Patients who come in to see me for minor plastic surgery interventions such as injections are sometimes confused about the different and correct uses of Botox and other skin fillers; they ask me which one is used for what. The simplest way to answer this is to look at what each product is supposed to do. Then you can decide which of the two types of products you need.
Botox, Xeomin, Dysport and other “neuromuscular synapse-blocking agents” block the effect of nerves on muscles. Then the muscle stops working. The effect takes about a week to reach its maximum and is temporary, lasting about 3-4 months. So, if you can make a facial wrinkle deeper by working a muscle, then Botox or some such neurotoxin can be used to soften the muscle action and the wrinkle. The best examples of the areas affected by Botox are the wrinkles on either side of the eyes (crow’s feet; in Spanish they are called “patos de gatos,” or cat’s feet!), lines between the eyebrows (glabella) or the “I’m angry” forehead lines, otherwise known as worry lines.
Skin fillers such as Restalyn, Belotero, Juvederm, Radiesse fat and such are just that—fillers. They are injected under the skin of the face to fill in the depression. If you think of the line as being a valley, we are filling in the “trough” of the valley to elevate it to the level of the “hills” on either side.
The difference between these depressions and the muscle-caused wrinkles is that these valleys are always there and you cannot make them deeper from facial expressions. These include the nasolabial and marionette lines at the corners of the mouth. They can also be used to fill in or plump up the lips. The differences between these types of products revolve around how long they last in the body. Radiesse lasts between 1.5 to 2 years, and Juvederm up to 1 year.
So, if you can make it worse by moving your face, Botox it; if it’s always there, fill it. Either way, it will get better!