Decoded: Everything You Ever Wanted to Know About Botox Versus Fillers

Decoded: Everything You Ever Wanted to Know About Botox Versus Fillers featured image
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Choosing the right moisturizer is hard; choosing the right noninvasive treatment at your plastic surgeon’s or dermatologist’s office is even harder—particularly if you’re a first-timer. “The difference between neuromodulators and fillers can be difficult for patients to understand, especially with all the different brand names on the market. Patients ask for brands by name because they’ve heard them before, but they really don’t know exactly what they do,” says Omaha, NE, dermatologist Joel Schlessinger, MD. In hopes of finding an easy way to decode just what “they do,” we asked the derms to break down the differences and answer some of the most common questions their patients pose.

How can I remember which one does what?
Richland, WA, dermatologist Sidney B. Smith, MD, says it’s very common for patients to come in and be confused between fillers and neuromodulators, as to which one volumizes and which one decreases muscle movement. His easy-to-remember rule: “I always try to keep the conversation very simple. Neuromodulators, like Botox Cosmetic, Dysport and Xeomin [there is now a new option, Jeuveau, that became available after this interview] relax the muscles that cause wrinkles, while fillers either add or replace lost volume.”

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What should I get if I want to fix wrinkles?
Beyond that simple cheat sheet, Dr. Schlessinger says neuromodulators help relax facial muscles to smooth the appearance of expression lines, like crow’s-feet, the “11s,” and forehead wrinkles. Fillers, on the other hand, aim to restore lost fullness to the face, lips and hands (think fillers = fullness). “Dermal fillers are injectable hyaluronic acid solutions, or other materials, that work to fill in areas of concern, such as deep-set lines around the mouth or loss of firmness in the cheeks,” he explains. 

“Fillers can include hyaluronic based–ones like Juvéderm, Juvéderm Voluma, Juvéderm Volbella, Restylane, Restylane Lyft and Restylane Silk. Additionally, there are fillers like Radiesse, Bellafill and Sculptra, which are longer-lasting and/or permanent. Some patients also opt to use their own fat to be used as the filler.” (For a full list of FDA-approved neuromodulators and fillers, visit expertinjector.org.)

Is it going to hurt?
Another question Dr. Smith says is often asked. “In general, people are mildly concerned about the potential pain factor involved in Botox Cosmetic injections, but almost all are surprised when the discomfort is negligible.”

Will people be able to tell I had anything done?
“Right after you receive Botox Cosmetic, it looks like a small mosquito bite,” Dr. Smith says. “But that only lasts a few minutes, and after that, no one can tell that you had it done.” Likewise, as the American Academy of Dermatology points out, one of the reasons fillers are popular is because patients like that they can return to everyday activities immediately after getting most of them. But, Montclair, NJ dermatologist Jeanine Downie, MD warns, side effects—including bruising and swelling—can still happen.

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Can I get both?
Like most treatments, Dr. Schlessinger says it really depends on which areas of concern you want to address. “Both can help minimize the appearance of fine lines and wrinkles, but neuromodulators are better for expression lines, mainly on the upper face, and fillers are better for plumping the appearance of skin and restoring lost volume throughout the facial area and certain off-face areas such as ears, hands and scars. For many patients, a combination of neuromodulators and fillers can provide best results.”

What’s the best age to get them?
“Generally, the age of patients can vary and I have seen people from 18 to 95 come in for these treatments,” Dr. Schlessinger says. “It all depends on the goal and personal situation. As volume is lost, fillers work to retain the youthful appearance, while neuromodulators relax wrinkles that have become fixed or expressions that are causing negative connotations.” One big-time bonus he adds that you probably never even considered: “Interestingly, many times these treatments can actually lead to less depression and more happiness just by changing an ongoing tendency to frown or appear unhappy.”

Boston plastic surgeon Joseph A. Russo, MD, concurs, and is a big proponent of prevention, prevention, prevention. “The way to use these treatments most effectively is to start at the first signs of aging. If you start these treatments at an earlier age, you may never get wrinkled or have to deal with sagging tissues. It is also easier to maintain a youthful look then to try and recapture youth once you have lost it. The millennial’s have realized this, and account almost 30 percent of all Botox sales! Largely due to social media, especially since the advent of selfies which magnify any perceived deformity, no one wants to get old. Any hint of age can be eliminated with the armamentarium of neuromodulators, fillers and noninvasive procedures now at our disposal.”

How long will they last?
“A typical neuromodulator treatment lasts about three months, but this time frame could be slightly more or less depending on the patient, other treatments they receive and their skin care routine. To maintain results, you’ll need to schedule regular treatments in three-month intervals,” Dr. Schlessinger says. Dr. Smith adds that he encourages patients to make their next three-month appointment when they check out.

Fillers, on the other hand, have a slightly different time frame. “They can last three, six or even up to 18–24 months in the case of Juvéderm Voluma, depending on the type,” Dr. Schlessinger says. “There are newer fillers such as Juvéderm Volbella that last up to 12 months in the lips, which is a great thing for people who don’t want to have repeated trips for cosmetic work. Your plastic surgeon, facial plastic surgeon or dermatologist can help you come up with a product treatment schedule that best suits your needs.”

Does anyone give a discount?
The price-quality discussion is a big one and Dr. Downie sums it up with this story: “Earlier this evening, I had a relatively new patient in the office who has been getting filler from a spa. She was looking for Groupon prices for her filler and was not seeing a core-specialist doctor. I explained to her that since her Voluma was so cheap, it may not actually be authentic product and that I was concerned about the actual level of training of the internal medicine doctor who was injecting her product. I further explained to her the use of fake and/or expired products in these medical spas. Obviously, there are significant dangers associated with all these issues. Get a discount on your shoes, but not on your face and your overall health.”

Are there any side effects I should know about?
While Dr. Russo stresses these are less common complications, side effects associated with an injection can include: localized pain, infection, inflammation, tenderness, swelling, redness, bleeding and bruising. “Less common reactions may include nausea, fatigue, flu-like symptoms, headache, excessive weakness of the muscle, temporary eyelid dropping, temporary brow dropping, infection at the injection site, asymmetry, bleeding, bruising and swelling, skin rash, under or over-correction, and vascular occlusions.”

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