Botox and Filler Together or Just One? And if So, Which?

I went for my consultation today for slight under eye wrinkles when smiling. Surgeon recommended one site Botox and one syringe Perlane along each cheekbone. I'm 36 and Latina so have been quite lucky as far as aging, thus, don't want to trade a small problem for a bigger one(ie: hollows, more wrinkles, bags, droopiness,changed eye shape, etc). Should I do just one for now since I'm new at this? I'd hate to overdo it. And I don't want to end up wishing I'd just left things alone.

Doctor Answers 11

Botox and Filler Together

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Botox and fillers, such as Perlane, work very well together.  Botox works by relaxing overactive muscle movement and fillers actually fill in areas of deep folds or volume loss.  It is difficult to determine the best course of treatment, without seeing your skin in person, but I often recommend a combination of Botox and fillers.  

If under eye wrinkles are your main concern, Botox will likely make a significant difference on its own.  However, it seem that the surgeon may have felt that you have some volume loss in your cheekbones that could be corrected with Perlane.  Since this is your first time having either Botox or fillers, I would recommend starting with the Botox.  Most practitioners will have you return to the office after 2 weeks to make sure that the Botox is perfect; at this time you could plan to do the Perlane injections.  By following this plan, you would have a chance to see what the Botox alone can do, and then decide whether to proceed with Perlane for your cheeks.  

New York Dermatologic Surgeon

Botox and fillers

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It is yoru choice how much of either you want to try. Being that you are concerned because it is your first time,. you may want to start off slowly.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Trust Your Instincts

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If you are worried about overdoing it and what to start conservatively, trust your instinct.  It is completely normal to try one of the procedures to see if you like the results.  I would try to Botox first from what you describe.  If like the results, then everyone is happy.  If the results are ok and you want to do more, then add the filler.  If you hate the results, it is all temporary and you will return to normal in a few months time period.  If you are seeing an experience doctor, these procedures are very safe.


I hope this helps.  

Botox + Fillers

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Without seeing you in person, it's difficult to say which is best for you. If you're worried about "overdoing it" I'd recommend trying the Botox first to relax the muscles around the eyes that cause excessive lines especially while smiling. Once you assess how satisfied you  are with that, you can consider the filler. 

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

Botox and Filler Together or Just One? And if So, Which

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Thank you for your question.  Go to a board certified experienced injector.  You did not submit a photo to evaluate your best options, but you will be pleased with the combination of Botox and filler.  If you were to choose one of the treatments, at your age, start with Botox.  Best Wishes.

Be're only 36 and want a small issue corrected...

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if you want anything done, start with the botox...hopefully you'll be happy with nothing more...and if you think something additional is required, then consider a filler...but if it's close to your lid or just under your eye, maybe Restylane might be a better option instead of Perlane...Perlane is certainly a good option for the area on the sides of your cheeks...but it may be too much if you're talking about treatment close to the eyes...

Ken Landow, MD
Las Vegas Dermatologist

Botox and fillers for under the eyes

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The best treatment option really depends on your individual circumstances and goals. In general, an appropriate skincare regimen, resurfacing procedures such as peels and lasers, and finally Botox or Dysport injections can address fine wrinkles under the eyes. For undereye bags, I typically use Restylane in the lower eye areas and then Perlane or Radiesse to fill in the entire cheek (not just the cheekbone). This makes the undereye bags less noticeable. I would recommend a consult with an experienced physician. When you are in good hands, the chances of any negative side affects are greatly minimized. I hope this helps, and good luck! 

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Botox and fillers combination

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Botox and soft tissue filler (e.g. Perlane) are often done and work well in combination: Botox works for upper face dynamic/movement wrinkles, while fillers work for lower face static/more permanent wrinkles.  Sometimes (e.g. when doing Botox & Juvederm), the combination is called the Soft Lift.

Anatoli Freiman, MD
Toronto Dermatologist

Botox with a filler

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Depending on what your aesthetic goals are, you probably have your answer. If it's volumizing, then any dermal filler injected well, will help improve that volume loss. It it's volumizing AND wrinkles you're trying to help avoid, then yes, doing both at the same time help for longer term correction of the area.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Botox and/or filler

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It's difficult to give you exact advice without a picture or seeing you in person.  Both the Botox and the filler together could possibly give you a better result than either one alone.  If you were considering only doing one first and the lines under your eyes are typical crow's feet type lines, then I would recommend the Botox first.  You could always have the filler done later if you were not satisfied with the result from the Botox alone. 

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.