Many patients considering non-surgical facial rejuvenation ask about the difference between Botox and fillers.  These treatments are both performed through injections in an office-based procedure.  Local anesthetic is generally not required and there is little to no downtime.  Understanding differences between Botox and fillers will enable one to understand their different applications.

 

Botox and fillers have different mechanisms of action

Botox is a neuromodulator, which means that it temporarily weakens muscles.  Botox may therefore soften the appearance of wrinkles that are created by dynamic movements of the face.  If a wrinkle is present at rest, Botox may have limited effect since weakening the muscles will not affect the static appearance of the skin crease.  Fillers in contrast act as plumping agents.  There are many different types of fillers and the most common group is made of hyaluronic acid.  This is a type of sugar, which may be reversed by injecting a particular enzyme that breaks down the product.  Hyaluronic acid fillers are generally safer than other types of fillers (e.g. calcium, collagen, polymers) given this reversible effect.  Fillers are effective in addressing static wrinkles and adding volume to the face.

They are used in different regions of the face

The most common site for Botox injections is the glabellar region, which softens the appearance of a furrowed brow (the so-called “11 lines”).  Off-label sites for Botox are expanding, including the transverse forehead lines, crows’ feet, bunny lines, as well as lines around the mouth and chin.  It may also be injected to narrow a square jawline caused by overactivity of the masseter muscle and to soften the appearance of dynamic neck bands.  Fillers in contrast are injected to add volume.  This may be beneficial to plump up static wrinkles, commonly smile and marionette lines around the mouth.  Fillers may also be used to add volume to the midface or cheeks that has been lost through the natural aging process.  The filler is injected at a deeper level in these cases to provide more structural support.  Another common site for fillers is lip augmentation and correcting fines lines around the mouth (so-called smokers’ lines).

Botox and fillers have different onset of action

The effects of Botox are not immediately apparent.  Botox takes effect in 4-5 days with maximum effect by two weeks post-injection.  Fillers in contrast immediately add volume, however swelling may be more commonly experienced than following Botox injections.  Cold compresses are recommended over the first 24-48 hours as able following fillers to reduce swelling and potential for bruising.

Botox and fillers also have different lengths of treatment effect

The effects of Botox last on average between 3-6 months.  The length of filler treatment effect varies based on the type of filler and specific preparation.  Older types of hyaluronic acid fillers generally resorb within a few months, while newer products with altered crosslinking may last up to 1-2 years depending on the product, site, and depth of injection.  Newer fillers used for lip augmentation generally last one year.  The lips have an excellent blood supply and significant movement, which led to faster breakdown of earlier types of hyaluronic fillers in this region.

 

Given these key product differences, Botox and fillers may be used to achieve different aesthetic goals.  In some patients Botox and fillers may be combined through an individualized treatment plan to address both dynamic wrinkles and static creases or for volume augmentation. 

 

Please contact us if interested in discussing non-surgical facial rejuvenation.