With so many new ways available to resolve every issue of unwanted wrinkles and skin folds, it can be a perplexing task to understand the benefits of each product. One of the common misunderstandings surrounds the discussion of Botox vs. injectable fillers such as Restylane, Juvederm and Collagen. Understanding the differences in these products will make the job of choosing a treatment far easier. As well, your board certified cosmetic surgeon believes an informed patient is a happy patient, so be sure to schedule your initial consultation and ask all of your questions about these beauty enhancing products before making a final decision.

The main difference between Botox and the other products mentioned is that Botox is a muscle relaxer, whereas Juvederm, Restylane, Collagen, etc. are tissue fillers. Generally speaking, your cosmetic surgeon will decide whether Botox, injectable fillers or a combination of both is best for you, based on his or her observations of the wrinkles and folds of your skin:
· If creases can only be seen when squinting or frowning, Botox is all you need
· If creases can be seen when your face is at rest, you likely need fillers
· If creases can be seen when your face is at rest and your facial expressions make the creases worse, you may need a combination of Botox and injectable fillers

Botox Cosmetic
Botox is most commonly used to relax the frown muscles between your eyes. It can also be used on the forehead, crow’s feet and other frown lines that form on the face. Botox can also successfully treat ‘neck bands’, the lines that deepen around our necks as we age. Recently the FDA has approved Botox for the treatment of armpit sweating and sweaty hands.

Botox works on frown lines and skin creases by first weakening the muscles that cause them and then ‘breaking the habit’ you have developed of squinting and frowning. Muscles treated with Botox become temporarily unable to contract, so that you are unable to frown, although you may feel as if you’re frowning. Since those muscles are not contracting, no wrinkles are forming, and the ones that already exist relax and look smoother.

Injectable Fillers
Injectable fillers are sometimes called ‘a face lift in a needle’ because of the excellent results and minimal downtime. You can generally resume normal activities immediately after treatment.

There are several different types of fillers available, and each is formulated to treat various types of wrinkle and skin folds. The thicker the filler’s formula, the more successful it is in filling creases. The downside of this is that the thicker the filler, the greater is the likelihood of possible bumps, which already have a greater chance of occurring in thin-skinned areas such as the lower eyelids and crow’s feet.

· Zyderm (a Collagen product), and Restylane are the least thick. They can be successfully used around the eye area, but also offer the shortest effects. Juvederm is longer-lasting, between three and six months, and can be used for deeper creases.
· Radiesse is the longest lasting injectable that can last up to one year and is ideal for the nasolabial folds (the ‘parentheses” around our mouths) that deepen as we age.
· Sculptra is a ‘voluminizer’, able to fill larger facial areas such as hollow cheekbones. Several treatments are required.
· Silikon 2000 and Artefill are permanent soft tissue fillers. Although many patients have had excellent results, it is important to note that once injected they do not wear off and cannot be removed.

Fillers are also an ideal choice for:
· Depressions in the skin left by acne scarring
· Filling out and defining cheekbones
· Getting that soft, full pout lip
· Correct deformed or asymmetrical lips
· Correcting areas along the bridge of the nose
· Under-eye hollows / dark circles

Some of the newest uses for fillers are:
· Nipple enhancement
· Vaginal rejuvenation
· Injections into the soles of the feet to make high heeled shoes more comfortable

As we age, our skin wrinkles. Creases become deeper and the skin loses elasticity. No treatment currently on the market can stop the aging process, but your cosmetic surgeon can help you decide on the best course of treatment based on your own unique circumstances, needs and expected outcome.