Botox and fillers get mentioned together, but they work differently and treat different problems. Knowing which is which helps you ask the right questions at a consultation.
Two different jobs
Neurotoxins such as Botox reduce activity in the muscle they are injected into. Fillers add volume or smooth a fold from beneath the skin.
A simple picture: a crease can come from a muscle that keeps folding the skin, or from skin that has lost support. Neurotoxins address the first. Fillers address the second.
A quick check
Relax your face in a mirror. A line that fades when your face is still is linked to muscle movement. A line that stays is more likely a matter of volume or skin support. Your provider can confirm.
Neurotoxins
The active ingredient in Botox Cosmetic is a botulinum toxin. It stops the release of acetylcholine, so the muscle becomes less active. Per the label:
- Muscles usually begin to weaken one to two days after injection and keep weakening through the first week
- The effect on frown lines lasts about 3 to 4 months
- The muscle may reinnervate, which slowly reverses the effect
Botox Cosmetic is not the only option. Dysport, Xeomin, Jeuveau, Daxxify and Letybo are also FDA-approved for cosmetic use, but their approved uses differ. Frown lines appear on all six labels. Crow's feet and forehead lines appear on the Botox Cosmetic and Xeomin labels. Ask whether your area is on the label of the product your provider plans to use.
Dermal fillers
Many fillers are made from hyaluronic acid, a sugar found naturally in skin that holds water. Others use different materials. Sculptra, for one, is poly-L-lactic acid, which builds its effect gradually.
- The FDA gives a general duration of about 6 to 12 months for hyaluronic acid fillers, and some products last longer in some areas
- An enzyme called hyaluronidase can dissolve hyaluronic acid filler, though that use is off-label
- Approved areas vary by product, and include the lips, cheeks, under-eye hollows and folds around the nose and mouth
The FDA says to avoid buying filler online and to avoid unapproved versions of products.
Choosing who injects
Product matters, but technique and judgment matter as well. Under Texas rules, cosmetic injections must be delegated by a physician and carried out by someone with the right training. See our guide on choosing a med spa for how to check.
Questions to ask:
- Which product will you use, and is my area on its label?
- How many units or syringes do you plan, and why?
- What happens if I dislike the result?
- Is hyaluronidase kept onsite if I get a hyaluronic acid filler?
Start modest
Ask whether a smaller first treatment and a follow-up visit makes sense for you. Adding more is easier than undoing too much.
Combining treatments
Some people use a neurotoxin and a filler in the same visit, for example one to soften forehead lines and another to restore cheek volume. This is sometimes called a liquid facelift.
Ask about doing it over several visits, so you can see how each step looks.