In today’s world you’d be hard-pressed to find someone who hasn’t at the very least considered cosmetic injections. However, if you’re new to undergoing the needle (and even if you’re not), it’s completely normal to be a little confused by your options, especially when you might not be sure about the difference between filler and Botox.
To help simplify the process, we asked four top doctors in their field to break it down. “There are so many new fillers added to the market in the US alone every year that it’s difficult to keep up with all of them,” says Beverly Hills cosmetic dermatologist Simon Ourian, MD.
What to know first is that there are two categories of injectables: neurotoxins and dermal fillers. “They’re both injectable aesthetic treatment products, but the similarities between the category of dermal fillers and neuromodulators stop there,” explains Ava Shamban, MD, board-certified aesthetic dermatologist. Botox “freezes” an area (e.g., forehead and the 11 lines between your eyebrows); fillers, on the other hand, add volume or structure—almost like a nonsurgical facelift.
Injectables are big business, and there are five major companies that manufacture both products. Each brand calls them something different. Allergan Aesthetics and Galderma have the biggest monopoly in the industry, boasting the largest portfolios of products. But other players, like Merz Aesthetics and Revance Aesthetics, are not far behind. And while there's only one (technically two, as of September) types of botulinum toxin, there are currently seven different types of filler (hyaluronic-acid-based formulas being the most popular).
Ready to dive in? Here’s what you need to know about all the cosmetic injections on the market as of January 2023.
Neurotoxins
Even though most of us say “Botox,” Botox is actually the brand name of a specific botulinum neurotoxin manufactured by Allergan Aesthetics. There are currently five FDA-approved neurotoxins available in the US: Botox, Dysport (from Galderma), Xeomin (from Merz Aesthetics), Jeuveau (from Evolus), and the newest, longer-lasting peptide-powered Daxxify (from Revance Aesthetics).
“Botulinum toxin type A acts on nerve endings in muscles to prevent muscle fibers from contracting,” says dermatologist Sheila Farhang, MD. Adds Dr. Ourian: “Neurotoxins are used to treat dynamic wrinkles that are caused by muscles that are hyper mobile, such as crow’s-feet or frown lines, and forehead lines above the brows.” They last only about 10 or 12 weeks, with the exception of the new Daxxify, which can be 6 to 12 months.
Daxxify was just approved by the FDA in September 2022. It’s the latest toxin innovation in 30 years and is unique from the four listed above. “It is the first neuromodulator powered by a different protein—a peptide exchange free of human serum albumin or animal-based components,” says Dr. Shamban. The best part: “It has the ability to deliver up to yearlong results with as few as one to two treatments annually,” she says.
Fillers
While Botox is pretty easy to understand, fillers are a bit more complex. As a category, fillers are composed of products that are used to add volume or structure to the lines or contours of the face. “They help in lifting sagging skin and smoothing out fine lines,” says Dr. Ourian. Says Dr. Shamban: “They last 12 to 18 months—and in some cases, 24 months—before absorption fully dissipates and next treatment is required.” They are also reversible and can be dissolved with hyaluronidase.
Hyaluronic acid (HA) fillers are one of the most popular thanks to their ability to replicate a soft, natural texture and youthful results. HA is found naturally in your body, so it dissolves naturally and gradually over time. “HA binds to water, making it an ideal product for correcting wrinkles and folds, as it binds with the skin’s own water,” explains Dr. Farhang. It generally lasts between 6 to 12 months depending on the individual and the product used.
Juvéderm comes from the Allergan Aesthetics family and has a few different variations meant to plump different areas.
- Juvéderm Volux is the newest injectable in the family. It's designed to create more harmony for the chin and jawline. “It's a bit firmer and stiffer to help define the jaw and it has more structure and cohesivity with the capacity to build out and lift,” Dr. Shamban says. “A stronger jawline will disguise a double chin and create angles where there were previously jowls for a more youthful appearance."
- Juvéderm Voluma XC gets injected deeper to help build structure and is typically used to build out the cheeks area when there's volume loss and to help define the chin profile. “It’s my favorite of all of the Juvéderm collection of fillers,” says Kian Karimi, MD, founder of Rejuva Medical Aesthetics. “It’s soft but sturdy and typically lasts one to two years, which makes it one of the longer-lasting fillers."
- JuvédermUltra XC is a wonderful filler for lip plumping. “It’s still one of the most popular fillers used in this area,” says Dr. Karimi.
- Juvéderm Volbella XC is the smoothest and thinnest of the family. “It is a really nice filler for very subtle hydration of the lips and is now used to soften under eye circles, which is my favorite area to use,” says Dr. Karimi.
According to Dr. Shamban, the next three Juvederm products are used interchangeably to correct various folds and facial wrinkles from mild to moderate. “It all depends on the patient, practitioner, needs, severity, and techniques,” she says.
