For the better part of the last decade, I’ve experimented with injectables. I say “experimented” because, unlike most medical treatments, it’s not an exact science. Rather, it’s more of an art — not only do techniques and preferences vary from dermatologist to dermatologist (or licensed injector, usually a nurse practitioner), but the same can be true for each patient.
That said, I started with preventative Botox when I was 27 — a prime age to start freezing your face to prevent wrinkles, mostly because they were barely perceptible then. Now that I’m months shy of 35, it’s something I do regularly because I like how it looks. I didn’t bother to try filler — a different kind of injectable — until nearly five years later. But what exactly is the difference between Botox and filler?
“Neurotoxins work by temporarily relaxing muscles that wrinkle overlying skin when we make facial expressions,” says Dr. Joshua Zeichner, a New York City-based board-certified dermatologist. He mentions that while Botox is one of the most common neurotoxins, it’s not the only one. Dysport, Jeuveau and Xeomin are other neurotoxins that also relax facial muscles to even out wrinkles. “Fillers, on the other hand, are designed to lift and fill the face by replacing lost volume,” he says. Basically, the latter is an injectable that doesn’t freeze your muscles but rather plumps the skin or contours the face.
While some have regarded injectables as “cheating,” I prefer to think of them as just other options in my skin care arsenal — and they’re not options that anyone should feel pressured into trying. Still, in decades past, if you wanted to smooth fine lines or plump your skin, you’d have to invest in a great topical, be consistent and wait it out.
Here’s what to know about how Botox and fillers.
What is Botox?
As Zeichner mentioned, Botox is the colloquial name for a neurotoxin that “freezes” or temporarily relaxes muscles to smooth wrinkles. It’s been around in the sense we know it today since 2002, when it received FDA approval to treat 11s — or the wrinkles between the eyebrows. It became more popular in the mid-2010s as a way to delay or treat the signs of aging, but again, it’s not an exact science: “There are several different neurotoxin brands on the market, each with slightly different properties,” says Zeichner. “I use all of them, and they are all effective. Ultimately the choice of product depends on your injector’s personal preference.”
Botox and other neurotoxins are also sometimes used to relax other muscles in an “off-label” manner (Someone might get Botox in their masseter to alleviate symptoms stemming from jaw-clenching or teeth grinding. Others may use it to stop sweat glands from working in a certain area).
What is filler?
Filler, on the other hand, is exactly what it sounds like: an injectable that fills wrinkles or plumps skin tissue. Most fillers are made from hyaluronic acid, a sugar that our bodies naturally make. Your injector may recommend a specific type of filler for a certain area but use another one elsewhere for a different result.
“Dermal and volumizing fillers are injected at different depths of the skin to help add volume and definition to areas of the face that have lost volume due to age, sun damage and environmental factors,” says Norah Gourlay, a Washington, D.C.-based Nurse Practitioner at SkinSpirit. They’re most often used to enhance or plump the cheek, lips, chin or tear troughs, as well as treat nasolabial folds, marionette lines and smile lines.
“I use hyaluronic acid fillers exclusively, including the Restylane, Juvederm and RHA families of products,” says Zeichner, who adds that each one has different properties. “Some are more firm and have better lifting properties; some are softer and plump the skin more; some are more flexible and are better for moveable areas like the lips.”
Zeichner also confirms my experience: Fillers tend to be more uncomfortable than neurotoxins when injected. If Botox is a three out of ten on the pain scale in most areas, filler is usually a five or six depending on the area, product and injector.
“I use topical numbing creams for all of my patients, which makes the procedure well-tolerated with minimal discomfort,” he adds. “Plus, pain can be minimized with careful injection technique, and some injectors are more heavy-handed than others.”
When do you see results from Botox and filler?
While it can vary from patient to patient, Gourlay says that most people will feel the effects of Botox start to work within three to five days, “with approximately two to four weeks for the full result,” she says. “Clients will look natural, refreshed or well rested after the Botox has fully taken effect, as the lines and wrinkles in the treated area disappear completely or appear much less noticeable.”
The downside is that the effects of Botox are fairly short-lived: While some see it last up to six months, many people find that it wears off within about three months—even more so if you’re particularly expressive. “If you’re unhappy with your result, however, the effect will eventually wear off on its own,” Zeichner adds.
Filler, on the other hand, shows fairly immediately. As soon as any swelling goes down, those are the results you’ll see for anywhere from six to nine months, depending on the amount used, the exact product, and your metabolism. Unlike Botox, any hyaluronic acid filler can be dissolved with an enzyme known as hyaluronidase, Zeichner says. “From a safety perspective, that’s why I prefer to work with these fillers. Even the best artist needs an eraser every once in a while.”
What are the side effects of Botox and filler?
It’s generally recommended that anyone pregnant, trying to get pregnant or breastfeeding stay away from injectables on the whole. There are a few general side effects like bruising, swelling or pain at the injection site that can take up to two weeks to resolve.
“The biggest side effect with neurotoxins is a dropped eyebrow or a droopy eyelid,” says Zeichner. “This occurs when the product relaxes unintended muscles, though this risk is quite low, especially when you are being treated by an experienced injector.”
“While extremely rare, there have been reports of fillers blocking blood flow to the skin and leading to permanent scarring or blindness,” says Zeichner. “This is a scary side effect that has been reported when fillers have been injected into high-risk areas, like between the eyebrows. Experienced injectors use specialized techniques to minimize this risk.”
In addition, Zeichner calls out some rare reports of blindness for those that have been injected around the eyes. “These side effects are extremely rare, but it is extra important to know who is injecting your face,” he says.
You should always talk to your doctor about the risks, benefits and goals before getting treatment to be sure you’re on the same page. I personally like to bring photos to show what I like and don’t like, especially for filler.
How much do Botox and filler cost?
Like most medical procedures in America, the cost can differ significantly based on location, clinic and the experience of the injector. Typically, a dermatologist will charge more than a nurse practitioner, but this isn’t always the case. In most areas, Botox will range from $8-18 per unit with an average of 20 units per treatment area, and filler will generally run you anywhere from $500-$1000 per syringe. The amount needed per treatment area also varies significantly, but an average patient might opt for anywhere from one to four syringes per appointment, depending on the desired outcome.
All that said, injectables aren’t something you should feel pressured into trying — nor is it for everyone. I enjoy the instant gratification of both Botox and filler. And while I wouldn’t call it “cheating,” I think it’s important to be honest about injectables or other appearance-altering beauty services, especially in the time of social media filters.
If you enjoyed this story, here are the questions you should ask before getting injectables.