Short answer
Botox relaxes the muscle behind lines that form when you move your face. Fillers add volume under the skin for hollows and folds visible at rest. The Botox Cosmetic label gives about three to four months for frown lines, and a 2023 pooled analysis found a longer estimate, about six months, for upper-face lines treated together. Fillers often last longer. Neither is better overall.
What is the difference between Botox and dermal fillers?
Botox is a botulinum toxin that blocks the signal telling a muscle to contract, so lines caused by repeated movement soften. Dermal fillers are gels injected under the skin to replace lost volume, smooth folds or add shape. One treats movement and the other treats loss, which is why they are not interchangeable.
The FDA label for Botox Cosmetic lists four adult uses, each for moderate to severe lines or bands tied to the activity of a specific muscle: frown lines between the brows, crow's feet, forehead lines and platysma bands in the neck. The FDA describes fillers as medical device implants approved for uses such as nasolabial folds, perioral lines and added fullness in the lips, cheeks, chin and backs of the hands, for adults 22 or older.
Age explains why you may need one, the other or both. The American Society of Plastic Surgeons (ASPS) says faces lose subcutaneous fat over time, so the facial muscles work closer to the skin surface and smile lines and crow's feet become more apparent. One line can therefore involve both movement and lost volume. Dr. Arshia Payman, MD, leads facial aesthetics at ANEWU and looks at your face at rest and in movement before recommending either treatment.
Which is better for you, Botox or fillers?
Neither is better in general. It depends on what is causing the line or hollow. If a line appears or deepens when you frown, squint or raise your brows, it is a movement line and Botox is the usual approach. If a fold or hollow shows while your face is relaxed, lost volume is the more likely cause and filler is the usual approach. Some faces call for both.
Your health history matters too. The Botox Cosmetic label lists allergy to any botulinum toxin product and infection at the injection site as reasons not to treat, and warns that people with neuromuscular disorders may face a higher risk of serious effects. The FDA tells filler patients to delay treatment if the skin is inflamed or infected, and to mention a bleeding disorder, severe allergies or a history of anaphylaxis.
Recovery differs a little. At ANEWU, a Botox visit takes about 15 to 20 minutes with a fine needle, and a filler visit usually runs inside an hour, with topical numbing where appropriate. ASPS's 2023 report describes neuromodulator (botulinum toxin) injections as offering minimal downtime. The FDA says most filler side effects, such as swelling and bruising, appear soon after injection and many resolve in a few days to weeks, and ASPS advises scheduling treatment well before significant events.
| Botox | Dermal filler | |
|---|---|---|
| What it does | Relaxes a targeted muscle | Adds volume or shape under the skin |
| Suited to | Frown lines, crow's feet, forehead lines | Hollows, folds visible at rest, lips, cheeks |
| First effects | Starts in 1 to 2 days, builds over about a week | Varies: ASPS says results may not be apparent for 2 to 4 weeks on average |
| Typical duration | Label: about 3 to 4 months for frown lines; 2023 pooled analysis: about 6 months | Varies by product and area, often longer |
| If you dislike it | Wears off over months | Hyaluronic acid types can be dissolved |
| Rare serious risk | Spread of toxin effect (boxed warning) | Blocked blood vessel: tissue loss, vision loss, stroke |
| 2023 ASPS national average fee (varies) | $435 per session | $715 for hyaluronic acid filler |
Which lasts longer, Botox or filler?
Filler often lasts longer than Botox, but how much longer depends on the product and the area. The Botox Cosmetic label gives approximately three to four months for frown lines, and a 2023 pooled analysis found a longer estimate, about six months. A 2026 systematic review of hyaluronic acid (HA) filler reported persistence of 60 to 86.4% at 12 months on 3D volume measurements.
That review analyzed 24 studies with 1,410 patients, and each reported quantitative data with at least 12 months of follow-up. It also reported persistence of 50 to 86% at 24 months, though one study reported 6 to 9 months. Patient satisfaction declined as the measured volume declined, and the authors say longevity is influenced by manufacturing technology, tissue mobility and anatomical factors. ASPS adds that dermal fillers are temporary and that ongoing treatments are needed for long-term results.
