What's the Difference Between Botox® and Fillers?

Let's chat a bit about the difference between Botox® and filler. Botox® (onabotulinumtoxinA) is a neurotoxin produced by the bacteria Clostridium botulinum. It is a molecule that acts at the neuromuscular junction to inhibit the release of acetylcholine and, in essence, paralyze the muscle. It acts very locally where it is injected and has numerous therapeutic and cosmetic applications. In the cosmetic realm, it works to smooth wrinkles that are a result of persistent and constant muscle movement. Commonly treated areas include the glabella ("11's"), horizontal forehead lines, crowsfeet, and browlift. These are by far the most common areas to treat but are definitely not the only areas. We also use Botox® for treatment of the undereye "jelly roll," for vertical lip lines, to treat downturned corners of the mouth, to produce a "lip flip," to treat a "gummy smile" (aka significant tooth show when smiling), to treat masseter muscle hypertrophy (aka TMJ pain related to chronic jaw clenching), as well as hyperhidrosis (aka sweaty underarms). Although it may sound a little scary, being a toxin and all, Botox® is incredibly safe to use, with increasingly diverse applications. Typical duration of treatment is 3-4 months.


Dermal fillers, on the other hand, function as their name implies: they fill and provide volume. Typically they are used to fill and/or lift in areas of volume deficit. By far the most common types of fillers used these days are hyaluronic acid (HA). There are numerous different HA fillers with slightly different molecular structure that make them more or less appropriate for use in certain areas. Commonly treated areas are typically in the mid to lower face: cheeks, cheekbones (defining this area often works to lift and soften the "smile lines"), tear troughs (the sunken appearance under the eyes), nasolabial folds (smile lines), lips, marionettes, chin, jawline, and more. The great thing about hyaluronic acid fillers is that we have hyaluronidase, an enzyme used to dissolve the filler in the rare setting of a complication. Typical duration of treatment is 8-12 months.

See the above Before and After that illustrates the different uses of Botox® and filler. This patient underwent Botox® treatment to her glabella (11's), forehead, browlift, and crowsfeet. We did filler to give her volume in the tear trough area (undereyes) as well as give her a bit more volume in her lips. She also had some filler to soften the creases around her mouth.

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