Posted:
12/14/2017
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Most people, including many practitioners, don’t realize that there’s a difference between Botox® and dermal (soft tissue) fillers. Popular press doesn’t help matters, since they often use the terms interchangeably, further confusing the issue. Without understanding the distinctions between the two it’s hard, if not impossible, to figure out how these procedures might fit into your practice and why you’d want to learn both – since they’re usually taught in tandem.
If you’re in the dark about injectables, don’t feel bad – you’re in plenty of good company. In this post I’ll break down the differences and indications for both Botox® and fillers as well as compare and contrast the “product identities” of each.
Before we do that, it makes sense to have a brief discussion about the aging face. We need to agree on what the problems are - before we consider ways to solve them.
Facial lines and wrinkles are the most obvious patient concern and usually the chief complaint for those interested in facial rejuvenation. But wrinkles don’t bear total responsibility. Facial senescence is multifactorial. Most people are unaware of the impact that facial fat loss has on aging. This leads to what’s known as “volume depletion,” or in other words, the disappearance of the full and soft contours of youth. Wrinkles and fat loss can occur independently or in degrees of combination. The presenting issues of the middle-aged face are usually binary: both loss of volume and hyperdynamic wrinkles.
Now let’s talk about how to address each of these issues. To make this simple we’ll use this analogy:
Imagine you have an oxford shirt that’s severely wrinkled. The remedy for that would be to iron it, right? Very simplistically, that’s what Botox® does. It smooths wrinkles. Alternately, what if you have a shirt that doesn’t quite fit, let’s say for example, in the shoulder area? Maybe it’s a little too large and the fabric hangs slightly off the shoulder.
This is similar to what happens in the face when we lose fat. Without the support of fat, skin begins to drape the face differently, creating hollows in some areas (as in the temple, eye-rings and cheeks) and sagging in other areas (as in eye bags and jowling). Obviously, taking an iron to an ill-fitting shirt won’t resolve our problem. So, what are our options? We could do one of two things: we could have it tailored (surgery) to remove the excess fabric or we could work out at the gym and bulk up our shoulders so that they now “fill in” the area. That’s what fillers do, they restore volume to areas that have become deficient.
As I mentioned, patients are largely unaware of, or confused by the differences between these products. Conversations aimed at educating patients are relatively common. However, explaining to a patient that a concern they presented with may require dermal filler or in some cases both Botox® and filler can be tricky, since the patient may perceive this as “up-selling.” Moreover, it can be frustrating and discouraging for a patient who thought their presenting problems would be resolved in five or ten minutes (today) with a few drops of Botox®. It’s crucial for the practitioner to be able to clearly communicate, in simple terms, what Botox® and soft tissue fillers can and can’t do. Taking the time needed to explain this will keep you out of the potential mine-field of “unrealistic expectations” and the dreaded bad Yelp!
Regarding product identity, here’s a list that will help to further clarify the differences (and similarities) of these products (SEE CHART).
This explains why these two treatment modalities are usually taught together and why it’s beneficial for the practitioner to be able to offer both. In fact, in such a rapidly changing field as facial rejuvenation, you can expect more new treatments which hopefully will come to be viewed as a comprehensive tool box instead of just Botox® and/or fillers. Yes, you could use just one "tool,” but yielding an incomplete result. Imagine having a dent in your car and fixing either the dent or the associated paint damage – but not both. If you only opt for one of the two remedies your eye will be naturally drawn to the defect. If you repair both, the defect becomes invisible.
© 2017 Gigi Meinecke, RN, BSN, DMD, FAGD
Dr. Gigi Meinecke is the principal and founder of FACES (Facial Anatomy for Comprehensive Esthetic Seminars) – providing cosmetic and therapeutic injectable training to medical and dental professionals with a core focus on comprehensive facial anatomy. FACES is the only training offered in this discipline to include cadaver study with live patient injections. Dr. Meinecke maintains a private practice in Potomac, Maryland.
