Fine lines, wrinkles, saggy skin – these are just a fraction of age-related concerns aesthetic medicine can treat.

In the past, patients were limited to just a handful of treatments – think botox, conventional dermal fillers and even plastic surgery (i.e. facelifts). 

Today, we’re spoiled with newer, sexier treatments all seemingly marketed to do the same things botox can, and even more (yes, it’s all about collagen biostimulation these days). 

Does this zeitgeist signal the end of botox’s era? Is botox truly replaceable? Let’s find out. 

Note: For the purpose of this article I will be referring to Botox as the treatment and not specifically just the brand.

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What is botox, and how does it work?

Botox refers to a brand of Botulinum toxin (Onabotulinum toxin). It’s the first brand on the market but there are several others now, such as Dysport (Abobotulinum toxin) and Xeomin (incobotulinum toxin) just to name a few. 

They are neurotoxins, and the primary aim is to block nerve activity in the muscles and relax them. 

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What can botox treat?

Botox is commonly used for; 

• Relaxing facial muscles to reduce wrinkles and dynamic lines in areas like the horizontal forehead lines, frown lines, crows feet[1]
• Slimming the face (from relaxing and shrinking the jaw muscles over time)
• Improving the jawline from platysma treatments.
• Treating hyperhydrosis (e.g. sweaty palms, sweaty armpits)
• Body contouring; specifically the shoulder and calves 
• Reducing oily skin and refining pores 

Aesthetics aside, botox is also FDA-approved for treating migraines and overactive bladder syndrome. 

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Botox vs fillers: Which is better?

This is a very commonly asked question. Botox and fillers are 2 very different treatments.

The role of a filler is to fill or replace volume. If injected superficially, fillers act as skinboosters to provide hydration (lack of moisture) and can help with skin texture concerns such as fine lines or open pores.

In this instance, skinboosters and botox can address similar problems. However, ONLY botox helps with dynamic /movement lines whereas fillers can improve the appearance of static lines (lines present at rest) 

Here are a few common indications and how botox and/or fillers come in: 

1. Jaw slimming and body contouring – only botox can address this. 
2. Frown lines – As areas with frown lines are considered high risk areas for filler treatment, these areas are best addressed with botox. 

With that said, there are a few areas both treatments can overlap, such as skin texture improvements i.e. smoker lines, crow’s feet, static forehead lines. Your doctor will be able to advise whether combining both treatments work better for you. 

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How about other anti-aging treatments?

When choosing between other popular anti-ageing treatments (e.g. Gouri, Profhilo) and botox,  patients tend to be wary of botox due to their perceived “negative social stigma” oh she’s got botox she’s so fake etc . 

Fact is, Botox is a safe and very effective treatment with no long term or life-threatening adverse effects[2]. It doesn’t require any loading (more sessions at the start) and results can be natural if done by an experienced injector.

As mentioned, Botox can prevent the development of static lines in the forehead, glabella (Frown area) and crow’s feet. It does not change the shape of your forehead. 

‘Stiff’, ‘expressionless’, and ‘frozen’ are common terms associated with botulinum toxin use. Understandably, these unpleasant side effects came from a time when patient and physician education was lacking.

Today, the notion of having a frozen upper face is no longer in vogue. Experienced injectors are using lesser toxins per treatment and often combining other treatments to allow patients to retain some facial expression. This can be in the form of skinboosters, collagen stimulators and even energy-based devices (Picosure Pro, Potenza) 

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Can Botox be used long term?

Yes! While there has been some adverse events (botulism) noted from botox for medical use (i.e to treat spastic muscles and large amounts are being used per session), such side effects are very unlikely in cosmetic use. 

When you stop doing botox, the muscles gradually regain their action. Your skin condition may gradually return to its normal state but it will be less severe compared to a botox naive patient. 

As we age, we lose collagen/elastin in the skin, our bone structure changes, we lose fat/ volume as well. With these changes come wrinkles, hollows and change in the shape of our face. Holistic treatment involve a variety of treatments including filler injections to recreate our youthful appearance.

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