Morsani College of Medicine

Dermatology & Cutaneous Surgery

Making Sense of Botox and Fillers

Published: April 10, 2010

Many of my patients have expressed confusion regarding the role of Botox and fillers for treatment of skin wrinkles.

Specifically, they often don’t realize that these very popular cosmetic procedures serve two very different purposes.

As we age, repetitive muscle movement results in dynamic wrinkles, such as those that occur around the eyes (crow’s feet) and between the eyes (frown lines). Botox, the brand name for OnabotulinumtoxinA, is injected into the muscles responsible for causing these wrinkles. By temporarily paralyzing these tiny facial muscles, the wrinkle is softened, making the face look younger and refreshed. It generally takes two to three weeks before the full benefit is seen. The effects of Botox only last three to four months.
Botox injections will not work for static wrinkles – wrinkles that are present all the time, even when the face is not animated. And Botox won’t eliminate the tiny creases already etched into the skin from many years of repeated movement – a good reason to commence with injections sooner, rather than later.
Botox injections are the most commonly performed nonsurgical cosmetic procedure performed in North America. They have an excellent safety profile. The only significant adverse events have been when large doses (many times that used for treating facial wrinkles) have been used “off label” in non-facial sites.

Newer varieties of botulinum toxins, such as Dysport, are becoming available. Whether these prove to be superior is yet to be determined.

I recommend that you purchase Botox by the unit, not by the area – it is the only way to accurately compare prices. Keep in mind that cost alone should not drive your selection of a provider. Experience and skill are necessary for a successful outcome!

Before Fillers

Before Fillers

Immediately Post Fillers

Immediately Post Fillers

Fillers, in contradistinction, are used primarily to restore volume to the aging face. As we age, our facial skin becomes thinner, fat diminishes, muscles atrophy and bone loss occurs, resulting in a face reminiscent of a deflated balloon. As the skin sags we develop unsightly furrows along the nose (naso-labial folds) and on the chin (marionette lines). These furrows can be safely filled with many different materials, and the results are immediate.

I generally prefer nonpermanent fillers, especially those containing hyaluronic acid (e.g. Restylane, Juvederm), a natural component of normal skin. These fillers last six to nine months, so if you don’t like the results, the skin will eventually return to baseline. Even better, if you hate the results, you can inject hyaluronidase and immediately reverse the effect.

Fillers are also used to enhance the lips, which also lose volume as we age. This is a case where less is more; if they end up being too big, it doesn’t look normal (restoration, not over-inflation, is the rule).

Remember, Botox and fillers are temporary “fixes” that have an excellent safety profile.

Injection is both a science and an art. It is foolhardy to just shop price – a lesson many have learned the hard way. Experience and an artistic eye are paramount to a successful outcome!

Neil Alan Fenske, MD

Neil Alan Fenske is the Professor and Chairman of the University of South Florida Morsani College of Medicine and the Medical Director of the USF HEalth Cosmetic and Laser Center on Davis Islands