Dermal Fillers vs Neuromodulators

Many people assume that all wrinkle treatments that come in a needle are essentially the same and can be used interchangeably. This is definitely not the case. Wrinkles develop as a result of muscles repeatedly contracting and relaxing, repetitively folding the skin. This can leave a crease at a microscopic level which then becomes deeper and more permanent, leaving the wrinkles that we all see in the mirror. Both neuromodulators (Botox, Dysport, Xeomin) and fillers (Restylane, Juvederm, Emervel etc.) are used to treat wrinkles, but they are different in many ways. When used properly by a well-trained injector they can be transformative in a Meghan Fox kind of way. When used improperly by an untrained injector they can also be transformative but in a more Dr. Frankenstein’s monster kind of way. Read on to learn more about dermal fillers vs neuromodulators and when each of them should be used.


Botox, Dysport, Xeomin and other neuromodulators are by far the most popular injectables. These work by using an incredibly dilute dose of the deadly neurotoxin that causes Botulism. Instead of paralyzing every muscle in your body like it does when it causes that disease, it weakens the muscle it is injected into which decreases that repetitive folding of the skin that causes wrinkles. A good example of this are the crow’s feet at the side of the eye. The muscle that closes the eyelid and allows you to squint is called the orbicularis oculi, and it runs around the eye as a circle. When that contracts, it folds the skin at the corner of the eyes like an accordion, which leads to the formation of crow’s feet wrinkles.

The wrinkles always go perpendicular to the fibers of the muscle, so when we put a little bit of Botox or Dysport into the muscle at the corners of the eyes, it weakens it them enough that it stops causing the wrinkles, but not so much that you can’t close your eye anymore. Similar for forehead wrinkles, the frontalis muscle that elevates the eyebrows causes the skin to fold in a horizontal way, and that’s how horizontal lines on their forehead are formed. Neuromodulators can weaken those muscles to both temporarily smooth existing wrinkles and help prevent the formation of new ones.

Dermal Fillers

Fillers, on the other hand, are used to deal with deeper folds or wrinkles. If someone has been contracting their forehead muscles for 40 or 50 years and has never had a neurotoxin treatment (which is pretty likely since they’ve only been around for 30), they develop wrinkles so deep that they can’t be corrected by weakening the muscle alone. Often, they can be improved with multiple neuromodulator treatments, allowing muscles to relax for 6-12 months. However, some people don’t want to wait that long and some wrinkles are just too deep, so this is where neuromodulators and fillers can be used together. Once Botox is used to weaken the muscles below the skin, a dermal filler is injected into the deep layer of the skin and pushes up those wrinkles from the bottom to flatten them out. When Botox and fillers are used together, it allows the filler to last longer and prevents the wrinkles from worsening over time.

Fillers can also add volume to places where it’s been lost. We have multiple fat pads in our cheeks that, as we age, fall down and inwards towards the midline of the face. Nasolabial folds are caused by tight ligaments that tether that portion of the skin to the bones below, and they get deeper with age in part because the fat pads of the cheek are just kind of falling over the top of that. A lot of injectors without surgical training who don’t truly understand the anatomy of facial aging will casually stick fillers into the nasolabial folds themselves, just like I would for forehead folds, but they don’t understand the underlying mechanism which can lead to visible “bars” of filler and double folds there when people smile. Typically, they look great in the exact position that they were injected in, but then as soon as the patient moves their face, the fact there’s a filler under there becomes painfully apparent.

I prefer to use fillers to actually reverse the changes that come with age and restore the volume that’s been lost, not simply camouflage it. For example, augmenting the cheeks with filler to produce nice, high cheekbones will also pull the skin and fat pads back “up and outwards” towards their original position, decreasing the depth of nasolabial folds in a way that looks natural. Of course, there is a point where adding filler crosses the line from restoring lost volume and becomes something along the lines of over inflating a balloon. That line is when it is time to stop using the nonsurgical options and start considering a facelift.

If you are interested in natural appearing nonsurgical facial rejuvenation, including Botox, Dysport or fillers, contact the office today to schedule your comprehensive consultation.

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