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David E. Berman, MD
Botox Versus Fillers
Berman Cosmetic Surgery and Skin Care Center
. http://www.bermancosmeticsurgery.com/

Botox Versus Fillers

One of the most frequent questions, I am asked as a cosmetic board certified plastic surgeon, is how I do decide between Botox and fillers?
Fillers and Botox are not competitive but rather serve quite different purposes and are complimentary. Botox is botulism neurotoxin and prevents the motor nerves from contracting in the very local area that they are injected. Thus it is most commonly used to decrease the vertical lines (note I use the word, “decrease” and not “eliminate”) in the glabellar area (between the eyebrows), the crows feet (the lines that increase lateral to your eyes when you smile) and the forehead.
Botox does not work instantly, but rather takes four to ten days to work. If used properly, it has a very natural look and should not look like the zombie face popularized by the over-zealous use of Hollywood stars. It does not affect the sensory nerves and should not alter sensation. Botox typically lasts about four months and many special activities need not be avoided after a Botox injection.
Fillers do exactly what they say, namely fill the creases in the skin. The most common use for fillers is decreasing the depth of the nasolabial line (between your nose and the corner of your mouth), decreasing the depth of any line in your face (such as in the glabellar region), filling in the pre-jowl area so that early jowls are much less noticeable and augmenting the lips. They work immediately upon being injected.
There are a myriad of fillers and there are new ones constantly being developed. Probably the best way to classify them is in one of three categories
1) Hyaluronic acid a natural substance which is found in our joint fluid and is produced in a laboratory. The best known of this type are Restylane and Juvederm. These last about six to ten months or longer in most patients. However, when they are injected into the lips, they last a shorter period of time, about three to four months, on average.
2) Calcium hydroxyapetite- another natural substance found in the body. Clinically this is marketed as Radiesse and this product lasts over a year in most cases. It is a little thicker but also a longer lasting product than Restylane and Juvederm. It is used fornasolabial folds which are deeper and also for injecting the pre-jowl area.
3) Arefill-. this is the only FDA approved permanent filler. It is
the only product that requires a skin test (and this has to be performed at least one month prior to a treatment session). Since it is permanent, it is
especially important that your physician be well experienced in using this product.
Regardless of the skill and care of the surgeon, a bruise will occasionally result since a needle is puncturing the skin. If you are taking aspirin there is a greater chance of bruising.

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