Understanding Botox and Fillers

Aesthetic, antiaging and facial rejuvenation treatments are gaining popularity every year. A growing demand has a positive effect on this medical field. This is especially true for non-surgical treatments, such as dermal fillers and Botox, because they are cheaper, less risky and require only a short recovery period.


Dermal fillers and Botox are the two most popular non-surgical aesthetic treatments. However, most people are not fully aware of the differences between the two. Both, Botox and dermal fillers are injected but this is the only thing they are similar in.

Botox is a toxin of a bacterial origin which is injected into the muscles in a very small dosage. Botox relaxes and paralyzes the muscle. By doing so, it minimizes the appearance of frown lines, crow’s feet, and other wrinkles caused by facial expressions. The effects of Botox’ treatments are always temporary.

On the other hand, dermal fillers are natural or synthetic substances which are injected into the skin to add fullness. They are used to treat creases, deep wrinkles, and the lack of volume. Lips, chin, and cheeks augmentation can also be achieved with dermal fillers. Depending on the type of the filler used, the results can be short-lasting, long-lasting, or permanent. 

Both types of treatments usually do not require the use of anesthetic or a hospital stay. The treatments are short and the results are visible within a few days. Side effects are rare. The most common ones include localized swelling, bruising, and redness.

Because they are different, Botox and dermal fillers treatments can be combined to achieve better results. The treatments should always be performed in an appropriate environment and by a trained medical professional. They are usually expensive and require more follow-up treatments to maintain the desired effects.  

Dermal Fillers

Dermal fillers are a group of injectable substances commonly used in cosmetic procedures to fill out creases and wrinkles in the skin. They can also be used to add definition and volume to the cheeks and lips. Dermal fillers can be permanent or temporary. This depends on the type of a filler and the material it is made from.

The following is a list of most commonly used dermal fillers:

  • Hyaluronic acid

Hyaluronic acid is the most popular dermal filler. This substance is naturally found in neural, epithelial, and connective tissues of the human body. Hyaluronic acid is an important component of cartilage and skin, and it has a major role in tissue repair.

As a dermal filler hyaluronic acid is used to treat wrinkles and add volume to different parts of the face (e.g. cheeks, lips, etc.)

The results of the hyaluronic acid cosmetic treatment usually last between several months and a year.

  • Collagen

A protein called collagen is a major component of connective tissue in humans. Collagen makes up a third of all protein in our body. It can be found in bone, tendon, cartilage, skin, and muscle tissue.

Collagen has many medical uses. Most of these are in reconstructive surgery and cosmetic treatments. Medical collagen can be human in origin but in most cases, it is derived from bovine (beef cattle).

In cosmetic procedures, purified collagen is used as a dermal filler for filling in wrinkles and facial creases. Although its effects do not last very long (up to three months), compared to other types of dermal fillers, collagen is often praised for the natural-looking aesthetic results it provides.

The use of collagen requires allergy testing prior to the treatment.  

  • Calcium Hydroxylapatite

Calcium hydroxylapatite is a mineral-like compound naturally found in human bones. However, the naturally occurring calcium hydroxylapatite is not used for cosmetic purposes. This substance can be biosynthetically produced. The use of calcium hydroxylapatite made in this way eliminates the risk of allergic reaction.

As a dermal filler, calcium hydroxylapatite is used to:

  • Enhance facial contours
    • Improve volume
    • Fill out frown lines and Nasolabial Folds

Calcium hydroxylapatite produces natural looking results with little or no side effects.     

  • Poly-L-Lactic acid (PLLA)

Poly-L-Lactic acid is a dermal filler used to add volume and create facial contours. It also possesses bio-stimulatory properties which means it stimulates the skin to produce more collagen.

The use of poly-L-lactic acid dermal fillers is appropriate in the cosmetic treatment of:

  • Lypoatrophy
    • Wrinkles
    • Hollow areas on the face

PLLA is not appropriate for lips augmentation and it is not recommended to people suffering from diabetes, blood-clotting problems, lupus, and oral herpes. Pregnant and breastfeeding women should not undergo a PLLA treatment.

The effects of the use of PLLA dermal fillers usually last up to two years. Some side effects such as redness, swelling, bruising, and the creation of lumps under the skin are also possible. These usually resolve over time.

  • Polymethylmethacrylate beads (PMMA)

Polymethylmethacrylate is a type of transparent thermoplastic. In cosmetic treatments, micro-beads made of this material are mixed with biological fluid (usually collagen) and injected, as a dermal filler, under the skin. This is done to restore the volume of the skin or reduce scars and wrinkles.

Once the PMMA micro-beads are injected the collagen is absorbed and a thin layer of connective tissue is formed around them. The growth of connective tissue increases the volume of the skin and over time (two to three months) causes the wrinkles and scars to become less noticeable.

PMMA beads have a long-lasting and sometimes permanent effect.   

Dermal fillers can be used for a variety of purposes. These include both, cosmetic and reconstructive procedures. Regardless of the purpose of their use, dermal fillers are usually expensive. They also have their limitations. The most important limitation is the longevity of the results as the effects of most dermal fillers are not permanent. Also, dermal fillers cannot stop the aging process nor can they be used to fix all aging-related issues (e.g. sagging skin).

