What's the Difference Between Botox and Filler?

First off, we don’t blame you for being confused about the differences between Botox vs. filler. The two terms are sometimes thrown around interchangeably in conversation. Here’s how they’re similar: They’re both injected into your skin using a needle (and preferably by a certified practitioner with extensive training). Aside from that, the two cosmetic treatments could not be more different, but we'll walk you through that all now.

Shawna Chrisman is a nurse practitioner and the CEO and founder of Destination Aesthetics, a premier med spa serving the Sacramento area. Chrisman is a certified national trainer for Allergan, and is a member of the Medical Advisory Board for Advanced MedAesthetic Partners. She received a Bachelor of Science in Nursing from California State University, Sacramento, and a Master of Science as an Acute Care Nurse Practitioner from the University of California, San Francisco.

For starters, "Botox" is actually the brand name of the drug itself (botulinum toxin). Other brands of botulinum toxin that are used in-office include Dysport and Xeomin, but Botox is the most well-known—hence, why people refer to the whole class of drug as "Botox."

Botulinum toxin works by blocking a receptor in a nerve, which prevents the muscle that’s being treated from contracting. Simply put, it relaxes the muscle that's activated when you make expressions like squinting or smiling, which can cause lines and wrinkles over time. That said, it’s most commonly used (and FDA approved) to treat forehead lines and crow’s feet.

It's also approved to combat underarm sweat and chronic migraines. There are some "off-label uses" as well, like using Botox to slim down your masseter muscles or your trapezius muscles, but you should consult a board-certified dermatologist or a practitioner who understands the anatomy of those areas before proceeding.

Some providers will charge by the area being treated; others charge by the unit, which, according to Chrisman, is more common. Botox typically comes in dosages of 50 to 100 units per vial, and the cost per unit ranges from $11 all the way up to $20. As for how many units you’ll need, the standard number of units for on-label use (frown lines, crow's feet, and forehead lines) is 64, which means your total cost could range anywhere between $700-$1,200.

Common side effects may include pain, bruising or swelling at the injection site. Less common side effects include headache, flu-like symptoms or temporary drooping of the eyelids or eyebrows until the treatment wears off. To help prevent these risks, avoid touching your face, rubbing or massaging the injected area for at least 24 hours to keep the toxin from spreading to other areas of the face; also avoid lying down or bending over for at least four hours after your appointment.

"Botox can last up to four months for most people, but it can wear off faster depending on your metabolism and other lifestyle factors like how active you are," says Chrisman.

The name itself gives you a clue on what it does—fill, in this case, lines and areas of your face that have sunken in. There are different types of fillers like hyaluronic acid fillers (common brand names include Juvéderm and Restylane) and calcium fillers (like Radiesse). And even within these collections of fillers, there are specific products that are meant for different areas of your face. For example, your injector might recommend Juvéderm Voluma XC for your cheeks, but Volbella XC for your undereye hollows or your lips, where the skin is thinner. To ensure you get the safest and most natural-looking results, it's important to go to a reputable provider, who can help determine which type(s) of filler to use, and how much, depending on the area you’re treating.

Similar to Botox, the cost of filler treatments will vary based on several factors like where you live and the credentials of your injector. Typically, fillers are priced out by the number of syringes used, which will depend on the area being treated, and each syringe can cost anywhere between $600 to $1,400 per syringe.

"The number one risk is a vascular occlusion, which is when filler goes into a vessel or artery," says Chrisman. "This can temporarily cut off blood flow or circulation in the area, so you want to watch for signs like blanching (the injected area turning white) or mottling of the skin. The good news is this can usually be reversed with an agent called hyaluronidase."

Fillers can last up between one to two years, depending on the dose (i.e., number of syringes administered) and your metabolism.

Whether you're opting for Botox or filler, you should stop taking any blood thinners, NSAIDs (i.e., Advil, Motrin, Aleve, Ibuprofen) and supplements like fish oil, ginkgo and ginseng a week before your appointment. This can reduce the risk of bleeding or bruising at the treated areas.

If you're looking to soften or smooth out any lines on your face that are dynamic (as in, they move with your facial expressions, i.e., around your eyebrows), Botox is a good choice. If the lines are deeper and more static (they’re visible when your face is relaxed) or you’re looking to add volume back to any sunken in areas of your face like the cheeks, you can ask your provider about filler.

On that note, regardless of which treatment you're considering, make sure you research your injector. Two things to look into:

• Does the injector have certification and/or proficient training? We love a good deal as much as the next person. However, this is one instance where the old adage of "if it sounds too good to be true..." should be taken seriously. Again, you want the person who is performing your treatment to be properly trained. Your best bet? Ask for personal recommendations from friends or check a site like realself.com (which is essentially Yelp for cosmetic treatments).
  
• Do you like their aesthetic? OK, now that you’ve found your certified injector, it's time to evaluate their aesthetic. Ask for before and after photos of their work to see if you're aligned. Also, during your consultation, study their face. More than likely they’ve performed (or received) similar treatments on themselves, so you can gauge how they might approach your face.

A word of advice for getting any type of cosmetic injectable: Be conservative. It’s always better to start with less than you think you need because it's easier to add a little more at a follow-up appointment than to start with too much and look overdone until the effects wear off or need to be dissolved (in the case of fillers).

And a parting tip from Chrisman: "You should have a lengthy intake, where your provider goes over every detail. What are your concerns, what's your medical history, what medications are you on, all of those things are important to note before you get treated. And then, you need to have a full face assessment because a lot of people come in with specific things they want to fix, like wrinkles between their eyebrows, but you need to consider the overall picture. For a proficient injector, the treatment itself shouldn't take very long. What should take longer is the discussion you have beforehand, so you feel secure in your decisions and know what to expect."