Face
What's The Difference Between Botox and Fillers?
Botox changes targeted muscle activity; dermal fillers add volume. This episode explains the distinction using lines that appear with facial expression and lines that remain when the face is at rest. The products serve different purposes and are not interchangeable.
In this episode.
Episode summary
Botox changes targeted muscle activity; dermal fillers add volume. This episode explains the distinction using lines that appear with facial expression and lines that remain when the face is at rest. The products serve different purposes and are not interchangeable.
In this June 25, 2020 episode of Plastic Surgery: Before and After, board-certified New York City plastic surgeon Darren M. Smith, MD introduces the concepts of dynamic and static facial lines. He uses the creases in a book's spine as an analogy for how repeated movement can leave a lasting mark.
Key takeaways
🔎 Dynamic lines relate to expression.
Examples in the episode include forehead lines when raising the eyebrows, frown lines and crow's feet with smiling or squinting.
🔎 Static lines remain at rest.
Dr. Smith explains how repeated movement can contribute to lines that no longer disappear completely.
🔬 Botox reduces targeted muscle contraction.
The discussion connects that effect with expression-related wrinkles.
🔎 Fillers occupy space.
The episode describes their role in selected folds and areas where additional facial volume is desired, including the cheeks.
Questions this episode answers
Are Botox and fillers the same type of injectable?
No. The episode groups them as cosmetic injectables but distinguishes a treatment that changes muscle activity from one that adds volume.
Are fillers only used for wrinkles?
No. Dr. Smith also discusses adding volume and shaping facial contours, particularly in the cheeks. Choosing a product and injection site requires an individual assessment.
ℹ️ Current safety context
The recording offers a broad introduction, not a treatment map for every facial line. Filler suitability is product- and site-specific. Complications can occur; accidental injection into a blood vessel can cause serious tissue injury or vision loss. Review the FDA's current filler guidance with a qualified clinician.
🔗 Related information
Explore Botox treatment information, dermal filler information, or request a consultation with Dr. Smith in New York City.
Originally released June 25, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Original show notes
While Botox and fillers are both cosmetic injectables, the similarities end there. Dr. Darren Smith, a board certified plastic surgeon in New York City, will help you to understand the difference between these products so that you can maximize the role of these wildly popular treatments in your own aesthetic journey.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. What is the difference between Botox and filler? I'll start by telling you what they have in common. They are... both cosmetic injectables and they represent a minimally invasive way to have a very nice impact on one's appearance with no downtime and very little risk when performed by an expert. The similarities really do stop there. To best understand the differences between Botox and filler, It is important to first understand that there are two different kinds of lines on the face and Botox is targeted at one of those kinds of lines and fillers are targeted at the other kind of lines and are also used to provide facial volume. The first kind of facial line is what we would call a dynamic line and those are lines that are not present when your face is at rest.
[01:29] but are only visible when you are moving your facial muscles to make expressions. And very common examples of these dynamic facial lines are the horizontal lines that you might see on your forehead when you raise your eyebrows. the vertical lines or 11 lines that you can see between your eyebrows when you're frowning or the radial lines that extend out from the side of your eyes when you're smiling or squinting that are often referred to as crow's feet and all of these lines are caused by the muscles of facial expression contracting under the skin and Causing that skin to wrinkle in response to their contraction On the other hand the other kind of facial line is a static facial line and those lines are the lines that are present on the face when the face is at rest and common examples of static facial lines are the nasolabial folds which are the parenthesis shaped lines that roughly span from your nose down around your lips or lines that or the horizontal lines that might be present on your forehead even when you're not raising your eyebrows or similarly vertical lines between your eyebrows when you're not scrunching your brow and similarly the crow's feet that are present when your facial muscles are at rest. And what's interesting about static lines is that they are often caused by the repetitive motion of the facial muscles such that these dynamic lines when they are created over and over again often leave an imprint and become static lines. And the analogy I like to use for this is that if you take a freshly bound book and you look at its spine, it's completely clear of any kind of creases or lines, but as you open and close the book, you'll notice that lines do appear when the book is open and closed, and those are akin to the dynamic lines on the face because they go away when the book is closed.
[03:50] However, over time as the book is repeatedly open and closed, those dynamic lines are visible as static lines even when the book remains closed because over time the binding of the book becomes worn and the dynamic lines have essentially carved their way as a permanent presence into the spine of the book in the form of static lines. With that background in place, we can make the broad claim that Botox is best at treating dynamic lines and fillers are best used for treating static lines and also for adding facial volume where it's needed. So specifically, Botox works by very selectively and in a controlled way weakening muscles of facial expression. So when Botox is injected, the muscles in the target area do not contract as strongly, so they're not able to produce the dynamic lines that they were previously producing with as much strength. Alternatively, fillers, which are aimed at treating static lines, simply take up space. They literally fill in the static lines that are present, often from that repetitive motion of dynamic lines.
[05:13] Fillers can also be used to add volume to areas of the face where there is a scarcity of volume. And some of the most popular places to place fillers are on the cheekbones to accentuate mid-face fullness. Fillers are often placed in those nasolabial folds to reduce their prominence. And fillers can also be placed in the hollows under the eyes, which are often referred to as a tear trough deformity. to reduce the prominence of those features as well. The truth is that the applications for Botox and fillers are very widely varied and are constantly expanding, but those are some basic guidelines to understand the difference between these two classes of products. Thanks for listening, and don't forget to subscribe, share the show, and head over to garonsmithmd.com for more real-world plastic surgery talks.
Sources and context.
Original Captivate episode. Original release date: 2020-06-25. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS