Six Things to Consider Before Getting Botox or Dermal Fillers
When it comes to making wrinkles disappear, Botox and dermal fillers are the next step up from creams and lotions. Both are effective, plus less costly and less traumatic to the body than surgical facelifts. Nevertheless, they come at a cost. If you’re thinking of graduating from wrinkle creams, here are some things you should know:
- Botox and Dermal Fillers Work in Very Different Ways. At first blush, these two methods of getting rid of wrinkles look similar. Both involve simple injections to the sagging, wrinkling, or blemished areas of the face. But there are significant differences in the way these two treatments work. Botox is a form of botulinum toxin derived from bacteria.1In other words, it’s a poison—the most acutely lethal toxin known. It prevents the release of the neurotransmitter acetylcholine from nerve endings, thus causing paralysis. But used in tiny enough doses to not kill the patient, and when injected into a facial muscle, it temporarily paralyzes only that particular muscle causing it to no longer contract. When the muscle stops contracting, wrinkles relax. And so, Botox (and other botulinum-derived products such as Dysport and Xeomin) only work on wrinkles caused by facial movement or expression, such as lines on the forehead, between the brows, or crow’s feet around the eyes caused by smiling or concentrating. As we’ve mentioned before, Botox is extremely popular, and in fact, 64 percent of women under the age of 35 have received botulinum toxin injections, with 7.23 million procedures performed in the US in 2017.2
Cosmetic fillers, on the other hand, are injected below the surface layer of the skin to plump it up. They temporarily add volume to wrinkled areas, smoothing them out. There are a number of different types of fillers available. One of the more common is Hyaluronic acid, a natural substance found in certain body tissues and fluids. Another popular option is Calcium hydroxylapatite, naturally occurring in bones. One more option, polylactic acid, triggers the skin to produce collagen. Bellafill, a combination of bovine collagen and polymethyl methacrylate (PMMA) microspheres, lasts up to five years.3 Unlike most other fillers, Bellafill doesn’t break down over time, so the process isn’t reversible.
- You’ll Need Repeat Procedures, Ad Infinitum Botox treatments usually last only three to four months. Fillers tend to last longer—six months to five years—depending on which type of filler you use.4 The problem is that if you don’t get a repeat treatment in time, all the benefits of previous treatments disappear, and wrinkles show up fast. It’s like stopping dying your hair and letting the gray grow in. If you’ve been a Botox girl (or boy) and then you stop, you may shock your boss or beau by aging years in a matter of days or weeks. Because of this, many who start the treatments can’t stop.
The good news is that because Botox relaxes the muscles related to wrinkle development, your face shouldn’t develop new or deeper wrinkles (in the “Botoxed area”) while Botox is being used because you aren’t working those muscles. Your face should just revert to the state it was in before you started using Botox. In other words, use it for 10 years and stop, and you’ll get back the wrinkles you had 10 years ago, but no new ones. In contrast, if you never use Botox, at the end of 10 years you’ll have new wrinkles as well as your original ones.
Likewise, with fillers, the youthful contours that you gained will disappear as the filler dissolves over time. Again, you’ll simply return to looking the age you did when you first got the filler treatment.
- Better Get Your Wallet Out. Insurance companies generally won’t pay for cosmetic procedures unless they’re being done for medical problems. In other words, your insurance might cover a Botox injection to allay your migraines, but it won’t pay to eradicate the frown lines caused by fretting over your son’s student loan debt. You’ll be paying out of pocket.
Botox costs average $550 per treatment, according to a survey of over 13,000 Botox patients.5 You may pay more or less depending on where you live, how much product you require, and whether you have the treatment done by a physician versus a nurse. The bottom line is that you’ll be paying at least $1000 a year and probably more like $1500 for your Botox habit.
The cost of dermal fillers ranges from about $680 per injection for hyaluronic acid products such as Juvederm, Restylane, or Belotero to $2000 or so for collagen. Keep in mind that multiple injections are usually needed each treatment. Given that fillers last longer than Botox, the annual costs probably are similar. It all adds up to enormous profits for the manufacturers. Botox alone netted $3.2 billion worldwide in 2017.6
- Procedures Gone Wrong. Yes, there are health risks associated with injectable fillers, but there are cosmetic risks as well. We recently visited a friend who answered the door with the right half of her mouth inflated and the left half looking like air let out of a balloon. We hadn’t even known she got Botox treatments, but the lopsided effect left no doubt.
