Cosmetic Injectables: Neurotoxins vs Fillers

Neurotoxins (like Botox®, Dysport®, and Jeuveau®) and fillers (like Restylane® and Revanesse® Versa™) both treat wrinkles. However, they are used in different types of wrinkles and different areas of the face because they work in different ways!

Neurotoxins

Neurotoxins work by temporarily blocking the chemical signals which tell our muscles to contract. We use neurotoxins most commonly in the forehead, around the eyes, and in between the eyebrows. There are additional areas in the lower face we treat too, like the lips, chin, and jaw muscles! In these areas, the wrinkles are created by muscles making the same expressions over and over. If we relax the muscles and don’t allow you to make these expressions so intensely, the wrinkles will smooth out and may even disappear completely.

Neurotoxins also prevent new wrinkles from forming in these areas. It is important for patients to get these injections every 3-4 months if they want to maintain the effects.

Doctor in pink gloves prepares syringe for Botox injection in Diehl Plastic Surgery

Fillers

Fillers work by…you guessed it…filling the wrinkle or hollow area! Filler is made out of hyaluronic acid, something found in many moisturizers nowadays and also naturally created by the body! Filler feels like Jell-O, and looks very soft and natural when used appropriately.

We use filler in the lower face – like the cheeks, undereyes, nasolabial folds between the nose and mouth, lips, chin, and many other areas! These are wrinkles or areas of hollowing that appear over time due to the natural aging process (loss of bone and movement of fat under the skin), and not necessarily muscle movement or facial expressions. Filler lasts about 9 months to a year or more, depending on the person and the area treated.

We hope that this helps you to determine which treatment may be a good fit for you. And as always, we are here to give you our professional opinion on which treatment or combination of treatments will help you achieve your goals.

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About the Author

I'm Dr. Cynthia Diehl, a native Peruvian raised in Raleigh, NC, and founder of Diehl Plastic Surgery. I earned dual degrees in Biochemistry and Chemistry from NC State University before completing medical school at UNC–Chapel Hill. I trained in general surgery at UNC Hospitals, one of the country's leading surgical centers, earning board certification through the American Board of Surgery. Drawn to the transformative power of cosmetic surgery, I went on to specialize in plastic and reconstructive surgery, also at UNC–Chapel Hill, and became board-certified by the American Board of Plastic Surgery. I'm a Fellow of the American College of Surgeons and an active member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. I was also named a 2025 Castle Connolly Top Doctor, an honor awarded to the top 7% of U.S. board-certified physicians. Outside of my practice, I'm happily married to orthopedic surgeon Dr. Lee Diehl, and together we're raising two children here in Raleigh.