Dermal Fillers

What is the Difference Between BOTOX®, Dysport and Dermal Fillers?

While all of these are injectables, BOTOX® and Dysport are called neuromodulators that work by relaxing the muscles that create wrinkles on the skin surface when they contract. This happens when we make certain facial expressions. When you frown or squint, you’ll feel the muscles around your eyes and on your forehead engage. When injected, BOTOX® and Dysport stop the muscle contractions, limiting the formation of wrinkles.

​Dermal fillers, such as Juvederm and Restylane, have no effect on dynamic wrinkles and work in an entirely different manner. When injected, dermal fillers simply “fill” in lost volume. The most popular fillers are made from hyaluronic acid, a naturally occurring substance in the body that is responsible for hydrating and plumping the skin. When a dermal filler is injected, the hyaluronic acid binds with nearby water molecules, instantly adding volume and pushing the wrinkled skin upward, erasing the wrinkle.


BOTOX® is a neuromodulator or neurotoxin that is made from a neurotoxin produced by the bacterium Clostridium botulinum, called botulinum toxin. Three brands of Botulinum toxin are available: BOTOX®, Dysport, and Xeomin. They vary in their formulation. When injected into muscles, BOTOX® causes those muscles to temporarily relax. The wrinkles in the skin overlying those muscles are softened and improved. BOTOX® can also be used to contour eyebrows (chemical brow lift), soften crow’s feet, smooth lines around the mouth (smoker’s lines) and soften the angle of the jaw. BOTOX® also has numerous non-cosmetic applications.

Whether your wrinkles are best treated with BOTOX® or Dysport, or with dermal filler, depends on the type of wrinkle. BOTOX® and Dysport work best for “dynamic” wrinkles. Dynamic wrinkles form due to muscle movements with expressions such as frowning, showing surprise, or squinting. Over time, as our skin thins and becomes less elastic, these movements create wrinkles on the skin overlying the muscle. Most frequently these lines present themselves on the upper third of the face as crow’s feet, the 11’s between the eyebrows, and horizontal forehead lines. When BOTOX® or Dysport is injected into the muscle that creates the wrinkle, it temporarily weakens the muscle by blocking the nerve messaging to that particular muscle.

The other type of wrinkles are known as “static wrinkles.” Static wrinkles are there all the time. They form due to sun damage, declining collagen production, personal habits such as smoking, and thinning skin. Dynamic wrinkles of the forehead can become static wrinkles over time, with continued muscle movements. Otherwise, static wrinkles form in the nasolabial folds from the nose to the mouth, parentheses lines that frame the corners of the mouth, marionette lines that run from the corners of the mouth downward, and vertical lines around the lips. On the mid and lower face, static wrinkles are best treated with dermal fillers such as Juvederm and Restylane.

The effects of BOTOX® generally last three to four months. As it wears off, muscle action gradually returns. Lines and wrinkles will begin to reappear and need to be treated again. However, lines and wrinkles often appear less severe with time as the muscles become used to being inactive. Most people choose to have treatments 2-4 times per year, depending on their individual needs.

BOTOX® is a drug made from a toxin produced by the bacterium Clostridium botulinum. It’s the same toxin that causes botulism. BOTOX® and other brands of a neurotoxin are highly purified and used in minute amounts. BOTOX® has been used in medicine safely for over 30 years.

BOTOX® blocks signal from the nerves to the muscles, inhibiting the ability of the muscle to contract. This causes the wrinkles to relax and soften. It is most often used on forehead lines, crow’s feet (lines around the eye) and frown lines.

BOTOX® and Dysport can be used on crow’s feet, 11 lines between the eyebrows, horizontal forehead lines, on the chin to smooth dimpling, to slim the face by softening the masseter muscle, and on lips to soften vertical lines.


BOTOX® was the original “lunchtime” procedure because it takes just 5-15 minutes to inject. Dr. Levin injects BOTOX® and Dysport with a very tiny needle. The injection isn’t deep, so patients generally don’t need any topical numbing cream. Patients equate the feeling of BOTOX® injections to that of a small pinprick. After your session, you can go right back to work or resume your normal activities. There isn’t any recovery time, but patients are asked to keep their head elevated for 4 hours, avoid exercise for 24 hours and not rub the injection site for 24 hours, as this can make the BOTOX® or Dysport migrate to an unintended muscle.

BOTOX® has been the world’s most popular cosmetic procedure every year since it was approved by the FDA for cosmetic use in 2002. It has been injected millions of times around the world. Over that time, it has proven to be safe and effective, hence its popularity. Dysport is basically the same as BOTOX, but BOTOX has a couple of proteins added.

The main side effect is redness and slight swelling at the injection sites that usually lasts 5-10 minutes. Some patients may experience a slight headache for a couple of hours after their injections. The primary concern with BOTOX® injections is the risk of an injection or migration into the wrong muscle; this can lead to problems such as a drooping eyelid or unnatural looking eyebrows. Extensive knowledge of facial anatomy and many years of experience as an oculofacial plastic surgeon allows Dr. Braunstein to avoid those complications.

BOTOX® can be charged per area or per unit. The average cost per unit of BOTOX® is about $15. The number of units needed depends on the size and muscle mass of the area being treated. The average number of units used to treat the forehead and glabella (the “11’s”) to improve the wrinkles and contour the eyebrows, is 35-50 units.

Dermal Fillers

As we age, the natural volume of our youthful face begins to diminish as wrinkles and folds settle in. Dermal fillers instantly restore your skin’s volume and smooth away deep lines and facial creases. The most common areas treated with dermal fillers are the nasolabial folds (the crease that runs from the bottom of your nose to the corners of your mouth), the lips, and the cheeks. The results of this minimally invasive treatment are immediate with little downtime.

Dermal filler treatments are unique and tailored to each individual. Upon evaluation with Dr. Braunstein, she will determine which dermal filler is best for you to give you your desired results.

A topical numbing cream is applied, the injection is administered, and you will see immediate results.

Approximately 6-12 months.

  • Lips
  • Nasolabial folds (the crease that runs from the bottom of your nose to mouth)
  • Marionette lines
  • Smokers lines
  • Under the eyes
  • Cheeks
  • Jawline
  • Temple


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