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BOTOX vs Filler 101

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For injectable newbies, it might seem like both Botox and plumping fillers are in the same family. While that’s partially true — they are both injectable options for combatting signs of aging and making minor alterations to our skin’s structure — they are actually quite different and have dissimilar uses.

Some people think Botox can go everywhere. Case in point: We once overheard a woman in a coffee shop expressing that she may need to get Botox for her smile lines. While we understood what she meant, a doctor won’t let that happen. We’ll explain.

There are numerous factors that can contribute to wrinkles — beginning with the aging process, which creates dwindling supplies of our collagen and elasticity. Sun exposure begins to take a toll on our less resilient skin. Repeated muscle contractions from squinting, frowning, surprise, or anxiety start to create creases and tension in the muscles, holding the form of the expression long after we’ve relaxed.

It’s this muscle tension that begins to reveal the most obvious wrinkles, mostly in our forehead and around our eyes. Botox, the name brand known for the compound Botulinum Toxin, works beneath the skin by relaxing the tense muscles that are causing the skin above it to contract and crease.

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Before our body has time to completely metabolize Botox — which can take about 3-4 months — it temporarily reduces the muscle activity in the injection site, revealing smooth, relaxed, unwrinkled skin over the muscle.

Because Botox relaxes our muscle activity, it limits where we can inject it. It’s safest to inject only where we would use muscles for expression use, not for vital functions like chewing, talking, and drinking liquids. This means that Botox is typically limited to problem areas like crow’s feet, “elevens” (the parallel lines between our eyebrows), and our forehead creases. And it means that it’s not likely that a dermatologist would recommend Botox for other areas, like smoker’s lines around the mouth, laugh lines, or our nasolabial folds.

However, there is a popular treatment among Botox enthusiasts called a “Lip Flip,” which is a small injection of Botox near the cupid’s bow of the lip in order to relax the muscle. That injection helps to expose more of the upper lip when smiling rather than allow it to curl under and reveal teeth or gums. It should be noted that for 4 weeks or so, it may be difficult to drink, whether out of a straw or a glass, when this muscle is relaxed.

Filler, on the other hand, is a completely different compound. There are many brands, from Restylane and Juvederm to Voluma and Sculptura — and more. Filler can be composed of calcium hydroxylapatite, which is a mineral-like compound found naturally occurring in our bones.

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This type of fillers (the most common name brand for this is Radiesse) is commonly used for moderate to severe creases, like the aforementioned nasolabial folds, marionette lines (sometimes indicated as jowls, or lines perpendicular to the mouth and framing the chin), and frown lines. Calcium hydroxylapatite can be used to give fullness to the cheeks or temples, and improve volume in the faces of those who suffer from tissue loss as a result of chronic illness.

Another very common filler these days uses hyaluronic acid, which we know affectionately as a hero ingredient when it comes to deep hydration, skin plumping, and wrinkle prevention when applied topically. Hyaluronic acid is also a compound found naturally occuring in the human body, and it’s totally safe: It’s mostly found in our soft connective tissues, cartilage, joints, and in the skin. And it’s amazing as a filler, working by improving our skin’s contours, evening texture, and reducing irregularities due to scars, injuring, or expression lines.

HA fillers are most commonly used for lip enhancement, but can also be used for crow’s feet, deep smile lines (aka nasolabial furrows), frown lines between the eyebrows (aka “elevens”), marionette lines, scars from injuries and burns, vertical lines around the lips (aka smoker’s lines), and can give definition to the lip border.

How long a filler will last depends on a number of factors: While Botox typically only lasts 3-4 months in each patient, filler typically lasts 6 months to a year, but varies depending on the type, the thickness of the compounds in the formula, and the patient’s metabolism, among other factors. While injectables are an entirely personal decision and neither forgoing them nor getting them regularly is right or wrong, we recommend doing whatever makes you feel your best, most vibrant self.