Injectables · Neuromodulator, filler, biostimulator

Two medicines. Two different jobs.

A neuromodulator relaxes a muscle. A filler occupies space. They treat different lines, wear off on different schedules, and the difference is worth understanding before you book anything.

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The lead nurse practitioner at Alder in her white coat

The distinction

A neuromodulator is botulinum toxin type A: a prescription drug that temporarily quiets the signal running from nerve to muscle. Treat the muscle that pulls your brows together and the crease it folds into the skin softens. Nothing is added; what changes is movement.

A hyaluronic acid filler is a regulated medical device: a clear, cross-linked gel placed into a specific tissue plane to restore volume or build structure. It does not touch movement. It occupies space that fat, bone or collagen used to.

So they answer different questions. A line that appears only when you frown is a movement problem. A groove that sits there at rest is usually a volume problem. Most people have some of each, which is why a plan is rarely one product.

At a glance

Neuromodulator: Botulinum toxin type A. A prescription drug, priced per unit
Filler: Cross-linked hyaluronic acid gel. A medical device, priced per syringe
Onset: Neuromodulator, typically three to seven days. Filler, the same appointment
Typical duration: Neuromodulator, three to four months for most people. Filler varies widely by product and area
Reversible: Filler, largely: hyaluronidase. Neuromodulator, no; it wears off instead
Consultation: Required before either. No exceptions

i. Neuromodulator · Botulinum toxin type A

Dosed by muscle, not by menu.

Units are what you pay for and units are what you get. Two people asking for the same area routinely need different amounts; muscle strength decides. The ranges below are typical starting doses. Not a quantity anyone can buy in advance.

Glabella — the elevensUpper face

The corrugator and procerus complex, between the brows. The most-treated area here, and usually the first anyone asks about.

Typically 18–25 units

$14 / unit

Frontalis — forehead linesUpper face

Dosed conservatively and rarely in isolation. The frontalis lifts the brow; treating it without the glabella is how people end up heavy.

Typically 6–14 units

$14 / unit

Lateral canthal lines — crow's feetUpper face

The orbicularis oculi at the outer corner. The expression stays; the fan of lines beside it softens.

Typically 8–12 units per side

$14 / unit

Mentalis — chin dimplingLower face

For the cobblestone texture that appears when the chin is tensed. Small doses, precise placement.

Typically 4–8 units

$14 / unit

Depressor anguli oris — downturned cornersLower face

The small muscle that pulls the corner of the mouth down. Dosed low and reviewed at two weeks, because overdosed it reaches the smile.

Typically 4–6 units per side

$14 / unit

Masseter — clenching, squared jawLower face

Larger doses, a longer interval and a much slower onset than the upper face. Often started for clenching rather than contour.

Typically 20–30 units per side

$14 / unit

Platysmal bandsNeck

The vertical cords in the neck. Assessed while you tense, never at rest.

Typically 20–40 units

$14 / unit

Axillary hyperhidrosisMedical

Excessive underarm sweating: a medical indication rather than a cosmetic one, and screened as one.

Typically 50 units per side

$14 / unit

Onset, duration, and what nobody can promise

Most people notice movement changing between day three and day seven, with the full effect around two weeks, which is when we look at you again on a first course. For most people it softens between month three and month four; some metabolize faster. Your interval is yours, and we find it in photographs rather than predicting it.

Several areas above are treated off-label. That is ordinary, well-documented practice, but you should hear it said out loud rather than discover it later. Which of your areas are on-label goes in writing on your plan.

ii. Filler · Cross-linked hyaluronic acid

Sold by the syringe, placed by the plane.

Filler arrives sealed, most of it one milliliter. Some areas take part of a syringe; some take three across two visits. We open what the plan calls for and nothing past it.

Midface & cheekStructural

The support the lower face rests on. Where a tired midface is the actual complaint, this is where a plan starts.

Often 1–2 syringes

$725 / syringe

Tear troughDelicate

The least forgiving area on the face, and the most often overfilled. Frequently declined in favor of treating the cheek above it first.

Often 0.5–1 syringe

$725 / syringe

Nasolabial & marionetteFolds

A consequence more often than a cause. Filling the fold without addressing what descended above it is how faces get heavy.

Often 1–2 syringes

$725 / syringe

LipsDefinition

Hydration, border and volume are three separate asks. A subtle first pass, then a look in three weeks, rather than a full syringe on day one.

Often 0.5–1 syringe

$725 / syringe

Chin & jawlineStructure

Projection and definition along the mandible. Often changes a profile more than anything done to the lips.

Often 1–3 syringes

$725 / syringe

TemplesHollowing

Reads as gauntness before anyone can name why. Small volumes, and a cannula wherever the vessels call for one.

Often 1–2 syringes

$725 / syringe

How long filler lasts

Longevity varies far more than a manufacturer's box suggests. Product family, cross-linking, the plane it sits in and how much the area moves all matter. Lips move constantly and typically metabolize faster than a chin. Published ranges commonly run from around six months to well over a year. You get a range and a review. You do not get a date.

iii. Adjacent, and routinely confused

iii-a$1,150 / vial

Sculptra is a biostimulator, not a filler.

Poly-L-lactic acid adds no volume in the room. It provokes your own collagen response, and what shows up builds gradually across the months after a series of sessions. People arriving expecting filler results leave disappointed on the day and pleased in the spring. The wrong product for anyone who wants to see something by Friday.

iii-b$250 / visit

Hyaluronidase undoes hyaluronic acid.

An enzyme that breaks down hyaluronic acid filler: ours, or work placed elsewhere. Booked as its own visit and discussed properly first, because it is not selective about which hyaluronic acid it dissolves. Bring whatever paperwork you have from the original injector.

Before any of it

None of this is for sale on a website.

Not by phone, not online, not as a gift card for a named treatment. Here is what stands between this page and a syringe.

CONSULT FIRSTA neuromodulator is a prescription drug and a filler is a regulated device. A licensed provider has to evaluate you and write the order. Thirty minutes, complimentary.
NOT THE SAME DAYNew clients are not injected at their consultation, including people treated elsewhere for years. The plan is written, slept on, then booked.
SCREENINGPregnancy, breastfeeding, certain neuromuscular conditions, some medications, an active breakout where the needle would go. Any of it changes the plan or the date. Taken in the room, in the practice's own records, not in a web form.
ONE INJECTOREvery injection here is performed by the lead nurse practitioner, with a supervising physician as medical director of the practice.

Common questions

Reasonable questions.

Which one do I actually need?

Often the answer is to start with the neuromodulator and look again in three months. Movement is what etches a crease into skin, and softening it first tends to make the volume question smaller. Sometimes the answer is neither: a pigment or texture concern wearing a wrinkle's clothing, which belongs on the skin or light side of the menu.

Does it hurt?

Neuromodulator injections use a very fine needle and most people describe them as brief and unremarkable. Filler is more involved: topical numbing first, and most hyaluronic acid gels contain lidocaine, so the initial placement is the sharpest part. A blunt cannula is used wherever the anatomy calls for one.

— Step one

Every plan starts with thirty minutes and a map.

Thirty minutes with the lead nurse practitioner. Face mapping, a photographic baseline, and a written plan with dose ranges and a total. Please don't send medical history through the website. We take it in the clinic.

Request a consult

Tue — Sat · 9 — 6248 East 3rd Ave · Denver720.555.0177consult@alderaesthetics.co