Medical Aesthetics
Botulinum Toxin or Fillers? Expression Lines and Volume Loss
What botulinum toxin and fillers aim to change, questions to ask before treatment and symptoms that need prompt assessment.
Before choosing botulinum toxin or filler for a line, we assess what has changed in the face. Both can involve injections, but their purposes differ. Botulinum toxin temporarily reduces selected muscle activity; fillers address volume and contour in suitable areas. [1,2]
Expression lines and volume loss
Frown lines or lines appearing around the eyes when smiling may relate to muscle movement. Botulinum toxin may be considered to reduce that movement’s effect. Not every line visible at rest will disappear completely; the intended outcome should be clear. [1]
Reduced cheek fullness or more noticeable folds may lead to a filler assessment. We look at the change you want to address and whether the area and product are suitable. A visible shadow does not itself mean that filler should be injected there. [2,3]
Different purposes
Botulinum toxin does not add volume. Its aesthetic effects often last around three to four months, with variation between products and individuals. Preserving the expression you value is part of planning. [1]
Fillers contain different materials and formulations, including hyaluronic acid. Their duration depends on the product and area. Ask which product is proposed, why it was selected and how long its effect may last. Another person's product or amount cannot determine your plan. [2,3]
Reading a trial carefully
The 2024 READY-1 trial randomised 297 adults with moderate-to-severe frown lines to a particular botulinum toxin formulation or placebo. At one month, 82.9% in the active group and 0% in the placebo group met a two-grade improvement criterion assessed by both participant and investigator. [4]
This concerns one formulation and one line type. It did not compare toxin directly with filler. It does not establish equal effects or duration across products, suitability for everyone, or availability and authorisation in Türkiye.
Must both be used?
No. Explain the concern and the degree of change you would like. One approach, staged assessment or no procedure may be recommended. If several methods are proposed, the purpose, added value and risk of each should be explained. Combination does not automatically mean a better result. [3,5]
Preparing for the consultation
- Previous procedures: dates, areas, product names if known and reactions.
- Medicines and supplements: prescriptions, painkillers, blood thinners, vitamins and herbal products. Do not stop medicines yourself.
- Health: allergies, illnesses, pregnancy or pregnancy plans, and breastfeeding.
- Describe the specific change that concerns you and the expression you want to preserve.
Clarify follow-up timing and whom to contact about unexpected symptoms. [3,5]
Symptoms that matter after treatment
Bruising, tenderness and swelling can occur. Botulinum toxin may also cause temporary eyebrow or eyelid drooping. Breathing, swallowing or speaking difficulties require urgent medical help. [1]
After filler, unusual or increasing pain, whitening, grey-blue discolouration or visual changes should not be watched without assessment. A vascular complication requires immediate medical attention; seek emergency help for visual change. Rare serious risks include tissue damage and visual loss. [3]
Start with the concern you want addressed. By the end of the consultation, you should understand the proposed area, purpose, product and follow-up.
Sources and further reading
- Botulinum toxin therapy: FAQs
- Dermal Filler Do's and Don'ts for Wrinkles, Lips and More | FDA
- Dermal Fillers (Soft Tissue Fillers) | FDA
- Efficacy and Safety of RelabotulinumtoxinA, a New Ready-to-Use Liquid Formulation Botulinum Toxin: Results From the READY-1 Double-Blind, Randomized, Placebo-Controlled Phase 3 Trial in Glabellar Lines
- Botulinum toxin therapy: Preparation
