Botox vs. Fillers
I was at a local gathering recently, and when someone learned that I was a plastic surgeon, they wanted to pick my brain about what would be better for a more relaxed, refreshed look – Botox or fillers? I realized that while the media has done a great job of bringing awareness about these great non-invasive options, there is room for more understanding about these products. This post is my effort to increase awareness of these two options. Read on to learn more about these injectable treatments, and which one is right for you.
Botox is a neurotoxin derived from Clostridium botulinum, an organism found in the natural environment. In extremely small concentrations, Botulinum toxin is used to reduce fine lines and wrinkles by paralyzing the underlying muscles. It works by preventing signals from the nerve cells reaching muscles, therefore paralyzing them, which in turn smoothens the lines that form when those muscles are active. This treatment can address horizontal forehead lines, lines between the eyebrows, and crow’s feet or laugh lines around the eyes.
Here are some of the misconceptions I have heard about Botox:
- “I don’t want a frozen face” – If used artfully and conservatively, Botox can really smooth the lines that make you look tired, angry, or like you have a perpetual scowl, without taking away your ability to show emotion
- “It hurts too much” – Botox treatments are not very painful, and when fine needle tips are used, do not cause noticeable bruising. Although there are individual variations, usually, this is something you can schedule during a regular day and expect to be back at work/social gathering in 1-2 hours.
- “I will get hooked on it” – Well, Botox is not habit forming in that it has no addictive potential. The effects last for about 3-4 months, and we recommend ongoing treatments to prevent fine lines from turning into more permanent deep lines. However, if you feel that Botox is not for you after the first treatment, then you don’t have to continue with the treatments and your muscles continue working just like before. Most patients love the results and keep coming back regularly.
There are multiple components to facial appearance and changes as we age. Botox works by relaxing the muscles that start fine and deep lines. Another component of facial aesthetics is a loss of soft tissue volume from the face. This causes hollowing of the cheeks, thinning of lips with fine vertical lines, smile lines that look like parenthesis, jowls, and under-eye hollows. Fillers, such as Restylane and Juvéderm, add volume in the right place for a more youthful, refreshed appearance.
Many of the currently available fillers, including ones from the Juvéderm and Restylane families, are hyaluronic acid based. Hyaluronic acid is a component of joint fluid and other soft tissues. They are injected at different depths to give the desired effect. For example, to add fullness to the cheeks, they are injected just above the cheekbone, whereas for the lips and smile lines around the lips, they are injected slightly more superficially for a more obvious effect. Of course, too superficial of an injection can also give undesirable results, and hence the importance of finding a qualified, experienced injector.
Some of the common misconceptions about fillers that I’ve come across are:
- “I don’t want to look plastic or like I’ve had work done” – With fillers, it is as much of an art as it is science. Most people need less than 1 mL of fillers placed strategically. This is equal to a fifth of a teaspoon. The end result is a face that still looks like you, but more refreshed.
- “They are permanent” – Most hyaluronic acid fillers last anywhere between 6-12 months. The Newer generation of fillers, such as Volbella, can last up to 18 months.
- “I don’t want duck lips” – Fillers can add subtle volume to the lips, and result in better lip aesthetics by enhancing natural lip landmarks. The result is lips that look well hydrated and symmetric. Dramatically large, unnatural appearing lips that don’t fit the facial frame are rare with good technique and planning.
- “They are very painful and invasive” – While filler injections are typically more uncomfortable than Botox injections, they can be a 15-20 min office treatment. You can ask for topical anesthesia, and most fillers have lidocaine, which results in numbing with ongoing treatment.
While Botox is used to treat wrinkles and lines caused by muscle contractions, fillers are used to treat lost volume and smile lines. They are used alone or in combination with each other and are an excellent tool for facial contouring. Of course, having a good basic skin care routine complements all these modalities. If you don’t know which injectable treatment is right for you, a consultation can help to determine which treatment can help.