Quick answer
Botox and filler do different jobs. Botox relaxes a muscle, so it is matched to lines that show when the face moves. Filler replaces volume or support, so it is matched to hollows and folds that show at rest. When a face has both, a plan uses both.
- Botox (botulinum toxin): forehead lines, frown lines and crow's feet. In two trials, 52.3% and 49.5% of treated people met a strict frown line standard at day 30, against none on placebo.
- Filler (hyaluronic acid): hollows and folds, such as the cheek, the tear trough and smile lines.
- Onset: the toxin effect was evident after 4 to 5 days. Duration: up to 150 days in one trial; 15 to 24 months for one cheek filler.
- Risks: toxin can droop an eyelid or brow; filler can swell, lump, and rarely block a vessel.
What does Botox do, and what does filler do?
Botox is a brand of onabotulinumtoxinA, one of several botulinum toxin type A products. It relaxes the muscle that folds the skin into a line, so the line softens when you frown, raise your brows or squint. How anti-wrinkle injections work explains the muscle side, and the brands (Botox, Xeomin, Dysport and others) are set out in the brands explained.
Filler is a gel, usually hyaluronic acid, placed under the skin to replace volume or give support. A review of facial ageing describes the changes as volume loss and descent, loss of elasticity, dynamic lines from muscle action, and static wrinkles. Toxin is matched to dynamic lines, and filler to volume loss. Skin quality is a separate question, and skinbooster or filler separates it from volume.
Botox or filler: which one for which concern?
The table lists the tool the evidence supports for each concern, not a product recommendation.
| Concern | What is happening | Usual tool | What the trials report |
|---|---|---|---|
| Forehead lines | The forehead muscle lifting the brows | Toxin | 57.7% to 66.5% strict responders at day 30 |
| Frown lines (the "11") | Muscles drawing the brows together | Toxin | 49.5% to 52.3% strict responders at day 30 |
| Crow's feet | The muscle circling the eye | Toxin | 32.4% to 51.7% strict responders at day 30 |
| Flat or hollow cheeks | Lost volume and support | Filler | Correction lasted 15 to 24 months in one trial |
| Tear trough hollow | A groove from lost support | Filler, after examination | Higher risk zone; see tear trough filler |
| Smile lines, marionette lines | Folds from lost support | Filler | See the line by line guide |
| Fine surface lines | Thin or sun-aged skin | Skin quality treatments, not either alone | Small trials only |
Each line is taken in turn in forehead, frown, crow's feet, smile and marionette lines.
How fast does each work, and how long does each last?
Toxin takes days and lasts months, and filler is followed in trials for months to two years. In two phase III trials of incobotulinumtoxinA (Xeomin) for upper face lines, the effect was evident after 4 to 5 days, day 30 was the formal measurement, and the effect was seen up to 150 days in people who did not need re-injection. An older trial of onabotulinumtoxinA found the effect maintained for many people through day 120. The ULTRA trials were funded by Merz Aesthetics; the abstract of the older trial does not state its funder.
For filler, one trial of 235 people found that about 2.0 mL of one hyaluronic acid filler gave correction for 15 to 24 months depending on the part of the cheek. These are different products measured in different ways, so they are not a ranking. How long anti-wrinkle injections last and how long filler lasts take each in full.
What are the risks of Botox and of filler?
The two have different risks. For toxin, the 120-day glabellar trial reported mostly mild eyelid drooping in 5.4% of the toxin group. In the ULTRA II trial, injection site haematoma was 8.8% with the toxin and 8.5% with placebo, which points to the injection rather than the product. Anti-wrinkle injection side effects sets out headache, bruising and brow or eyelid droop.
For filler, the usual effects are swelling, tenderness, bruising and lumps, and the rare serious one is a blocked blood vessel. Hyaluronic acid filler can be dissolved with hyaluronidase: low or moderate doses for the bluish Tyndall effect and non-inflamed lumps, immediate high-dose treatment for vascular occlusion. Dermal filler risks lists the warning signs.
When do you need both Botox and filler?
You need both when a face has movement lines and lost volume at the same time. A review of upper face rejuvenation describes toxin and filler as each treating specific concerns but often combined, within a plan made for the individual.
In a study at four sites in adults aged 35 to 50, repeated combined treatment with a toxin, hyaluronic acid filler and a skinbooster gave a better aesthetic outcome and higher satisfaction than toxin or filler alone, and even modest filler volumes gave good outcomes. The abstract does not state who funded it. One practical link: the frown muscles pull the brows down and the forehead muscle lifts them, so a doctor plans those toxin areas together.
What should I ask before choosing Botox or filler?
Ask what the doctor sees as the cause: movement, lost volume, or both. A line that shows only when you frown is a movement question, and a fold or hollow that shows at rest is a volume question. Ask which product is being used and whether it is registered; how to check the product explains the register, and toxin units cannot be swapped from one brand to another.
Ask who injects, how a droopy eyelid or brow would be handled, and what happens if a filler affects a blood vessel. These are normal questions before any injection.
Who performs Botox and filler at The Retreat Clinic in Setia Alam?
The Retreat Clinic offers anti-wrinkle injections and dermal fillers, and Dr Ong performs the injections himself, after looking at the face at rest and in expression. The clinic pages set out each treatment: anti-wrinkle injections and dermal fillers.
