Time is undefeated. Thus far, humans have found no way to slow down the aging process, but science and dermatology have developed a number of methods to treat the dreaded combination of growing older and succumbing to gravity’s pull — especially on the face. Facial fillers and botox treatments both have the potential to rejuvenate skin, but they each use different methods and processes.

What is the difference between a filler and Botox (and other toxins such as Dysport and Xeomin)?

Botox (Dysport, Xeomin)is like a chemical reorganization of the body’s natural tendencies, essentially hacking the nervous system to stop it from behaving in a way that results in wrinkles. When the toxin is injected, it works on nerves to block a receptor at the end of the nerves that allows muscles to contract. This forces wrinkles to soften, which is why Botox (or Dysport or Xeomin) is used routinely on the face, to treat crow’s feet or frown lines between the eyebrows and around the mouth. Over time, having repeated botox (or Dysport or Xeomin) injections can help improve the lines permanently since the face is “retrained” to stop using those muscles as forcefully.

A facial filler is quite different. Here, the areas that a patient wants to treat are injected with collagen, elastin, or hyaluronic acid, all substances that our bodies produce less of as we age. Collagen is a protein found in our skin, hair, nails, tendons, and muscle fibers; it gives skin its elasticity. By helping draw water into the skin, hyaluronic acid helps to keep skin hydrated and supple, providing what we refer to as the volume. By using a filler, the skin is reinvigorated and gets a more youthful appearance. Fillers are gradually resorbed by the body and the skin goes back to its original configuration.

Fillers are also meant to treat those lines and wrinkles that occur in the face when it is at rest — pesky areas that are always visible, known as static wrinkles. Botox is specifically designed to attack and treat lines and dynamic wrinkles that appear when the muscles in the face move, either when laughing, frowning, or smiling. That’s why it’s primarily used to treat crow’s feet around the eyes, or lines around the mouth and forehead.

Where are fillers placed on the face?

Fillers can be used to replace old tissue in the cheeks, under and around the eyes, lips, and chin, and on the forehead. Depending on the type of treatment you and your doctor agree to, the substance is injected into the area, plumping up the skin, so to speak — “filling” it in. Again, this is different from botox, which does not add anything to your skin. Botox uses your body’s biochemical reaction to a neurotoxin as a way to short-circuit the nerves in the areas you want to improve.

A filler adds natural substances to a targeted area and helps prop it up, and there are several different aspects to how they are injected. One difference among fillers is how deep they are sent into the skin. Some fillers go deep into the dermis. But a procedure known as hydrofilling puts hyaluronic acid into the top layer of the skin, which helps give the skin a slight swell, increasing its pliability, response to light, and texture.

One common area that is treated with fillers is under the eye, either to address bagginess, dark circles, or sunken features. And reduction in the discoloration or dark circles under your eyes has been shown to be present when fillers are followed by Botox injections. There have been documented successes with using fillers for acne scars, as well. But in general, fillers are less effective for skin that has lost much of its elasticity, either from too much dehydration over time or too much sun.

What are the different types of fillers?

The most popular in the United States are Juvederm, Voluma, Restylane, and Belotero. These utilize hyaluronic acid and no allergy testing is needed as HA is the same in all species. They differ in their placement within the skin.

Radiesse and Sculptra are thicker fillers that help the body with collagen production. They are generally avoided on the lips and have been added to hands or even upper chest at times. These fillers can help make the skin thicker, which gently reduces the appearance of wrinkles and folds.


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