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Interviewer: Botox and fillers, common question, what is the difference and how can they help you? Dr. Eric Cerrati is the Director of Facial Plastic Surgery at University of Utah Health. So, first of all, are Botox and fillers the same? I would say probably not, but that's why you're here. I want to find out.
Botox vs. Fillers: What's the Difference?
Dr. Cerrati: So they're very different. Botox is a neurotoxin. And Botox, it just happens to be the trade name that everyone knows of. But actually, there's three others now that are FDA-approved, and they affect the muscles, whereas fillers are volumizing agents.
Interviewer: Okay. And how are they used differently then?
Dr. Cerrati: So, in general, Botox is used for the upper third of the face. FDA approved for three different areas, which are the horizontal forehead lines, the vertical 11s that you have between your eyes, and the smile lines outside. Obviously, there are some other off-label uses that we tend to use them for. And then, fillers are the lower two-thirds of the face. You know, I'm not a huge fan of using Botox and, you know, around the mouth or other areas, because obviously the lower two-thirds of the face is very mobile and you want to maintain that mobility.
Types of Botox
Interviewer: So kind of give us a general rundown, what are the different types of Botox and fillers? When would you use them? What do they do?
Dr. Cerrati: So Botox, in general, so it's a neurotoxin that's injected into muscles. It takes about two to three days to take effect. I usually tell patients to give it a full seven till you kind of go to the mirror and see what it does. And on average, it lasts about three to four months. After three to four months, you're right back where you started. No better, no worse.
Types of Fillers
Dr. Cerrati: Fillers, on the other hand, you know, there's a whole variety of fillers that are out there. There are permanent ones, and there are, you know, hyaluronic acid ones that are dissolvable. I tend to use the dissolvable ones just for safety because, you know, it's not a benign procedure that should be taken lightly. And the different fillers, they come in different thicknesses, you know. Some are placed deeper. Some are placed more superficial. Some last a year. Some last two years.
Risks of Filler Injections
Interviewer: And when you say safety, what do you mean exactly?
Dr. Cerrati: With any filler injection, there's a risk of bruising and swelling. All hyaluronic acid fillers attract water to a certain degree, so that's how you get the swelling. They pick up red blood cells, and doing so, that's how you end up with the bruise. I don't consider those risks. I consider them known side effects. And there are certain things you can do to try to limit those side effects. Kind of the scary risk that people see and hear about online is more if the filler is injected in or around a blood vessel. That's why it's very important to go to someone who's very knowledgeable about the facial anatomy and where the filler is going and what we're trying to accomplish.
Getting Long-Lasting Results
Interviewer: The dissolvable versus non-dissolvable, so let's just take, for example, maybe under the eye. That would be a place where you might use a filler. Is the dissolvable . . . does that mean that the results don't last as long much like the Botox and the dissolvable would last longer?
Dr. Cerrati: So the filler that I tend to use around the eye will last about a year. Again, after about a year, your body dissolves it or metabolizes it, and you're back to where you started. Under the eye tends to be an area where people will swell and bruise pretty significantly. I tend to use a cannula to try to limit that, you know. And it's also a high-risk area. Given the risk associated with the under the eye fillers, I tend to favor the dissolvable fillers.
Interviewer: Yeah. It sounds like it's a little bit more complicated than just an injection of Botox here, some fillers there.
Dr. Cerrati: Exactly. And, you know, I do all of my injections myself in the office. I just think that I can give a little bit more high-quality product to the patients if I do it that way.
Facial Rejuvenation Procedures
Interviewer: And during either type of treatment, whether it's Botox or fillers, where does this happen? It happens in your office?
Dr. Cerrati: It happens in the office. Actually usually a pretty quick procedure, probably it takes anywhere from 5 to 15 minutes. And a lot of times, we can couple them together to accomplish, you know, full facial rejuvenation. That's where you start to get into things called liquid facelifts. You know, you can use Botox in the neckline to tighten the jaw line. There's a lot of different, you know, kind of off-label uses that you can really accomplish quite a bit with these two modalities.
Choosing a Qualified Surgeon
Interviewer: And it sounds like the advantage of having someone like yourself do the procedure. I mean, you're a surgeon. On the surface, it might seem like it's a little overkill. But a lot of factors involved as to what to use and safety concerns, and it's a balance of outcome versus safety. I think I'm starting to understand why I would come to someone such as yourself.
Dr. Cerrati: So I tend to believe that surgeons are going to have a more thorough knowledge of the anatomy of the face and can place the fillers in the safest way possible to give the longest-lasting result. I think when you're seeing a surgeon for a complication, it's probably not the best setting.
Interviewer: We've talked before about being comfortable with the person that is doing the procedure in the terms of when it's like a facelift, when it's a surgical procedure. These non-surgical procedures with fillers and Botox, does the same thing apply? You should be comfortable with that person?
Dr. Cerrati: Absolutely. So this is very customizable for each patient. And you can think of the surgeon as, you know, someone who's trying to sculpt or mold an image that they have in their face, of how to rejuvenate a patient's face. And so the combination of Botox and fillers and what they can accomplish is very specific to what the surgeon sees and what that patient desires. And so having that conversation before doing any of the injections is very important.
Interviewer: And there are some great surgeons to choose from here.
Dr. Cerrati: Absolutely. So we have a team of surgeons here that offer this. And obviously, Botox and fillers are widely used all across the country and all over the world. But it's very important to go to someone who's well qualified and knowledgeable.
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