Fillers vs. Botox® in Beverly Hills

These two get discussed as alternatives, and they are not. They do different things to different tissue for different reasons, and the reason patients find the comparison confusing is that the marketing around both has flattened them into one category called injectables. The useful question is not which is better. It is which one addresses the thing that is actually bothering you.

Sam Assassa, MD has worked with both neuromodulators and dermal fillers since founding Beverly Hills Aesthetics in 1995 and has performed more than 25,000 aesthetic procedures. He is board certified in Internal Medicine, serves on the advisory committee of the American Aesthetic Medicine Association, and developed the SmileLift™ and SweatZap™ procedures.

“Patients ask which one is better. That is like asking whether a hammer beats a screwdriver. Filler replaces what has gone. Botox stops a muscle from doing something. Most faces past forty need some of each.” — Sam Assassa, MD

The Core Difference in One Paragraph

Botox® relaxes muscle. It blocks the signal telling a specific muscle to contract, so the muscle stops pulling on the skin above it and the line that pulling created softens. Nothing is added to your face.

Fillers add volume. They are placed under the skin to replace structure that has been lost or to build structure that was never there, changing shape and contour directly. Nothing is relaxed.

Which means: if your concern appears when you make an expression, that is usually a Botox® question. If your concern is visible when your face is completely still, that is usually a filler question.

Botox® Compared With Fillers

When Botox® Is the Right Choice

Botox suits concerns produced by muscle activity, which is why the test is whether the line appears or deepens when you move.

• Frown lines between the brows, deepened by the muscles that pull the brows together
• Forehead lines, from raising the brows
• Crow’s feet, from squinting and smiling
• Jaw slimming and clenching, where the chewing muscle has enlarged
• Neck bands, where the platysma has tightened into visible cords
• Gummy smile, lip flip, chin dimpling, where relaxing a small muscle changes proportion
• Excessive sweating and migraine, where the goal is symptom relief rather than appearance

When Fillers Are the Right Choice

Fillers suit concerns visible when your face is completely still, because those are structural rather than muscular.

• Flattened cheeks and midface, where fat and bone volume have diminished
• Hollow temples, narrowing the upper face
• Under eye hollows, casting the shadow read as dark circles
• Thin or undefined lips
• Weak chin or undefined jawline, where projection and support are lacking
• Deep nasolabial folds, where the cause is descent rather than muscle
• Nose shape, where filler can camouflage a hump or lift a tip

Why Most Plans Use Both

The two address different layers of the same aging process, and treating one while ignoring the other produces a partial result.

A patient with deep forehead lines and hollow temples needs Botox® for the lines and filler for the temples, and treating only the lines leaves a smooth forehead on a narrowed upper face. A patient with a heavy lower face may need masseter treatment to slim the jaw and filler to define the border of the jawline, which are opposite actions in adjacent tissue.

Treatment is frequently staged rather than combined in one sitting, since it is easier to judge how much volume a face needs once muscle activity has settled.

Off-label use of an approved medication is legal and standard in aesthetic practice. Dosing outside the approved regions is determined by examination rather than by a published figure, which is one reason it belongs with an experienced injector.

Individual results vary and no outcome can be guaranteed.

Glabella (Corrugator)

* smooths frown #11 lines

* FDA approved treatment for
both Corrugator + Procerus: 20U

Infrabrow (Orbicularis)

* lifs tail of eyebrows, brightens eyes

Crow's Feet (Orbicularis)

* softens wrinkles while smiling and
animating

* FDA approved treatment: 12U per side

Marionette Lines (DOA)

* elevates corners of the mouth
and softens marionette line

Chin (Mentails)

* softens chin wrinkles during animating

Forhead (Frontalis)

* smooths horizontal wrinkles

* FDA approved treatment: 20U

Glabella (Procerus)

* smooths horizontal wrinkles

* FDA approved treatment for
both Corrugator + Procerus: 20U

Bunny Lines (Nasalis)

* smooths diagonal wrinkles along
the nose

Masseter Muscle

* slims jawline

* treats grinding (Bruxism)

Neck (Platysma)

* relaxes hyperactive neck muscles
this softening neck contours

Legend

* Anatomic Region (Target Muscle)

* Dosing of FDA approved anatomical regions is indicated

* All other areas do not have FDA-indicated dosing

* This infographic is for educational puposes only and not a
garantee of a particular result

* Individual results may vary

Neurotox

 

BEVERLY HILLS AESTHETICS BOTOX® TREATMENTS

• WRINKLES (Forehead & Frown Lines, Crows Feet, Chin Dimples, and enhancement)
• TMJ
• GUMMY SMILE
• LOWER FACE SLIMMING AND CONTOURING
• JAWLINE SLIMMING
• CHIN AUGMENTATION
• LOWER FACELIFT – NEFERTITI FACELIFT
• NECK BANDS (TURKEY NECK)
• UNDERARMS EXCESSIVE SWEATING
• MICRONEUROTOX® LIFT
• ACNE and LARGE PORES

DERMAL FILLERS: REJUVENATE, LIFT AND CONTOUR THE FACE

There are many types of dermal injections on the market today, the most popular consist of a substance called Hyaluronic Acid.
Hyaluronic Acid-based, cosmetic dermal fillers are among the safest and the results are immediate. Hyaluronic Acid is structurally similar to collagen and has the same appearance when injected into various areas and depths of the face.

