The Core Difference
Anti-wrinkle injections (Botox, Dysport, Bocouture) temporarily relax specific facial muscles to reduce dynamic wrinkles — the lines that appear when you make an expression.
Dermal fillers are hyaluronic acid gels placed to restore lost volume (cheeks, temples, tear troughs) or enhance features (lips, chin, jawline).
They are not interchangeable. They do not address the same problem. Confusing the two is the source of most early-aesthetics regret.
At a Glance
| Anti-Wrinkle (Botox etc) | Dermal Fillers | |
|---|---|---|
| What it does | Relaxes muscle to reduce movement | Adds volume or defines features |
| Best for | Dynamic wrinkles (forehead, glabella, crow’s feet) | Volume loss, lip/cheek/jawline definition |
| Treats | Lines created by expression | Grooves, hollows, flat features |
| Visible immediately | No — full result at day 14 | Yes |
| Duration | 3–4 months | 9–18 months |
| Reversible | No (wears off) | Yes (hyaluronidase) |
| Price range | £200–£450 per area | £350–£800 per ml |
| Typical first-treatment age | Mid-30s to early 40s | 35+ (feature) or 40+ (volume) |
The Decision Tree
Step 1: Is the line visible when your face is completely still?
- No (only visible during movement) → anti-wrinkle territory
- Yes, faint → anti-wrinkle first, re-assess at review
- Yes, deeply etched → anti-wrinkle plus possibly filler for the groove, plus skin rejuvenation
Step 2: Is the line produced primarily by movement, or by volume loss?
- Forehead, glabella, crow’s feet → movement (anti-wrinkle)
- Nasolabial folds, marionette lines → volume loss (filler, often with anti-wrinkle adjunct)
- Under-eye, cheek flattening → volume loss (filler)
- Jawline sagging, pre-jowl groove → volume loss (filler)
Worked Examples
A 33-year-old with a visible “11” between her eyebrows
The “11” appears on frown and is now faintly visible at rest. This is the textbook indication for anti-wrinkle treatment of the glabella (2–4 units). Filler into the “11” at this stage would be a mistake — the underlying muscle continues to contract and deepen the groove faster than filler can fill it. Relax the muscle first; at 2-week review, assess whether any residual static line requires a tiny filler placement.
A 42-year-old with hollow cheeks and downturned mouth corners
The downturned mouth has two contributors: hyperactive DAO muscle (anti-wrinkle indication — 2–4 units per side) and volume loss in the mid-face that allows the corners to descend (filler indication). A filler-only approach fails because the DAO keeps pulling; an anti-wrinkle-only approach fails because the volume loss remains. Combined treatment is the right answer.
A 48-year-old with “tired” resting face
Assessment: fine line etching across forehead, mid-face volume loss, tear-trough hollowing, skin quality dull. This is the classic case for a staged multi-modal protocol over 4–6 months: anti-wrinkle three-area + cheek and tear-trough filler + Profhilo + a skin rejuvenation course. Not a one-visit problem, not a single-product problem.
The Most Common and Expensive Mistake
Patient comes in asking for filler in their forehead because “the lines are bad.” The lines are dynamic-dominated. They get filled. The underlying muscle continues to contract, the filler lumps around the injection point, and six months later they need hyaluronidase to remove it before anti-wrinkle treatment can be started correctly. They have spent £400 on filler, £250 on dissolving it, and are now starting where they should have started on day one.
Rule: relax the muscle first, assess, fill only if a static groove remains.
Which Should You Start With?
- Dynamic wrinkles, no volume loss → anti-wrinkle only
- Volume loss, no dynamic wrinkles → filler only
- Both → anti-wrinkle first, filler at 2-week review after assessing the relaxed face
- Neither yet → skincare and SPF; come back when indication develops
