So you’ve been debating for the longest time whether to get Botox or Fillers. You’ve spent countless hours searching online, reading reviews and perhaps, doctor-shopping as to who gives the most discount. Now I’m going to stop you right there. If someone quoted you a too-low-too-good-to-be-true price, proceed with caution and ask for the injector’s background or credential because in the world of aesthetics, you can’t stick a bargain tag for quality. I say this because I get asked a lot of times if our clinic does Groupon. The answer is no because we strive for high patient retention due to excellent treatment vis-a-vis service. The cost of procuring the products straight from the manufacturer is pricey enough and if you factor in the cost of administration (depending on who does the procedure i.e. MD, RN, PA, NP and where it’s done i.e small clinic in the suburb vs. plush med spa in Hollywood), simple math ain’t that hard to comprehend. Most states do not allow estheticians to inject Botox because they lack medical training in terms of facial anatomy, drug process, and barring complications, they cannot diagnose, assess and treat you. Buyer beware, I can’t emphasize this enough. This leads you to your next and most pressing concern, should you get Botox, Filler, or both? so let’s use my face and assess together (all photos are unretouched just so you know).
Now let’s keep an open mind here because I want you to leave this blog with informed decision. Don’t be like my husband “you don’t need Botox” or my mom “you need to eat more so you have fuller cheeks”. You are here because like all the gazillions of women out there, sometimes we can’t avoid but be very critical of ourselves. I know my body more than anyone does. RBF. Resting bitch face, you don’t see crows feet. Smile, and boom! that’s 42 for you! But let’s not forget, I had oily skin from teenage years up to my late 30s, add the fact that I do take extra care of my skin (moisturizer, sunscreen, serum, the works) so the amount of wrinkles you see from me is probably less than the average, sun-worshipping, dry-skinned woman in her 40s.
My quick answer for you: Botox is for expression lines a.k.a “dynamic facial wrinkles”. Filler is for loss of volume. Botox relaxes the muscles. Filler contours the face. Let me expound further.
A neuromodulator, Botox temporarily reduces the contraction of the muscles which cause wrinkles. By principle, it works best on the upper 1/3 of the face: forehead, around the eyes, in between the brows. You may have heard of Xeomin or Dysport, they are also neuromodulators and although they differ in terms of molecular configuration and onset of action, both produce the same effect as Botox. So regardless whether you’re getting Botox, Xeomin or Dysport, it all boils down to quality: the injector, the location of injection, and the number of units injected. You want to look “young” but not crazily expressionless. Using my left photo as reference, I can benefit from six units of Botox on each side around the eyes (crows feet, 2 units on upper outer, 2 units on mid, 2 further down). The more wrinkles you have, the more units you will need. I don’t have horizontal lines on my forehead and vertical lines in between my brows (1’s, 11’s, 111’s: used to evaluate from mild to severe wrinkles) so I am not going to insist putting Botox on those areas. If it’s your first time to do Botox, you will see full effect around two weeks and it may last up to four months. The next time you do it, you will most likely require less units especially if you combine it with skin resurfacing treatments (check out my Botox experience).
While Filler “fill wrinkles”, they actually perform better in restoring volume and plumpness, both of which are associated with “youth”. Up to 10 years younger when done correctly. And if I may add, realistically, because if you’re 65 wanting to look 25, it’s unicorn goal (it doesn’t exist) so in a very polite manner, I tell my patient “we can help you look fabulous at your age but shooting for 25 is more like fiction”. Some of the areas you can work with dermal fillers include sunken cheeks, smile lines, vertical lines around the mouth (very prominent among smokers), lips and even earlobe mind you! Anywhere you want volume, filler can definitely help. Fillers are not made equal. Each formula is different in terms of texture, depth of injection, and intensity in order to satisfy each patient’s goal. The most common of all, Hyaluronic Acid is naturally-occurring. Meaning, it’s found on our skin already, it helps with hydration and suppleness. When injected (i.e Juvederm, Restylane, Belotero, Voluma), the gel-like formula instantly lifts the area of treatment, hence it contours the face without surgery. The results last up to two years depending on the area and type of filler used. Now using my right photo as reference, you will see that my cheeks are not sunken yet, my lips still have volume, I don’t have vertical lip lines around the mouth and while I have some laugh lines, you and I know that I don’t really need fillers at the moment.
Bottomline, if you have prominent wrinkles accompanied by obvious loss of facial volume, you can benefit from both Botox and Fillers. Just don’t overdo it and be realistic. You want to keep people guessing… did you do anything to your face? oh my gosh, you haven’t aged! these are the things you want to hear deep inside. Not a fan of enhancements? not a problem, we’re all gonna get old and wrinkly no matter what. Respect for those who do it, respect for those who don’t. In light of all the negative things happening around us, just do you.
Disclaimer: The opinion stated herein comes from my experience as Aesthetic Registered Nurse as well as from a patient’s perspective as I subject myself to certain procedures. If you have serious medical concerns, please consult your doctor before doing any of these treatments. My opinion does not replace your doctor’s diagnosis and protocol.