Juvederm vs. Botox: Which Injectable Wrinkle Treatment Suits You Better?

Juvederm vs. Botox Comparison: Juvederm and Botox are two popular anti-aging treatments that work differently. The first is a dermal filler, while the second is a muscle paralyzer. Besides their action mechanisms, these drugs also differ vastly in their indications, benefits, risks, and effect onset and duration. 

You may have been considering getting one of these treatments but aren’t sure which is suitable for you. That is understandable—it’s easy to confuse one with the other until you go to a dermatologist visit. Read on as I explain the critical differences between these two injectables.

What Is Juvederm, and How Does It Make You Look Younger?

Juvederm is a bacteria-derived, non-animal-sourced hyaluronic acid (NASHA). This drug is related to the hyaluronic acid moisturizers people commonly use at home. However, Juvederm has a more complex formulation, making it a much more powerful water absorbent.

Water absorption expands hyaluronic acid molecules. With the expansion, Juvederm can lift skin creases and smoothen static wrinkles from within the skin’s deep layers, collectively called “dermis.” The drug can also restore facial volume, which we lose as we age. Thus, Juvederm and other hyaluronic acid injectables are called “dermal fillers.”

Juvederm and other hyaluronic acid dermal fillers are biodegradable. An enzyme called “hyaluronidase” gradually digests these molecules in the tissues. Juvederm lasts for a year up to 18 months, depending on the specific formulation. 

What Are the Indications for Juvederm?

Hyaluronic acid fillers like Juvederm are FDA-approved for correcting moderate-to-severe facial wrinkles and folds, such as laugh or smile lines (nasolabial folds). Juvederm filler treatment is also used for volumizing the mid-facial region in adults older than 21.

Dermatologists have likewise used hyaluronic acid dermal fillers off-label to augment the following areas:

• Upper lip
• Around the lips
• Above the brows
• Earlobes
• Back of the hands
• Cheeks
• Under the eyes

Juvederm treatment may be combined safely with other cosmetic procedures like radiofrequency, intense pulsed light, and Botox injection for treating complex skin aging signs. Note that a dermal filler like Juvederm may look unnatural in patients without tissue volume problems.

What Is Botox, and How Does It Make You Look Fab?

Botox is a renowned brand name for botulinum toxin, a bacteria-derived nerve toxin with various medical and cosmetic applications. As an anti-aging drug, Botox smoothens dynamic wrinkles—those facial wrinkles formed by repeated muscle use—by paralyzing the facial muscles. Thus, it is frequently called a “wrinkle relaxer.” Neuromodulators like Botox do not directly improve skin texture or static wrinkles, which result from collagen and tissue volume loss.

Like Juvederm, the tissue’s digestive enzymes also break down Botox molecules and terminate their actions. Botox’s relaxing effect lasts 3-4 months on average. Frequent or high-dose Botox use may result in antibody formation, which can shorten the duration of its effects. Additionally, Botox injection in the wrong areas or using an excessive dose produces the frozen-face look.

What Is Botox Cosmetic Injection Indicated For?

Botox cosmetic treatment is FDA-approved for smoothening moderate-to-severe wrinkles in the following regions:

• Glabella or the area between the brows (wrinkles here are called “elevens” or “frown lines”)
• Forehead (“forehead wrinkles” or “forehead lines”)
• Corners of the eyes (“crow’s feet”)

Off-label applications include the following:

• Smoothening of nasal wrinkles, also known as bunny lines
• Nonsurgical nose lift
• Treating repeated nasal flare
• Smoothening of wrinkles around the lips, also known as smoker’s lines
• Nonsurgical brow lift
• Smoothening chin and neck wrinkles
• Relaxing “marionette lines” around the nasolabial fold areas
• Improving gummy and asymmetric smiles

Botox treatment may also be combined with other procedures, such as facial plastic surgery, dermal filler injection, and laser therapy.

Juvederm vs. Botox: How Else Do These Injectables Differ?

Juvederm and Botox differ in other aspects besides their action mechanisms and effects. Other important factors to consider clinically when choosing between the two include action onset and duration, safety profile, and posttreatment care complexity. Safety profiles help clinicians determine which treatments will help patients avoid complications. Meanwhile, the other factors matter if a treatment can potentially disrupt daily activities.

Does Juvederm Work Faster Than Botox?

Yes, you will see immediate results following Juvederm injection. The treated area will look plump right away after the session. Initially, the injected site may look overcorrected because of the drug’s suspending fluid. The tissues will absorb the injection fluid after a day or two, and you will see Juvederm’s full effects by then. The drug’s volumizing action will wear off after 12-18 months, depending on the formulation used.

By comparison, it takes 1-3 days on average for muscle relaxation to begin after Botox injection. The drug’s full effects will be evident by the end of the second week. By the third or fourth month, fine lines will begin to reappear as the facial muscles recover their strength.

Juvederm vs. Botox Lasting Effects: Does Juvederm Last Longer?

Yes, Juvederm lasts longer than Botox. Juvederm has several formulations, some lasting in the tissues for a year while others linger for up to 18 months. Botox typically wears off after 3-4 months.

Is Juvederm Safer Than Botox?

In the context of Juvederm vs. Botox, drug safety significantly hinges on patient sensitivities. Both cosmetic agents cause immediate, transient inflammation and have mild redness, discomfort, and swelling as their most common side effects. Though Juvederm and Botox are generally safe, each can elicit unique tissue reactions in vulnerable individuals.

In Juvederm’s case, a bluish skin discoloration known as the Tyndall effect may result if the drug is injected too superficially. Water binding by hyaluronic acid increases in the superficial dermal layers. Water bound to hyaluronic acid reflects the blue component of white light, giving the skin a blue tinge.

