Botox Cosmetic and dermal fillers are both effective and helpful to provide a more refreshed and youthful appearance if performed properly. Each product has its unique properties and they are not interchangeable.
Botox Cosmetic (onabotulinumtoxinA) works differently from dermal fillers. Botox Cosmetic cleaves to the synapse of the nerve ending in the muscle group being treated. This results in a loss of communication to the muscle group creating a relaxed effect. As a result, there is a smoothing out of lines and wrinkles as the muscle group is temporarily immobilized with the Botox Cosmetic. While Botox can be used in the lower face with caution and in a conservative manner, it is generally used to soften frown lines between the brows, forehead and crows feet. Additional areas Botox Cosmetic can be utilized are in the “bunny lines”, lips, chin and neck. This may sound concerning but if performed by an experienced injector it is very safe and effective.
Some dermal fillers are designed to fill lines, wrinkles and folds while other fillers help to replace lost volume to the face. Volume in the face generally diminishes during the natural aging process. With facial aging there is a gradually progressive depletion of collagen to the skin and atrophy to fat pads, bone structure and muscle. Overall, there are surface and subsurface changes occurring that may require an approach of correcting multiple layers for optimal results. If this is the case, we may use multiple types of fillers to achieve a more youthful appearance.
Dermal fillers have evolved greatly in the U.S. market over the past 12 years. In the 1980’s animal based collagen products were the only available dermal fillers used to correct lines and wrinkles. These products had some limitations such as required skin testing for allergic reactions and they only lasted 2-4 months resulting in multiple treatments yearly to treat the same problem area over and over. The second filler family was the hyaluronic acids, starting with Restylane in 2003. Hyaluronic acid (HA) is a naturally occurring sugar acid in all living organisms and therefore is considered much safer to use, has fewer allergic reactions, lasts longer and is more pliable. The next dermal fillers to enter the arena were the synthetic fillers (Sculptra, Radiesse and Artefill). Radiesse and Sculptra were both used for correction of lipoatrophy in HIV patients. Sculptra is considered long-lasting and can last for up to 2 years while Radiesse can last 9-18 months in many patients. Of these synthetic fillers, Artefill is considered permanent and should be used with caution due to this characteristic, i.e. if the “permanent” outcome is to your dislike you will be left with undesirable results for a lifetime if you use a “permanent filler”.
To determine which product is right for you be sure to consult with a trained medical professional to discuss the risks, benefits, and side effects. Discussing your concerns, setting realistic expectations, and planning for cost and frequency of treatment should also be discussed. Botox Cosmetic is generally applied every 3-6 months to soften lines and wrinkles between the brows, forehead and crows feet. Significant volume loss to the mid and lower face may require multiple visits to the office spread out over several months to gradually build up the tissue and best ensure a more natural appearing result. Botox Cosmetic and dermal fillers can be injected on the same day and multiple fillers can be used to treat a patient to get the results desired. So, if you start with a hyaluronic acid in one area you may also use synthetic filler in the same area or in another area ~ they work well together when utilized with a conservative and gradual approach.
For deep to moderate lines, such as the nasolabial folds, Restylane, Juvederm Ultra Plus XC or Perlane are good choices. For global volume loss, use of Sculptra Aesthetic and/or layering of another durable HA filler, such as Voluma, in a deep cutaneous or supraperiosteal manner (for a direct midface augmentation) can provide for a desired result.
The HA, Sculptra and Radiesse dermal fillers do not require skin testing but should be avoided in those patients with sensitivity to the proteins (gram-positive bacteria proteins found in HAs), have a history of severe allergy reactions (anaphylaxis) or have a history of allergy to any of their components ~ please read package inserts for more details. Most common side effects from any injection would be bruising. Each product has its own side effects and the package inserts are a great way to educate yourself on those potential problems. In general though, dermal fillers can cause temporary injection-site redness, pain/tenderness, swelling, firmness, lumps/bumps, bruising, itching and discoloration.
Some skin care treatments can be done on the same day as Botox Cosmetic and/or dermal fillers and some cannot. For instance, patients can have a microdermabrasion just prior to either Botox Cosmetic or dermal fillers but it is not recommended to do a microdermabrasion immediately after an injection. It is always best to consult with your injector about the sequence of events to coordinate your treatment regimen.