Are Botox and Fillers Right (and Safe) for Me?

As the anti-aging market booms, understand your options.
Adult woman gets cosmetic filler botox in face

Selfies, video calls, and filters on TikTok and Instagram are boosting the popularity of Botox and dermal fillers.

The demand for Botox and fillers is rising and there is no slowdown in sight. The anti-aging market is expected to increase globally from $15.4 billion in 2023 to $25.9 billion by 2028. Botox and fillers are especially popular because they are minimally invasive and can reduce wrinkles or signs of aging with minimal recovery time.

The problem is that the increase in demand has meant that many unlicensed practitioners are now doing cosmetic procedures in cosmetic clinics or spas. Because there is no federal oversight of these facilities, rules governing them can be poorly enforced in some areas, resulting in infections (including HIV), disfigurement and even life-threatening consequences.

According to a recent study in the journal Dermatologic Surgery, cosmetic services provided at med spas found far higher complication rates than those performed in physician offices. If you are planning on seeking cosmetic surgery, make sure you do your research about who will be performing your procedures.

The Difference Between Botox and Fillers 

Botox is an injectable wrinkle muscle relaxer. It uses botulinum toxin type A to temporarily paralyze muscle and soften wrinkles on the forehead, around the eyes, eyebrows, neck, mouth and chin.

Fillers are soft, gel-like substances injected under the skin to help lift skin around the cheekbones, plump the lips and smooth lip lines.

Surprising Uses For Botox

Although these days Botox is most commonly known for its cosmetic uses, it was first developed in the 1970s as an alternative to treating eye impairments.

American ophthalmologist Dr. Alan Scott wanted to find alternatives to extensive eye surgeries. He used Botox to treat people with strabismus, or cross-eyes, and blepharospasm, which is an uncontrollable closure of the eyes. 

Today, Botox is used to treat an extensive range of ailments including neck spasms, overactive sweat glands and bladders, migraines, Bell’s palsy, twitching eyelids and amblyopia, or lazy eye.

“Botox is widely used across specialties at UVM Medical Center,” says Charles Patterson, MD, a plastic surgeon at University of Vermont Medical Center.

Botox first received FDA approval for cosmetic applications in 2002, for treatments for frown lines, forehead lines and crow’s feet (the fine lines at the outer corners of your eyes).

“Botox can provide benefits to a wide variety of people, both as prevention and treatment,” says Dr. Patterson.

What Botox Can and Cannot Do Cosmetically

Botox is typically used on people between the ages of 25 and 69. People under the age of 18 aren’t allowed to get Botox without their parent’s consent. Little is known about the long-term health effects of using Botox or starting treatments at a young age.

In 2020, about 811,000 Botox procedures were performed on people in their 30s, according to a report from the American Society of Plastic Surgeons. By starting at that age, patients are able to postpone wrinkles, says Dr. Patterson.

Deeper wrinkles that develop with age cannot be fully treated with Botox. Only milder wrinkles seen with muscle activity – when you’re smiling or squinting, for example – disappear with Botox. Existing wrinkles that are present when your facial muscles are resting don't go away, Dr. Patterson explains.

The results from Botox can take about two weeks to fully appear; immediately after Botox treatment, you may have temporary bruising, redness or swelling at the injection site, a headache, or watery or dry eyes. Botox is metabolized by the body, and over three to six months, wrinkles will slowly return.

What Fillers Can and Can't Do 

Facial fillers date back to the late 1800s, shortly after the invention of the syringe, when unfortunate chemical agents, like paraffin, were used for facial augmentation.

Today, FDA-approved injectable filler products include hyaluronic acid, polymethyl methacrylate or even a person’s body fat. Fillers can last between six months and two years, at which point the body breaks them down and absorbs them.

“Fillers can’t fix everything,” Dr. Patterson says. That’s even true for some of the more common areas people want treated such as nasolabial fold – the creases that run from the side of your nose to the corners of your mouth – and marionette lines on both sides of your lips.

“You can certainly soften those areas,” he says. “But to do away with a nasolabial fold, for example, would look unnatural.”

Where Should You Get Botox and Fillers?

You can find services for Botox and filler at hospitals, plastic surgery clinics or medical spas. 

“Not all med spas are created equal,” Dr. Patterson explains. “Some might be better places and more reliable than others, and it’s up to the consumer to figure out which is which.”

For example, in April the FDA investigated the origins of counterfeit Botox after 19 people in nine states including New York reported adverse reactions. All 19 people reported receiving injections from unlicensed or untrained individuals or in non-healthcare settings, including homes and spas.

That's why choosing a licensed facility with highly trained professionals is essential.

“The main difference between UVM Medical Center and some cosmetic spas is that, as plastic surgeons, we are able to use filler and Botox to reduce facial aging, but also perform the surgical procedures that are sometimes the best choice for our patients' concerns,” Dr. Patterson says. “The quality control alone lets you know you’re working with professionals who have years of training to do these procedures.”

Get a Consultation First

When it comes to Botox or fillers, the result you’re looking for and what you’re asking for might not produce the best results. That's where consults with a medical professional come in.

Let's say a patient wants Botox to treat lines across their forehead, but they also have extra skin or hooding around their eyelids. 

“In a case like that, I can't completely soften lines on the forehead without giving the patient a more tired eyelid look,” says Jennifer Ashline, PA, a plastic surgery physician assistant at UVM Medical Center.

Instead, she'll talk with the patient and make her case for injecting Botox around the eyes and forehead to create a brow ridge.

“You can do a couple of injections and get a bit of a lift,” she says, describing treatment to the eyes and forehead. “Patients are happier with that result than if I treated just the forehead like they asked.”

What’s Right For You?

For some people looking for cosmetic changes, there are better solutions than either Botox or fillers.

“A person who isn’t a good candidate might be someone who would benefit from plastic surgery,” Dr. Patterson says. “Fillers might not have the impact you're looking for without making someone look unnatural.”

Dr. Patterson treats patients with Botox and filler and performs plastic surgery – allowing them to navigate their options while staying with the same provider.

He says plastic surgery is used for more significant changes like a facelift, tightening sagging skin or replacing lost facial fat. Surgical options include brow lifts or eyelid surgery to correct asymmetries or sagging in specific areas that dermal fillers can’t effectively treat.

When It Comes to Botox and Fillers, All In Moderation 

Dr. Patterson advises patients against overdoing Botox or fillers. The goal is for patients to look refreshed or rested, not "done."

“I'm going for subtle changes that the patient will certainly notice, but other people might not be able to pinpoint what's exactly changed,” he says. “Maybe you just came back from vacation. Or maybe you just got a haircut.”

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