Patients often ask what the differences are between botox and dermal fillers. Why we should use one or the other?
Botox and Dermal Fillers have very different properties, however, we often use them both together to get the best results in rejuvenation.
Botox is a toxin produced by a bacteria. We are using it in minute doses to weaken muscles of expressions of the face to reduce wrinkles. Why do we do this? Is this enough? Why do we age the way we do? Is the wrinkles produced by the muscles?
Actually we age because we produce less of everything that supports the skin. Collagen and Elastin are 2 components that are essential to give the skin elasticity and thickness. Hyaluronic acid, the fluid that is between these fibres, also diminishes with age. Eventually we lose fat and bone as well. As a result, we develop sagginess and folds. We can’t replace collagen and elastin, but we can replace hyaluronic acid by injecting dermal fillers in small amount e.g. Restylane Skin Boosters. We can also stimulate the skin into repair to produce collagen with micro-needling and energy device.
Why do we need to treat the muscles as well? When we are younger, we only have wrinkles when we move our facial muscles such as in smiling and frowning. These are called dynamic wrinkles. When we are older, we have wrinkles even when we are not smiling or frowning. These are called wrinkles at rest. Botox is very good at treating dynamic wrinkles. It weakens the muscles that produce our facial expressions. The aim is to reduce wrinkles but not to completely abolish them, as this will make facial animation difficult. If we keep up with botox treatment, it can prevent you from developing wrinkles at rest.
However, when we think about the mechanism of how we age, it does not make sense just to treat the wrinkles with botox. There is loss of structural support in the skin as I already described. Hyaluronic acid fillers can be used to replace volume that is lost and give some structural support to the skin. We often use it in the outer cheek area to provide anchor and lifting of the skin to reduce sagging. A thicker product such as Juvaderm Voluma is used for lifting. The mid cheek fat and bone loss also require volume replacement. Depending on the quality and thickness of the skin, products like Juvaderm Voluma or Juvaderm Volift can be used in this area. Similarly, we can treat the temples, jaw and chin area with these dermal fillers.
Are botox and fillers just for older people? We know that aging starts pretty much as we are born. It does make sense to treat early, but how early is too early? The person who is being treated needs to be old enough to understand the pros and cons of the treatment. A younger person may want to look more attractive, looks for treatments that will enhance his/her beauty. Dermal fillers can be used to correct asymmetry, create a more pleasing forehead, nose or chin by adding volume, to add contour to the cheekbones. Some people complain of undereye hollows, dermal filler can be used in the cheeks and undereye to improve the appearance. Botox is used to widen the eyes and to slim the jaw. Botox can also have some additional skin benefits such as reduce sweating or redness of the face. For rejuvenation in a younger patients, they may require less volume in products that we use. The older the patients, the more difficult to treat and the more volume is required.
In short, the earlier you seek treatment, the better the outcome. Younger patients may have different needs. Both botox and dermal fillers are useful and can be used synergistically to give better result.