The results of dermal fillers are incredible including contouring of the face, directly adding volume, stimulating new collagen formation, and completely rejuvenating the look and feel of your skin.

Additionally, Hyaluronic Acid-based injectable fillers are reversible. Though it’s rare, if a patient is unsatisfied with the results, we can safely remove the filler at a future appointment. Generally, fillers will last approximately 12 months.

BEVERLY HILLS AESTHETICS DERMAL FILLERS TREATMENTS

• FACIAL CONTOURING: Forehead and Temples, Cheeks & Jawline & Chin
• NON-SURGICAL FACELIFT AND NECK LIFT
• DARK CIRCLES AND HOLLOWNESS UNDER EYES
• EYEBROW LIFT
• NON-SURGICAL RHINOPLASTY
• NON-SURGICAL LIPS CONTOURING, LIFT, AND ENHANCEMENT
• CHIN ENHANCEMENT
• DECOLETTE: CHEST WRINKLES
• HANDS REJUVENATION
• ACNE SCARS
• NON-SURGICAL LIFT

Filler Treatment Areas

Filler is used across two broad patterns, and which one applies depends more on what has changed than on age.

Contouring, generally for patients whose facial structure is intact but who want definition: cheekbones, jawline, chin, lips, nose, and brow.

Restoring, generally for patients who have lost volume: temples, under eye hollows, midface, jowls and lower face, neck, and the perioral region.

Detail on each is on the dermal fillers page and the products used.

Risks and Safety

Both are medical procedures with real risks, and they are different risks.

Botox® commonly causes temporary bruising, swelling, tenderness, and headache. Product affecting a muscle other than the target can cause temporary brow or eyelid droop, asymmetry, or altered smile, resolving as the effect wears off. Treatment in the neck carries considerations relating to swallowing.

Fillers commonly cause swelling, bruising, tenderness, and temporary lumpiness. Rarely, filler injected into or compressing a blood vessel can restrict blood flow, causing tissue damage, and in very rare cases has been associated with vision loss. That risk is highest at the nose, glabella, and forehead.

Individual results vary and no outcome can be guaranteed.

Frequently Asked Questions About Botox® and Fillers

Which is better, Botox® or fillers?

Neither, because they treat different problems. If the line you dislike appears or deepens when you make an expression, it is muscular and Botox® addresses it. If what bothers you is visible when your face is completely still, it is structural and filler addresses it. Most patients past their forties have some of both, which is why combined plans are common rather than an upsell.

Can I have Botox® and fillers at the same appointment?

Yes, and many patients do. Treatment is sometimes staged instead, particularly when the plan involves the same region, because it is easier to judge how much volume a face needs once muscle activity has settled. Whether yours is combined or sequenced is decided at consultation based on which areas are involved.

Which lasts longer, Botox® or fillers?

Fillers, by a considerable margin. Botox® lasts three to four months because the effect ends as nerve signaling recovers. Fillers last six to eighteen months depending on the product and where it sits, with deep structural placements in static areas like the cheek, chin, and temple lasting toward the longer end and lip filler toward the shorter, since the lip is in constant motion.

Which is more expensive?

Per appointment, filler generally costs more, since it is priced by syringe and structural work often requires several. Over a year the comparison narrows, because Botox® requires three or four appointments annually while filler may require one. Current pricing is on the fees page and several payment options are available.

Can either one be reversed?

Hyaluronic acid filler can be dissolved with an enzyme within a day or two, which is a genuine safety feature and a reason to prefer it for a first treatment. Botox® cannot be reversed and instead wears off over three to four months, so an unwanted result is waited out rather than undone. Calcium hydroxylapatite and poly-L-lactic acid fillers are also not reversible.

Should I start Botox® in my twenties to prevent wrinkles?

The idea that early treatment prevents future lines is widely repeated and less well established than the marketing suggests. What is reasonably supported is that reducing repeated muscle contraction reduces how deeply a line becomes etched over time. Whether that justifies starting in your twenties depends on how much movement you actually have and how visible the lines already are, and it is a question worth an honest conversation rather than a default yes.

Schedule a Consultation in Beverly Hills

If you are trying to decide between the two, the useful step is having someone look at your face while it is moving and while it is still, because that comparison answers the question faster than any article can. Dr. Assassa will tell you which of your concerns are muscular, which are structural, and what treating each would actually involve. Beverly Hills Aesthetics serves patients from Beverly Hills, Los Angeles, West Hollywood, and Century City. Request a consultation or schedule your appointment online.

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Botox® and Botox® Cosmetic are registered trademarks of Allergan, an AbbVie company. Beverly Hills Aesthetics is not affiliated with, endorsed by, or sponsored by AbbVie.