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What the pros know: New York City's Dr. David Shafer of Shafer Clinic gives us the lowdown on what to expect before visiting your dermatologist or cosmetic surgeon for a little pick-me-up.

Non-invasive cosmetic beauty upgrades continue to get better and better. Whether you're hoping to erase wrinkles, define cheekbones, or hoping for an overall lift to tighten and revitalize your complexion, there's an injectable option tailored to the purpose. Here, Manhattan surgeon Dr. David Shafer breaks down exactly what does what, what you can expect to pay, and how long results will last.

Botox is a brand name but has also become a common name encompassing an entire product category of injectables that relax dynamic wrinkles of the upper face. It recently celebrated its 20th anniversary this year and is the only neurotoxin with FDA indication for all three upper face areas: crow's feet, glabella, and forehead. When administered properly, the results leave the face refreshed, relaxed, smoother, and brighter. New FDA indications expected soon are for lower face slimming and neck to reduce vertical bands.

Your doctor will evaluate the wrinkles around your eyes when you smile, between your eyebrows when you frown, and on your forehead when you raise your eyebrows. The wrinkles that appear with movement of the underlying muscles are called dynamic wrinkles. Botox Cosmetic works by softening the contracting of the underlying muscle and decreasing the overlying wrinkles. All of these muscles work in harmony, so it is very important to have an experienced injector who knows the underlying anatomy and natural movements of the face. In most cases, the Botox Cosmetic injections can be performed the same time as your initial consultation.

FDA-approved uses: Botox Cosmetic is commonly applied to the crow's feet wrinkles, to the sides of the eyes when smiling or squinting, to the vertical glabellar lines (the 11s) between the eyebrows when squinting, and to the frontalis (forehead lines).

Botox Cosmetic starts working approximately three to five days after the injections. So if you look in the mirror right after you get home, you are not going to notice any difference. However, after a few days, you will notice the wrinkles start to soften. The effects last for approximately three to five months. Most patients return every four months for repeat treatments. It's important to have your next treatment before the effect wears off so you don't lose the beneficial effects of stress reduction in the skin.

Botox is usually priced per unit. Different areas of the face require different amounts of units. For example, the crow's feet by the eyes require 12 units per side, the glabella between the eyebrows requires 20 units, and the forehead 20 units. The average number of units my patients use is 64 units per session. However, every patient is evaluated as an individual and the treatment plan is customized to their specific anatomy. The unit price in my office is $30 per unit, so the total treatment cost based on 64 units is $1920.

Prices can range based on geographic location and experience of the injector. An alternative method for pricing is per area. For example, $700 for the crow's feet, $700 for the glabella, and $700 for the forehead. I prefer unit pricing, as the patient knows they are getting exactly what they are paying for.

Juvederm Ultra XC and Juvederm Volbella XC is from Allergan's Juvederm family of fillers. The Juvederm family of fillers are hyaluronic acid (HA) dermal fillers that differ in concentration of (HA) and bonding between the (HA) molecules. The bonding and concentration gives the products different properties for injecting based on location and depth of the tissue.

Juvederm Ultra XC was FDA-approved for lip augmentation in October 2015 and Volbella in June 2016. If you're interested in lip injections, your doctor will talk to you about the kind of look you want to achieve: more definition, alignment, symmetry, or a fuller, pillowy look—all very natural.

Based on what type of look you're trying to achieve, there will be a series of small injections along the vermilion border, cupid's bow, and inside the lips. It's important to talk to your doctor about your goals and expectations as there are many different "looks" with lips. Fillers enhance what you already have, adding definition and volume. Over-injection certainly can look fake, so it's important to go to an experienced injector and plan on possibly a series of treatments—especially the first time you are doing your lips—to reach the final result.

Expect some swelling the first day or two, so don't have lip injections the same afternoon as an important date or meeting. Patients sometimes return after the swelling goes away wanting more injections since they liked the "swollen" look. I often find myself as a gatekeeper reminding patients what looks normal or not and occasionally patients come back after seeing another doctor who adds another syringe which now needs to be "melted" as they obviously look over injected. There is always hyaluronidase to melt the product if you want to soften the look, but its best to get the injections right the first time around if possible.

Additionally, Volbella is now approved for the treatment of the infraorbital (under-eye) hollows. A lot of people call them "tear troughs," but in reality, the infraorbital hollows involve the whole under-eye area and not just the tear trough area. This is the first indication that the FDA is requiring additional training for injectors as this is a complex area to treat.

FDA-approved uses: Dermal fillers can be injected almost anywhere. The most common areas are the cheeks and chin (Juvederm Voluma XC), the nasolabial folds and marionette lines around the mouth (Juvederm Ultra Plus XC and Juvederm Vollure XC), the lips (Juvederm Ultra XC and Juvederm Volbella XC), and the under-eyes (Juvederm Volebella XC).

How long does it last?:

Juvederm Ultra XC and Ultra Plus XC both last between six and 12 months. It slowly metabolizes over time. So, patients often return in half that time for maintenance treatments. However, every patient is different and the location of the injection also affects the duration of action. One nice property of HA fillers is the existence of hyaluronidase, an enzyme that instantly "melts" the filler. This is a great safety net for patients worried about whether they will like the results or not and also for patients who may have gone to an inexperienced injector.

Dermal filler prices are per syringe. Each syringe of Juvederm is one cc. In my office, I charge $1,400 per syringe of Juvederm Ultra XC and Ultra Plus XC. Most patients use two syringes per treatment session. Just like Botox Cosmetic, the prices can vary by geographic location and by the experience of the injector. Once again, I caution patients not to choose their injector based on price alone.

