Botox vs Dermal Fillers: Costs, Effectiveness and Duration

Both Botox and dermal fillers like Restylane and Juvederm are great for treating wrinkles. When comparing Botox vs Juvederm or Botox vs Restylane, it is important to keep in mind they work in different ways. Botox is better for preventing wrinkles and to treat dynamic wrinkles, while Juvederm and Restylane are great for treating static wrinkles by filling and restoring skin volume. In this article, we will review various aspects comparing treatment with Botox and the two top dermal fillers Restylane and Juvederm. If you are not that familiar with botulinum toxins and hyaluronic acid fillers, go to the bottom of this article for a short introduction and come back up for details on this interesting comparison.

How does Botox work?

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 Juvederm and Restylane 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.

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 Restylane and Juvederm?

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.

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.

Juvederm and Restylane average 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 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.

Juvederm and Restylane 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

	Botox	Restylane	Juvederm
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	Intramuscular	Mid to deep dermis	Mid to deep dermis
Indications	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)
Precautions	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
Cost	$300–$1,000	$300–$800	$550–$1,200

Conclusion

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: Short explanations

What are botulinum toxins?

Botulinum toxin is a natural substance isolated from Clostridium bacteria, which is then purified and formulated for clinical and cosmetic use. Botulinum Toxin 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 Botulinum Toxin 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.