Botox vs. Fillers: Which Injectable Is Right for You?

Experts break down the two wildly popular cosmetic treatments.

Filler. Photo: Getty Images

Even before the pandemic-induced plastic surgery Zoom Boom, injectables have been rising for the past decade. According to the American Society of Plastic Surgeons 2020 Plastic Surgery Statistics Report, dermal fillers remained the most popular minimally invasive procedure, despite surgeons' offices being closed for part of the year.

With growing transparency about cosmetic procedures from celebrities and your social circle, you're probably already well aware that dermal fillers are more popular than ever. But what you might not know the differences between the options and how to choose which one is right for you, should you be interested in trying the treatment.

Keep reading to get all the details on Botox and fillers, straight from the experts.

What Is Botox?

First, it's important to note that Botox is the brand name for a specific Botulinum neurotoxin by Allergan. Aesthetics. There are currently four FDA-approved neurotoxins in the U.S.: Botox, Dysport, Xeomin, and Jeuveau.

Botulinum neurotoxin is best used for wrinkles, frown lines, and crow's feet. Botox is the only neurotoxin that has FDA approval as a treatment for crow's feet and excessive sweating, but any neurotoxin can treat these concerns. This is often called "off-label" use.

"Botox (Botulinum toxin) is a neuromodulator used to relax the muscles in our face and neck thereby decreasing the appearance of fine lines and wrinkles," says Dr. Adrienne O'Connell, Medical Director and Founder of Laguna Beach Aesthetics. "It's a neurotoxic protein produced by the bacterium Clostridium botulinum. It prevents the release of acetylcholine (a neurotransmitter) from the axon endings at the neuromuscular junction, causing flaccid paralysis. When 'paralyzing' the muscles in our face, it prevents the formation of fine lines and wrinkles."

Expect for the Botox to take effect a day or two after the injection, with full results in one to two weeks.

Dr. Smita Ramanadham, a plastic surgeon based in New Jersey, says Botox and other neuromodulators typically last three to four months, which is when patients will typically return for their next treatment.

What Are Fillers?

Filler is a compound, usually comprised of hyaluronic acid [which also occurs naturally in the body], and does exactly what the name suggests — it fills in deep wrinkles and restores volume to areas where it is lost. The most popular hyaluronic acid fillers include the brands Juvéderm, Restylane, RHA Collection, Revanesse, and Belotero.

"These areas can include the nasolabial folds, marionette lines,or tear trough," Dr. Ramandham says. "It can also be used to replace fat that we lose normally as we age, such as in the cheeks and temples."

Additionally, filler can be used to augment areas of the face and add definition, such as the jawline, lips, or chin. Off-label, fillers are used on the earlobes and hands to minimize the look of crepey skin.

Hyaluronic acid isn't the only type of fillers. Brands like Sculptra and Radiesse have different mechanisms and are made from different ingredients. "Sculptra is Poly-L-Lactic acid, which is injected and builds volume and collagen over time, versus Radiesse, which is comprised of Calcium Hydroxylapatite that produces immediate volume while improving collagen over time," Dr. Ramandham explains.

Depending on the area you inject and the type of filler you get, the results can last six months up to two years. Dr. Ramandham says patients generally return for treatment one or two times a year.

What's The Difference Between Botox and Fillers?

The only similarity between Botox and fillers is that they're both administered with a syringe. The compounds do completely different things. Botox helps to eliminate wrinkles that come from muscular contractions by keeping those muscles from moving, whereas fillers are effective for areas that are hollowing, flattening, or where fat is moving.

That being said, you don't necessarily have to pick one over the other. Doctors may opt to use a combination of both depending on the areas you wish to treat and your desired results.

"Most of the time, we pair Botox with fillers when restoring a patients youthful appearance. Botox will help decrease fine lines and wrinkles created by muscle movement, whereas fillers will increase fullness where there is a loss of volume," Dr. O'Connell says. "When assessing a patient, it is crucial to assess skin texture, tone, laxity and volume. This will help determine what products are needed and where."

Your doctor may also use a few different fillers. "Different fillers are also chosen based on the location of injection and the desired effect," Dr. Ramanadham says. "In regards to hyaluronic acid fillers for example, these differ in their rheological properties, meaning some are thinner and more fluid while others may have more lifting power or may be stiffer."

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Potential Side Effects of Botox and Fillers

There is the potential for pain and bruising whenever the skin is punctured. "Swelling and allergic reactions are also a risk," says Dr. O'Connell. "Infection is another possibility, but it's somewhat higher of a risk with filler."

Dr. Ramanadham says that minor side effects such as bruising, headaches, itchiness, a bluish tint to the skin, and asymmetry (from the injection and not the amount administered) typically resolve after 24 to 48 hours.

For Botox, if too much is injected, it can cause muscles not to function properly. "Neuromodulators weaken muscle, so if too much is placed in one area then that muscle will not function normally," says Dr. Christopher Zoumalan, a board-certified oculoplsatic surgeon in Beverly Hills. "For instance, if too much neuromodulator is injected in the forehead of someone that really needs the forehead muscles since they have low set brows, then the brows will drop and the patient will be very unhappy for several months until the neuromodulator wears off."

For fillers, improper technique can lead to lumps and bumps. "Filler can migrate to unwanted areas," Dr. O'Connell says. "Filler can also pose a risk for vascular compromise due to inadvertent injection into a blood vessel or compression by the filler volume. This can lead to skin necrosis, blindness and stroke."

Even though injectables are minimally invasive, the treatments come with potentially serious risks. The best way to avoid complications is for a board-certified dermatologist or plastic surgeon to perform the injections.

Who Should Get Botox and/or Fillers?

Most people are good candidates for Botox and fillers. Those with neuromuscular diseases. For filler, Dr. Ramanadham says injectors will avoid administering filler to those with "active inflammatory conditions or infection such as a recent tooth infection or dental work."

Additionally, anyone with autoimmune disorders should consult with their doctor before getting injectables. "Active rashes, infections, lacerations, or other active skin issues in the area of injection should also be avoided," Dr. Ramanadham adds.

How Much Do Botox and Fillers Cost?

The price of Botox and fillers will vary depending on how product you need injected, where you live, and the qualifications of who is doing the injections.

According to 2020 statistics from the American Society of Plastic Surgeons, the average cost of Botox injections is $466.

However, the main factor that determines how much filler costs is the type you get. Current statistics from the American Society of Plastic Surgeons found the average syringe of hyaluronic acid fillers, such as Juvederm and Restylane, are $684, while polylactic acid fillers like Sculptra are $853 per syringe.

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