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The empress of youth and beauty: Botox VS Hyaluronic acid injections

Characteristic features of skin aging are a loss of elasticity, laxity, rough-texture surface, and wrinkling. While wrinkles are physiological, and appear with age, a number of cosmetic and medical procedures exist to delay their occurrence or flatten them. New trends, and in particular injectable fillers are now increasing in popularity. In the last 5 years, more than 8.5 million nonsurgical injection procedures were performed globally. The most commonly used injected solutions are botulinum toxin type A, followed by hyaluronic acid fillers [1].

Briefly, botox injections block the release of acetylcholine, resulting in a relaxation of the local muscles, while hyaluronic acid, which is naturally found in our skin, acts as a soft tissue filler [2, 3]. Botox usage has an advantage whenever the muscle movement wants to be restricted, or making more stable muscle position, while hyaluronic acid fillers are well known for volume restoration and recontouring. By saying that, it is understandable that the cornerstone for the upper part of the face is treatment with botox, while middle face treatment and lip recontouring are managed with hyaluronic acid fillers. Furthermore, in the lower part of the face, the combination of both of them is important because rejuvenation involves control of muscle movement as well as restoration of volume [4]. The safety profile of these is consistent with their use, and therefore the expected side effects are mild. The most frequent botox-related undesirable effects are mild pain, tenderness, bruising and headache while treatments with hyaluronic acid have shown immediate reactions, such as oedema, erythema, pain, bruising, etc. The majority of these reactions are transient and self-resolving [1]. A serious complication that can occur in the use of fillers is focal necrosis. It is very rare, in 0.001% of cases, and it usually appears very quickly within 24–48 hours. People that are hypersensitive to components of fillers, or have bleeding disorders and a history of anaphylaxis should avoid these types of facial aesthetics [2]. Also, the treatments should be avoided during pregnancy and breastfeeding because of the lack of adequate data [1]. Injections of botox lead to an effect approximately after 24 hours while the effect of hyaluronic acid is immediate [4]. Neither of the treatments is ever-lasting, although their effect is rather prolonged. Both are able to reduce wrinkles for a period between 3 and 12 months [2, 3].

In the end, it is an individual choice. As for everything in life, each of us needs to make an informed decision. This means that the person should read in detail about each of the methods, make appointments with at least two different aesthetic doctors, read reviews of the clinics she/he is planning to go to, and be aware of her/his medical history.

Keywords: skin aging, wrinkles, aesthetic injections, hyaluronic filler, botox


[1] Goodman GJ, Liew S, Callan P, Hart S. Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australas J Dermatol. 2020 Aug;61(3):217–25.

[2] Satriyasa BK. Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect. CCID. 2019 Apr;Volume 12:223–8.

[3] Kalmanson OA, Misch ES, Terella A. Hyaluronic acid fillers may be longer-lasting than previously described: A case report of delayed filler-associated facial cellulitis. JPRAS Open. 2022 Sep;33:37–41.

[4] Carruthers JDA, Glogau RG, Blitzer A. Advances in Facial Rejuvenation: Botulinum Toxin Type A, Hyaluronic Acid Dermal Fillers, and Combination Therapies?-Consensus Recommendations: Plastic and Reconstructive Surgery. 2008 May;121(SUPPLEMENT):5S-30S.

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