Many people are confused about which wrinkles are best treated with Botox and which with dermal fillers. Let’s start by explaining the clear difference between the two products. When Botox is injected it has a medicinal effect on the muscles that are targeted. It relaxes those muscles for three to four months. Dermal fillers are products injected into the skin to occupy space. They have no medicinal effect, only a physical effect. They lift wrinkles and folds by occupying the space beneath them.
Wrinkles that come from decades of muscles folding the skin are well treated with botox. The muscles between the eyebrows allow us to make those faces some of us have been making forever. Ultimately, all that folding makes a permanent crease. These muscles are perfect targets for botox. A few units of the medicine injected there works in about 10 days to relax the muscles causing the crease. In a few more weeks the creases are gone. There are several other places where botox works well, including the whole forehead, the crow’s feet and to some extent the vertical creases above the upper lip.
The folds that are due mainly to gravity draping the looser skin of middle age are the ones we soften with filling agents. These folds are mainly the naso-labial folds (also called the parenthesis lines), and the marionette lines that go from the corners of the mouth down to the jaw line. There is one other application of the fillers that I love. As we age the corners of the mouth turn down giving people a “look of disapproval” even at rest (even while thinking happy thoughts!). A little filler can pop those corners right up and give the client a much more pleasant visage. It looks like there’s a little Mona Lisa thing going on.
Sometimes, the best choice between botox and fillers is both. Many faces have muscle and gravity induced lines and folds. Sometimes a single fold comes from both sources. Those little vertical creases above the lips are a great place to use just a smidge of botox and a soft filler like Cosmoplast. As you can see, these kinds of choices bring the science of “injectables” up to an art.