What is the Difference Between Filler and BOTOX®?

If you are wondering what are the differences between BOTOX® and filler, do not worry, you are not alone. I get this question every day in my cosmetic practice, and frequently people confuse the terms filler and BOTOX®, thinking they are interchangeable. However they are very different treatments that achieve different goals. Having said that, BOTOX® and filler are often used together to maximize an aesthetically pleasing, natural cosmetic result.

How many of you feel tired of staring at your frown and forehead lines on Zoom meetings? You are not alone. BOTOX® might be part of the solution you are looking for. So what exactly is BOTOX®? When we say BOTOX® it refers to the “brand name” for a purified protein made from botulinum toxin. It has been used safely in Canada and across the world for more than thirty years. BOTOX® injections are the most commonly administered aesthetic procedure performed worldwide. There are other brands of purified proteins made from botulinum toxin including XEOMIN®, which achieves the same goals as BOTOX®.

BOTOX® treatments relax the facial muscles that create wrinkles, resulting in a freshened yet natural appearance. When my patients ask, I try to give them the following analogy to better understand. You know those accordion Venetian blinds that open and close by pulling a string up and down? The more you pull the blinds up and down, the deeper the seams of the blinds become, until you can see them even when they are in the resting down position. The same applies to your facial muscles of expression. Take for example your forehead lines, you lift your brows up and down all day as you express, analogous to pulling the blinds up and down all day, thus creating rest lines that will remain, even when you are not expressing – aka “rest wrinkles”. If we can relax the repetitive movement all day of lifting up and down the brows (ie the blinds), then we are essentially stopping our rest lines from forming, resulting in a smoother, more relaxed youthful appearance. This applies to other facial wrinkles as well, due to similar repetitive movements, such as smiling, frowning, concentrating, chewing, and squinting. When performed well, by an experienced injector, the difference between your appearance before and after a BOTOX® injection is natural and beautiful, with a relaxed and pleasant facial expression.

Since BOTOX® naturally breaks down over three to six months, depending on the area it is injected into and how dynamic the muscle is, I encourage you to maintain treatments regularly to preserve an ongoing wrinkle-free, relaxed look. Almost every day my patients ask me how my own forehead got to be so smooth. They ask me if I have had BOTOX® treatments? The answer is yes, of course. I like to share my own personal experience with injectables, as it always makes my patients feel more comfortable and reassured to know that I too have received the cosmetic treatments that I perform. They are reassured to hear that I can speak from personal experience on the procedure, comfort levels, downtime and results. I started my BOTOX® injections shortly after I finished nursing my last child and have not stopped since. When I look back at my older photos, prior to when I started BOTOX®, I see that I had rest lines starting to form. Ten years later, my rest lines are gone, yet I feel like I still can express, move my face, and look very natural! These similar results are what my patients ask for every day.

So if BOTOX® relaxes muscles of facial expressions, what does filler do? Have you ever stood in front of the mirror and used your finger and thumb to pull the sides of your face up to see what you would look like with a lift? Yes, we all do that now and again! Well, filler can help you achieve a soft lift without surgery by lifting the facial sagginess that occurs with aging. So what exactly is filler and who would benefit from it the most?

Filler is a clear gel-like substance made of hyaluronic acid, which is a sugar that normally occurs naturally in the dermal layer of the skin, giving your skin structural support. As your skin ages, there is a natural loss of hyaluronic acid. Filler is used to restore lost volume, fill in deeper wrinkles and grooves and subtly sculpt and reshape your face to look less tired, less saggy and more youthful. Many areas can be treated with filler including lifting and volumizing cheeks, improving jawline contouring, reducing the appearance of jowls, softening the under eye dark lines and circles, filling in the smiles and marionette creases, and adding volume to thin or uneven lips. These are just a few of the areas where filler can be used to subtly lift tissues that have begun to sag and weaken due to loss of structural support.

The biggest reluctancy I find patients have to trying filler is that they are worried they will look over-filled. The goal with filler is always to look like you! The goal is never to look overfilled, puffy or over volumized. I like to use the analogy of a slow leaking deflating balloon. If we use filler appropriately and distribute it in small quantities over areas that are slowly deflating, we can subtly re-inflate those areas (ie like slowly re-inflating the balloon to maintain its size). However by no means do we ever want to over pump large quantities of air into that balloon to make it look over inflated. The same applies to your face, we want to slowly restore the volume loss, without ever over-inflating. This will lead to the most natural, youthful and subtle results.

So the next time you are on a zoom meeting and want to erase those rest lines, or the next time you look in the mirror and lift your face up to see if you look better less saggy, consider the treatments above as good options to achieve a more youthful, attractive, natural and rested appearance!

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