Botox vs. Fillers

Cosmetic surgery has become more and more complicated for patients to understand because the options have increased rapidly over the past few years. There has also been a strong push for less invasive procedures (“non-surgical”- meaning “no cutting”) which is natural, as people seek less expensive ways of putting off or decreasing the effects of aging. Prominent among these new techniques are the use of Botox^® and fillers. It is a common event for patients to ask for one, when their complaint(s) really would be better addressed with the other category of treatment. Both are treatments for surface wrinkles on the skin surface. They are not equivalent. Allow me to clarify.
Botox^® is a medication that acts by stopping or decreasing the function of the muscles of facial expression that are responsible for wrinkles in the skin overlying the muscle. When the individual muscle contracts, the skin that is immediately over it tends to fold, and after many repetitions of this, the fold begins to stay in the same place, and eventually deepens and shows even when the muscle is not contracted. Commonly these folds are in the area between the brows, called the glabella and in the area around the eyes where we develop “crow’s feet”, although this really happens all over the face. When Botox^® is injected, the muscle stops working and the skin over the muscle begins to relax. Over the course of months, this allows the skin to smooth out and look younger. The effect typically lasts about 3-4 months and diminishes gradually. People often seek re-treatment as the effect goes away, but may go longer between treatments at their discretion. There do not appear to be any non-surgical treatments that provide the same benefits at this time. There is a competing product know as Dysport^® which is another variety of the same type of chemical. It has some different characteristics and does not appear benefits beyond what are available with Botox^®.
In contrast, fillers are injectable substances that actually occupy space within the tissue to build it up, plump it or fill folds, creases and/or wrinkles. The earliest commonly available was collagen which was harvested from cattle and which required double allergy testing before use. As time has gone by, numerous fillers have become available and offer options in consistency, duration of effect, cost, and biologic activity. These include, for example, Restylane^® and Juvederm^®, which are hyaluronic acid fillers, Cosmonderm^® which is human collagen, Radiesse^® which uses hydroxyapatite to stimulate tissue reaction in addition to providing mechanical filling, Sculptra^® which is a synthetic polymer that stimulates new soft tissue production and is among the longest lasting product outside of “permanent’ fillers.
One’s own fat is perhaps closest to the perfect filler in terms of its behavior, but it requires a procedure to harvest the fat from one part of the body and preparation of the fat for reinjection. Once the fat is successfully grafted, however, it will persist without continuously repeating the injections. These materials each have pros and cons, so a discussion specific to the individual is necessary to select the right material and/or procedure.