Dr. Stefan Weiss

Dear Dr. Weiss, I have been considering having a procedure like Botox or Restylane but I am not sure which one. Can you explain the difference?

Over the last several years many products have been introduced to achieve what is commonly referred to as minimally invasive facial rejuvenation. The first was Botox®Cosmetic. Botox is short for botulinum toxin, a neuromuscular blocking agent derived from the bacterium Clostridium botulinum. This can initially sound very scary and many patients hesitate at the thought of having a toxin injected. However, it has been shown to be safe and effective in multiple clinical trials for the FDA approved indication of correction of glabellar wrinkles, the frown lines that form between the eyes, as well as in clinical use over the last decade for wrinkles across the upper face including forehead and “crow’s feet,” the area adjacent to the eyes. The one caveat is that it should always be product from the manufacturer and performed by a board-certified physician, as there have been instances when unlicensed providers have injected fraudulent substances.

Restylane™ is hyaluronic acid, specifically cross-linked for injection. Hyaluronic acid is a substance found naturally in the body. Although FDA approved for the treatment of nasolabial folds, the deep crevices between the nose and the corners of the mouth, it is also used for lip augmentations and correction of fine lines and wrinkles across the face. Importantly, unlike forms of collagen, Restylane contains no animal proteins. This means that no allergy testing is required prior to administration and the risk of animal-based disease transmission is low.

The choice between Restylane and Botox is driven by the desired result. Botox blocks the ability of the muscle to respond to the signals from the brain. As a result, the muscles relax causing the wrinkles in the overlying skin to disappear. Restylane, rather than restrict movement, is used to fill wrinkles that have been created over time. Correction of these grooves, especially around the mouth, serves to restore a person’s youthful radiance. The filler can also be injected in and around the lips to restore or enhance the natural lip contour. Because treatments with a filler can be mildly uncomfortable, topical anesthesia or nerve blocks are often used.

Often times a combination of the two products is found to yield the best result. By softening the overlying skin where dynamic movement occurs in the upper face with Botox, while at the same time using Restylane to restore the natural fullness of the central and lower face, friends and colleagues will frequently comment on a more youthful and energized appearance.

Importantly, neither Botox nor Restylane require any significant downtime and you can usually resume your normal activities immediately after treatment.