Botox runs on a shorter cycle. The label says the effect begins one to two days after injection and builds over the first week, and that dosing more often than every three months has not been clinically evaluated. The 2023 pooled analysis is a meta-analysis of 14 randomized trials with 8,369 people. It estimated 182 days (95% confidence interval 179 to 215) until investigator-assessed return to nonresponder status when frown lines, crow's feet and forehead lines were treated together.
Filler timing is harder to pin down. ASPS's 2024 statistics report says noticeable neuromodulator results can take one to five days, while hyaluronic acid filler results "may not be apparent for two to four weeks on average," in a passage about the body needing time to heal. ANEWU's filler page describes visible change when you leave and settling over the first week or two, so the two timelines differ. Ask what to expect for your product and area, and judge a filler after it has healed, not on the day. ANEWU's guide to how long Botox lasts covers what changes it.
Are fillers more risky than Botox?
They carry different risks, and the published numbers cannot rank them. Both cause mild, common effects such as bruising. The rare serious risk with filler is injection into a blood vessel, which can cause tissue death, blindness or stroke. The rare serious risk with Botox is spread of the toxin beyond the injection site, which carries a boxed warning on the label.
In the label's placebo-controlled trials, eyelid ptosis (a drooping lid) occurred in 3% of 405 people treated for frown lines versus 0% with placebo, and brow ptosis in 2% of 665 treated for forehead lines with frown lines versus 0%, with headache in 9% versus 5%. The boxed warning says toxin effects may spread, with symptoms reported hours to weeks after injection, and that swallowing and breathing difficulties can be life threatening. The label also says no definitive serious reports of distant spread have been made at the labeled cosmetic doses.
The FDA calls unintended injection into a blood vessel the most concerning filler risk and says the chance is low. In a 2025 retrospective study from one Japanese clinic group, 12 serious complications followed 290,307 hyaluronic acid injections, an incidence of 0.0041%, and 8 of the vascular cases were in the forehead. A 2024 review found 365 new published vision-loss cases from 2018 to 2023, most often from the nose, forehead and glabella, and 68.2% of those reporting an outcome had no vision recovery. The FDA's filler page, last updated in July 2023, lists injecting the glabella, nose or forehead among uses that are not approved, and says approved uses vary by product.
Ask which areas will be treated and why, and what the plan is if blood flow is blocked. The FDA tells providers to have one, and a 2026 meta-analysis of 231 patients found that hyaluronidase given within 6 hours was linked to better outcomes. Speed matters, so unusual pain, vision changes or white, gray or blue skin near the injection need immediate medical attention. ANEWU's post on filler risks and dissolving covers more.
Is filler cheaper than Botox?
No, not on average. ASPS's 2023 statistics report, the most recent of its reports that lists injectable fees, gives average surgeon or physician fees of $435 for a neuromodulator injection session and $715 for hyaluronic acid filler. These are national averages, and cost varies by case and location.
ASPS listed $528 and $794 for the same two services in 2022, so treat any figure as a snapshot, not a quote. ASPS also says the cost of neuromodulator injections depends on the amount needed. At ANEWU, cost depends on how many areas are treated and what each area needs, so it is quoted after a free consultation rather than from a price list.
A per-session price also hides how often you pay. Botox wears off over months and is repeated a few times a year, while filler schedules depend on the product and area. Ask for a plan with a 12-month total, not just the first visit. ANEWU says insurance does not typically cover cosmetic treatment, and it works with CareCredit and Proceed Finance.
What is a cheaper alternative to Botox?
No source identified for this article shows a like-for-like cheaper substitute, so the answer depends on what you want to change. Other botulinum toxin products exist, but the Botox Cosmetic label says its units cannot be compared to or converted into units of any other product, so compare a full quote, not a price per unit.
The ASPS 2024 statistics report lists several neuromodulator brands and says more competition can mean more competitive prices. It gives no price comparison, and no source identified for this article prices the options head to head. The $435 average in ASPS's 2023 report covers the whole neuromodulator category, so it is not a price for any one product.
Ask each office for the full plan cost for the areas you want, how often you would repeat it and what a touch-up costs. A lower quote may cover a different product or fewer areas, so compare plans, not first-visit prices.
Can you use Botox and fillers together?
