Botox Vs. Fillers: Experts Explain the Difference Between the Injectables
Welcome to the wonderful world of injectables. If you're new here: Don't be scared! Yes, there are needles involved. But you might discover that a pinch or two is totally worth it (and more people are doing it than you think). Your first lesson covers the basics: Botox vs. fillers.
The first and maybe the most important lesson you'll need is that Botox is a brand — not a treatment. The actual aesthetic treatment is called a neuromodulator, and yours may be done with a few different brands — Botox, Dysport, Xeomin, or Jeuveau. Botox has become a catch-all term for the treatment, regardless of which you get (Like saying “Band-Aid" instead of “adhesive bandage." Neuromodulator is a bit of a mouthful, and definitely not as sexy sounding).
To understand the difference between Botox and dermal fillers, it may be helpful to think of them in a Venn diagram. On the left is Botox, which addresses the lines in your face you get from years of simply moving (like the "11" lines you get from furrowing your brow). On the right are fillers — injectables that restore the natural volume loss that often occurs as you get older. They can also help to define features like your jaw, nose, or lips.
In that respect, Botox and fillers are two totally different treatments. But in the Venn diagram — they meet in the middle. Both injectables work to give you smoother, younger looking skin. So you can choose between Botox and fillers — or you can do them both depending on what results you’re looking for.
We asked the experts about the differences between Botox and fillers and what you can expect from each treatment.
What Is Botox?
Botox is a neuromodulator that temporarily relaxes muscle movement by inhibiting the release of acetylcholine, according to New York City-based board-certified dermatologist Brian Hibler, MD. (Acetylcholine is an organic chemical and neurotransmitter that's responsible for smoothing fine lines or contracting certain muscles.) When strategically injected around the face — it will help smooth out existing lines and inhibit movement that can leave deeper wrinkles over time (which is why many dermatologists and aestheticians recommend it as a preventative treatment). It can also be used for non-cosmetic reasons like treating chronic migraines, spasticity, or excessive sweating, adds Dr. Hibler.
Botox is actually a brand of botulinum neurotoxin that has been adopted as the catch-all term for the treatment. So while you may book an appointment for "Botox," you may be getting another brand like Dysport, Xeomin, or Jeuveau. All of them are approved by the Food and Drug Administration (FDA), and which one you get will depend on what your dermatologist recommends based on your anatomy, needs, or goals.
What to Expect at a Botox Appointment
A Botox appointment will usually begin with a consultation where you discuss your medical history, your goals, and have "before" photos taken of your face (or wherever you'll be getting the treatment). You may also be given an ice pack to do some light numbing before the procedure.
"The most common areas for cosmetic Botox are the forehead, between the eyes, and crow's feet," says Dr. Hibler. "But it has a number of other cosmetic uses; 'bunny lines' on the nose, turning the corners of the mouth up, reducing nostril flare, or even lifting the tip of the nose by relaxing the muscle that pulls it downward."
Once you and your dermatologist discuss the areas that make the most sense, they'll disinfect your skin and distribute a series of small injections in the treatment area with tiny needles (not the same size as, say, a vaccination). "It's very quick and painless," says board-certified dermatologist Morgan Rabach, MD, who is based in New York City. "You just need a few minutes to ice it afterwards and you might see a few tiny bumps before it's absorbed." Dermatologists also recommend avoiding any strenuous activity for a few hours to allow the molecule to fully bind.
A good practitioner will usually err on the conservative side when it comes to dosage, and once the first pass settles in (a week or two after the treatment), you can always go in for more. Once you're happy with the result, it should last three to four months before you'll see your dynamic lines reappear and regain full motion.
As with anything, there are some risks involved. Swelling, bruising, redness, and headache are minor side effects, and in some cases, temporary ptosis (or a drooping eyelid), says Dr. Hibler.
The treatment can cost anywhere between $300 to $1,200, depending on where you live and how many units of Botox were administered (though some dermatologists charge by area instead of individual units).
What Is Filler?
Dermal and volumizing fillers are cosmetic gels commonly made of hyaluronic acid, a substance which binds to water to restore volume, says Dr. Hibler. The volume essentially plumps the face and therefore helps fills out any lines or improve the appearance of sagging in the skin.
“Fillers are best for addressing volume loss and folds on the face. They help with lines present at rest — like nasolabial folds or marionette lines — and help restore structure and volume to the cheeks, mid-face, or lips,” says Dr. Hibler. “They are also used to define certain features, like the nose, jawline, or chin, or to soften shadowing under the eyes.”
What to Expect at an Appointment for Fillers
Much like Botox, fillers are given in a series of injections, depending on the area you're treating. While the needles are fairly small and the pain should be mild, you may experience some bruising or swelling, says Dr. Rabach. Some fillers contain lidocaine within the product, so subsequent injections in the same area tend to be less painful, says Dr. Hibler. “For certain areas, a topical anesthetic may be applied prior to filler treatment to minimize the pain with injection.”
With fillers, you'll see results immediately, says Dr. Hibler. There may be some swelling in the first day or two, but it should settle down into better definition and natural-looking volume. The results should last anywhere between nine months and a year.
There should be no major risks if you're seeing a board-certified dermatologist or medical professional, but Dr. Hibler says that inadvertent injection into a blood vessel could cause necrosis of the overlying skin. Other risks are minor infections, swelling, bruising, and asymmetry, says Dr. Rabach, though asymmetry can be addressed with another visit.
The results should last anywhere between nine months and a year and can cost between $900 to $1,500 per syringe, according to Dr. Rabach.
How Are Botox and Filler Different?
The main difference between Botox and filler is what they're targeting. "Botox is best for addressing dynamic lines on the face," say Dr. Hibler. "Fillers are best for addressing volume loss and folds on the face." The overall effect of both, however, should be smoother, plumper looking skin.
With that, your goals will also dictate which treatment you should try. Fillers typically address existing volume loss, while Botox can address existing lines or be a preventative treatment for younger patients (though Dr. Hibler notes that Botox may not get rid of deep, long-standing wrinkles).
Commitment is also a big difference between the two. Getting Botox is kind of like using salt when you're cooking. You can always add more, but you can't remove it. The neurotoxin will just need to degrade in your system on its own over time. Fillers, however, can be dissolved with an enzyme called hyaluronidaise. When injected into the filler area, hyaluronidaise can break down hyaluronic acid, allowing it to dissolve.
What Do Experts Recommend?
There are a lot of misconceptions about both Botox and fillers. Many believe that Botox will make you look frozen and unable to emote, and fillers will leave them looking puffy or unnatural. That should not be the case, says Dr. Hibler, which is why you may want a practitioner that starts with a lesser amount and increases as needed. The best injectables should not even be noticeable by anyone but yourself. "It's enhancing normal features," says Rabach.
In the end, the most important recommendation is finding a trained dermatologist or plastic surgeon to do your injections, says Dr. Hibler.
Botox vs. Filler: The TL;DR
Both treatments are safe and recommended by our experts, so long as they're performed by a certified dermatologist or plastic surgeon. If you're looking to restore some volume loss — fillers can help you look more plump and hydrated. If you're looking to take a first step into injectables and want to prevent or treat fine dynamic lines — Botox is a great entry-level treatment.