21 Sep 2023 | by Leonard Miller, MD, FACS, FRCS

Neurotoxins and dermal fillers are not the same thing.

As a Board-Certified dermatologist, a huge part of my practice is devoted to injectables. This is a broad term for any procedure that is administered through a very fine needle such as Botox® and fillers. Unfortunately, as these two have gained in popularity, people have become even more confused about what can and cannot be achieved with dermal fillers. I find that many of my patients don’t really understand the difference between a neurotoxin such as Botox® or Dysport®, and a filler such as Juvéderm or Restylane®. Or they think that a filler can lift loose skin. So, here is a filler 101 guide to what you can and can not expect from your filler procedure.

Botox® and Fillers Are Not the Same Thing

To begin, neurotoxins and dermal fillers are not the same thing. Many patients are not aware of this as the two treatments are often performed in conjunction with one another as part of a non-surgical facial rejuvenation procedure. While both can address fine lines and wrinkles, they work on different mechanisms. A neurotoxin like Botox® or Dysport® relaxes the underlying dynamic muscles in the treatment area. This, then, causes the surface skin to relax and appear more smooth. It is ideal for the:

  • 11 lines between the eyebrows
  • Crow’s feet
  • Forehead wrinkles

These are the common areas on the face where the muscles move the most. Fillers, on the other hand, literally fill in areas of lost volume.

Different Types of Fillers

One of the things to understand about dermal fillers is that there are different types based on their active ingredients as well as their level of viscosity or thickness. The 3 filler types that I use in my practice are:

  • Hyaluronic acid (HA) based fillers like Juvéderm & Restylane
  • Poly-L-lactic acid fillers like Sculptra
  • Calcium hydroxyapatite fillers like Radiesse

HA fillers are the most common, and since hyaluronic acid is a naturally occurring substance in the body, these fillers are highly tolerated. They work by attracting water, and come in a number of different thicknesses depending on the viscosity of the HA molecule. The heavier the molecule, the longer-lasting the result. They are also dissolvable. Sculptra and Radiesse work a little differently. They are both biostimulatory fillers, causing your body to produce more collagen.

Matching Right Filler to Your Unique Issue

Since there is such a wide range of filler options, the important thing is matching the right one to your unique anatomy and needs. Social media can be extremely helpful in my work as it allows patients to quickly and easily find photos of the “look” that they are hoping to achieve with any given procedure. The downside of social media, however, is that it often promotes a “one size fits all” mentality that is simply not true when it comes to facial rejuvenation. Just because Juvéderm Voluma® improved the appearance of your favorite influencer’s lower face does not mean that this is the right choice for you.

This is one of the many reasons why I am so adamant about patients seeing a Board-Certified dermatologist or plastic surgeon. Sadly, an injectable treatment can be performed by anyone with a medical degree. But this does not mean that your dentist or gynecologist has the experience, training and artistic eye to deliver a safe, great looking result.

Best Treatment Areas for Fillers

One of the many benefits of dermal fillers is that they are extremely versatile. As discussed, fillers can be an ideal option for improving the appearance of fine lines and wrinkles. Properly placed filler can also:

  • Rejuvenate the eyes
  • Create more definition at the jawline
  • Smooth out veins on back of your hands
  • Lift the corners of your mouth
  • Plump up your earlobes

The eyes and surrounding structures are the focal point of the face so refreshing this area can have a profound effect on your overall look and well-being. Properly placed filler in the hollows of your temples can help erase that skeletal look that occurs with time and bone loss, and improve the appearance of fines lines at the outer corners of your eyes. Fillers in the brow bone can deliver a non-surgical brow lift like result in the right patient, and fillers under the eyes may improve the appearance of dark circles.

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Goal is You, Only Better

Though properly placed filler in the mid-face/cheek area, for example, may improve the appearance of mild “jowling” or folds of skin in the lower face, fillers fill. They don’t lift severely droopy skin. We have all seen photos of people who have tried to fill in sagging tissue. The end result is that they just look weird, like they’ve sucked up too much water from the garden hose. My goal with any procedure is for you to look like you, just that version of you after 10 hours of sleep, a relaxing vacation and a visit from your favorite masseuse.

To find out more about dermal fillers at the Boston Center for Plastic Surgery, contact us today or call (617) 735- 8735 to schedule a consultation.

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