It is important to understand the difference between Botox, a muscle relaxer, and Juvederm, Restylane, Collagen, etc. which are fillers.The easiest way to visualize the difference is to think of a crease as a valley between two mountains. Botox prevents the mountains from being pushed together, and fillers fill in the valley.

Botox® Cosmetic
If someone has a crease that is apparent only when frowning or squinting, Botox should be all that is necessary. Botox is most often used on the forehead, crows feet, and frown lines. It can also be used to treat neck bands. (Its most recent FDA approval is for armpit sweating and sweaty hands. For these conditions, results can last 6 months or longer.) Botox works on creases in two ways. First, it weakens the muscles that cause the creases. Second, and even more important, as the muscles get weaker, the patient gets out of the habit of creasing and using those muscles. In this way, Botox actually prevents the progression and deepening of creases:

Injectable Wrinkle Fillers
The differences between fillers has to do with thickness and longevity. In general, the thicker the filler, the better it will fill creases, but the greater the chance of possible bumps. Bumps are more likely in thinner skin such as the lower eyelids, and crows feet. Zyderm (a type of Collagen), and Restylane Fine Line are the least thick and can be used around the eyes, but they are also the shortest lasting. Juvederm Ultra Plus is one of the longer lasting hyaluronic acid fillers. It can be used for deeper creases. Juvederm Ultra Plus can last between 3 and 6 months.

Fillers can also be used to improve or enhance facial structures such as:

• Filling in acne scars
• Enhancing cheek bones to make them fuller and more defined
• Enlarging lips for a fuller, softer pout
• Correcting lip deformities or asymmetry
• Non-surgical nose-job to fill in dips and valleys in the nose bridge
• Filling in hollows under the eyes that contribute to dark circles

Other new trends include:

• Nipple enhancement
• Vaginal rejuvenation
• Injecting into the soles of the feet to make wearing high heeled shoes more comfortable

Four other fillers deserve mention:

Radiesse is considered the longest lasting filler, It is made from a similar material that bone is made from. Although it is not permanent, it can last up to one year in many cases. It is ideal for the nasolabial folds that get deeper as we get older:

Sculptra is a volumizer, and fills larger areas of the face, such as sunken cheeks. It requires more than one treatment, each about one month apart. It is also an injectable filler, but its effect is is more like a tissue expander, filling in larger areas. Imagine a balloon being blown up under the skin. It is not a balloon of course. It is made from the same material that dissolvable sutures are made, and is not permanent.

Silikon 2000 (Silicone) and Artefill (polymethyl methacrylate aka PMMA) are permanent synthetic products that the body cannot metabolize or remove. While they have unique benefits, they also have unique risks in that once injected, they are permanent, and cannot be removed.

Botox vs. Fillers
In summary, as we get older, our creases also age. They become deeper and deeper, even when we are not frowning, squinting, or using facial muscles. If creases are only apparent when we squint, only Botox is needed. If creases are visible at rest, and not made worse by squinting, then fillers are necessary. If creases are present at rest, and get worse with facial expressions, then Botox AND fillers will be necessary.

For more information, visit Dr. Kaplan’s medical website at Skindoc.Net.