In aesthetic-oriented medicine, physicians can perform injections of botulinum toxin or hyaluronic acid. Many patients wonder about the difference between these two methods. In reality, the characteristics and applications of the two products are quite different. Botulinum toxin is recommended to reduce certain expression lines by decreasing the activity of specific muscles, whereas hyaluronic acid is a filler used to visibly smooth wrinkles and also to restore volume for facial contouring. Although often confused, these two products are distinct, yet they can complement each other effectively.
Confusion between these two products commonly used in aesthetic-oriented medicine is frequent. This misunderstanding stems from their similar mode of application, namely injection. Both botulinum toxin and hyaluronic acid are used in aesthetic medicine to achieve facial rejuvenation without surgery.
They also share another point in common : their effects are temporary. For botulinum toxin, maintaining optimal results requires renewing the injections approximately every six months. As for hyaluronic acid, the duration of its effects depends both on the treated area — more or less mobile — and on the type of acid used, which can be more or less cross-linked. In general, the results last between 10 and 12 months.
The action of botulinum toxin on the skin is not the same as that of hyaluronic acid. Botulinum toxin has a muscle-relaxing effect, neutralizing the contraction of muscles responsible for expression lines such as the glabellar line (frown line), crow’s feet, and forehead wrinkles. It therefore induces a slight paralyzing effect on the muscles, which explains the somewhat “frozen” look often criticized when excessive amounts are injected. Botulinum toxin is also used to treat primary axillary hyperhidrosis. Hyaluronic acid, on the other hand, smooths wrinkles through a filling effect. At the same time, it is recommended to create or restore volume — for example, to sculpt and define the cheekbones when the doctor observes a loss of malar fat. It is also used for contouring, facial enhancement, and medical lifting techniques.
The choice of product also depends on the type of wrinkles to be treated. So-called dynamic wrinkles appear during facial movements and are linked to the repeated activity of certain muscles. These expression lines, mainly located on the forehead, the glabella, and around the eyes, are the primary indication for botulinum toxin.
Static wrinkles, on the other hand, result from a gradual loss of skin volume, tissue relaxation, and a decrease in collagen and elastin fibers. They are visible even at rest. Hyaluronic acid is therefore the treatment of choice to fill these depressions, restore skin density, and provide structural support to the face.
The main goal of a treatment with botulinum toxin or hyaluronic acid is to preserve the patient’s proportions and identity. A successful injection should not be noticeable; it should simply be perceived through a refreshed appearance and a relaxed expression.
Botulinum toxin helps prevent facial expressions that create a stern or tired look while maintaining natural mobility. The idea is not to freeze the face but to modulate the muscles responsible for excessive tension.
Hyaluronic acid restores support where it has been lost over time, reshapes volumes, and rebalances proportions. This technique enhances facial features while preserving the skin’s suppleness and youthful appearance.
Injection procedures require a thorough knowledge of anatomy, as well as a deep understanding of tissue behavior and facial expressions. Each product has its own specific injection depth, appropriate dosage, and particular technique. Botulinum toxin is injected into the muscle through very precise points, calculated according to facial dynamics. Hyaluronic acid can be injected at different depths : superficially to improve skin quality, at an intermediate level to smooth fine lines, or deeply to restore facial structure or create volume.
Safety is the top priority. A detailed medical assessment, a careful examination, and a precise execution of the procedure ensure a reliable and tailored treatment. Possible side effects are generally limited to mild bruising, redness, or temporary discomfort.
The effects of injections change over time and require regular follow-up. Botulinum toxin provides results that develop gradually over a few days and reach full effectiveness after about two weeks, before gradually diminishing after several months. A biannual maintenance session helps maintain stable results and prevents the progressive reappearance of expression lines.
For hyaluronic acid, the results are visible immediately. The skin appears smoother, the face more defined, and the volumes restored. Depending on the injected area and the type of product, the duration of effectiveness varies but often exceeds ten months. The gradual breakdown of the product ensures a smooth and natural transition between sessions.
While the word “acid” may sound intimidating to some, hyaluronic acid is in fact a completely biodegradable and biocompatible substance. Hyaluronic acid (HA) is naturally present in the human body. This molecule is found in the dermis, in the synovial fluid of the joints, and in the aqueous humor of the eye. Playing a key role in the healing process and in protecting against ultraviolet rays emitted by the sun, hyaluronic acid is known for its ability to capture and retain water within tissues, helping to deeply rehydrate the skin. With age, the skin loses firmness and elasticity as the production of collagen and hyaluronic acid decreases. The cells of the epidermis regenerate more slowly, tissues loosen, and wrinkles and fine lines appear.
In addition to its hydrating properties, hyaluronic acid is also an excellent filling product. When injected subcutaneously, this substance tightens and plumps the skin, visibly reducing wrinkles that alter facial expression, such as nasolabial folds and marionette lines. Because it is natural, hyaluronic acid is extremely well tolerated by patients, and injection side effects are rare and minor. Over the past few years, hyaluronic acid has become the flagship product of aesthetic-oriented and anti-aging medicine. Involving no surgical procedure, the method of hyaluronic acid injection in Geneva and elsewhere is performed in-office.
The combination of both techniques now represents the most advanced approach for harmonious rejuvenation. Botulinum toxin prevents the worsening and softens dynamic wrinkles, while hyaluronic acid restores lost volume and improves skin quality. Together, they correct different mechanisms of aging, working simultaneously on muscle dynamics, skin structure, and deep hydration.
This combined treatment, adjusted according to the proportions and needs of each face, achieves a more natural and longer-lasting overall result than an isolated approach. It forms the foundation of modern medical facial rejuvenation strategies, emphasizing prevention and harmony rather than drastic transformation.
Article written by Dr Romano Valeria
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