People often talk about Botox and fillers in the same breath, yet they act in different ways on different concerns. Understanding the difference makes it easier to ask useful questions when you sit down for a consultation.
They do different things
Botox and other neurotoxins lower the activity of the muscle they go into. Fillers sit beneath the skin to add volume or soften a fold.
One way to think about it: some creases come from a muscle that folds the skin over and over, and others come from skin that has lost its support. Neurotoxins are aimed at the first kind and fillers at the second.
Try this at home
Look in a mirror with your face relaxed. If a line disappears when your face is at rest, muscle movement is involved. If it remains, lost volume or skin support is the more likely cause. Your provider can tell you for sure.
How neurotoxins work
Botox Cosmetic's active ingredient is a botulinum toxin, which blocks the release of acetylcholine and so makes the muscle less active. According to the label:
- Weakening of the muscle typically starts one to two days after the injection and increases over the first week
- For frown lines, the effect lasts roughly 3 to 4 months
- Reinnervation of the muscle may occur, slowly reversing the effect
Other neurotoxins exist. Dysport, Xeomin, Jeuveau, Daxxify and Letybo are FDA-approved for cosmetic use too, but each is approved for different uses. Every one of the six labels includes frown lines. Crow's feet and forehead lines are on the Botox Cosmetic and Xeomin labels. Check that the area you want treated is on the label of the product your provider intends to use.
How fillers work
Hyaluronic acid, a sugar that occurs naturally in skin and holds water, is the base of many fillers. Other fillers are made of different materials. Sculptra, for example, is poly-L-lactic acid and produces its effect gradually.
- For hyaluronic acid fillers, the FDA gives a general duration of roughly 6 to 12 months, and some products last longer in certain areas
- Hyaluronic acid filler can be dissolved with an enzyme called hyaluronidase, although using it this way is off-label
- Which areas a filler is approved for depends on the product. Approved areas include the lips, cheeks, under-eye hollows and the folds around the nose and mouth
The FDA advises against buying filler online and against using unapproved versions of products.
Picking an injector
The product is only part of it. The injector's technique and judgment count too. Texas rules require cosmetic injections to be delegated by a physician and performed by a person with appropriate training. Our guide to choosing a med spa explains how to check.
Worth asking:
- What product will you use, and does its label cover my area?
- How many units or syringes are you planning, and what is the reasoning?
- What are my options if I do not like the result?
- If I get a hyaluronic acid filler, do you keep hyaluronidase onsite?
Begin with less
Ask if it makes sense for you to start with a smaller treatment and come back for a follow-up. It is easier to add than to undo.
Using both together
Some patients have a neurotoxin and a filler at one appointment, for instance the neurotoxin for forehead lines and the filler for lost cheek volume. People sometimes call this a liquid facelift.
You can also ask to spread the work across several appointments so you see the effect of each step.