Ready to take the plunge into the world of injectable treatments, but not sure where to start? Wondering if you should be using Botox or dermal fillers? And what on earth is the difference? You’re not alone! Injectables are a hotly debated topic in the beauty world, with so much (mis)information floating around about their purpose and effectiveness, it’s no wonder people can get confused. Here’s a simple, non-technical guide to help you decide if Botox, dermal fillers, or a combination of both is the right solution for your individual needs.
Botox vs fillers: What’s the difference?
So, let’s start by breaking down the very basic, fundamental difference between these two popular injectable treatments, to help set the stage for understanding the rest of the information we cover below. With Botox vs fillers, it’s really all about the type of facial aging you’re addressing. Dynamic wrinkles vs volume loss. Expression lines that result from repeated muscle movement over time vs soft, youthful curves and contours that naturally diminish and fade with age. Injectables are wonderful tools in the armamentarium of anti-aging, but if you don’t have a good understanding of what’s causing the aging changes in your face, it will be difficult to determine the best solution.
The Power of Botox
Scientifically speaking, Botox is a neuromodulator, and is used to treat what we call dynamic wrinkles, which result from repetitive facial muscle movements over time. Every time we raise our eyebrows, squint, purse our lips or furrow our brows we are creating small creases in the surface of the skin. Over time these little creases gradually become permanent, and we end up with visible expression lines that are still a result of muscle movement, but aren’t going away. The way that Botox works is by interrupting the chemical signal that is sent from our nerves to the muscles they innervate. When injected in very small, carefully measured doses it prevents the underlying muscle from contracting as strongly. In the absence of that constant, underlying muscle movement the skin will gradually smooth and soften over time, making those dynamic wrinkles less noticeable or, with an optimal dose, even completely disappearing. Botox injections are a quick treatment that rarely take longer than twenty minutes, and require zero recovery time so you can get right back to your day, usually as soon as the bandaid comes off! Patients will start to see results over the course of several days to two weeks and last for about three to four months, after which they can come in for a follow up treatment.
Filler Magic
While Botox has to do with softening the results of muscle movement, fillers are all about adding back volume. In the natural aging process our face loses a lot of important structural support in the form of subcutaneous fat, collagen and elastin fibers. Over the years this volume depletion causes the face to change from that heart-shaped, plump and full youthful face we once had, to something more oval and saggy. We see the cheeks flatten, the folds between the nose and mouth deepen, and the lips lose their shape and fullness. This is where dermal fillers come in. Most modern day fillers are made from hyaluronic acid, which is a naturally occurring substance that already exists in our skin, but also has the unique ability to bind to up to one thousand times its own weight in water. In other words, it can create volume fast and volume that will last. This makes hyaluronic acid based fillers a great tool in restoring that lost volume, when placed strategically by a trained, experienced professional. Fillers can be used to fill out the cheeks, smooth deep folds like the nasolabial creases that run from the nose to the corner of the mouth, as well as add shape and volume to the lips. They can also be used to add definition and contour to the jawline and chin, and very carefully placed to help improve under eye hollows. Unlike Botox, filler results are typically immediate but do require some swelling so patients should plan on taking it easy and a little recovery time before going about their day. Fillers will last significantly longer than Botox, but exactly how long depends a lot on the specific product as well as where it’s placed. Typical longevity is six to eighteen months, but again this will vary. The major safety advantage to fillers is their reversibility. If patients are unhappy with their results, an enzyme can be injected that essentially dissolves the filler, usually within twenty four to forty eight hours.
