Non-surgical aesthetic medicine in Paris 16 — hyaluronic acid and botulinum toxin

Facial ageing combines a downward migration of volume, a hollowing of the contours and repeated muscle contraction that marks the skin. Non-surgical aesthetic medicine makes it possible to fill hollows, soften lines and relax the muscles that give a severe or tired expression, without surgery and without time off.

Practised with restraint, it often makes it possible to postpone surgery by several years. Used instead of surgery that has become necessary, it produces overloaded faces: that is precisely what has to be avoided.

What is non-surgical aesthetic medicine?

It covers the procedures carried out without surgery and without general anaesthesia, in the consulting room. It rests mainly on two injectable products with opposite mechanisms: hyaluronic acid, which restores volume, and botulinum toxin, which relaxes a muscle.

These are medical procedures. They are a matter for a doctor, and the prior analysis of the face counts as much as the injection itself.

All the products used at the practice are resorbable and traceable. This is not a detail: non-resorbable products expose patients to late complications that are difficult to correct, and the traceability of every batch injected is a regulatory obligation.

Botox or hyaluronic acid: what is the difference?

This is the most frequently asked question, and confusion between the two lies behind most disappointments. They are two unrelated products, with opposite mechanisms.

A frown line hollowed by repeated muscle contraction is a matter for botulinum toxin. A nasolabial fold hollowed by the descent of volume is a matter for hyaluronic acid. Injecting one instead of the other produces no result at all.

The two are frequently combined during the same session, on different areas.

When should you consult?

The reasons for consulting, in patients' own words:

• because you would like to look fresher, without being frozen, while still looking natural;
• because lines on the forehead, at the corner of the eye or between the brows give a constantly severe or cross expression;
• because folds have deepened over the years, particularly the nasolabial folds, giving the face a tired look;
• because the upper lip has lost its definition and fine lines have appeared above it;
• because weight loss has caused the cheekbones to drop;
• because excessive underarm sweating is disabling day to day: a medical indication for botulinum toxin.

Hyaluronic acid: which areas can be treated?

Hyaluronic acid is a molecule naturally present in the dermis, where it retains water and supports the tissues. Injected as a resorbable gel, with a cross-linking suited to each area, it restores lost volume.

• Cheekbones and temples — restoring volume to the middle third of the face, which hollows with age and weight loss.
• Nasolabial folds and marionette lines — filling contours hollowed by the descent of volume.
• Hollow tear troughs — filling the depression at the junction between the lower eyelid and the cheek. To be distinguished from the pigmented shadow, which is a colouring of the skin and is not a matter for injection.
• Lips — defining the outline, restoring definition, treating fine perioral lines.
• Chin and jawline — redefining the contour of the face.
• Nose — correcting a depression of the dorsum or slightly increasing the projection of the tip: this is non-surgical rhinoplasty. It can never reduce volume, only add it.
• Skin quality — superficial injections of non-volumising hyaluronic acid, for hydration and texture.

A useful clarification: where eyelid bags are associated with a hollow tear trough, it is preferable to treat the bags first, surgically. The bags accentuate the appearance of the trough, and filling before treating them leads to overloading the area.

Botulinum toxin: what are the indications?

Botulinum toxin reduces the contraction of the muscle responsible for an expression line. It adds no volume.

• Forehead lines — the horizontal lines linked to contraction of the frontalis muscle.
• Frown line — the vertical line between the eyebrows, at the glabella.
• Crow's feet — the fine lines at the outer corner of the eye.
• Eyebrow position — targeted relaxation makes it possible to reposition the tail of the eyebrow slightly.
• Excessive underarm sweating — a medical indication, distinct from the aesthetic ones.

Dosage is what distinguishes a natural result from a frozen face. The objective is not to abolish all movement, but to soften an excessive contraction while preserving expression.

How does an injection session work?

The session takes place in the consulting room, without general anaesthesia.

It begins with an analysis of the face: which volumes have melted away, which lines are muscular, which areas should not be treated. It is this stage that determines the choice of products and their dilution.

Where several areas are concerned, an anaesthetic cream may be applied forty minutes beforehand. Depending on the area, injection is by fine needle or by blunt-tipped cannula. Allow fifteen to thirty minutes per session.

