I have heard many patients say “Can you fill up my lips with Botox’ or ‘I need a filler between my eyes to stop me from frowning’. This confusion comes from the fact that all these in-office anti-aging treatments come out of a needle. But the reality is not all that comes out of a needle is the same. While such confusion is understandable due to the relative newness and apparent similarity of these injectable treatments, that is a little like saying that one scalpel can do all the same surgeries. Injectable agents are treatments which have different mechanisms of action, even if the end result is often times similar. (facial wrinkle or fold reduction)
To clear up the confusion, I often explain to patients the difference between static wrinkles and dynamic wrinkles that appear on one’s face. Dynamic wrinkles are those wrinkles and lines that appear when your face is moving or expressing yourself such as smiling or frowning. When we were younger, the only lines and wrinkles we had were dynamic. Our face was otherwise wrinkle-free when we weren’t expressing ourselves. Static wrinkles are those facial lines that are evident even when our face is not moving. All dynamic wrinkles, with time, will eventually lead to static wrinkles. When we are older, those static lines look even worse when they become dynamic. What looks cute on a child’s face when they laugh, decades later, will someday be viewed quite differently.
These two types of wrinkles are what separates Botox and any of the injectable fillers. (e.g., Restylane, Juvaderm and eight other brands) Botox is for dynamic wrinkling. It is a muscle-paralyzing or muscle weakening agent so it will soften the wrinkles and lines that occur from a dynamic facial movement, such as between the brows with frowning….or the crow’s feet around the eyes from smiling. Injectable fillers are for static wrinkling. They soften lines and larger wrinkles by plumping them out so they look less evident at rest. In some cases, the combination of Botox and fillers are used at the same when the line or wrinkle is very deep and weakening the muscle action will help preserve the longevity of the filler material but not being ‘beaten on’ by continuouosmuscle movement. This dual combination is almost exclusively in the furrows between the eyebrows from frowning. (also known as the ’11 sign’)
One other important difference between Botox and injectable fillers is where they are used. Botox is primarily a ‘northern’ facial procedure used on the forehead and around the eyes. Injectable fillers are a ‘southern’ facial procedure, used mainly around the mouth.
Feel free to contact me and get a free copy of my book on this subject entitled ‘INJECTING YOUTH’.
Dr. Barry Eppley