Botox or dermal fillers: which is better for me?

As we age, the skin on our faces loses its full and firm appearance. Thankfully, there are various cosmetic procedures that can help us to retain a youthful look. The problem is choosing the best option for you. In this article, leading dermatologist Dr Harryono Judodihardjo, who sees patients in London and Cardiff, compares Botox and dermal fillers. Looking at both procedures, he explains what they treat, how the most suitable procedure is chosen, and what risks need to be considered beforehand. 

What is the difference between Botox and dermal fillers? 

Botox and dermal fillers are very different products that have different functions and purposes. Botox, also called botulinum toxin, has a trace amount of protein that can be used to relax muscles that are not needed for expression. For example, if you frown, strong lines commonly known as the ‘11’ lines appear and these can be relaxed with Botox. Similarly, when we smile, it can cause smile lines on the side of the eyes which can also be minimised. Botox can also be used to reduce sweating, in the palms or parts of the face, for instance. 

Dermal fillers are different. As the name suggests, fillers are used to create volume. Patients with an asymmetrical face, with one side fuller than the other, can benefit from a more balanced look achieved by dermal fillers. As people age or if they have lost fat from dieting, collagen can be lost. Collage is an important protein in connective tissue and without it, the face will drop, losing volume. Fillers can then be used strategically to lift the face. It is a procedure that needs to be done carefully as there needs to be good knowledge of anatomy and aesthetics to get the best results. 

What are the main reasons for undergoing Botox?

The main reason why Botox is used is to reduce unwanted movement in the face. It can also be used, as I mentioned, to reduce sweating. There are, however, other uses of botulinum toxin. It can be used to treat the eyes, specifically, a squint where the eye doesn’t appear straight, it goes to one side, because the muscle is too strong. Botox can balance the movement by relaxing the dominant muscle. It can also be used to correct scars.

How will I know if I should undergo Botox or dermal fillers?

Usually, the doctor will decide whether Botox or dermal fillers are more suitable. During the first consultation, the doctor will listen to the problem you want to fix, perform an examination, take a medical history, and based on this, the doctor will recommend the best procedure for you. Sometimes, a combination of the two can be used, one at a time. 

In terms of results, what can I expect from Botox or dermal fillers?

Botox relaxes the muscles; it can’t lift them. Patients often request ‘lifting’ an issue area with Botox, but this isn’t possible. Certain parts of the face, notably the eyebrows, have two opposing muscles, so in this instant, Botox can be used to lift an opposing muscle, if it is stronger than the other one to balance them out. 

If you are treating excessive sweating, it can improve low self-esteem as it can be quite embarrassing if the sweat from your armpits, for example, is visible on clothing. Botox can also be used to relax the jaw if the muscle is too strong and is causing pain or teeth grinding at night. 

Fillers, on the other hand, create volume. If the temples are sunken, for example, they can be brought up. As we get older, we don’t only lose our collagen or fat, but our bones decrease in volume too. Sometimes fillers will be needed on the bones, therefore, to lift up the skin. 

Are these procedures safe? What are the associated risks?

Botox and dermal fillers are both minimally invasive treatments, that require injections so they can create problems if it's not done properly. Whenever you inject someone, it can cause inflammation and/or swelling, which should be expected. If the injections are put into a blood vessel, it can cause bruising. Smaller needles are used for Botox so the chance of bruising and inflammation is reduced, but still present. 

Both Botox and fillers are foreign bodies, which can potentially cause an allergic reaction. The chance of this happening with Botox is very rare, almost unheard of because the amount used is so small. With fillers, you can get an allergic reaction to either the chemical, hyaluronic acid, or some of the preservatives used in the product.

If fillers are injected into the blood vessels, this can actually block them. Blood will then not be able to flow to the areas where it should, which may result in the oxygen-starved areas dying. In the most serious cases, if the blood supply to the eyes is blocked, then patients can go permanently blind. 

Due to these risks, it is very important that you consider the procedure beforehand and choose the correct doctor, one who is experienced with a great knowledge of anatomy, and an eye for aesthetics as well so that the best results are achieved. 

Dr Harryono Judodihardjo is an experienced consultant dermatologist specialising in cosmetic and aesthetic dermatology, who sees patients in London and Cardiff. If you would like to book a consultation, visit his Top Doctors profile.