One possible cosmetic problem is over-inflation. Too much product can puff lips or cheeks to the point of absurdity. You can also end up with the infamous Botox frozen face, surprised eyebrows, or droopy eyelids.7 And, as described above, lopsided lips or faces can and do occur. While hyaluronic acid fillers (Juvéderm, Belotero, Restylane) have an antidote called hyaluronidase that can reverse the work done, other fillers do not. Good reason to start with hyaluronic acid.
With Botox, if you have complications (droopy eyelids and stiff upper lips for example) or aren’t happy with the results, you have to wait it out until the effect of the injection wears away.
- Health Risks. While serious complications resulting from injectable fillers are rare, they do occur. The most common complaints involve swelling, nodules, and bruising. Unfortunately, though professionals are urged to report adverse events to the FDA, doing so is voluntary, so there are probably far more complications than reported.8 That said, a 10-year study out of Rutgers Medical School and Wayne State University found over 5000 reports of adverse events.9 Most common were nodules, infection, inflammation, allergic reactions, tissue death, and vascular complications. There were 62 strokes resulting from the product being inadvertently injected into a blood vessel and blocking it, as well as 47 cases of blindness, mostly the result of injections to the nose.
The products with the worst track record for complications were Juvederm Voluma XC (hyaluronic acid), Sculptra (poly-1-lactic acid), and Radiesse (calcium hydroxylapatite).
- Botox Dulls Your Ability to Empathize with Others. Botox injections have an interesting side effect not seen with facial fillers. After having a dermal filler injection, the recipient can still smile, frown, and so on. But since Botox affects underlying facial muscles, after a Botox treatment, the recipient can't move facial muscles in the normal way to express emotions. That’s a problem in and of itself, but the bigger problem is that in order to interpret the emotions others express, we need to mimic those emotions. The mimicry happens fast, and it's quite unconscious -- just a flicker. After mirroring the other person, your face sends a message to your brain. The brain matches the expression you've embodied to an associated emotion. Conversely, when you can't mimic a perceived emotion, the brain has trouble sorting out what it is. And of course, if you can't tell what other people are feeling, you can't really empathize with them. Since Botox tends to keep the face stuck in neutral, it limits the emotions recipients can identify. For some people, that’s a small price to pay for looking young. But for others, it’s a big-time deal breaker.
Bottom Line, it’s essential to realize that even if all your friends are having it done, Botox injections and facial fillers aren’t to be taken lightly. If you’re going to have a procedure, it’s essential to find someone who knows what they’re doing and who has adequate training. It will cost more to go to a plastic surgeon that to an esthetician, but you might want to consider that option, and at the least, get solid recommendations before submitting to the needle.
- 1. Berry, Jennifer. “What is the difference between Botox and dermal fillers?” 6 January 2018. Medical News Today. 12 April 2019. https://www.medicalnewstoday.com/articles/320510.php
- 2. “New Statistics Reveal the Face of Plastic Surgery.” 1 March 2018. American Society of Plastic Surgeons. 12 April 2019. https://www.plasticsurgery.org/news/press-releases/new-statistics-reveal-the-shape-of-plastic-surgery
- 3. https://www.realself.com/bellafill
- 4. Fowler, Katie. “Botox Vs. Dermal Fillers: Which is Better at Fighting Wrinkles?” 2 May 2017. Westlake Dermatology. 12 April 2019. https://www.westlakedermatology.com/blog/botox-vs-dermal-fillers/
- 5. https://www.realself.com/botox/cost
- 6. https://www.statista.com/statistics/737477/global-sales-of-allergan-s-botox/
- 7. https://www.skintour.com/fillers-botox-injectibles/botox-dysport/botox-mistakes-and-how-to-fix-them/
- 8. Howard, Jacqueline. “Cosmetic skin fillers rise in popularity, and in complications.” 21 December 2017. CNN. 13 April 2019. https://www.cnn.com/2017/12/21/health/dermal-lip-filler-injections-risks-study/index.html
- 9. Doheny, Kathleen. “Dermal Fillers: the Risks to Eliminating Wrinkles.” 22 March 2018. WebMD. 14 April 2019. https://www.webmd.com/beauty/news/20180322/dermal-fillers-the-risks-to-eliminating-wrinkles