Botulinum Toxin or Fillers? Expression Lines and Volume Loss

“Should I have botulinum toxin or filler for my lines?” starts with understanding what has changed in the face. Both may involve injections, but their purposes differ. Botulinum toxin temporarily reduces selected muscle activity; fillers address volume and contour in appropriate areas. [1,2]

Expression lines and volume loss

Frown lines or lines appearing around the eyes when smiling may relate to muscle movement. Botulinum toxin may be considered to reduce that movement’s effect. Not every line visible at rest will disappear completely; the intended outcome should be clear. [1]

Reduced cheek fullness or more noticeable folds may prompt a filler assessment. Yet every facial shadow does not call for an injection directly into it. Ask what change is being addressed, rather than only where a line is visible. Area and product suitability need separate assessment. [2,3]

Different purposes

Botulinum toxin does not add volume. Its aesthetic effects often last around three to four months, with variation between products and individuals. Preserving the expression you value is part of planning. [1]

Fillers include different materials and formulations; hyaluronic acid is one example. Duration depends on product and area. Another person’s product or amount is not a ready-made plan for you. Ask its name, why it was selected and the expected duration. [2,3]

Reading a trial carefully

The 2024 READY-1 trial randomised 297 adults with moderate-to-severe frown lines to a particular botulinum toxin formulation or placebo. At one month, 82.9% in the active group and 0% in the placebo group met a two-grade improvement criterion assessed by both participant and investigator. [4]

This concerns one formulation and one line type. It did not compare toxin directly with filler. It does not establish equal effects or duration across products, suitability for everyone, or availability and authorisation in Türkiye.

Must both be used?

No. Explain the concern and the degree of change you would like. One approach, staged assessment or no procedure may be recommended. If several methods are proposed, the purpose, added value and risk of each should be explained. Combination does not automatically mean a better result. [3,5]

Preparing for the consultation

• Previous procedures: dates, areas, product names if known and reactions.
• Medicines and supplements: prescriptions, painkillers, blood thinners, vitamins and herbal products. Do not stop medicines yourself.
• Health: allergies, illnesses, pregnancy or pregnancy plans, and breastfeeding.
• Expectations: describe the specific concern and the expression you want to preserve rather than simply asking to look younger.

Clarify follow-up timing and whom to contact about unexpected symptoms. [3,5]

Symptoms that matter after treatment

Bruising, tenderness and swelling can occur. Botulinum toxin may also cause temporary eyebrow or eyelid drooping. Breathing, swallowing or speaking difficulties require urgent medical help. [1]

After filler, unusual or increasing pain, whitening, grey-blue discolouration or visual changes should not be watched without assessment. A vascular complication requires immediate medical attention; seek emergency help for visual change. Rare serious risks include tissue damage and visual loss. [3]

A useful starting point is identifying the need before choosing a procedure name. You should understand the proposed area, purpose, product and follow-up before leaving the consultation.