What’s the Difference Between Botox and Facial Fillers?

For every person who sees the folds, ridges and creases on their face as evidence of a life well-lived, there’s another person who looks at them with dismay. Wrinkles and fine lines are an inevitable part of getting older and beautiful in their own right. But that doesn’t mean you have to like them!

Plastic surgery is an option, but it’s expensive, invasive and can take a long time to heal. That’s why more and more people are turning to Botox® and dermal fillers to turn back the clock. But what are they exactly? And how can you tell which to get?

We talked to dermatologist Shilpi Khetarpal, MD, about neuromodulators and fillers — what makes them different, what kinds of wrinkles they’re used on and things to be aware of if you’re considering either procedure.

The differences between Botox and filler

Botox and fillers may seem similar at first glance, but Dr. Khetarpal explains that they’re actually completely different.

Botox is a neuromodulator. To be more precise, it’s a purified form of clostridium botulinum bacteria. In far higher doses, botulinum toxin causes botulism. But in small doses, the neurotoxin blocks the nerves, causing the muscles injected to weaken.

While best known as a cosmetic procedure, Botox injections can also ease pain and help correct issues caused by muscular disorders. It’s common, for example, to get Botox for migraines, overactive bladder and pain caused by temporomandibular joint (TMJ) disorders.

There are actually several different brand-name injectable neuromodulators on the market that have a similar impact on wrinkles, including:

• Dysport® (AbobotulinumtoxinA).
• Xeomin® (IncobotulinumtoxinA).
• Jeauveau® (PrabotulinumtoxinA).
• Daxxify® (DaxibotulinumtoxinA-lanm).

Unlike neuromodulators, which can have several uses, dermal fillers are strictly cosmetic. Think of them as liquid implants that are injected into your skin (not your muscles) to plump and smooth your facial features. Different brands of fillers use different synthetic materials, from hyaluronic acid to polymethylmethacrylate (PMMA). How long the filler lasts depends on what material your provider uses.

In some cases, a cosmetic dermatologist will use fat from another part of your body instead of a synthetic substance to fill your wrinkles — that’s called “autologous fat grafting.”

When to get Botox and when to get filler

Not every wrinkle and fold should be treated the same way. That’s why Dr. Khetarpal says it’s common to receive both facial fillers and neuromodulators in one appointment. “Neurotoxins and filler are designed to do two different things,” she clarifies. To understand the difference, you should know that there are two main types of facial wrinkles:

• Dynamic wrinkles are caused by muscle activity seen with motion (think crow’s feet at the corner of your eyes or the lines on your forehead when you raise your eyebrows). These types of wrinkles are from facial movement.
• Static wrinkles are lines or folds that can be seen when the face is relaxed (think laugh lines). These types of wrinkles are from the skin losing elasticity and collagen as we age.

Dynamic wrinkles are best treated with Botox or another neuromodulator. Dr. Khetarpal notes that the three most common treatment areas are in the upper face around the eyes, between the brows and the forehead.

Fillers are also used to treat volume loss in the lower face (like cheeks and smile lines). They can also be used to add fullness, like in sunken cheek bones or to plump up the lips.

Static wrinkles are often treated with both neuromodulators and filler. In these cases, Dr. Khetarpal explains, neurotoxins like Botox treat the underlying muscle, while the filler treats the lines at rest.

Risks and considerations for both procedures

Both neuromodulators and dermal fillers are considered safe procedures, with less than 1% of patients experiencing significant side effects. Still, it’s important to be aware of the risks and possible side effects of any cosmetic procedure, so you can decide if they’re worth the potential results.

Risks and side effects of Botox

Most of Botox’s potential side effects are minor and temporary, lasting only a day or two. They include:

• Pain, swelling, redness or bruising at the injection site.
• Flu-like symptoms.
• Temporary paralysis of nearby muscles — like eyelid drooping (ptosis), for example.
• Headache or neck pain.
• Upset stomach (indigestion).

In rare cases, the following severe side effects have been observed:

• The botulinum toxin spreading away from the injection site, causing a potentially deadly bacterial infection called botulism.
• Cardiovascular complications like arrhythmia or heart attack (myocardial infarction).

It’s important to note that this list doesn’t cover the side effects and risks associated with Botox’s noncosmetic uses. Also keep in mind that people with neuromuscular disorders like peripheral neuropathy or multiple sclerosis (MS) should not get Botox or any other neuromodulator, as it can cause symptoms to worsen.

Risks and side effects of dermal fillers

As with neuromodulators, dermal fillers are generally safe. Most people don’t experience side effects, but those that do sometimes have to deal with them for a while.

Short-term complications of filler include:

• Pain, swelling, bruising, redness or other kinds of skin discoloration at the injection site.
• Numbness.
• Itchiness or an ability to feel the filler material in your face.
• Infection, which, if untreated, can cause more serious issues like tissue death (necrosis).
• Cold sores.

Long-term complications are mostly aesthetic:

• Lumpiness, ridges or facial asymmetry due to poor distribution of the filler material.
• Skin damage and scarring.

When it comes to filler, the biggest potential issue is an allergic reaction to whatever synthetic substance is injected. That’s why it’s important to watch for the following symptoms:

• Shortness of breath, chest tightness, wheezing or difficulty breathing.
• Difficulty swallowing.
• Hives or rashes.
• Gastrointestinal symptoms like abdominal pain, cramps, diarrhea or vomiting.

Another rare but serious side effect of dermal fillers is vision problems. If you have issues with your eyesight, along with weakness, discomfort or pain on one side of your body, Dr. Khetarpal says you should get immediate medical help.

In rare cases, poorly trained practitioners have accidentally injected filler material into a blood vessel, which can cause serious complications like stroke, tissue death or blindness. That’s why it’s important to always get dermal fillers from a qualified professional. It’s also important to confirm that your healthcare provider is using a high-quality, medical-grade filler that doesn’t contain ingredients you’re allergic to.

Filled … with knowledge

Botox and dermal fillers are both nonsurgical cosmetic procedures that help reduce signs of aging, but the similarities stop there.

Botox is one of a range of neuromodulators on the market. These neurotoxins are injected into the facial muscle, relaxing it in a way that reduces dynamic wrinkles from facial movement.

Fillers are injected into the skin to plump and smooth static wrinkles.

But it’s common to get fillers and neuromodulators at the same time, as the two procedures target different areas of concern and work well together to reduce overall signs of aging. Both procedures are generally considered safe, but — as with all procedures — come with some risks and potential side effects. A qualified professional should always inject Botox and fillers.

If you’re interested in learning more about neuromodulators, dermal fillers or both, Dr. Khetarpal recommends talking to a cosmetic specialist. They’ll help you decide what makes the most sense for you given your goals, budget and health status.