Which is the better to use: Botox or filler?

shutterstock_73907851Dr. Dean Kane Q & A Q. Which is the better to use: Botox or filler? I have a very little top lip and would like it done along with eye wrinkles. I am 47 years old and I need something. I would appreciate just knowing my safest choice. I live in New Zealand but am currently in Bali. A.  ​There are various ways to reduce lines around the mouth and lips. Each depends on the level of the wrinkle deformity, ie., epidermis, dermis, fat, muscle and skin color. The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting “cousin” Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial (“parentheses”) and marionette folds, the brow (“number 11”) lines and fill and lift the cheeks and lateral brow or chin. Voluma and Lyft are the longest lasting HA fillers, up to 2 years and 1.5 years duration HA. Each one is used to expand, project or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!. ​ Restylane Silk is a wonderful new addition to the filler family. It is thinner and smoothening, particularly for the lines around the mouth and lips. I have also found it useful for the crow’s feet and forehead lines too. Scuptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent. Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles even around the mouth! ​
  • ​Fillers in the lip like fillers elsewhere require and understanding of the anatomy and injectable results. For example:
  • ​Beyond the white roll, upper and lower lip wrinkles improve with Botox and smoothening fillers such as Silk in the dermis 
  • The white line and philtrum project better with smoothening or volumizing fillers like Silk or Restylane
  • ​The lipstick lines of the dry (pink) vermillion are best injected with a volumizing filler like Restylane in the sub-mucosal layer
  • Lip fullness is best with projecting to volumizing fillers such as Lyft, Juvederm Ultra Plus along the wet/dry border of the vermillion lip
  • ​Lip pout can be improved with filler injections in the buccal mucosa (ie., back of the lip, inside the mouth) allowing the lip to push off the teeth.
  • ​Artistic use of Botox and similar injectable muscle relaxers just outside the upper and lower lip white line will reduce lip creasing and increase the pout of the lip(s) without fillers.
Dr. Obagi’s new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin. IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation. ​ ​These options maybe used similarly around the eyes with the caveat that the Injector must understand the art and science behind the injectables he or she are using and the anatomy and dynamics of facial expression. All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills. ​ ​I hope this has been helpful. All the best!  
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