: 10-30 minutes
  • Anesthesia: topical
  • Side effects: swelling, bruising
  • Recovery: 1 day

Injectables Technique

Dr. Sieber may apply a topical numbing agent to the treatment area and use ice to help make the experience more comfortable. He will then inject the filler in the appropriate spots through a very fine needle.

Preparing for Injectables

To minimize any bruising from injections, avoid aspirin, ibuprofen or similar products like Advil, Motrin, and Aleve as well as fish oil, Vitamin E, and gingko biloba for two weeks prior to your treatment.

Recovery from Injectables

You may experience some pin prick redness for a few hours immediately following your treatment. There will be some minor swelling and/or bruising in the injected areas for 2-3 days after treatment. Injections in and around the mouth may result in more severe swelling which can last for up to 5 days. Taking over the counter Benadryl or Zyrtec and icing the treatment areas can both help with the swelling if it’s an issue.


Q: How long will my results last?

A: Most fillers typically last about 1 year except for Voluma which can last about 2 years.* The length of your result is going to depend on the filler used as well as how your body reacts. Some patients get really long results with filler.* Others, less so.

Q: What can be done to help with swelling?

A: One of the best things to help with swelling after the procedure is ice. You may apply the ice for 15-20 minutes at a time. Be careful if you’re numb so that you don’t freeze your skin!

Q: How many syringes of filler will I need?

A: The number of syringes needed is really going to depend on how many areas you want treated, and the result you are trying to achieve. Dr. Sieber likes to deliver natural appearing results when using fillers*. During your initial consultation, he’ll go over a detailed treatment plan including an accurate estimate in terms of how many syringes of filler he recommends as well as the cost.

*Disclaimer: Results may vary from person to person. Editorial content, before and after images, and patient testimonials do not constitute a guarantee of specific results.


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*Disclaimer: Results may vary from person to person. Editorial content, before and after images, and patient testimonials do not constitute a guarantee of specific results. All images feature models except for before and after images.

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