Botox vs Dermal Fillers Like Juvederm & Restylane: Complete Guide

woman wondering between botox or juvederm

Botox contains botulinum toxin and dermal fillers like Juvederm and Restylane are made of hyaluronic acid. Botulinum toxin and hyaluronic acid-based fillers are anti-aging treatments with high safety profiles and proven effectiveness. Although both can rejuvenate the face by erasing lines and wrinkles, they work differently. It’s important to remember that Botox is an effective treatment for dynamic wrinkles or those that are caused by repetitive facial expressions, making it a good preventative treatment for forehead lines and frown lines. On the other hand, dermal fillers are effective for static wrinkles or those that are present at rest. To make a better treatment plan with your practitioner, consider the mechanism of action of the 2 treatment modalities.

Botulinum Toxin and Hyaluronic acid explained

What is botulinum toxin

Botulinum toxin (BoNT) is a natural substance isolated from Clostridium bacteria, which is then purified and formulated for clinical and cosmetic use. BoNT contains ~150 kDa neurotoxin and proteins, also known as NAP (neurotoxin-associated proteins). These proteins protect the neurotoxin from degradation in the gastrointestinal tract. Each BoNT injection contains an extremely small concentration of neurotoxin and is completely safe to be injected on humans. Allergan uses type A serotype in manufacturing their Botox® brand.

What is hyaluronic acid?

Hyaluronic comes from a family of glycosaminoglycans—essential molecules that can bind water up to 1,000 times its volume. A number of studies reported that hyaluronic acid is depleted in photoaged skin. In the skin of young individuals, HA is found at the periphery of collagen and elastin fibers. The depleted amount of HA, leads to less HA connected to collagen and elastin, and less water binding within the skin. This demonstrates the role of HA in aged skin—characterized by undesirable skin changes such as decreased turgidity, altered elasticity, and wrinkling.

Mechanism of action for, Botox and dermal fillers; Juvederm and Restylane

How does Botox work for wrinkles?

Botox revitalizes the face by reducing fine lines and wrinkles caused by muscle movement. Repetitive facial expressions such as smiling, frowning, or squinting can turn temporary lines into permanent ones (static wrinkles). The neurotoxin in Botox “paralyzes” the underlying muscles by binding to the receptors of acetylcholine—a chemical that triggers the particular muscles to contract. When the nerve releases acetylcholine, it won’t be able to bind to its receptors hence the muscles will be partially paralyzed. Such event is not permanent and the body will be able to regenerate those receptors over time. By relaxing the muscles, Botox can improve or erase the appearance of wrinkles and furrows created by expressions. However, it won’t get rid of wrinkles that are already present at rest.

How do dermal fillers work?

More than 88% of soft-tissue fillers available in the market contain hyaluronic acid (HA) as an active ingredient. HA fillers revitalize the face by filling moderate to severe lines and folds. When injected deep into the dermis, the hyaluronic acid attracts large amount of water molecules, creating a plumping effect underneath the skin. It smooths out the surface of the skin and restores volume loss to make it more supple and younger looking.

How fast can you see results from either Botox or fillers like Juvederm or Restylane?

When will I see results from Botox?

For moderate to severe lines and wrinkles, the patient will begin to notice results within a few days, typically between 24–48 hours. The full effects will become apparent in about 2 weeks post-injection.

When will I see results from dermal fillers?

Patients can experience immediate results from 1 hyaluronic acid filler injection. Depending on the desired outcome of the patient and the filler used, optimum results are often seen after a month or 2 or after repeat injections.

What do they cost?

Botox cost and effects

During clinical testing for moderate to severe frown lines, the duration of effects from a Botox injection lasts for up to 4 months. The flat rate for 1 Botox treatment ranges from $300–$1,000 in the US. The cost per unit is $9–$20. An average person may need 2 to 25 units to treat lines and wrinkles, such as crow’s feet, horizontal forehead lines, and glabellar lines.


Dermal filler cost and effects

The effects from temporary facial fillers may last between 3 months to a year. Permanent fillers have a duration of longer than 2 years. According to the American Society of Plastic Surgeons, the average cost for each syringe is $687 for calcium hydroxylapatite fillers like Radiesse and $644 for hyaluronic acid fillers such as Juvederm, Restylane, and Belotero.


Are these treatments painful?

Patients may experience mild pain during a Botox injection. Some patients described a stinging or burning sensation while some only experience a slight discomfort.

The patients may expect mild pain and discomfort from regular facial filler injections. The majority of manufacturers offer dermal filler variants with added lidocaine to make the administration pain-free.

Botox and dermal fillers side effects

Botox side effects

Botox injections are generally safe and can be repeated indefinitely, but like other injectable cosmetic procedures, there are associated adverse effects from its use. Temporary drooping of the eyelids, headache, double vision, and bruising are some of the common adverse effects associated with Botox.

Dermal filler side effects

Dermal fillers are proven safe and effective when administered by trained medical professionals. Severe complications are rare and overcorrections can be reversed by administering hyaluronidase. Some common adverse effects to look out for include redness, swelling, localized tenderness or pain, bruising, and lump formation. These often go away within a couple of days or up to a week.

Comparing Botox to Dermal fillers





Active ingredient

Botulinum toxin type A

Hyaluronic acid (NASHA)

Hyaluronic acid

Ingredient source

Clostridium botulinum bacterium

Streptococcus equine bacterium

Streptococcus equine bacterium

Site of injection


Mid to deep dermis

Mid to deep dermis


Glabellar lines, frown lines, wrinkles in the forehead and around the eyes

(dynamic wrinkles)

Nasolabial folds, marionette lines, crow’s feet, and periocular lines (static wrinkles)

Nasolabial folds, marionette lines, crow’s feet, and periocular lines

(static wrinkles)


-Allergic reaction to Botox components,

-pregnant and/or breastfeeding, -muscle and nerve conditions

-taking aminoglycoside antibiotics

-Allergic reaction to bacterial proteins,             -Pregnant

and/or breastfeeding,  

-Below 18 years old

-History of skin infection

-Allergic reaction to bacterial proteins,             -Pregnant

and/or breastfeeding,  

-Below 18 years old

-History of skin infection

Adverse Effects

Dry mouth, localized pain, headache, double vision, drooping eyelids and eyebrows, decreased eyesight

Erythema, edema, transient pain or tenderness, bruising, and lump formation

Erythema, edema, transient pain or tenderness, bruising, and lump formation

Longevity of effects

Up to 4 months

9 to 12 months

3 to 6 months





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