Hyaluronic Acid or Botox? How to Choose the Right Treatment for Wrinkles and Facial Rejuvenation

The popular name “Botox” is frequently used for botulinum toxin treatments, although Botox is a brand name. In aesthetic practice, authorised botulinum toxin type A products are used and must be administered according to the characteristics and indications of each product.

What types of wrinkles does it treat?

Botulinum toxin temporarily inhibits the release of acetylcholine at the neuromuscular junction, reducing contraction of the injected muscles. It can therefore diminish wrinkles that appear or become more pronounced during facial movements.

Common aesthetic indications include:

• Glabellar lines between the eyebrows. • Horizontal forehead lines. • Periocular lines, known as “crow’s feet.”

Its effect on static wrinkles, which are also visible at rest, may be more limited, particularly when they are deep or associated with structural changes in the skin.

When do the results appear, and how long do they last?

The effect generally begins within the first few days after injection, and the result develops progressively. When treating facial wrinkles, the effect often lasts approximately 3–4 months, with variations depending on the product, dose, treated area, and individual characteristics.

Treatment goals are agreed upon with the doctor. Some patients want a “frozen face” appearance, with movement eliminated completely. Other patients want to retain a natural appearance, preserving a certain degree of muscle movement and expressiveness without completely immobilising the face.

What are the risks?

Adverse reactions may include local pain, erythema, bruising, and headache. In some situations, eyelid or eyebrow ptosis may occur, usually temporarily. Serious systemic events are very rare, but symptoms such as difficulty swallowing, speaking, or breathing require emergency medical assessment.

Dermal fillers are injectable products designed to alter tissue volume or contour. Hyaluronic acid is one of the materials commonly used, but fillers with other compositions also exist and have different properties and risk profiles.

What can a filler correct?

Depending on the product, the area being treated, and the medical assessment, filler may be used for:

• Increasing lip volume and defining the lip contour. • Correcting certain facial folds and depressions. • Selectively restoring volume in the cheekbone, temple, or chin area, or in other suitable facial areas. • Correcting certain asymmetries and improving particular facial proportions.

However, filler is not a universal solution for all signs of ageing. For example, significant skin laxity, uneven texture, or wrinkles caused predominantly by muscle contraction may require other approaches.

When do the results appear, and how long do they last?

The volumetric result is generally visible immediately, but post-procedure swelling may temporarily alter the appearance of the treated area. The effect lasts between 6 and 24 months, but this varies depending on the composition and characteristics of the product, the injected area, the amount used, and individual metabolism. Therefore, there is no single duration that applies to all fillers.

Some hyaluronic acid fillers can be broken down with hyaluronidase when clinically indicated. However, this does not guarantee a straightforward correction in every situation and does not eliminate the need to prevent complications.

What risks should you be aware of?

Common reactions include swelling, bruising, tenderness, and local pain. Nodules, infections, inflammatory reactions, or migration of the material may also occur.

A rare but serious complication is accidental intravascular injection, which can cause vascular occlusion, ischaemia, and tissue necrosis. In some situations, visual disturbances, including vision loss, may occur. Unusual or increasing pain, blanching or a net-like change in skin colour, and any visual symptom occurring after injection require immediate assessment.

Because of these risks, filler injections must be performed by qualified medical professionals who can recognise and treat complications at an early stage.

Yes. In selected cases, botulinum toxin and filler may form part of the same treatment plan. For example, botulinum toxin may reduce dynamic wrinkles, while filler may correct clinically relevant volume loss.

However, combining them is not mandatory and is not always the optimal choice. The indication, order of procedures, and interval between them are determined individually, based on anatomy, goals, and risk assessment.

A conservative approach that prioritises the correct indication and avoids overcorrection may contribute to a harmonious result and reduce unnecessary procedures.