Cosmetic injections: Botox, fillers and what the FDA warns

Most people searching “cosmetic injections” want to know three things: which one fixes their problem, how long it lasts, and how risky it is. The honest answers are that the type depends on whether the problem is movement, lost volume or fat; that nearly everything wears off; and that the FDA’s most serious warnings involve toxin spreading beyond the injection site, filler entering a blood vessel, and counterfeit products or unlicensed injectors.

The main types at a glance

Injections fall into four groups that work in completely different ways. Wrinkle relaxers are drugs that quiet a muscle. Fillers are FDA-regulated medical devices that physically take up space. Biostimulators are fillers that, in ASPS’s description of Sculptra, prompt your body to make collagen. Fat-dissolving injections destroy fat cells, according to the Kybella label.

Durations are from ASPS (wrinkle relaxers) and the FDA’s filler materials page; fees are ASPS’s “latest statistics”, which don’t state a year. In ASPS’s 2025 statistics, wrinkle-relaxing injections made up about half of all non-surgical (minimally invasive) treatments, and hyaluronic acid fillers another 30%. The 2025 report gives each treatment’s share and rank but no count, while ASPS looks for a better data source, so there’s no reliable total to quote. For how injections fit alongside surgery, see our overview of the types of plastic surgery.

Botox and other wrinkle relaxers

The Botox Cosmetic label says botulinum toxin type A blocks the signals from nerve to muscle, so the muscle can’t contract fully and the lines it makes soften. The approved cosmetic uses are all lines tied to muscle activity: the vertical “11s” between the brows (glabellar lines), forehead lines, crow’s feet and, for Botox Cosmetic, neck bands. None of the labels lists volume loss or sagging.

Six brands are FDA-approved for cosmetic use in the US, and all are prescription drugs:

Anything else, such as a “lip flip”, masseter (jaw) slimming or a “Botox brow lift”, is an off-label use the FDA hasn’t reviewed for that brand. Brands aren’t dosed alike either: the Botox Cosmetic label says its units can’t be compared to or converted into units of any other botulinum toxin, so per-unit prices across brands aren’t comparable.

ASPS says you may notice results within a few days, the full effect can take up to a week, and the improvement typically lasts about three to four months, after which the muscle movement and the lines come back. ASPS says you can resume normal activities immediately, but advises not rubbing the treated area, because the toxin can migrate and cause temporary drooping.

Hyaluronic acid fillers

The FDA describes hyaluronic acid (HA) as a type of sugar found naturally in skin and cartilage. As a gel it combines with water and swells, which is how it fills a fold or adds shape. The FDA says HA in fillers is chemically crosslinked to last longer, and some fillers contain lidocaine to reduce pain. Brands include the Juvéderm range (Voluma, Vollure, Volbella), Restylane, Belotero and RHA.

The FDA has approved fillers for adults 22 and older for specific areas: moderate to severe wrinkles and folds such as the lines from nose to mouth, and adding volume to the lips, cheeks, chin and back of the hands. Since then it has approved specific products for under-eye hollows, the jawline and the temples. Each product is approved only for particular areas, and the FDA recommends against filler in places no product is approved for, such as the nose, forehead and between the brows. Ask what your injector is using and where.

The FDA says HA’s effect lasts about 6 to 12 months. ASPS describes filler results as lasting from several months to several years depending on the product and the person, and both sources say the area injected matters. HA fillers accounted for 30% of ASPS members’ non-surgical treatments in 2025; 70% of those treatments were for facial rejuvenation and 23% for the lips.

Their big advantage is that they can be broken down with an enzyme, hyaluronidase (see dissolving filler below). Their main drawbacks are repeat cost and the risk the FDA calls most concerning: injection into a blood vessel.

Biostimulatory fillers: Sculptra and Radiesse

By the FDA’s figures these last longer than HA, but hyaluronidase doesn’t dissolve them.

ASPS ranked non-hyaluronic acid fillers fifth among non-surgical treatments in 2025: 80% were for facial rejuvenation and 10% for lips. In ASPS’s survey, a third of its surgeons (33%) said they used biostimulatory injectables for facial rejuvenation. The trade-off comes up in the patient quotes above: hyaluronidase won’t remove a biostimulator, and the FDA warns that non-HA and permanent fillers may be difficult or impossible to remove. Ask your injector what they would do about a lump or overcorrection.

Kybella for fat under the chin

Kybella is deoxycholic acid, a drug its label says destroys fat cells. It’s FDA-approved only for moderate to severe fullness from fat under the chin (submental fat) in adults; the label says it’s not approved for fat anywhere else and such use isn’t recommended. Each session can involve up to 50 small injections, and up to six sessions may be given at least a month apart.

