The popularity of injectables is on the rise and has been for over a decade. While BOTOX® is still number one, dermal fillers are quickly encroaching on that spot.
Either way, the more pressing issue is selecting the right option for your skin if you choose to give these treatments a try. Knowing the differences between all of your options is a job for the pros, so we called in the experts and asked them to give us all the details.
What Is BOTOX®?
First things first: plastic surgeon Dr. Matthew Schulman points out that BOTOX® is the brand name of a specific botulinum neurotoxin. There are four FDA-approved neurotoxins available in the U.S.: BOTOX®, Dysport, Xeomin, and Jeauveau.
So, how does it work? “BOTOX® or any neurotoxin works by temporarily weakening or paralyzing the muscles,” says Harvard and Cleveland Clinic board-certified plastic surgeon Dr. Munique Maia.
“Botulinum toxin is best used in areas of facial expression such as the frown lines, crow’s feet, and ‘11s’ between the eyebrows,” says Dr. Schulman.
BOTOX®, adds Dr. Maia, “treats dynamic wrinkles, though some relatively non-cosmetic uses for BOTOX® are incredibly popular as well: injections in the armpits can help stave off hyperhidrosis (excess sweating), and injections in the jaw muscle can be used to prevent teeth grinding caused by TMJ. According to plastic surgeon Dr. Dara Liotta, BOTOX® will start to work between 2-10 days, “depending on your individual reaction to the toxin and which toxin is used.”
BOTOX® itself is a muscle relaxer made from bacteria. It’s been on the market for over two decades, and has been used to treat neurological disorders that cause muscle weakness. It’s also used for the treatment of migraines and other medical conditions.
For wrinkle treatment, BOTOX® is primarily used to treat dynamic wrinkles. These wrinkles occur naturally around the eyes and mouth, as well as in between your eyebrows. They become more pronounced with age. BOTOX® injections relax the muscles near these wrinkles. Not allowing the muscles to move reduces the appearance of dynamic wrinkles.
BOTOX® is not used for fine lines caused by collagen breakdown.
Your healthcare provider will inject the muscles that contribute to the specific wrinkles you want treated. The injection process itself takes just a few minutes with noticeable results within two weeks.
What Are Fillers?
“Hyaluronic acid fillers are gel-like products that fill folds and creases and replenish lost volume. They can also contour the face,” Dr. Maia says.
Fillers can be of a variety of temporary or permanent materials, and are used to fill lines. Hyaluronic acid fillers like Restylane, Juvederm, and Belotero, and calcium fillers like Radiesse are the most common. Dr. Schulman explains, “While both botulinum toxin and fillers are commonly used together, they work differently and are used on different lines.”
Hyaluronic acid fillers, which come in a variety of thicknesses so that the right one can be chosen for each particular skin type, last 5-24 months. “There are other fillers composed of [calcium hydroxyapatite] (like Radiesse), which are better for deep filling and can last 12 to 14 months,” Dr. Schulman says.
Dermal fillers
Dermal fillers also treat wrinkles on the face. They’re primarily used to treat smile lines, though the fillers can also be used to plump up the lips or cheeks. Sometimes, they’re used for hand treatments or to reduce the appearance of scars. Dermal fillers aren’t approved for plumping up other areas of the body, though, such as the breasts.
Dermal fillers come in different forms, and like BOTOX®, they’re injectable. Some are temporary and used primarily for soft tissues in the face along the smile lines. The U.S. Food and Drug Administration has approved the following options:
- calcium hydroxylapatite (Radiesse), a temporary gel solution that lasts for 18 months
- collagen, a temporary material that lasts for up to four months
- hyaluronic acid, a temporary material that loses its effect after 6 to 12 months
- poly-L-lactic acid (Sculptra, Sculptra Aesthetic), a man-made material that lasts about two years
- polymethylmethacrylate beads, the only permanent type of dermal filler available
BOTOX® vs. Fillers: Which Is More Effective?
The effectiveness of either procedure depends on what you’re in need of. BOTOX®, for instance, can be used preventatively (ie. even before you’re really noticing any deep-set wrinkles).
“I have a lot of patients in their mid-twenties that do preventative BOTOX®,” says Dr. Maia. “They want to prevent wrinkles from forming. They are hyper aware of their faces and want to improve their appearance.”
The most common areas for fillers, meanwhile, are “under eye, cheeks and jawline,” Dr. Maia says. “The choice of each product depends on the area of concern.”
The simple rule? “Lines of expression need botulinum toxin. Lines at rest need filler.” Dr. Schulman says that while BOTOX® is a great choice for hitting those “crease points” where muscles contract, fillers are best for deep lines that are present even when facial muscles are not contracting. Check out the chart below for a guide to the lines on the face for which BOTOX® and fillers should be used, respectively.
Is BOTOX® effective?
BOTOX® injections produce results for most people, according to the American Academy of Ophthalmology (AAOS). You’ll likely see noticeable effects within a week of the injection. Side effects are minimal, and most go away after a short time. You may not notice the full effects of BOTOX® if you have certain conditions that prevent them. You’ll need to talk to your healthcare provider about all these potential risks ahead of time.
