From Good Housekeeping
The rise of smartphone cameras, selfies, and now video calls has meant more focus on our faces than ever— which can lead to more time spent looking at your reflection, analyzing every line and wrinkle. In addition to the endless anti-aging products on the market that can help treat these lines, there is another option: facial injectables.
You may already know the basics about injectable wrinkle relaxers like Botox and fillers from your initial research — but if you don’t really get the difference, we’re here to get into the nitty gritty details about each of these injectables, including the price difference, pain factor, which lasts longer, which to get first, and very importantly, where to get what. Keep reading for the full scoop on Botox versus fillers, straight from the pros.
What is Botox?
In case you need a little refresher, “Botox, or Botulinum toxin, is a neurotoxin that temporarily paralyzes the muscle that it is injected into, therefore reducing the wrinkling and pulling of the overlying skin,” explains board-certified dermatologist Michelle Henry, M.D., founder of Skin & Aesthetic Surgery of Manhattan. “It is used to treat dynamic wrinkles, which are wrinkles and lines seen when one animates their face.” Botox itself is a specific (and popular) brand of neurotoxin; others include Dysport, Xeomin, and Jeuveau.
What are fillers?
“Fillers are injectable gels that function to add volume in the areas of the skin that have sunken in,” says board-certified dermatologist Corey L. Hartman, M.D., founder of Skin Wellness Dermatology in Birmingham, Alabama. “When you see folds, crevices, creases, or crinkles, different fillers of various consistency can be used to replace the volume, correct the deficit and give a plumper look.”
There are two main different types of fillers: those made of hyaluronic acid (HA) and calcium hydroxyapatite (CaHA). “Each filler has specific and unique properties,” says Dr. Henry. “This is why choosing an injector that is experienced in understanding the anatomy and the rheology of these products is critical.”
“HA fillers come in a variety of consistencies and viscosities across several brands and can be used all over the face, including the temples, tear troughs, naso-labial folds, cheekbones, chin, jowls, nose, forehead, neck – just about anywhere,” Dr. Hartman says. “Certain HA fillers, like Belotero Balance Plus, are softer and best suited for fine superficial lines,” says Dr. Henry. She often refers to this product as the final touch or finishing product, as it gives an airbrushed effect. “Others like Juvéderm Voluma provide greater lift to give sharp cheeks or a more projected chin.” For someone who wants a very natural look, Dr. Henry suggets Restylane Defyne, a filler made to move with the skin.
CaHA is a heavier, less forgiving substance that is best injected deep to mimic bone and provide structural support, so it’s mainly used in the cheeks, jawline, and lower face.
The main difference between injectable neurotoxins like Botox versus fillers, according to Dr. Hartman: “Botox relaxes muscle movement and the lines that form as a result of moving, or dynamic wrinkles,” he explains. “Fillers replace volume to correct folds, grooves, and creases that are present when the face is at rest.”
How — and when — to opt for fillers vs. Botox
While we’d love an easy answer for which injectable to try first, both doctors say that it really depends on the patient and their needs and desires. “Aging is a dynamic process that is different for ever individual,” Dr. Henry says. “Based on one’s genetics, they may wrinkle before they sag or ‘sink’ before they wrinkle.”
Dr. Hartman agrees, but shares that many of his patients start with Botox, since the concerns occur at a younger age and Botox has less potential for downtime. “I liken Botox to tiptoeing into the shallow end of the cosmetic pool,” Dr. Hartman says. “It gives someone a nice taste of how injections feel and what to expect from the treatments.” Now that we’ve got the definitions down, it’s time to learn exactly where to use what:
Forehead: Dr. Hartman recommends starting with Botox. “Most people will be able to see noticeable improvement in their forehead lines with Botox, particularly if the procedure is started at a younger age before the lines become etched into the skin and apparent even at rest,” he says.
There is one spot on the forehead where Dr. Hartman doesn’t go for Botox: The line right above the eyebrow (he calls it the “comma”) which can be difficult to treat with Botox “for fear of causing the dreaded droopy eyebrow,” he says. Instead, he considers filler placed deep into the frontalis muscle of the forehead a great option for this location. “It lasts longer than Botox and gives the muscle something to work against instead of restricting the action of the muscle through the nerves that control it.”
Eyes and crow’s feet: Both Botox and fillers can work wonders to revive the eye area, depending on what you are aiming to treat. “Botox will smooth and prevent later crow’s feet, elevate the brow and open up the eyes, while fillers can replace lost volume in the tear trough and medial cheek that contribute to dark circles, hollowness and a “tired” appearance,” Dr. Hartman says. To avoid bruising and the risk of blod clotting, which can lead to blindness, be sure to visit a board-certified dermatologist: “This is not the area to trust to an inexperienced injector,” he advises.
Cheeks: “Filler is the way to go for cheeks, as it will improve lift and highlight the cheekbones to produce a greater effect of light, shadow and contour,” Dr. Hartman explains. Dr. Henry agrees and specifically recommends Restylane Lyft, Juvederm Voluma, or Radiesse for the cheeks. “They all have excellent lifting capacity and give a natural result,” she says.
Lips: When it comes to your mouth, it really depends how quickly you hope to see results, how long you want them to last, and what you are looking to achieve.
✔️ “Fillers are a great option to help smooth perioral [smile] lines that have started to form, and to provide hydration, volume, and pout to the lips,” Dr. Hartman says. With fillers, you will see immediate results which should last eight to 12 months.
✔️ Botox is a good option for a subtle “lip flip” where you relax the muscle around the mouth to turn the lip up slightly or to prevent lipstick from bleeding. When you use Botox on the lips, the effect is slower as the “product will gradually paralyze portions of the muscle with time,” Dr. Henry explains. “The initial results start to take place two to five days after the injection and peak at two weeks.” However, Dr. Hartman warns that “you are limited in the amount of Botox you can use in the lips, because too much can impair the ability to chew properly, control drooling, or speak properly.”
How much do Botox and fillers cost?
Fillers are also the more expensive of the two injectables. Dr. Henry says, “Botox typically ranges from $250 to $600 per area, while fillers can range in price from typically $600 to $1,250 depending on the location, geography of the practice, and product used.”
All this being said, fillers (including Juvéderm) do last longer than Botox. Filler results are visible for anywhere from nine months to two years, while Botox typically lasts three to four months.
Are there any side effects when getting injectables?
Both types of injectables do have potential side effects:
Pain during procedure. They are both administered with needles so there is potential for slight discomfort associated with the procedures, but most of that pain can be ameliorated with a topical numbing agent prior to the procedure. In terms of the pain factor, “it depends on the area that is injected; however, in general, both procedures are quite tolerable,” Dr. Henry says. But slightly larger needles are used for fillers, so both experts agree that fillers may be minimally more uncomfortable.
Bruising and/or swelling. “Whenever needles are involved, there is the potential for temporary bruising and swelling as well,” Dr. Hartman notes. He recommends applying ice packs after the treatments as well as anti-bruising supplements and creams containing arnica, bromelain, and vitamin K.
“Frozen” features. When it comes to Botox, “excess or incorrectly placed Botox can lead to a frozen forehead, ptosis (excessively heavy eyelids), or an uneven smile,” Dr. Henry says. Even with Botox gone wrong, “they often self-correct with time and wear off in three to four months or less.”
Uneven results. “Overfilling an area is a great concern, as well as injecting into a blood vessel and hurting the overlying skin,” she adds. “One can help mitigate this risk by choosing a well-trained injector, like a board-certified dermatologist, that has a strong grasp of anatomy.”
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