Botox vs. Fillers: What’s the Difference?

Botox (onabotulinumtoxinA) and dermal fillers are nonsurgical procedures commonly used for cosmetic purposes, but they are not the same.

Botox is a neurotoxin made from Clostridium botulinum bacteria. Its cosmetic use includes treating wrinkles and fine lines on the face. However, it is also used medically for overactive bladder, migraines, and certain types of neurological conditions. Different neurotoxin brands, such as Dysport, Xeomin, Jeuveau, and Daxxify, are available on the market. 

Dermal fillers have become popular in recent years. They reduce wrinkles and deep lines, fill out the facial features, and help treat acne scars. Different types of dermal fillers are available.

Main Similarities and Differences

Botox and dermal fillers are similar in their method of administration. They are injected directly under the skin at the target area. Both are temporary procedures and need routine visits to maintain the outcomes.

Botox and dermal fillers are different in several ways, including:

• The materials they contain
• How they work
• Target areas for use
• How long they last
• Age limitations
  

What Is Botox Used For?

Botox is made from botulinum toxin and is used for various medical and cosmetic procedures. It blocks the nerve signals that cause muscle movements as a way to improve fine lines.

The Food and Drug Administration (FDA) approved Botox to treat the following in people over 18:1

• Wrinkles between the eyebrows
• Crow's feet lines (wrinkles on the outer corners of the eyes)
• Forehead lines 

The results may be noticed within three to seven days and last three to four months.2

Medically, Botox is also approved by the FDA to treat:3

• Bladder conditions, such as overactive bladder, urinary incontinence, and neurogenic detrusor overactivity (a neurological condition that causes bladder muscle contractions)
• Migraine prevention
• Spasticity (a condition characterized by muscle stiffness, rigidity, or tightness)
• Cervical dystonia (a neurological disorder that causes muscle contractions in the neck)
• Severe axillary hyperhidrosis (excessive sweating in the armpits)
• Blepharospasm (a neurological disorder that causes eyelid twitching and blinking)
• Strabismus (a vision disorder that causes crossed eyes)

What Are Dermal Fillers Used For?

Types of temporary dermal fillers include the following:4

• Hyaluronic acid
• Calcium hydroxylapatite
• Poly-L-lactic acid (PLLA)

They are FDA-approved for use in people over 21 to:56

• Create a smooth appearance and improve wrinkles
• Increase fullness of different facial areas, such as cheeks, lips, and hollowness under the eyes
• Add volume and smooth appearance of hands
• Restore facial fat loss in people with human immunodeficiency virus (HIV)
• Correct acne scars
  

The FDA does not approve using dermal fillers for body feature enhancements such as:5

• Increasing breast and buttocks size
• Alterations to the feet
• Implanting into bone, tendon, ligament, or muscle
• Injection at the area between the eyebrows, on the nose, around the eyes, on the forehead, or on the neck

Dermal fillers are naturally absorbed by the body over time. To maintain the desired results, you may need to repeat the procedure.

Risks and Safety Considerations

Botox and dermal fillers are widely used to improve facial appearance. They are generally safe and convenient procedures when administered by a licensed healthcare provider in a medical setting. However, some side effects and risk factors may need medical attention.

Botox

A major risk factor associated with Botox is the spread of injected toxin from the injection site to other areas. Immediately seek medical help if you have any of the following symptoms:1

• Change in or loss of voice
• Difficulty swallowing or breathing
• Difficulty speaking
• Drooping eyelids
• Inability to control urination
• Loss of strength
• Muscle weakness all over the body
• Vision problems

Avoid undergoing the procedure if you have bruising or inflammation at the injection site.

Dermal Fillers

Some common side effects are injection site reactions causing bruising, pain, and swelling. Other risk factors may include the following:7

• Accidental injection into a blood vessel, which can cause stroke, blindness, or tissue death
• Formation of permanent hard nodules
• Severe allergic reaction to filler material

Seek immediate medical attention if you experience any of these symptoms during or shortly after the procedure, such as:5

• Discoloration of skin
• Signs of a stroke (including sudden difficulty speaking, numbness or weakness, difficulty walking, face drooping, severe headache, dizziness, or confusion)
• Unusual pain
• Vision changes
  

Which Is Right for You?

Multiple factors matter when choosing between Botox and dermal fillers. Discuss with your healthcare provider what is better suited for you. The choice of procedure usually depends on:

• Cost: Botox is generally more affordable than dermal fillers.
  
• Length of time they last: Botox results are a short-term treatment lasting only three to four months. Dermal filler can work a little longer. Injections can last anywhere from three to 18 months.89 In some cases, they may last for several years.10
• Type of fine lines or wrinkles you want to treat: Botox is a better choice for wrinkles and fine lines, while dermal fillers can restore volume in facial areas or enhance lips and face outlines. 
  

A healthcare provider, such as a dermatologist or plastic surgeon, can assess your cosmetic needs and budget to determine a personalized treatment plan.

Can You Get Them Together?

Combining Botox and dermal fillers such as collagen and hyaluronic acid can restore facial appearance through their dual mechanisms of action. In addition, the combined use can increase the duration of the procedure's effects.

Botox should be administered first, followed by either dermal fillers such as hyaluronic acid or threads after a few weeks.11

As per FDA guidelines, the safe use of dermal fillers in combination with Botox has not been evaluated in a controlled clinical study.5

Summary

Botox and dermal fillers are cosmetic treatments to improve skin appearance. Botox improves wrinkles on the face and lasts for three to four months. Botox is also used for medical conditions such as migraine, bladder conditions, and certain neurological disorders.

Dermal fillers enhance the fullness and plumpness of aging skin. They last longer than Botox and require fewer revisits.

Both are injected directly under the skin at the target area by a qualified professional. They are usually safe and effective, but immediately call your healthcare provider if you experience any unusual side effects or unease.