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 four FDA-approved neurotoxins available in the U.S.: Botox, Dysport, Xeomin, and Jeauveau. “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. 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."
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, 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.
"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.
Hyaluronic acid is a naturally occurring polysaccharide found in the human body. It acts as a cushioning and lubrication agent for our joints, nerves, hair, skin, and eyes. When used in skincare, it acts as a moisture binder, which means that it will attach itself to the water in the cells (while also attracting and holding water from the air) making them plump.
"The fillers currently available and FDA-approved in the United States have been tested extensively and are safe," says Dr. Liotta.
"Possible side effects include the Tyndall effect, which is the appearance of a bluish cast to the skin, 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."
She 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.
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.”
American Society for Aesthetic Plastic Surgery. Cosmetic (Aesthetic) Surgery National Data Bank Statistics 2018.
American Society for Dermatologic Surgery. Neuromodulators.
Shilpa PS, Kaul R, Sultana N, Bhat S. Botulinum toxin: the midas touch. J Nat Sci Biol Med. 2014;5(1):8-14. doi:10.4103/0976-9668.127274
American Society for Dermatologic Surgery. Dermal fillers.