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    Botox and Fillers - Better Together

    By Debra Jaliman, MD

    Every day people come into my office for a consultation on whether they need Botox or injectable fillers to look younger. The first thing I do is to carefully observe the new patient’s face to see how it moves and how it looks in repose. Then we have a conversation that sounds like this:

    Doctor: For optimal results, you’ll need both Botox and a filler injected into your lines and creases.

    Patient: Why do I need both? I thought a shot of Botox would do the trick.

    Doctor: The Botox will paralyze the muscle so it doesn’t move, but you will still have lines at rest and creases. So if you want a smooth forehead, you will need to get both.

    Patient: Well, what about my frown lines? Can I just get fillers for those?

    Doctor: Certainly, but you should be aware that if you don’t get Botox shots along with it, the filler will not last long.

    This is when I start citing recent studies that show that a combination treatment of Botox and fillers works better than either treatment alone. Botox and fillers such as Restylane, Perlane, Prevelle, Juvederm and Radiesse perform differently. Botox paralyzes the underlying facial muscle, while fillers plump the skin and smooth out fine lines and wrinkles. Young people with only superficial lines may just need mainly Botox.  But Botox is not going to make deep forehead furrows or marionette lines (the vertical creases that run from mouth to chin) disappear – for that, people need fillers.

    The problem with fillers is that sooner or later they break down and are absorbed by the body. The more animated and active the face, the faster the filler will break down.  Prevelle, one of the lighter fillers, lasts about four months, while Perlane and Juvederm Ultra Plus last about eight months to a year. However, the duration of any filler will significantly increase if Botox shots are given first in the same sitting.  For the forehead, for  example, I inject Botox into the lines, followed immediately by fillers.  Instead of the usual five to six months with a smooth forehead if a filler alone is used, the combination treatment will last nine to ten months. And the forehead will look a whole lot better during that time, because the etched-in lines will be smoothed away.

    Botox and fillers can even be used around the mouth, which is where fillers break down fastest. Think about it: your mouth is in constant movement every waking moment, and the more movement there is, the faster the filler will break down. Botox should never be injected into the smile lines, but diluted Botox shots can be used successfully with fillers on the lips and the corners of the mouth on most people. There are exceptions, though: people who need extremely mobile lips for their professions, such as singers or horn players, should never get Botox near their mouths, although they can have fillers.

    Using this combination approach can really take years off your face. It’s a simple and quick procedure that usually takes about twenty minutes. My personal opinion is that while a combination treatment may be more expensive, it is worth the money because the results are better and last longer.


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