Botox® vs. Dermal Fillers: How to Choose Which One is For You?

Botox and dermal fillers (Belotero, Radiesse, Juvederm, Restylane, Voluma etc.) are two very different products, both are used for treating skin wrinkles and folds.


Skin wrinkles and folds, how are they formed?

Skin wrinkles and folds, which naturally occur as we age, can develop through two mechanisms; 1) repeated muscle overactivity, and 2) loss of skin fullness and support due to depletion of fat, connective tissue and skin elasticity. Muscle overactivity seen during facial expressions such as squinting, frowning or smiling, will form wrinkle over time. The end results of muscle overactivity often occur at areas such as the forehead, between the eyes, or at the outer eyes (crow's-feet). On the other end, loss of skin fullness results in skin sagging and the development of folds. Loss of skin fullness is commonly seen at the cheeks result in naso-labial or marionette folds. Loss of skin fullness can also lead to depression of the skin; tear trough, the dark circles under the eyes and thinning of the upper lip are good examples for skin depression.

How these drugs work?

A simple way to visualize the difference between Botox or Xeomin and fillers is to think of a crease as a valley between two mountains. Botulinum toxins (Botox and Xeomin) prevent the mountains from being pushed towards each other; fillers fill-in the valley.

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facial fillers


Botox is a drug containing an agent that in large quantity paralyses the nerves and muscles. A minute quantities injected into a muscle will just weaken and relax it from over working and will stop it from causing wrinkles. It can also be used to treat neck lines and bands. This medicine is used to treat "active" facial lines, meaning those that have only recently formed. Its most recent FDA approval is for armpit sweating and sweaty hands.


Botox works on creases not only by weakening the muscles that cause the creases. In addition, it works through a different mechanism, which is even more important; as the muscles get weaker, the patient gets out of the habit of creasing and over using those muscles. In this way, Botox may actually prevent the progression and deepening of wrinkles.


Dermal fillers

Dermal fillers on the other hand, are used to treat established and deeper wrinkles by replacing the lost fat and connective tissue that support the skin. Fillers usually contain hyaluronic acid, a naturally occurring substance that can be used to fill out the grooves. The difference between fillers has to do with thickness and longevity. In general, the thicker the filler, the better it will fill creases, but the greater the chance of creating bumps. Bumps are more likely in thinner skin such as the lower eyelids and crow's feet.

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Fillers are used not only to "lift" the skin to overcome wrinkles, but also to reshape, improve or enhance facial structures such as filling-in acne scars, enhancing cheekbones to make them fuller and more defined, enlarging lips for a fuller, softer pout and filling-in hollows under the eyes that contribute to dark circles.


A rule of thumb:

If creases are only apparent when we squint, only Botox is needed.

If creases are visible at rest, and NOT made worse by squinting, then fillers are necessary.

If creases are present at rest and get worse with facial expressions, then Botox AND fillers will be necessary.


A more detailed description of different Botulinum toxins and fillers - in Women's Magazine, January 2014 issue.

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