Botox vs. Fillers: The Key Difference, According to Derms

Medically reviewed by Julia A. Siegel, MDReviewed by Steven Williams, MD

The popularity of injectables is on the rise and has been for over a decade, especially as the subject becomes less and less taboo. It seems like the topic is constantly being brought up whether it's by your favorite celebrities or your curious friend in bookclub. But when it comes to Botox or fillers, which one is best for you?

Botox is still number one, though dermal fillers are quickly encroaching on that spot. Either way, the more pressing issue is selecting the right option for your skin concern, if you choose to give these treatments a try. Knowing the differences between all of your options is a job for professionals, so we tapped plastic surgeons, Dr. Matthew Schlman, Dr. Dara Liotta, and Dr. Munique Maia, to get all of the details on Botox vs. fillers.

Meet the Expert

• Dr. Matthew Schulman is a New York City based board-certified plastic surgeon and founder of Schulman Plastic Surgery.

• Dr. Dara Liotta is a dual board-certified facial plastic surgeon practicing on the Upper East Side of Manhattan.

• Dr. Munique Maia is a plastic surgeon with Virginia and Maryland-based practices called Maia Plastic Surgery & Skincare, which provides non-surgical and medspa services in addition to plastic surgery services.

What Is Botox?

Botox is a neurotoxin that has the power to "temporarily weaken or paralyze the muscles," explains Dr. Maia. But, before we get too far, Dr. Schulman points out that Botox is the brand name of a specific botulinum neurotoxin. It's kind of like Kleenex and tissues– Botox is just the name that stuck when it comes to talking about neurotoxins. However, there are four FDA-approved neurotoxins available in the U.S.: Botox, Dysport, Xeomin, and Jeauveau.

“Botulinum toxin is best used in areas of facial expression such as the frown lines, crow's feet, and ‘11s’ between the eyebrows,” says Dr. Schulman.

Botox, adds Dr. Maia, treats dynamic wrinkles, though some relatively non-cosmetic uses for Botox are incredibly popular as well: injections in the armpits can help stave off hyperhidrosis (excess sweating), and injections in the jaw muscle can be used to prevent teeth grinding caused by TMJ. According to Dr. Liotta, "Botox" will start to work between 2-10 days, "depending on your individual reaction to the toxin and which toxin is used."

What Are Fillers?

"Hyaluronic acid fillers are gel-like products that fill folds and creases and replenish lost volume. They can also contour the face," Dr. Maia says.

hyaluronic acid

Hyaluronic acid is a naturally occurring polysaccharide found in the human body. It acts as a cushioning and lubrication agent for our joints, nerves, hair, skin, and eyes. When used in skincare, it acts as a moisture binder, which means that it will attach itself to the water in the cells (while also attracting and holding water from the air) making them plump.

Fillers can be comprised of a variety of materials, and are used to fill lines. Hyaluronic acid fillers like Restylane, Juvedérm, and Belotero, and calcium fillers like Radiesse are the most common. Dr. Schulman explains, “While both botulinum toxin and fillers are commonly used together, they work differently and are used on different lines."

Hyaluronic acid fillers, which come in a variety of thicknesses so that the right one can be chosen for each particular skin type, area, and concern, last 5-24 months. “There are other fillers composed of [calcium hydroxyapatite] (like Radiesse), which are better for deep filling and can last 12 to 14 months,” Dr. Schulman says.

Benefits

As Dr. Maia explains, Botox and fillers could have benefits that go further than skin-deep. "The impact of these products in facial appearance and facial expressions are much more complex than what it appears." In addition to "improving" your appearance aesthetically, "Botox has a wide range of indications that goes beyond wrinkle reduction. It can reduce sweating, teeth grinding, headaches, and more recently there are studies showing that it may lessen depression," adds Dr. Maia.

In other words, they aren't just for reducing wrinkles (though they help with that, too).

Botox vs. Fillers: Which Is More Effective?

The effectiveness of either procedure depends on what you're in need of. Botox, for instance, is heralded by some doctors as a preventative measure (meaning you get it before you're really noticing any deep-set wrinkles to prevent deeper wrinkles from taking hold).

"I have a lot of patients in their mid-twenties that do preventative Botox," says Dr. Maia. "They want to prevent wrinkles from forming. They are hyper-aware of their faces and want to improve their appearance."

The most common areas for fillers, meanwhile, are "under eye, cheeks and jawline," Dr. Maia says. "The choice of each product depends on the area of concern."

