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 New York City board-certified plastic surgeon Dr. Matthew Schulman and asked him to give us all the details.
First things first: Dr. Schulman points out that Botox is the brand name of a specific botulinum neurotoxin. “There are three FDA-approved neurotoxins available in the United States—Botox, Dysport, and Xeomin,” Dr. Schulman says. All three work by paralyzing the muscles and preventing muscle contractions, and each typically wears off around the four month mark. “Botulinum toxin is best used in areas of facial expression such as the frown lines, crow's feet, and ‘11s’ between the eyebrows.”
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.
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. The injections will start working 1-3 days post-treatment.
Regardless of the fact that botulinum toxin is one of the most deadly toxins in the world, botox is incredibly safe when performed correctly. 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. The most likely side effects are bruising and pain at the injection site—the same as any injection, not exactly a toxic reaction.
If you're experiencing something like eye dryness, a crooked smile, drooling, or a drooping eyelid, you should keep watch on it, but it's still normal. You may need it corrected, but speak to your doctor about how long to wait in order to figure that out. If any of those symptoms evolve into muscle weakness or trouble breathing, speaking, or seeing, you should call your doctor or get to a hospital right away.
"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 nine to 12 months. “There are other fillers composed of calcium (like Radiesse), which are better for deep filling and can last 12 to 14 months,” Dr. Schulman says.
Dr. Schulman says hyaluronic acid fillers are great for lines of the face and filling lips. “Filling the deeper lines of the face, such as the marionette lines or nasolabial lines (i.e., laugh lines) is best accomplished with a hyaluronic acid filler.” For even deeper filling power—think sleep wrinkles on the cheeks and chin—he says to choose a calcium-based filler. Hyaluronic acid fillers can also be dissolved if you don't like how they've turned out, while other types of fillers cannot as easily.
Fillers are also fairly safe, but their potential side effects range a bit more greatly. Most concerningly, the Tyndall effect, where your skin turns blue, is a possibility (although it can be treated.) Depending on the kind of filler, an allergic reaction is a possibility. So are bumps under the skin similar to acne. There are even nastier side effects (necrosis, blindness) that are possible, but they're very unlikely. The best way to stave off anything negative is, of course, to see a doctor that performs filler procedures regularly and will talk you through any potential risks for your particular procedure.
The Bottom Line
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.”