Dermal Fillers vs Neuromodulators

Many people think any treatment that comes in a needle will work for their wrinkles and that they are all essentially the same. This is not the case. Wrinkles come as a result of muscles repeatedly contracting and folding the skin, leaving a crease at a microscopic level. Neuromodulators (Botox, Dysport, Xeomin) and fillers (Restylane, Juvederm, Emervel etc.) are used in the facial area, but they are different in many ways. When used properly by a well-trained injector they can be transformative. In the wrong hands, they are also transformative but in a more Dr. Frankenstein kind of way. Read on to learn more about dermal fillers vs neuromodulators.


Botox, one of the most popular injectables, is a neuromodulator that weakens contracting muscles. An example that Dr. Plant uses to explain this to patients concerns 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,” Dr. Plant said. “So when we put a little bit of Botox or Dysport into the muscle at the corners of the eyes, it weakens it there 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 and temporarily smooth these wrinkles.

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 treatment, they may have wrinkles so deep that it 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, so Botox 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 prevent 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,” Dr. Plant explained. “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 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 move their face, the fact there’s a filler under there becomes painfully apparent.”

Dr. Plant prefers 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, a heart-shaped face associated with youth, will also pull the skin and fat pads back up and outwards to decrease the depth of nasolabial folds in a way that looks natural.

Overall, Botox and fillers are great when used separate or together, as long as they are injected by someone who truly understands what they are doing.

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