Written by Dr Alison Colville, Medical Director at The Avery Clinic, Leamington Spa, Warwickshire
These days celebrities are much more transparent about having certain 'tweakments' done, but it still leaves us confused as to what they all mean. Do we need botulinum toxin injections or dermal fillers? Or even BOTH! Here's your go-to guide to break down the difference between botulinum toxin injections and fillers and how they may be suitable for you. Let's dive in...
Firstly, what are botulinum toxin injections?
The term 'bo(h)tox' is actually a nickname for a product containing Botulinum Toxin type A which has a muscle-relaxant action. Practitioners will usually refer to this treatment as 'anti-wrinkle injections' or 'muscle-relaxant injections'.
How does botulinum toxin work?
The toxin temporarily blocks the nerve endings at the area of the muscle it is injected into. This causes the muscle to relax and as a result of this, the overlying skin appears smoother, therefore making these treatments very popular in order to help against signs of ageing.
Botulinum toxin injections can also be used to change the shape of certain facial feature, e.g. lifting the eyebrows, or dropping the top lip to reduce a 'gummy smile'. This is because muscles in the face often work in opposition so if we reduce the strength of one muscle (e.g. giving a dose to the muscles that pull the eyebrow downwards), and leaving the other muscle (e.g. the muscle pulling the eybrow upwards), then it results in a slight change in position (i.e the eyebrow sits slightly higher)
Other medical uses include, reduction in the sweat glands e.g. in the armpits and palms of the hands, and also preventing jaw clenching or teeth grinding.
What can you use anti-wrinkle injections for?
The most common areas where botulinum toxin treatment is used are:
frown lines
horizontal forehead wrinkles
crow's feet / smile lines
bunny lines
smoker's lines / perioral wrinkles
chin dimples
eyebrow lift
masseter reduction / jawline slimming / anti-jaw clenching
reduction of sweating in forehead/scalp/armpits/hands
(plus many non-aesthetic medical uses)
What age is best for botulinum toxin injections?
Although often recommended to prevent wrinkles from setting in and favoured by people in their 20s-30s. It certainly doesn't mean that it can't be used when wrinkles have started to set in, in fact it can be vital at preventing them from worsening. However, other treatments will likely be useful to lift and even remove these more permanent wrinkles (which we'll come to later). Anti-wrinkle injections and filler compliment one another as they both target different aspects of the ageing process.
What are the side effects or risks of anti-wrinkle injections?
Thankfully, this treatment is very safe, and has very few side effects beyond a possible mild bruise at the site of the injection.
The main side effect is an unwanted result - either with too much relaxing of a certain muscle, (e.g. the eyebrows drooping) or an asymmetrical result. One of the ways that medical professionals avoid this is to inject lower doses and review at 2 weeks to 'top-up'.
As with any drug, there is a risk of allergy/anaphylaxis and there are a number of medical conditions which can mean it would be advised against having the treatment.
Do anti-wrinkle injections hurt?
Considered 'mildly' uncomfortable, or even painless by most, anti-wrinkle injections are generally very well tolerated, thanks mostly to the teenie-tiny needle that we use (you're welcome). Some areas of the face are also more sensitive to others.
When will I see results ?
It takes about 4-5 days for the muscles to start relaxing and you will have a full result after 2 weeks. This is the time to review and get a 'top-up' if needed to achieve the desired result.
How long do anti-wrinkle injection results last?
Usually it lasts for 3-4 months and you will slowly notice the muscle action returning. With more regular treatments we often see the effects lasting much longer as the muscles get used to being used less.
Now let's consider dermal filler treatments...
What is dermal filler?
Dermal filler is an injectable product containing various concentrations of hyaluronic acid (HA), used to add volume or 'fill' an area of the face. HA is a naturally occurring substance that attracts water and therefore hydrates the area and creates a firmer structure. As it is naturally occurring, the body slowly reabsorbs it over time but it also stimulates collagen in the area it is injected into so has the benefit of longer lasting results by improving elasticity of the tissue/skin.
