The short answer
These two treatments work in different ways. Botulinum toxin is a prescription medicine injected into a specific muscle, where it blocks the signal to contract. Dermal fillers are gels placed under the skin to restore volume or projection.
So the useful question is what is causing the change you see. Dr Sin Yong examines the face at rest and in movement, and performs the injections himself. Many faces are assessed for both, which is common after the mid-thirties.
Typical toxin targets are the frown, forehead, crow's feet and masseter. Typical filler targets are the cheek, chin, temple, jawline and lips. Hyaluronic acid is the most common filler. Calcium hydroxylapatite (CaHA), polycaprolactone (PCL) and poly-L-lactic acid (PLLA) are other materials.
Which concern fits which
| Concern | Usual approach |
|---|---|
| Frown and forehead lines | Anti-wrinkle injections |
| Crow's feet | Anti-wrinkle injections |
| Jaw width from masseter bulk | Anti-wrinkle injections |
| Downturned mouth corners | Toxin and/or filler, often in sequence |
| Hollow cheeks, temples and chin | Filler |
| Nasolabial fold | Treated as structural, assessed from the cheek first |
A simple way to think about botulinum toxin vs fillers
A line that appears with expression and fades at rest points to toxin. A fold or hollow present at rest usually needs volume or structure, sometimes with skin treatment. Where both are planned in one area, toxin is often placed first and the face is reviewed once it takes effect. In the forehead, heavy brows are examined before injecting, because full relaxation can drop the brow.
Products and reversibility
| Product | Can it be reversed? |
|---|---|
| Botulinum toxin | No. The effect wears off as nerve endings recover. |
| Hyaluronic acid filler | Yes, with hyaluronidase. It is the usual first choice for anyone new to filler. |
| CaHA, PCL and PLLA | No. These are placed conservatively and in deep planes. |
Who should wait, or be assessed carefully
Deferred in pregnancy and breastfeeding, and with infection or inflamed skin at the site.
Avoided in neuromuscular disorders such as myasthenia gravis, and reviewed where medicines affect nerve transmission.
Discussed carefully with a bleeding tendency, autoimmune disease, a keloid tendency or earlier non-resorbable product.
Redundant skin is assessed for lifting, or referred to a plastic surgery specialist.
What neither can do
Neither tightens loose skin, lifts descended tissue or changes skin quality.
It does not relax muscle.
It does not add volume, and it does not fill a groove already etched into the skin at rest.
Risks
Too much in the wrong muscle can cause a heavy brow, an asymmetric smile or a frozen upper face until the effect fades.
The wrong plane, excess quantity, or layering over product that has not cleared can cause heaviness and loss of contour.
This is the most serious filler risk, and the glabella is one area of concern. Hyaluronidase is kept available wherever hyaluronic acid is injected. See the warning signs.
Sessions and fees
How long each lasts and how often it may be repeated varies, and is discussed at consultation. Fees follow the examination and cover the areas treated, the product or material, and the quantity your anatomy requires. Prices are not published, as Singapore's advertising rules do not allow it. A written, itemised quote follows consultation, and the options explained include no treatment.