Botulinum Toxin or Filler? The Differences and What Each One Is Used For

Why are the two methods confused?

Both treatments are given by injection, they are often discussed in the same consulting room, and their results are described as a more rested look in the face. This is why, in everyday speech, the name of one may be used for the other.

Yet the two methods target different changes in the face. When the wrong method is chosen for the wrong problem, the expected result is not achieved and an unnecessary risk is taken. That is why the cause of the line or appearance must be understood first.

How do they work? Muscle relaxation and volume support

Botulinum toxin temporarily reduces, in the area where it is injected, the release of the chemical messenger that carries the command to contract from the nerve to the muscle. The muscle contracts less, and the lines formed by that muscle contracting again and again soften. For details, see our article “Botulinum Toxin”.

Hyaluronic acid filler, on the other hand, is a processed gel form of a molecule found naturally in the body. It creates volume where it is injected into or under the skin; it does not affect muscle movement. Over time it is broken down by the body. For details, see our article “Hyaluronic Acid Filler”.

Dynamic and static lines: the difference

Dynamic lines are lines that appear or become more visible with facial expressions. Examples include the vertical lines between the eyebrows when you frown, the horizontal lines on the forehead when you raise your eyebrows and the lines at the corners of the eyes when you smile. Botulinum toxin is considered mainly for this type of line.

Static lines are lines and folds that are visible even when your face is at rest. They can form over the years through the combined effect of volume loss, changes in skin structure and repeated facial movements. For some static lines and folds, filler may be considered depending on the physician’s assessment.

A simple observation can give you an idea: does the line become visible only when you make an expression, or can it be seen when your face is at rest too? Still, this distinction is not always clear, and both situations can exist in the same line. Your physician makes the diagnosis and the plan through an examination.

Comparison table

The table below is a general comparison. Which method may be considered for you, in which area and in what amount, is determined after an examination.

When will I see the result, and how long does it last?

The effect of botulinum toxin usually begins within a few days and becomes noticeable in about two weeks. In most people the effect lasts about 3–4 months; the duration varies with the area, the dose, muscle strength and individual differences.

With filler, the volume effect is visible immediately after the procedure. However, swelling in the first days can be misleading; your physician decides when the final appearance should be assessed. How long filler lasts varies with the structure of the product, the area and the person; in areas that move a lot, such as the lips, it may be shorter. The effect of both methods wears off over time, and repeat treatment is needed if you want it to continue.

How the risks differ

The most common side effects of both methods are mild and temporary: redness, swelling, tenderness and bruising at the injection site. The important difference lies in the type of rare but serious risks.

With botulinum toxin, unwanted effects are usually related to the medicine affecting neighbouring muscles: temporary drooping of the eyelid or eyebrow, a frozen expression or asymmetry. Very rarely, problems with swallowing, breathing, speech or vision caused by the medicine’s effect spreading have been reported; these symptoms require you to call 112 (or your local emergency number) immediately.

With filler, the most serious risk is vascular occlusion, which occurs when the gel enters a blood vessel or presses on a vessel from outside. It is rare; but if it is not recognised in time, it can lead to tissue loss in the skin and, very rarely, to loss of vision or a stroke. The area between the eyebrows, the nose and its surroundings, the forehead and the area around the eyes are considered among the higher-risk areas in this respect. The warning signs and what to do are explained in detail in our article “After Fillers: When Is It an Emergency?”.

If you cannot reach the physician who performed the treatment, do not wait; go to the nearest emergency department and say which procedure you have had. Unless your physician advises it, do not massage the area or apply heat or ice.

Can the two be used together?

The face often shows not a single change but several changes at once. For example, expression lines on the forehead and volume loss in the cheeks may be seen in the same person. In this case, the physician may suggest the two methods for different areas as parts of the same plan.

Whether they are combined, whether they are done on the same day or at different times, and in what order, varies from person to person. Your physician makes this decision after an examination. More procedures do not always mean a better result; a natural look and safety come first.

How is the decision made?

The right question is not which procedure you want, but what it is that bothers you. Explaining this clearly at the examination helps the physician assess the cause of the line.

• Your physician assesses your face both at rest and while you make expressions.
• Your medical history, the medicines you use and your previous aesthetic procedures are discussed.
• The expected result, risks and alternatives of each method are explained.
• Having no procedure is also a valid option; wrinkles are not a health problem.

If you are considering a treatment for the first time, our article “A Guide for First-Time Medical Aesthetic Patients” can help, and to assess who will perform the treatment and where, our article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics” can guide you. Both procedures should be performed after an examination, by a physician, in a licensed healthcare facility.

This page is for general information. The method that is right for you can only be determined through an examination and a physician’s assessment.