When it comes to injectables it can be hard to know where to start. If you’re looking for a non-invasive cosmetic boost, a quick trip to the doctor can prove just the ticket. But whether you want to treat fine lines and wrinkles, or maybe just want a little plumping and smoothing, do you go for Botox or do you get a filler? Well, the answer could be both, or one and the other, depending on the region of your face that you want to treat.
Here, Dr. Gabriel Chiu, Plastic Surgeon and founder of Beverly Hills Plastic Surgery Inc and Dr. Dara Liotta, double board certified Facial Plastic Surgeon in New York City, give us the rundown on Botox, fillers, and how the injectables can be used to augment your appearance.
What’s the main difference between Botox and Filler?
At their most basic, Botox and neuromodulators like it relax muscles, while filler adds volume to areas of the face.
Where does one typically get Botox on the face?
According to Dr. Chiu, the most common areas for Botox use are forehead frown lines and crow’s feet. “This has been the case even more so lately for millennials as they scroll online and for individuals on camera at home more often than normal.” Less commonly treated areas include turkey neck, square jaw, smoker’s lips, and depressor anguli oris muscles (corners of mouth frowning), he explains.
Dr. Liotta reminds that you can also use Botox preventatively, injecting and treating areas to prevent the wrinkles from forming in the first place. “You can also use Botox to enhance features. For example a Botox brow lift to raise or shape the arch of the eyebrow, Botox lip lifts to increase lip volume and definition, Botox at the angle of the jaw to slim the jawline, or even Botox to improve a gummy smile.”
What part of the muscle is Botox injected into?
Neuromodulators are injected into the belly of the muscle. But, it should be noted, says Dr. Liotta, that the face has many layers of overlapping muscles that are in different locations and depths in the face, and they each exert a pull at rest as well as a pull during animation. “Botox must be injected directly into the target muscle in both the proper location and proper depth, and in the proper amount, in order to affect the movement in the correct, desired way without causing unwanted weakening of the very nearby other muscles,” she says
And another thing: if the Botox does produce an unwanted effect by affecting the wrong muscle, there’s no way to reverse it. You just have to wait it out 3-4 months.
The takeaway? Choose your board certified, experienced injector carefully!
How long does it take to see results from Botox injections in expression lines?
“The results from Botox can start to take effect and be noticeable in 1-3 days and are in full effects in 7-10 days after injection,” says Dr. Chiu.
What are some off-label uses for Botox and why?
First, a note from Dr. Liotta: “A use being “off label” doesn’t mean that it’s not safe there! It’s the same product. The same substance—injected just inches, or less, from the area of approval, it’s just that they haven’t done official studies in that area.”
So where can you get Botox injected that isn’t necessarily for aging related issues? Treating the pain of TMJ, as a migraine treatment or even as a way to make the face more symmetrical after facial paralysis or spasm. Similarly, turkey neck, square jaw, and smoker’s lips are all off-label uses that can effectively treat certain cosmetic issues.
Can Botox and filler be used together?
In short: definitely. Dr. Liotta explains: Botox can be used to help refine the results of filler in an area. The combination can often produce a more elegant, sophisticated result.
For example, when treating the chin non-surgically, Botox and filler can be injected to enhance the shape of the chin. “The combination of filler and Botox in this area means that the filler physically adds volume and projection to the chin bone on profile, and the Botox relaxes the muscle that pulls back on the skin and allows us to see the full effect of the filler, making the result more dramatic,” she explains.
Another area that Dr. Liotta often uses the combination is with the lip. “When most people think of lip augmentation and lip plumping with needles, they think of filler like Juvederm and Restylane, but Botox can also be used, either alone, or in combination with fillers, for a subtle pout-magnification.” Filler adds volume, and makes the lip larger by literally making it bigger. Botox works differently. Botox relaxes muscles, and by relaxing the muscle around the mouth, called the “orbicularis oris,” it rolls the lip outward (or “flips” the lip), giving the illusion that the lip is bigger without actually adding any volume
Where are the most common places to inject filler?
The classic areas where people have filler injected, according to Dr. Chiu, are intuitive. “the lips, nasolabial folds (your smile lines), and cheeks are all common—and which you probably most often see celebrities taking part in. Recently, injection along the jawline and chin have become very popular, especially as we’re all staring at ourselves on Zoom more. These are all areas where aging causes changes in volume. Adding volume by dermal filler injections to the cheeks, lips, nasolabial folds, and jawline generally creates a more youthful and stronger appearance. Filler can also be used for under-eyes too to help eliminate hollow bags aka “tired-looking eyes.””
What are the typical kinds of filler used and how do they work?
There a few different kinds of filler that you can have injected. The first group is hyaluronic acid filler (Juvederm, Restylane, Belotero), which Dr. Liotta describes as “tried and true.” They are not permanent (we have an enzyme in our body, hyaluronidase, that breaks them down over time) and can be injected clinically with that same enzyme to dissolve them immediately if there’s some reason you need to. They last 1-2 years.
Then, there’s Radiesse, which is made of calcium hydroxyapatite. It lasts around 15 months but can NOT be dissolved.
Last but not least, there’s Sculptra. The filler contains PLLA, which acts as a collagen stimulator, helping to gradually restore fullness to facial wrinkles and folds. Results are not immediate like with other fillers and can take up to 3 months to fully develop, and last around 2 years. An important note: the results are also not able to be reversed until the treatments wears off.
And when it comes to permanent filler of various types, Dr. Liotta has this and only this to say: don’t do it.
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