How long do the results last?

The effects of botulinum toxin appear within three to five days and last about six months.

The effects of hyaluronic acid are immediate and last about twelve months, with variations according to the product, the area, the quantity injected and each person's metabolism. As the product is resorbable, the result is never permanent: that is a choice, not a limitation.

The result can be judged precisely once the swelling has settled, that is after a few days.

What is the recovery and what precautions apply?

Social and professional activity can be resumed immediately after the consultation.

Redness, tenderness, slight swelling or a bruise at the injection point are possible; they settle within twenty-four to forty-eight hours.

Avoid sun exposure in the forty-eight hours following the injections.

What are the risks of injections?

The risks of these procedures are rare, but they exist and must be known.

The commonest are minor: a bruise at the injection point, temporary swelling, local tenderness. More rarely: a nodule, an inflammatory reaction, a granuloma, an asymmetry requiring a touch-up.

Vascular occlusion

This is the rare but serious risk of hyaluronic acid: the accidental injection of product into an artery of the face, which interrupts the blood supply to the area concerned.

It presents with intense and immediate pain, blanching of the skin, and in severe forms visual disturbance. It requires emergency treatment.

This risk justifies two requirements. First, that the injection be carried out by a practitioner trained in the vascular anatomy of the face: that is why these procedures are a matter for a doctor. Second, that hyaluronidase, the enzyme that dissolves hyaluronic acid, be immediately available on site. That is the case at the practice.

A detailed information leaflet is available from the SoFCPRE.

Are there any contraindications?

They are looked for systematically in consultation:

• pregnancy and breastfeeding;
• current skin infection in the area to be treated;
• a history of allergy to any of the components;
• active autoimmune disease;
• a clotting disorder or anticoagulant treatment.

Non-surgical treatment or surgery: where is the line?

These two approaches are not opposed, they answer different stages.

Non-surgical aesthetic medicine treats volume and muscle contraction. It does not remove skin. No injection will correct established jowls or excess eyelid skin.

Surgery becomes necessary once an excess of skin has formed. It is then the cervicofacial lift or blepharoplasty that answers the problem.

Between the two, Morpheus8 acts on the quality and firmness of the skin by fractional radiofrequency, for mild to moderate laxity.

Multiplying injections on a lax face leads to visible volumetric overload without correcting the real problem. Conversely, operating on a face that does not yet show excess skin is not justified.

Frequently asked questions

What is the difference between Botox and hyaluronic acid? Botulinum toxin relaxes a muscle and treats expression lines. Hyaluronic acid fills and restores volume. They are two opposite mechanisms: one never replaces the other.

Can hyaluronic acid correct tear troughs? Only hollow troughs, linked to a deficit of volume at the eyelid-cheek junction. Pigmented shadows are a colouring of the skin and are not a matter for injection.

How long does a hyaluronic acid result last? About twelve months, with variations according to the product, the area, the quantity and the metabolism. The product is resorbable: the result is not permanent.

Can the nose be corrected without surgery? Partly. Non-surgical rhinoplasty with hyaluronic acid makes it possible to fill a depression or increase the projection of the tip. It can neither remove a hump nor refine a wide nose: it adds volume, it does not take it away.

Are injections painful? Not very. An anaesthetic cream can be applied forty minutes beforehand when several areas are treated.

Can hyaluronic acid be dissolved if the result is unsatisfactory? Yes. Hyaluronidase dissolves injected hyaluronic acid. It is also the antidote used in an emergency in the event of vascular occlusion.

Is there an age to start? There is no reference age. It is the analysis of the face that determines the indication, and the absence of an indication is a legitimate answer.

Before-and-after photographs

These photographs are published with the agreement of the patients concerned. They illustrate individual results and do not constitute a guarantee of outcome.

Consultation in Paris 16

Dr Benjamin Pulvermacker, 14 rue Pétrarque, 75116 Paris. Telephone: 01 47 20 48 70. Metro: Trocadéro (lines 6 and 9), Boissière (line 6).

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Last updated: August 2026 Medical content written and reviewed by Dr Benjamin Pulvermacker, board-qualified plastic surgeon (Medical Council no. 75/72049), Paris 16. This site is an information site. It does not replace a medical consultation.