What can you use dermal filler for?
In various concentrations of HA (some fillers are thicker, some thinner, some flexible, some firmer), and injected in different depths of the skin/facial tissues we can choose the correct dermal filler for various concerns/goals. Here is a list of common ways we can use dermal filler:
lips - to hydrate, volumise and define shape
fine lines - used just under the skin we can smooth out stubborn fine lines e.g. around the mouth
deep lines - used to soften folds and contour the skin e.g. naso-labial folds (nose to mouth corners) or marionette lines (mouth corners to chin edges)
cheeks - to shape and define, to replace volume lost due to ageing and the lift the lower face
chin and jawline - to create structure, contour and balance the profile creating a younger/more feminine/more masculine appearance
tear troughs - to create smooth under-eye area, improve wrinkles and dark circles
temples - can give a youthful smooth shape to the face
nose - to straighten and lift the tip
What age is best for filler?
Dermal fillers can be used at any age. Younger patients (<30y) will likely have good volume within their fat pads and therefore more commonly favour the use of fillers to accentuate a certain feature e.g. lips or lateral cheek bones.
Over age 35, signs of ageing start showing in the face as the fat volume decreases, skin loses its firmness and elasticity and things start dragging downwards. This can make us appear tired, frustrated or sad despite us not necessarily feeling this way! By using dermal filler, we can target specific concerns to lift and rejuvenate areas of the face and thus turn back the clock.
What are the side effects and risks of filler?
As with botulinum toxin injections, when injected correctly and safely (which involves your practitioner being medically trained with a good knowledge of anatomy), then dermal filler treatments are very safe. As with any injection, there is a risk of bruising and swelling at the site, and rarely infection. There is a chance of filler migrating/moving to other areas of the face and therefore having an unwanted effect. Thankfully, one of the benefits of filler is that it is fully reversible, so if it ends up where it shouldn't be, we can dissolve it. To prevent this, we advise no massage for a few days so that it can integrate with the tissue and then is more likely to stay put.
The main risk with filler, although rare, is that it blocks an important blood vessel which becomes very obvious if it were to happen. Again, we can reverse this by dissolving the filler, and by having a good knowledge of the anatomy.
Does filler hurt?
Filler is usually very well tolerated as a whole and considered to be only mildly painful. Around and into the lips is more painful and so we usually numb this area with topical cream, or using a dental block. Otherwise, numbing is generally not needed, and there is often just a simple prick of the needle passing through the skin. We have fewer nerve endings underneath the layers of the skin so the deeper the injection, usually the less sore.
Many filler products have some local anaesthetic within them which adds to the comfort of the procedure.
When will I see results of filler?
Often immediately! The dermal filler injected will give an instant result but will continue to work over the next few days as the HA substance draws in more hydration to the area so we prefer to 'under-fill' initially to allow for this.
How long does filler last?
Dermal fillers can last anywhere from 6 - 24 months depending on where they are injected and your lifestyle. Areas like the lip tend to reabsorb the product quicker than the cheeks/jawline/chin due to excessive movement and a slightly thinner filler. Certain lifestyle choices such as intense exercising, or even a fast metabolism can cause the breakdown of the filler to occur quicker.
So, in summary...
Both anti-wrinkle injections and fillers are injectable, non-permanent treatments, but otherwise are very different. When combined, they can give fantastic results at any age. It is important to assess each person individually so that their specific concerns or goals can be addressed.
If done with care, attention to unique anatomy, and in a safe environment, then the use of both botulinum toxin injections and fillers can, and should(!) give subtle (and hopefully unnoticeable to others), natural results. They can both help with signs of ageing, both are safe, both have little downtime and also show results within a few days.
Interested in how either treatment might work for you? Book in for a free consultation today and we can discuss your individual concerns/goals.
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