When to Use BOTOX® and Dermal Fillers

Dermal fillers and BOTOX® injections are highly popular non-surgical cosmetic procedures becoming very commonplace as the baby boom generation ages. Among the top ten most popular procedures, dermal fillers and BOTOX® injections are desirable as long-lasting although temporary fixes for the visible signs of aging. Knowing how to counsel patients about the benefits and contraindications of both procedures will help produce the best outcome.

Most Common Cosmetic Uses for BOTOX®

There are a host of areas where the application of BOTOX® can improve appearance by smoothing fine lines and wrinkles. The most common areas of treatment are horizontal forehead and neck lines, glabellar frown lines (between the eyes), crow's feet around the corners of the eyes, bunny lines on the sides of the nose, and turkey neck.

Most important to remember is that everyone's skin is different, and not all wrinkles are created equal. Different forces cause wrinkles, some internal, some external.

For the best results with BOTOX®, patients with fine wrinkles, lines caused by muscle action, thin skin, and hyper-functional lines that can be spread out with their fingers. If this describes your client, you will want to use BOTOX®. However, be aware that patients who depend on emotive expression, such as actors, on-air personalities, and politicians should be counseled about the potential for BOTOX® to cause a reduction in expression, especially when used on the upper lid or brow area.

For patients with thicker skin or deep dermal scarring, who've had previous surgery near the treated areas, and those who fail a finger spread test are more likely to receive minimal benefit from BOTOX®. These clients are better candidates for dermal fillers.

Expected Duration of Treatment

Of course, all patients want the procedure used to have long-lasting effects. A client's skin type is the primary selection factor. So what can they expect in terms of how long their new look will last?

With BOTOX®, the injection's effects can last three to six months. Patient who have ongoing treatments have the best success with treatment effects lasting longer, due to the way BOTOX® paralyzes the muscles.

With dermal fillers, patients can expect the effects to last between six months and a year.

Contraindications Patients who shouldn't be treated with BOTOX® include those with the following contraindications:

- Pregnancy

- Breastfeeding

- Prior allergic reaction to toxin or albumin

- Neuromuscular disorders, such as myasthenia gravis, ALS, or Lambert-Eaton syndrome

- Medications that decrease neuromuscular transmission, including aminoglycosides, penicillamine, quinine, and calcium channel blockers

- Antibiotics used to treat infections, such as gentamicin, tobramycin, clindamycin, and lincomycin

- Medications to treat heart rhythm problems, such as quinidine

Women who have been inadvertently injected during pregnancy have thus far had uneventful deliveries, and to date no congenital anomalies has been attributed to botulinum toxin. Nonetheless, it is a category C medication, and delay of injections is recommended until pregnancy is complete and breastfeeding has ended.

Always keep in mind that both BOTOX® injections and dermal filler treatments are medical procedures. These treatments should only be administered by experienced, well-trained doctors, nurses, and staff.


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You can improve your BOTOX injection techniques before offering these services to your patients. You can learn more from a BOTOX injection training DVD. You can find a BOTOX' training video at Aesthetic VideoSource, where you can preview an excerpt for free, watch a pay-per-view download, or purchase the DVD.