The application of dermal fillers should only be trusted to a trained specialist. This is the way to achieve the best results and decrease the risk of complications to a minimum.

Dermal fillers are injected causing minimal trauma to the skin. Low-intensity pain can sometimes be present and the treatment usually lasts less than one hour. A specialist can use a local anesthetic to reduce the discomfort. The treatment is commonly followed by a massage to ensure the even spreading of the injected filler. No hospitalization is necessary.

Following the treatment, the treated area can become slightly swollen and sensitive for the next 24 hours. During this period it is best to avoid the exposure to sunlight as well as drinking coffee or alcohol.

Potential Side Effects

Not all dermal fillers are associated with the same side effects. In most cases, when the procedure was performed correctly, in a proper environment and with the right type of filler, the risk of complications is very low. Permanent fillers are avoided by some specialists as they are the ones usually connected with more severe complications.

However, there are some general risks associated with the use of all dermal fillers:

  • Infections – Dermal filler’s injection is a mildly invasive procedure which involves the introduction of a needle into deeper layers of the skin.
  • Swelling and Bruising
  • Itchiness
  • Dislocation of the Filler – Over time the filler can move from the treated area into an unwanted position. This can cause a lump to appear under the skin.
  • Tissue Death – This is extremely rare and it can happen in cases when a dermal filler blocks a blood vessel stopping the oxygen supply to the depending tissue. 


Botox or Botulinum toxin is a neurotoxic protein used in medicine to treat conditions such as muscle spasticity, migraines, excessive sweating, neuropathic pain, and certain allergy symptoms. Botox is naturally produced by a type of bacteria called Clostridium Botulinum. Its medical application is possible only in low doses as it is very toxic otherwise (a single gram can kill 1 million people).

This substance has found a wide application in cosmetics. Injections of botulinum toxin are used to facilitate the relaxation of facial muscles. Such use of botulinum toxin is beneficial for making the frown lines, wrinkles, and crow’s feet less visible.

Cosmetic treatment with botulinum toxin injections can temporarily improve the physical appearance and, to a certain degree, replace plastic surgery.

However, these treatments are normally expensive and they have their limitations:

  • The effects are not permanent
  • Botox’ injections do not stop the aging process
  • The results can be less than expected

It is important to understand that Botox is only helpful when muscle relaxation is needed to achieve an aesthetic result. Other facial imperfections such as saggy eyelids cannot be improved with Botox.

Today Botox is the most popular non-surgical cosmetic treatment worldwide.

How Botox Works

Muscle contraction occurs when the nerves, which are attached to muscle cells, release a neurotransmitter (chemical messenger) called acetylcholine. This chemical gets attached to the muscle cells receptors causing the muscle to contract. This is a perfectly normal activity. However, the contraction of certain muscles, such as facial muscles, can cause wrinkles to appear on the surface of the skin.

When Botox is injected into facial muscles it inhibits the release of acetylcholine. This prevents the contraction and paralyzes the muscle in a relaxed position.

Botox is mainly used in cosmetic procedures but its application is constantly expanding beyond aesthetic medicine.

The following is a list of medical conditions currently treated with botulinum toxin injections:

  • A chronic migraine
  • Excessive sweating (Hyperhidrosis)
  • Spasm of the eyelids (Blepharospasm)
  • Strabismus (Crossed eyes)
  • Severe neck spasms
  • Urinary incontinence caused by detrusor overactivity
  • Post-stroke upper limb spasticity

Commercially, botulinum toxin is available under the names:

  • Botox
  • Dysport
  • Vistabel
  • Bocouture
  • Xeomin
  • Myobloc

It is normally available in a powder form which is mixed with saline solution and injected into the neuromuscular tissue. The effects start after one to three days and they can be fully visible after one or two weeks. They usually last for three to six months.     

Side Effects           

Usually, there are no side effects following the treatment with botulinum toxin. When the substance is properly injected by a trained professional it is, in most cases, well tolerated. One in every hundred patients will develop antibodies which will make future treatments ineffective.

In rare cases when side effects are present they can include:

  • Pain
  • Swelling
  • Redness
  • A headache
  • Nausea
  • Numbness
  • Unwanted paralysis of nearby muscles
  • Dysphagia – problems with swallowing
  • Temporary eyebrow and upper eyelid weakness
  • Decreased eyesight
  • Blurred vision
  • Double vision
  • Bleeding
  • Gallbladder dysfunction
  • Full legs symptoms

To avoid potential complications botulinum toxin should be injected by a qualified healthcare professional (Doctor, Dentist, or a Trained Nurse) and in a clean and safe environment.

Botulinum toxin treatments are not recommended for pregnant or breastfeeding women. 

The Final Word

Dermal fillers and Botox injections are a safe and minimally-invasive way to achieve limited aesthetic results. For this reason, the approach to their use should be realistic and their application in other, non-cosmetic, medical treatments should also not be underestimated.

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