Cosmetic Injectables 101 – Botox vs Fillers


For many patients common questions about injectables involve their uses and longevity. Injectables can be divided into 2 categories: Neuromodulators and Dermal Fillers.

 1) Neuromodulators  – With names like Botox, Dysport, or Xeomin, these medications are neuromodulators and act by relaxing muscles that cause facial expressions such as frowning or squinting which over time lead to wrinkles.  The effects of  neuromodulators last for 3 to 4 months and wear off gradually.    For this reason Botox and other neuromodulators have  high safety profiles and low complication rates when used by trained professionals. The specific areas in the face that are most commonly treated with Neuromodulators are; the nasal furrow between the eyes, the horizontal lines of the forehead, and the crows feet. All of these lines are caused by muscle contraction which over a long period of time will cause lines in the skin to form. By  relaxing muscle contraction,  these lines slowly disappear if they are not too deep and this is why it’s best to start the use of these muscle relaxants as the lines 1st appear.  The rules of three’s best explains how these agents work over time.  Patients will first notice the effect of neuromodulators in 3 days,  the maximal effect takes 3 weeks to develop, and the effect last 3 months before it starts to wear off. If a patient stops using a neuromodulator the lines caused by facial expression return slowly but no worse then before treatment.  To keep the full effect of these agents most patients receive treatments three to four times per year. Other uses of neuromodulators include treatment of migraines, TMJ pain, and excessive sweating of hands and underarms.  Complications are rare with the most common being asymmetry in the eyebrow which can easily be corrected.                                                                                                                                                                             

 2) Dermal  Fillers  – As we age we lose the natural substance hyaluronic acid in our skin which acts to absorb water and give skin a full, firm, and  smooth appearance.  Loss of hyaluronic acid leads to loss of fullness of cheeks, lips and deepening of facial lines. With a number of trade names such as Restylane, Perlane, and Radiesse, most fillers contain hyaluronic acid and come as gels that can be injected superficially under the skin to plump up lips and reduce fine lines or more deeply to reduce the appearance of deep folds around the mouth, nose, and cheeks. Additionally, fillers can be used to plump up broad areas such as the cheek, commonly referred to as the” liquid lift”  and are effective in restoring lost volume in the cheek area and reducing the depth of nasolabial lines. Generally,  fillers will last approximately 6 to 12  months unless one is using a permanent filler. Most fillers are designed for specific areas ie. fine or small particle fillers are used on the lips to reduce the apearance of fine lines while larger particle fillers are used more deeply to reduce the appearance of larger folds around the mouth and nose.