The simple rule? “Lines of expression need botulinum toxin. Lines at rest need filler.” Dr. Schulman says that while Botox is a great choice for hitting those “crease points” where muscles contract, fillers are best for deep lines that are present even when facial muscles are not contracting. Refer to the chart above for a guide to the lines on the face for which botox and fillers should be used, respectively.

Possible Side Effects

• Bruising or swelling at the injection site

• A bluish cast to the skin

• Acne-like bumps under the skin

Although there's always a chance of side effects, "the fillers currently available and FDA-approved in the United States have been tested extensively and are safe," says Dr. Dara Liotta. That being said, the easiest way to avoid any negative side effects is by finding a qualified, board-certified physician to do your injectables.

The most likely side effects of either Botox or filler are bruising and pain at the injection site—the same as any injection, not exactly a toxic reaction. If you're experiencing something like eye dryness, a crooked smile, drooling, or a drooping eyelid, this is not normal. Per Dr. Liotta, "Under no circumstances are trouble seeing, speaking, or breathing reasonable reactions to Botox." If you experience any of these symptoms, you need to contact your board-certified injector immediately.

Side effects specifically from filler include the Tyndall effect, which Dr. Liotta explains is the appearance of a bluish cast to the skin, and "can occur if thicker hyaluronic acid fillers are injected too superficially beneath the surface of the skin. The Tyndall effect can be treated by injecting a small amount of hyaluronidase (the enzyme that dissolves hyaluronic acid filler) into the area."

Dr. Liotta continues, "Acne-like bumps beneath the skin are an exceedingly rare complication. Much more common are bruising, tenderness, and mild swelling at the injection sites that may last up to 2 weeks."

Keep in mind that the more severe "side effects" like the Tyndall effect and bumps beneath the skin are not actually true side effects, but rather complications that occur from improper injection. That's why it's crucial to only receive injections (whether medical or cosmetic) from a board-certified injector.

The Costs

The average cost of Botox injections is $466, according to the most recent statistics from the American Society of Plastic Surgeons. The cost, of course, can vary, and is generally based on how advanced wrinkles are (and therefore how much product is needed) and the qualifications of the person performing the procedure. It also depends where you're located geographically as a bigger city is likely to have higher prices than a small town.

The price of fillers varies widely depending on the product. The most recent statistics from the American Society of Plastic Surgeons found the average syringe of Radiesse was $717, while hyaluronic acid fillers such as Juvéderm and Restylane were priced at $684.

How to Choose

Of course, both fillers and Botox come with their own risks and sets of advantages, and they're not really used for the same thing. Botox treats wrinkles by paralyzing the muscles surrounding them, while fillers, well, fill the areas they're injected into. This is another time when having a board-certified injector comes in handy because they can help you choose the best route for your own particular needs and facial features. It's nice to go into an appointment with an idea of what you want– so, do your research– but your doctor may tell you why choosing one neurotoxin or filler over another would be best.

The Final Takeaway

Botox and filler do completely different jobs and work in different ways– they're also priced differently and that depends on a range of factors including your injector and location. And Botox isn't the only option out there as far as neurotoxins. You may wind up preferring or opting for one of the other FDA formulas. Above all, adequate research is required, and understanding that there are side effects– albeit mostly treatable– is key. "The best thing to do is to see a board-certified plastic surgeon or a dermatologist,” Dr. Schulman says. “They will be able to evaluate your skin and help you select the best treatment for your skin, desires, and pocketbook.”

Frequently Asked Questions

Botox vs Filler: Which one is better?

It depends on your area(s) of concern. Dr. Schulman says it's easy to remember that: "Lines of expression need [botox]. Lines at rest need filler.” Filler would also be appropriate for any areas of the face that you want more contoured.

How much is Botox? Filler?

Prices will vary based on how many units are used, as well as the qualifications of the professional performing the treatment. The price of Botox injections in 2020 averaged $466, while the average cost for a syringe of Radiesse was $717 and hyaluronic acid fillers, such as Juvéderm and Restylane, were priced at $684.

Which lasts longer: Botox or filler?

Once again, it depends. Hyaluronic acid fillers, which come in a variety of thicknesses (so that the right one can be chosen for each particular skin type) last 5-24 months. Botox can last around 3-6 months.

Up Next: I Tried This "Needle-Free" Facial Instead of Botox—Here's What Happened

Read the original article on Byrdie.