- Juvéderm Vollure XC is often used for laugh and marionette lines and even lips. “It's a smooth and very versatile filler that can be used to soften lines and folds around most parts of the face, but most commonly it is used in the middle and lower part of the face,” says Dr. Karimi.
- Juvéderm UltraPlusXC is “thicker for deeper lines from midface including outer corner of lips down to the chin area or lifting nasolabial fold,” says Dr. Shamban.
- Juvéderm UltraXC also addresses the “vertical corner mouth and the marionette lines.”
Restylane is a HA dermal filler Galderma made to correct a wide range of concerns. It’s the second most popular HA filler on the market and has very similar uses and results to Juvéderm. According to the brand, it can be used to add volume and fullness, correct moderate to severe facial wrinkles and nasolabial folds. “[It addresses] deeper lines and wrinkles in the mid face,” says Dr. Shamban. It can also be used for lip enhancement.
- Restylane Lyft is best for “revitalizing and restoring the back of hands with volume,” says Dr. Shamban. It can also be used to give the cheekbones a nice lift.
- Restylane Refyne can help soften and minimize laugh lines, nasolabial folds, and marionette lines. It can also be injected “mid to deep dermis to augment those with a moderate chin profile,” says Shamban.
- Restylane Defyne is best used to help enhance chin projection, according to the brand.
- Restylane Kysse is the most popular Restylane for lip augmentation and perioral lines. It has lidocaine to help ease the injection pain and lasts for about a year.
- Restylane Contour “helps to build up volume in cheeks,” says Dr. Shamban.
- Restylane Silk is administered with a fine-point needle and is FDA-approved “to smooth lines around the perioral and corners of the mouth or adds a lift to cheek area,” says Dr. Shamban.
RHA Collection (resilient hyaluronic acid) is the latest innovation in HA-filler science from the Revance Aesthetics portfolio. It’s quickly gaining popularity for its uncannily natural-looking results. “It’s designed with a composition that is most similar to the natural HA found in our skin,” says Dr. Shamban. “The manufacturing also has minimal chemical interactions.” Revance offers four formulations in the portfolio, each of which uniquely address a range of areas resolving various signs of aging. Results last about 12 to 15 months.
- Redensity was recently approved by the FDA and is designed to correct moderate to severe wrinkles around the mouth and lips also known as perioral rhytides (a.k.a. smokers lines or the vertical lipstick lines). “It also works to improve the appearance of the tissue around the mouth by increasing hydration and infusing amino acids and antioxidants,” says Dr. Shamban.
- RHA 2, RHA3, and RHA 4 are used for the most dynamic areas of the face,” she says. Number 2 is the most versatile and lightest, “for more superficial smoothing radial cheek lines corners of mouth”; 3 administers “deeper for more moderate nasolabial folds and commissures”; and 4 is the stiffest product, “for more severe nasolabial folds and lower face.”
Belotero Balance is the one and only filler offered from the Merz Aesthetics portfolio. “I use it quite a bit in my office,” says Dr. Farhang. “I personally like how soft the product is.” It’s most commonly used for moderate-to-severe etched-in lines and wrinkles in your lower face, most popularly in the lips. “People should understand that the formulation of the filler is so important and areas around the lips, in the lips, under the eye, for example, need a filler that is flexible,” she says. Using a product that is too stiff is what makes people appear puffy and unnatural.
Revanesse Versa is a small-batch HA product made in Canada. “It’s less popular but has a similar mid to deep dermis volumizer and wrinkle corrector with a higher molecular weight,” says Dr. Shambam.
Radiesse is made with an ingredient called calcium hydroxylapatite (CaHA) instead of HA. This naturally occurring filler from the Merz Aesthetics portfolio is “one of my go-to fillers for jawline definition due to how structured the product is,” says Dr. Farhang. It’s thicker than HA filler, so it has more lift capacity and delivers results in just one treatment. “It also biostimulates the skin to create its own new collagen and elastin for up to 12 months,” she says. Radiesse is also FDA-approved to increase volume and minimize the look of veins and tendons in the hands.
Sculptra is a poly-L-lactic acid filler that is not naturally occurring. However, it is a biodegradable synthetic substance that is safe to use in the body. “It's a biostimulator, which will activate stimulation of the body's own collagen production over time,” says Dr. Shamban. It’s used for smile lines, nasolabial folds, and chin wrinkles.
Bellafill by Suneva Medical Inc. is another FDA-approved synthetic filler. “It contains a resorb-able microbead suspended in a gel, which offers volume first and then leaves the structure for the formation of collagen,” says Dr. Shamban. It’s good for smile lines, nasolabial folds, and even filling in acne scars. It’s the longest-lasting FDA filler, clocking up to five years of wear.