Once you receive the injections, you’ll be able to continue your daily activities without any recovery time. The effects of BOTOX® last about 3 to 4 months. Then, you’ll need additional treatments if you want to maintain the results.
How effective are dermal fillers?
Dermal fillers are also considered effective, and the results last longer than results from BOTOX® overall. Still, results differ depending on the exact type of filler you choose. Like BOTOX®, you’ll need maintenance treatments once the fillers wear off.
Possible Side Effects
- Bruising or swelling at the injection site
- A bluish cast to the skin
- Acne-like bumps under the skin
“The fillers currently available and FDA-approved in the United States have been tested extensively and are safe,” says Dr. Dara Liotta.
The most likely side effects of either BOTOX® or filler are bruising and pain at the injection site—the same as any injection, not exactly a toxic reaction.2 If you’re experiencing something like eye dryness, a crooked smile, drooling, or a drooping eyelid, this is not normal. Per Dr. Liotta, “Under no circumstances are trouble seeing, speaking, or breathing reasonable reactions to BOTOX®.” If you experience any of these symptoms, you need to contact your board-certified injector immediately.
The solution in BOTOX® and other brands like Myobloc is a very, very diluted form of botulinum and the formula itself is honestly the last thing you should be worried about. At the top of your list should be getting a qualified doctor, because that’s the easiest way to avoid any negative side effects.
Side effects specificially from filler include the Tyndall effect, which Dr. Liotta explains is the appearance of a bluish cast to the skin, and “can occur if thicker hyaluronic acid fillers are injected too superficially beneath the surface of the skin. The Tyndall effect can be treated by injecting a small amount of hyaluronidase (the enzyme that dissolves hyaluronic acid filler) into the area.”
Dr. Liotta continues, “Acne-like bumps beneath the skin are an exceedingly rare complication. Much more common are bruising, tenderness, and mild swelling at the injection sites that may last up to 2 weeks.”
Keep in mind that the more severe “side effects” like the Tyndall effect and bumps beneath the skin are not actually true side effects, but rather complications that occur from improper injection. That’s why it’s crucial to only receive injections (whether medical or cosmetic) from a board-certified injector.
BOTOX® risks and side effects
According to the AAOS, BOTOX® is only recommended for people in good health to reduce the risk of side effects.
Possible side effects include:
- bruises at the site of injection
- drooping eyelids, which can take several weeks to resolve
- eye redness and irritation
- headaches
Taking eye drops before receiving BOTOX® injections may help reduce the chances of some side effects. You should also stop taking any blood thinners a few days before to prevent bruising.
BOTOX® isn’t recommended if you:
- are pregnant or nursing
- have weak facial muscles
- currently have skin issues, such as thick skin or deep scars
- have multiple sclerosis or another type of neuromuscular disease
Risks and side effects of dermal fillers
Dermal fillers carry the possibility of more risks and side effects than BOTOX®. Severe side effects are rare. Moderate side effects usually go away within two weeks. However, serious adverse effects have been connected to the use of unregulated, needle-free injection devices for dermal filler procedures. A licensed medical professional should provide all procedures with dermal fillers, using only FDA-approved fillers injected with a syringe.
Some side effects include:
- allergic reaction
- bruising
- infection
- itching
- numbness
- redness
- scarring
- sores
In severe cases, long-term swelling of the face might occur. Ice packs can help alleviate temporary numbness and swelling. To reduce the risk of this side effect and others, do allergy testing before getting a dermal filler if it’s recommended for the particular filler.
Dermal fillers are discouraged for people who smoke. As with BOTOX® injections, you’ll receive the best results and fewer side effects if you’re in overall good health.
The Costs
The average cost of BOTOX® injections is $466, according to 2020 statistics from the American Society of Plastic Surgeons. The cost, of course, can vary, and is generally based on how advanced wrinkles are (and therefore how much product is needed) and the qualifications of the person performing the procedure.
The price of fillers varies widely depending on the product. The most recent statistics from the American Society of Plastic Surgeons found the average syringe of Radiesse was $717, while hyaluronic acid fillers such as Juvederm and Restylane were priced at $684.
The Final Takeaway
BOTOX® and fillers have more impact on quality of life than we initially thought, explains Dr. Maia, and could have impacts that go further than skin-deep. “The impact of these products in facial appearance and facial expressions are much more complex than what it appears. For example, there is a new concept that fillers can modulate the action of muscles of facial expressions resulting in improvement of facial appearance. BOTOX® has a wide range of indications that goes beyond wrinkle reduction. It can reduce sweating, teeth grinding, headaches and more recently there are studies showing that it may lessen depression.”
Of course, both fillers and BOTOX® come with their own risks and sets of advantages, and they’re not really used for the same thing. While BOTOX® is used to deal with wrinkles, it does so by paralyzing the muscles surrounding them. Fillers, on the other hand, do exactly what they sound like by filling in the areas they’re injected into.
“The best thing to do is to see a board-certified plastic surgeon or a dermatologist,” Dr. Schulman says. “They will be able to evaluate your skin and help you select the best treatment for your skin, desires, and pocketbook.”