Additionally, in more established and high-volume practices such as mine we offer additional services such as hyaluronidase treatment to "melt" the filler and Vbeam Perfect laser to erase bruising, if needed, included in the cost. As part of a full-service practice, patients find this convenience well worth it.

Lower face sculpting with dermal fillers has increased in popularity as part of the "Zoom Boom." Juvederm Voluma XC is from Allergan's Juvederm Family of Fillers, which are all hyaluronic acid (HA) dermal fillers that differ in concentration of (HA) and bonding between the (HA) molecules. The bonding and concentration give the products different properties for injecting based on location and depth of the tissue. Among the newest of fillers, Juvederm Voluma XC has a lifting effect when injected in the midface and also resists swelling often seen in other fillers. In June 2020, it also got FDA approved for chin enhancement.

Juvederm Volux is another injectable coming to market soon and this indication is for jawline and chin as well. This is a much thicker filler than Voluma XC so it will be great to help enhance profiles. Juvederm Volux will be the thickest and strongest of all the hyaluronic acid gel fillers with the highest lifting capacity.

Your doctor will evaluate your face from many angles—looking at your deep wrinkles and creases, as well as volume deficits seen with aging. It's important to discuss what areas bother you with the doctor so they can explain how the filler will work to correct that area.

Sometimes, the filler needs to be injected above or below the area of concern to achieve the optimal result. As an example, with Voluma, injecting in the midface/cheek area helps improve the nasolabial lines around the mouth and also the tear trough area under the eyes. An inexperienced injector or patient may insist on only injecting directly into the nasolabial lines, which may lead to an inferior result.

The injections are performed with a small needle. The product (XC version) has an anesthetic mixed right into the product that helps almost immediately with any discomfort. You can expect minimal swelling and a small possibility of bruising. The initial results are visible immediately.

FDA-approved uses: Dermal fillers can be injected almost anywhere. The most common areas are the cheeks and chin (Juvederm Voluma XC), the nasolabial folds and marionette lines around the mouth (Juvederm Ultra Plus XC and Juvederm Vollure XC), the lips (Juvederm Ultra XC and Juvederm Volbella XC), and the under-eyes (Juvederm Volebella XC).

Juvederm Voluma XC lasts up to 2 years. This is the longest-lasting HA filler. It's important to note that the filler does not last that entire time and then immediately disappears. It slowly metabolizes over time. So patients often return in half that time for maintenance treatments.

Dermal filler prices are per syringe. Each syringe of Juvederm is one cc. In my office, I charge $1,600 per syringe of Voluma XC. Most patients use two syringes per cheekbone treatment session and two to four syringes for chin augmentation procedures.

Volux will have premium pricing as it is delivering premium results. Price in our office is $2000 to $6000 depending on the area being treated and the amount of product required.

Editor's Note: Juvederm Volux is expected to be FDA approved later this year.

Up until recently, your only options for double chin treatment were fat removal with liposuction or CoolSculpting to freeze the fat. Now there is an injectable, otherwise known as fat modulators. This category is limited to one product, Kybella. Kybella is made up of deoxycholic acid, a substance the body naturally secretes in the GI tract to break down fat cells and cholesterol caused by eating fatty foods. The difference between the deoxycholic acid in Kybella and that in your body is that Kybella is plant-based and therefore less likely to cause skin allergies or irritation.

Kybella is meant for the treatment of moderate to severe submental (under the chin) fullness so your physician will assess the "double chin" area and see if you're a candidate. Most of my patients come in and say, "This has been bothering me for a long time..." and "There is nothing I can do to get rid of it," which is true given the only other option is surgical.

The actual treatment involves 25 to 30 small injections at a time, which sounds like a lot—until you consider that the average treatment of Botox involves somewhere around 12 to 20 small injections, depending on how many areas you treat at a time. After the treatment, the most common side effect you see is temporary swelling that can last a week and may be noticeable to other people. Some patients describe it as a bullfrog-like swelling, and the area can be temporarily larger than before the injection but it eventually goes away.

This treatment involves a very precise application of the product in the submental fat below the chin. The injections are limited to the midline of the neck which is the larger problem area for most people. Kybella cannot be injected in the jowls, face, or other areas as this can lead to increased side effects. For treatment of these areas, traditional liposuction may be the best option. Additionally, patients with loose skin may opt for a skin tightening procedure or treatment in addition to Kybella. Right now, the use of fat modulator injections is restricted to a handful of plastic surgeons and dermatologists who have been trained extensively on proper administration for the best results.

Unlike fillers and neurotoxins, which offer semi-permanent results, Kybella is meant to permanently kill the fat cells, dissolve them, and help your skin tighten up a bit and improve contour. Full results require treatments every four weeks for a total of two to six sessions depending on the amount of fat, so the results are not instant, but they are permanent.

It varies but you're looking at about $1,500-$2,500 per treatment and will require at least two, on average four, and up to six treatments spread out every four weeks. CoolSculpting in the submental area is $750 per treatment.

Juvederm Volite will be the first skin quality injectable approved in the U.S. It's currently approved outside the U.S. It will have a different name when the approval comes through the FDA soon—likely incorporating "skin" to emphasize the new skin-based indication.

Juvederm Volite is a thin hyaluronic acid product targeting the dermis. It is not for volumizing, but for skin quality, hydration, and elasticity. Patients can expect a smoother, more hydrated appearance with increased skin elasticity.

As a master trainer for Allergan, I will be one of the first people to be able to administer this. It can be used anywhere on the face, neck, décolleté, and hands to help smooth and enhance the skin.

Results will last six months with repeat treatments maintaining and enhancing the effects.

The price in our office is $1400 to $2800 per treatment depending on areas being treated and the amount of product required.

Editor's Note: Juvederm Volite is expected to be FDA approved later this year.