The label warns about injury to the nerve that controls the corner of the mouth, which showed up in trials as an uneven smile or facial weakness (all cases resolved), as well as difficulty swallowing, bruising, hair loss in the treated area, and skin ulcers or tissue death at the injection site. Swelling is the most common side effect on the label (87% of treated patients in trials), and one patient above says it “swelled a lot for 1 week”. The label also tells doctors to weigh the risks in people with very loose skin or prominent neck bands, where the result may look worse. If that’s you, ask a surgeon how it compares with chin liposuction (18,842 procedures in 2025) or a neck lift; see our guides to body contouring and facial plastic surgery.

Skin boosters and PRP

Skin boosters are thin HA injections placed in the skin itself to improve texture rather than add volume. In the US, the FDA approved SKINVIVE by Juvéderm in May 2023 to improve the smoothness of cheek skin in adults over 21. Other “skin booster” products marketed abroad or online aren’t necessarily approved here; ask for the brand and check it.

Platelet-rich plasma (PRP) is made by spinning your own blood to concentrate the platelets, then injecting it or applying it after microneedling (the “vampire facial”). We couldn’t find an FDA approval for PRP as a wrinkle or skin treatment, so ask your provider what evidence they’re relying on. Hygiene is the other concern, because blood is involved: in 2024 the CDC linked HIV infections in four clients of an unlicensed New Mexico spa, plus one client’s sexual partner, to PRP microneedling facials there. It was the first investigation to tie HIV transmission to nonsterile cosmetic injection services.

What injections cost

ASPS publishes average fees from its member surgeons. The cost pages say “latest statistics” without giving a year, and the 2025 statistics report has no fee data, so treat these as national averages, not this year’s local prices.

Three things make the real bill different:

A very low price is worth asking about. The FDA’s 2024 counterfeit Botox alert involved products bought from unlicensed sources and injected by both licensed and unlicensed people, sometimes in non-medical settings. The FDA’s advice: confirm with your provider that the product comes from an authorized source.

Risks and FDA warnings

The FDA lists bruising, redness, swelling, pain, tenderness, itching and rash as common filler risks, and ASPS lists bruising, pain, headache, nausea, redness and temporary drooping among toxin side effects. ASPS says filler swelling and bruising mostly settle within hours to a few days, and recommends avoiding intense exercise for the first 24 to 48 hours. The FDA’s more serious warnings are below.

The FDA also points out that the safety of fillers combined with toxins, or used repeatedly over many years, hasn’t been studied in controlled trials, and that safety is unknown during pregnancy and breastfeeding. For comparison with surgical risks, see the riskiest types of plastic surgery.

Dissolving filler: hyaluronidase

Hyaluronidase is an enzyme that breaks down hyaluronic acid. The Hylenex label lists other approved jobs, such as helping other injected drugs spread, so dissolving filler is an off-label use. Even so, a 2022 review in Aesthetic Plastic Surgery describes it as commonly used to correct overcorrection, asymmetry, lumps and nodules after HA filler, and summarizes how it’s used when filler blocks a blood vessel.

Two cautions. It only works on HA: the FDA warns that fillers not made of materials like hyaluronic acid, and permanent fillers, may be difficult or impossible to remove. And it can cause allergic reactions; the same review says it shouldn’t be used in people who have reacted to bee or wasp stings. The FDA tells providers to have an up-to-date plan for treating a filler injected into a blood vessel, on site or by immediate referral. Ask your injector what theirs is and whether they keep hyaluronidase on hand.

Who should inject you

The FDA’s advice is to treat filler as a medical procedure, not a cosmetic treatment: choose a licensed health care provider experienced in dermatology or plastic surgery, ask about their training and experience injecting the area you want treated, and never inject yourself. ASPS, the plastic surgeons’ society, goes further and says being treated by a board-certified plastic surgeon is essential for fillers. In practice nurses and physician assistants also inject, and whether they need a physician’s supervision depends on the state.

Who may legally inject is set by each state’s medical and nursing boards, and the rules differ. In California, for example, the Medical Board says physicians may inject Botox or direct registered nurses or physician assistants to do it under their supervision; medical assistants may not, and a nurse may not run a cosmetic practice without physician supervision. Check your own state’s board rather than assuming.

Injections or surgery?

Injections involve no incisions, and HA fillers can be dissolved. ASPS says normal activities can resume right after a toxin, and asks for 24 to 48 hours without intense exercise after filler. Their limits: the sources above put most results at months to two years, so the cost repeats for as long as you want the result, and none of the toxin labels or filler approvals covers removing loose skin. One patient quoted below says lower-face filler left them looking “older, more masculine and droopy”.

For the surgical options and how they compare, see facial plastic surgery for the face and neck, body contouring for fat and loose skin, and reconstructive surgery when the goal is repair rather than appearance. If you’re leaning toward surgery, our plastic surgery checklist covers what to check before you book. Whatever you choose, make the decision with a qualified doctor who has examined you.

The bottom line