Filler? Botox? Which one and Where?
by Beth Comeau, M.D.
Okay, let’s lose some of the confusion about what product or service you need to help with your particular circumstance. Often patients want to improve their appearance, soften their nasolabial folds (parenthesis from the nose to the lip), enhance their lips, lose a wrinkle or 2, or 3 or 4; anyway, you got the idea; and patients see ads for various facial aesthetic procedures, but don’t know what to schedule the appointment for. No need to fret…many physicians performing aesthetic procedures will understand that the patient might not be familiar with what exactly they need to achieve a more youthful appearance. Consultations are performed for exactly that purpose, but for the reader’s of ‘Women’s Journal’ you can be the savvy consumer!
What are They
Let’s first talk a little bit about what is the difference between Botox vs. filler. Botox is simply a protein that when injected into the muscle relaxes that muscle and thus prevents the skin from repetitively folding onto itself making a wrinkle. Initially, we develop ‘dynamic’ wrinkles, or wrinkles that appear only when the face is moving in a particular way; these eventually become ‘static wrinkles’, or wrinkles that are present even at rest. Filler is an actual voluminous substance that is injected into the dermal layer of the skin or even deeper to fill certain lines and wrinkles or to add volume to the face.
What area of the face
Depending on what it is you would like to improve, this will dictate which product your doctor will choose to use. If the problem is due to constant muscle contraction, then Botox is your product of choice. If there is loss of volume due to loss of subcutaneous fat, collagen, elastin, and in some cases even bone, then filler is what you need. Keep in mind that there are some areas that are not appropriate to inject Botox or certain fillers. Your aesthetic medicine physician will be aware of the appropriate uses for the various products. Often times we are able to use a combination of Botox and filler to achieve what we call a “liquid face lift.” See below common areas where patients frequently like non-surgical facial rejuvenation.
· Glabella - This area is sometimes referred to as the ‘elevens’ or ‘frown lines.’ These wrinkles are secondary to us making a face while concentrating, becoming angry, sad or squinting. This area is typically injected with Botox. Once the Botox has taken full effect, usually 2 to 3 weeks, the area may be reevaluated and if the wrinkle(s) is still present and bothersome, filler may be used.
· Forehead lines- These lines are present because of the constant contraction of the muscles that lift our eye brows. Thus, Botox is the appropriate choice. The forehead muscles are an important elevator of our face, so if a patient wants to soften these lines I usually recommend what I call “spritzing” with Botox. By just focusing on a few areas and keeping the doses relatively low, you can achieve a much softer look and still maintain plenty of expression. If the patient wears bangs and is okay with having a few lines in the forehead, I often will discourage patients from injecting that area.
· Crow’s Feet- The lines around the eyes. Botox is the answer. If not completely softened after Botox, filler can be used.
· Brow Lift- Here Botox is your quick fix, but if the patient wants to avoid surgery, there are techniques using a very tiny needle to apply an underlying structure to the skin just under the eyebrow that can lift the sagging brow.
· Cheek Augmentation- This is usually a problem due to loss of volume in that area and filler will be the corrector of choice.
· Nasolabial Folds- This area is corrected with filler. It can also be corrected by adding more volume to your cheek bones with a cheekbone augmentation. This directs the skin upward and thus in many cases corrects or substantially softens the appearance of the nasolabial folds.
· Submalar Area- This is the area below your cheek bone that can make a person look tired or ‘drawn’ if there is loss of volume, so again, filler is placed in this area for correction.
· Lips- Here the answer is usually filler, but there are some advanced techniques of injecting Botox to soften vertical lip lines that some women have. This is not to be done for anyone who regularly plays a wind instrument or is an avid singer because those individuals need that ability to forcefully pucker their lips.
· Oral Commissures- This is the area located at the corner of the lip that can be tilted up or lifted by either filler or Botox.
· Marionette Lines- These are the lines we develop because of both a loss of volume and constant contraction of muscles. Filler is often injected into this area to replace lost volume. Certain advanced Botox techniques can be used to soften these lines and prevent wrinkles in this area. Jowls can be corrected with an ‘Injectable Thread Lift ™.’ This has provided great success in those patients who want to avoid surgery, but need to literally pull back the skin that has fallen forward.
· Chin Augmentation- Filler may be added easily in the chin area to give it more volume or for reshaping, but Botox can be very effective in softening those little dimples we develop in our chin over time called “Peau D’ Orange.” When Botox is injected here, it can significantly soften the appearance of that dimpling.
As you can see, non-surgical facial rejuvenation is just as much an art as it is a science. Be sure that the physician or physician extender that you go to for these services is well trained in the art of aesthetic medicine.
BIO
Dr. Comeau received her medical degree from The University of Maryland School of Medicine and is a board certified physician. She trained at the Aesthetic Advancements Institute in Facial Aesthetics and the use of Botox Cosmetic and Dermal Fillers. Her pursuit of quality care not only involves the aesthetic services she administers, but also the establishment of a doctor-patient relationship which encompasses integrity, compassion and continuity. Your can reach Dr. Comeau at 410-495-0505.
