I have many patients coming into the office confused about the use of Botox or a filler. Unfortunately, both are considered to be “injectables” but they are very different, work very differently, and are used in different areas of the face.
Botox is an injectable which is used to weaken the muscles that are causing wrinkles. It was initially used around the eyes and continues to be the main way to decrease folds around the eyes. This includes between the eyebrows, the forehead and the crows feet. Injectable fillers in these areas run the risk of migrating along the blood vessels to the eye and therefore are used less in these areas than Botox.
Fillers, on the other hand, are the mainstay of improvement in the cheek and the area around the mouth. Although Botox can be used in these areas, fillers are considered necessary to fill the cheeks or the deeper folds from the nose to the mouth and from the mouth down to the jawline.
There are many types of fillers employed. Each filler has its own advantage and preferred location. In order to obtain soft tissue and bulk, Sculptra is the filler typically injected into the cheek areas. The use of Sculptra has almost eliminated the use of cheek implants in my practice. After multiple injections, your body develops collagen which maintains its structure for over two years. It is very soft and diffuse as compared to some of the other fillers which include the colloid fillers (Restylane, Juvéderm) or microspheres (Radiesse, ArteFille). In my experience these materials tend to clump in the cheek area and are better suited for correction of the line between the nose and the mouth (nasolabial fold) or the deep area between the corners of the mouth and the jawline (marionette lines).
One of the advantages we have with FDA approval of multiple injectable materials is the ability to use each of the materials singularly or together. “Layering” is something that we do frequently to give us the advantages of each of the injectables. For example, it takes Sculptra some time to develop collagen, up to about six months. During that time, we could use one of the immediate acting injectables (Restylane, Juvéderm, Radiesse) in order to give us a result now. In this way you are able to walk out of the office with your desired result and in six months the Sculptra will be established filling the area with your own collagen. Although initially this is a little bit more expensive, it tends to last longer and give us a transitional fill effect. These are all outpatient procedures and can be done in the office with topical local anesthetic.
Thomas J. Francel, M.D., F.A.C.S.
