dr. brett kotlus botox or fillers

What is the difference between Botox and Fillers ?

Botox or fillers ?

“Do I need Botox and fillers?”

I’m asked this question almost every day in any of my New York offices (not to imply that wrinkles only happen to New Yorkers, it’s just where I practice).

The answer depends on where you have wrinkles or loss of fullness.

Sometimes the answer is both Botox and filler

Botox works best around the eyes- the frown lines between the eyebrows, the crow’s feet, and the forehead.  Botox (and Dysport) relax the muscles that cause these expression lines.

In the hands of a Botox expert, Botox can gently lift the eyebrows, improve lines around the mouth, and lift the corners of the mouth.

Fillers are best for deeper creases, nasolabial creases (from the side of the nose to the mouth), lines that are not from expressions,  and sunken areas (under eyes, cheeks, lips, temples).

“Will I have to do it again?”

Yes, if you want to keep looking younger .  This infographic I made describes some of the differences and applications of Botox and fillers including the very popular Juvederm Voluma, Sculptra, and Restylane.  Most of my patients who enjoy the benefits of injectable treatments undergo Botox approximately 3 times per year and fillers once or twice a year.


infographic botox


How to get rid of crow’s feet

Crow’s feet arise from repeated expression

“Crow’s feet” are the creases that radiate outward from the outer corners of your eyes when you smile or squint.  They begin to show up for most people in the mid 30’s to early 40’s.  They are thought to convey sincerity when you smile (see this video about the SQUINCH by photographer Peter Hurley).  The crow’s lines can make you look more photogenic, but if you have too many or they are too deep, they make you look older.


smile wrinkles

“Crow’s Feet”


How do I get rid of them?


Use a broad-spectrum sunscreen of at least SPF 30 and preferably a mechanical blocking agent like zinc oxide.  Even while you are driving, your face is exposed to damaging UV radiation that causes aging signs and wrinkles. Other ways to prevent these lines from forming or worsening, use scientifically-proven topical creams like a prescription-strength retinol and a vitamin C  (L-ascorbic acid).   I don’t recommend that you stop smiling in order to prevent smile lines.  You may look younger, but you will lead a less happy life!


Botulinum toxin type A (Botox, Dysport, Xeomin) are liquid protein injections that selectively relax the muscles that create the crow’s lines.  An expert injector can do wonders by placing small amounts of Botox in just the right places.  Botox done well looks natural and gives your eyes a younger glow.


Lasers (fractional CO2 and erbium) and chemical peels (glycolic, TCA, phenol) will remove the outer skin layers leaving space for newer, smoother skin to take over.  In the case of crow’s feet, if you continue to crease with repeated expressions, the lines will eventually return.  A combination of resurfacing with Botox as maintenance will provide the longest-lasting results.

What about fillers like Juvederm or Restylane?

Fillers have a limited role in treating crow’s lines but can be helpful in smoothing very deep, fixed creases.  Dermal fillers can also stiffen and plump the skin to limit the amount of folding and creasing that occurs when you squint.

What about eye lift surgery?

A lower or upper eyelid lift may somewhat reduce crow’s feet but is not a good choice if your primary target is expression lines. Surgery is better for heavy upper eyelid skin or lower eyelid bags.

How long does Botox last?

Botox starts to work after a few days and lasts for months.

How many months is the big question.  I’ve been treating patients with cosmetic botulinum type A since my residency days in New York City and I’ve administered thousands of Botox injections.  On average, Botox lasts about 4 months.  But, this isn’t the case for everyone.  Why?

Botox works better with successive treatments.

The smoothing effect on wrinkles is a result of targeted muscle relaxation.  When a muscle isn’t moving as much as it used to, it begins to shrink.  Just like when you remove a cast from your arm that has been there for 2 months, the arm looks smaller. With the next Botox treatment, your muscle may take longer to recover because it’s smaller.  I have some patients that see Botox results for 6 – 9 months, mostly if they have been getting treatments for a few years.

What if Botox lasts less than 4 months?

The most likely reason for a shortened duration of action is under-treatment.  My first consideration would be to look at how many units were used and perhaps a stronger treatment is required.  There is a rare possibility of developing antibodies to the Botox molecule,  but this is unusual.  Some doctors advocate the use of supplements that improve the absorption of zinc in your diet.  These supplements may help but they’re not completely reliable.

Botox remains the most popular cosmetic treatment in the world so the length of effectiveness is acceptable to most people.


botox duration

timeline for botox cosmetic


How Botox became #1 in popularity

Botox, also known as botulinum toxin type A, is a purified protein that stops the transmission of nerve signals to muscles.  In other words, it relaxes muscles.  It was discovered based on the muscle weakening effects of the proteins produced by a bacteria named clostridium botulinum, named after the sausages that used to harbor the microorganisms.  Current commercial forms of botulinum toxin are highly purified and delivered in small, safe amounts.  As a medical therapy, it has come a long way from its original use in alleviating crossed eyes caused by overactive extraocular muscles.  Now it is used for a wide array of conditions including migraines, neck spasm, overactive bladder, and excessive underarm sweating.

But its claim to fame will always be its amazing anti-wrinkle properties.  It is the #1 treatment to date for glabellar wrinkles (the “11” lines between your eyebrows) and for crow’s lines (the smile wrinkles that radiate from the outer corners of your eyelids).  After a treatment, the results typically last for about 3-6 months.  It is expected that the global market for Botox will reach $2.9 billion by 2018!

Why is Botox so popular?

1. It works.  It reduces or eliminates frown lines and crow’s feet and lifts the eyebrows. It can work almost as well as surgery for some people.  And it prevents future deep wrinkles.

2. It is a no-downtime procedure. Botox can be done during your lunch break and when you return to work no one will know you had something done.

3. It is safe. Its safety has been proven over many years. Over 5 million Botox treatments were performed in 2013 alone, and its safety record is better than that of aspirin.

As a cosmetic eyelid and facial surgery specialist I have performed many hundreds of Botox treatments and it remains one of the most requested procedures in my office.  As this infographic details, it is the most popular cosmetic procedure in the world!