Matching Treatment to Concerns
Ok, so where does that leave us, Botox vs fillers, which one should I choose? Well, now that we have a basic understanding of how each treatment works, it’s time to talk about the actual clinical applications of these treatments, so that we can match specific concerns to the appropriate treatment. The easiest way to remember which is best for what is to think about the difference between dynamic wrinkles (Botox) vs volume loss (fillers). Botox is most effective for wrinkles and lines located in the upper face, those that are caused primarily by muscle movement. This includes horizontal forehead lines caused by raising the eyebrows, vertical frown lines (aka “11 lines”) between the eyebrows, and “crow’s feet” caused by the repeated movement of the orbicularis oculi around the eyes. Botox can also be used for other more specialized indications, including softening bunny lines across the upper nose, decreasing a gummy smile by relaxing the upper lip muscle, and for jaw tension and clenching by injecting into the masseter muscle. Dermal fillers are much more focused on helping with concerns related to volume loss and facial structure. They are great for adding volume and definition to thin lips, contouring and lifting up the cheekbones to restore a more youthful facial framework, smoothing the deep folds that run from the nose to the mouth, and restoring definition and contour along the jawline and chin. Fillers can also be used to very carefully add volume and support to under eye hollows, but this should only be done by the most skilled and experienced injector as this is an extremely delicate area.
Magic combination
For a lot of patients the best results are seen when both Botox and fillers are used together. The reason is simple, most of our faces show a combination of both dynamic wrinkles and volume loss. The magic of a combination approach is that you can use Botox to soften the upper face, while at the same time using fillers to restore volume and structural support to the mid and lower face, resulting in a more comprehensive and harmonious rejuvenation than if you would have used just one or the other. Let’s take a hypothetical patient as an example. Let’s say she’s a woman in her late forties who is looking for a comprehensive anti-aging facial. After a consultation you both agree she has moderate dynamic wrinkles in the forehead and crow’s feet, as well as significant volume loss in the cheeks leading to deepened nasolabial folds. If you only did Botox you would be able to soften the upper face, but the sagging and volume loss in the mid face would be unaddressed. If you only did filler you would be able to restore the lost volume and smooth the deep folds, but the expression lines in the upper face would be left untouched. By using a combination approach you could use Botox to create a smooth, relaxed appearance in the upper face, and fillers to restore structural support to the mid face, resulting in a very comprehensive rejuvenation that addresses both the causes as well as the effects of the aging process in different facial regions.
Pick the right injector
Before we wrap up this overview of the most important information you need to know about injectable treatments, there’s one thing that’s more important than what treatment or what combination you choose. That would be making sure you have the right doctor or nurse to perform your treatment. There are literally no shortage of horror stories about injectables, all due to getting them done by the wrong person. These are minimally invasive procedures that require an intimate knowledge of facial anatomy and medical expertise to perform safely and with the best possible result, so it’s important to choose a provider who knows what they are doing and has a great deal of experience. Look for a board-certified dermatologist or plastic surgeon, or in the case of registered nurses or physician assistants who are highly trained, very experienced and work under direct physician supervision. A qualified provider will take the time to really listen to your goals, and will be able to have an honest and open conversation with you about what’s possible as well as what’s not. They will discuss your medical history, thoroughly explain all risks and benefits, and tailor a treatment plan to your specific needs using only FDA approved products purchased from reputable sources. They should also have a portfolio of their work available to view and be able to clearly and simply explain their approach to you. Be suspicious of any provider that offers massively discounted prices or who can’t or won’t show you where their products are sourced from.
The overall approach to cosmetic injectables has evolved significantly over the last few years, moving more and more towards a natural, refreshed look, as opposed to the super smoothed out, “done” look that we used to see more commonly in the past. The idea is to enhance your natural beauty and help you look like the best, most rested and healthy version of yourself. Whether you choose to treat with Botox, dermal fillers, or both you should be empowered to have an open, productive conversation with your medical provider about your concerns. Understanding the differences in how Botox and dermal fillers work and their different clinical applications is a great first step towards that goal. Armed with that knowledge you are well on your way to being able to have an informed discussion with your doctor and a better understanding of their recommended treatment plan. This will ensure you’re both on the same page, so you can actively work together to get you the results you want, while still preserving the safety and natural elegance that are the hallmarks of modern aesthetic treatment.
