What Comes First: Neurotoxins Or Fillers?

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What Comes First: Neurotoxins Or Fillers? featured image

You’re open-minded about dealing with your inevitably aging skin, but do you know where to start? Neurotoxins, like Botox, Dysport and Xeomin, can help with fine lines by immobilizing the muscles, and fillers can help to restore volume-but which should come first? We asked Greenwich, CT, dermatologist Henry Gasiorowski, MD, to explain.

Loss of volume and fine lines can often occur simultaneously, he says, but starting with neurotoxins can be a smart start. “We often get patients in their 30s and 40s who start early, but often people don’t have that luxury,” Dr. Gasiorowski says. “I recommend starting earlier to prevent wrinkles, because if you can stop the movement, then you can stop the wrinkling.”

However, because fine lines and volume loss can happen simultaneously, Dr. Gasiorowski says, “You can do a combination of both [fillers and toxins], but again, it’s good to start early with neurotoxins. Many doctors recommend doing fillers and then neurotoxins because there is the thought that starting with neurotoxins and then doing a filler will drive the neurotoxin deeper and push it to places you don’t want it.”

One approach some doctors choose is to first inject neurotoxins and then have the patient come in a week later for the fillers.

Ultimately, Dr. Gasiorowski says, it comes down to the individual patient. “A lot of times patients come in wanting a specific thing, but that’s often not what they need,” he says. “A good rule of thumb is that I look at the patient’s face and wherever my eye is drawn, that’s probably where everyone else’s eye is drawn.”

Neurotoxins and fillers “can work together beautifully, but sometimes you can only do one, sometimes neither,” he says. “It’s all on a patient-by-patient basis.”

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