Yes. Many plans use both, on different areas or on the same line, because Botox quiets the movement and filler restores volume. The evidence is limited, though: the FDA's filler page, last updated July 2023, says the safe use of fillers in combination with neuromodulators has not been evaluated in a controlled clinical study. What exists is small trials.
A 2022 study of 40 people with moderate to severe frown lines compared toxin alone with toxin plus hyaluronic acid filler. The combination group scored lower on a wrinkle scale at weeks 20 and 28 and gave higher satisfaction ratings at the final visit. A 2013 randomized split-face trial of 20 people found comparable results through week 12, with the combined side showing greater wrinkle reduction in the frown area at week 24 and longer-lasting results in dynamic forehead lines.
Both studies are small, and follow-up ended at 28 weeks and 24 weeks, so a combined plan is a clinical judgment, not a proven protocol. It also adds two sets of risks and two costs. At ANEWU, Dr. Payman often plans the two together in a single visit and maps the order and the areas with you at a free consultation.
What happens at a Botox or filler consultation at ANEWU?
At ANEWU, the consultation is free and starts with your goals and health history. Dr. Arshia Payman, MD, looks at your face at rest and in movement, then tells you whether Botox, filler or both fits. If one is the wrong tool for what bothers you, she says so. Offices are in Buckhead, Cumming and Dawsonville.
Dr. Payman names the specific filler she recommends for each area at the consultation, and cost is quoted afterward. The FDA advises asking a provider about their training and experience injecting fillers in the face, and tells providers to know the signs of injection into a blood vessel and have a treatment plan ready. To have Dr. Payman look at your face, book a free consultation at the office closest to you, or read ANEWU's Botox page, dermal fillers page and lip treatments page first. If jaw clenching brought you here, start with the post on Botox for TMJ and teeth grinding, and see who can legally inject Botox and fillers. Questions to bring:
- Which product, in which areas, and why?
- What is your training and experience with filler in the face?
- What is the plan if a filler blocks a blood vessel?
- What is the 12-month total cost, and when is my follow-up?
Sources and further reading
- BOTOX Cosmetic (onabotulinumtoxinA) prescribing information and Medication Guide DailyMed, U.S. National Library of Medicine; label revised October 2024
- The Efficacy and Duration of Onabotulinum Toxin A in Improving Upper Facial Expression Lines: A Systematic Review and Meta-Analysis (title shortened) Aesthetic Surgery Journal, 2023
- Dermal Fillers (Soft Tissue Fillers) U.S. Food and Drug Administration, content current as of July 6, 2023 (page read October 2026)
- Dermal Fillers American Society of Plastic Surgeons, patient information page, read October 2026
- 2023 Plastic Surgery Statistics Report (Procedural Statistics Release, including average surgeon and physician fees) American Society of Plastic Surgeons, 2023 (archived copy)
- 2024 Plastic Surgery Statistics Report (Procedural Statistics Release) American Society of Plastic Surgeons, 2024 (archived copy)
- Clinical Durability of Hyaluronic Acid-Based Dermal Fillers for Facial Application: A Systematic Review Aesthetic Plastic Surgery, 2026
- Serious Complications of Hyaluronic Acid Fillers: A Retrospective Study of 290,307 Cases Annals of Plastic Surgery, 2025
- Update on Blindness From Filler: Review of Prognostic Factors, Management Approaches, and a Century of Published Cases Aesthetic Surgery Journal, 2024
- Hyaluronidase Protocol in Management of Hyaluronic Acid Filler-Related Vascular Complications: A Systematic Review and Meta-Analysis Aesthetic Plastic Surgery, 2026
- Comparison of Effectiveness and Safety of a Botulinum Toxin Monotherapy and a Combination Therapy with Hyaluronic Acid Filler for Improving Glabellar Frown Aesthetic Plastic Surgery, 2022
- Treatment of forehead/glabellar rhytide complex with combination botulinum toxin A and hyaluronic acid versus botulinum toxin A injection alone: a split-face, rater-blinded, randomized control trial Journal of Cosmetic Dermatology, 2013
This article is general information about dental and facial procedures, not a diagnosis or medical advice. Every jaw and every health history is different, so the right plan for you can only be set after an exam and imaging with a surgeon.