Small lumps may result from using the wrong technique when injecting Juvederm. Additionally, the trace bacterial contaminants in NASHAs may produce an immune reaction or, rarely, an infection. The intensity of NASHA immune reactions varies individually.

Blood vessel obstruction due to pressure from the dermal filler or direct injection into an artery is also possible if the provider is inexperienced. This catastrophic complication can result in skin ulceration, blindness, and stroke-like symptoms. Hyaluronidase and steroid injection can relieve the pressure and clear the skin manifestations easily. However, eye and nerve damage may be permanent if the blood vessel obstruction is not treated right away.

Hyaluronidase injection can remove poorly placed hyaluronic acid fillers. Immune skin reactions may improve with steroid or hyaluronidase injection. Antibiotics can get rid of infections from dermal filler treatment. Blood vessel obstruction can only be avoided if the dermal filler injector has a good knowledge of anatomy.

Meanwhile, Botox’s unique complications, though rare, include the following:

• Allergic reaction
• Headache
• Altered sensation on the treated site
• Antibody formation
• Stroke-like facial expression
• Frozen-face look and other undesirable cosmetic effects
• Double vision

Botox itself will not cause an infection. However, such a complication may arise if the neuromodulator is injected without cleaning the treatment area. Additionally, Botox may produce deadly botulinum toxicity, manifesting as difficulty breathing, speaking, and swallowing. 

Note that severe adverse effects from these drugs are rare but typically arise from inappropriate use by inexperienced providers. Trusting a board-certified dermatologist to perform these cosmetic procedures ensures their safety and effectiveness.

Is Juvederm Recovery Easier Than Botox Recovery?

Both Juvederm and Botox have straightforward recovery processes. Cosmetic injections do not create big skin defects needing meticulous aftercare, unlike procedures like CO2 laser skin resurfacing and plastic surgery. Additionally, Juvederm and Botox injections require only minimal to no downtime.

Juvederm posttreatment care measures include the following:

• Repeated icing of the injection site
• Avoiding heat on the treated area for 48 hours
• Refraining from picking on the injection site
• Cold-sore medication intake
• Arnica or bromelain intake for bruising

Meanwhile, the aftercare regimen for Botox cosmetic injection consists of the following:

• In the first 4 hours after treatment, avoid lying on your back, scratching the injection site, applying pressure or heat to the area, and activities that cause facial flushing.
• Icing of the injection site if bruise-prone
• Protection of the treated area from trauma for a few days
• Bromelain or arnica intake for bruising

Other helpful measures to help you recover after Juvederm or Botox injection include elevating the injected site and avoiding harsh chemicals the first few days after treatment. The first measure minimizes swelling, while the second avoids further irritation to healing skin.

How Do You Choose an Injectable Treatment?

Choosing an anti-aging procedure should be primarily based on clinical grounds. As clinicians, our medical findings guide us in determining which wrinkle treatment will be safe and effective for each patient. Therapeutic plans must be personalized.

For example, both Juvederm and Botox improve wrinkles, but only Juvederm can address tissue volume loss. Patients who do not need more volume are better off using Botox unless they have contraindications to neuromodulators or want to augment certain parts of the face. Meanwhile, patients who have developed Botox resistance from antibody formation may consider Juvederm instead.

Considering the potential for activity disruption is essential when comparing Juvederm vs. Botox. Both Juvederm and Botox have easy aftercare regimens. However, Botox maintenance treatments are more frequent and, thus, potentially disruptive due to the duration of the drug’s effects. Note, however, that many patients with complex skin problems combine these injectables as long as they don’t have medical contraindications to either drug.

How Do You Maximize the Benefits of Your Injectables?

The most important measures you can take to optimize Botox and Juvederm’s benefits are the following:

• Good pretreatment preparation and aftercare – Preparing well for your appointment and strict adherence to the prescribed aftercare regimen help avoid complications during recovery.
• Meticulous skin care – Nothing can stop the aging process, and Juvederm and Botox’s anti-aging effects are temporary. However, good skin care can slow down facial aging by minimizing oxidative stress.
• Healthy lifestyle – Regular exercise, a balanced diet, adequate sleep, and stress management are all parts of a healthy lifestyle. Healthy habits keep you free of physical and mental stress, which can speed up the aging process.
• Sun protection – We all love a bit of sun, but too much can accelerate skin aging. Protecting the skin from excessive UV exposure keeps away the signs of photoaging and skin cancer.

Most importantly, choose a board-certified dermatologist to perform your cosmetic procedure. Botox and Juvederm are powerful beauty boosters but can produce disfiguring side effects in inexperienced hands. Only a highly trained cosmetic specialist can ensure the best aesthetic and safety outcomes from your Botox or Juvederm treatment.

A Recap of Juvederm vs. Botox

Juvederm and Botox are two powerful wrinkle treatments that offer a range of benefits for those seeking to improve their appearance. Both treatments have unique advantages and disadvantages. The choice will ultimately come down to personal factors. Thus, therapeutic approaches using these cosmetic agents must be personalized.

Regardless of which treatment you’re having, the best ways to maximize their benefits include good pre- and posttreatment care, religious skin care, adopting a healthy lifestyle, and sun protection. Most importantly, remember that Botox and Juvederm’s aesthetic effects largely depend on your provider’s skill. Therefore, choosing a highly experienced cosmetic specialist is your best move to get the most from Botox or Juvederm injection.

Award-Winning Juvederm and Botox Specialists in LA

In the Juvederm vs. Botox debate, both treatments stand out as popular options for facial lines unresponsive to topical medications. A highly skilled cosmetic specialist can give you the best results from these procedures. At BHSkin Dermatology, our skincare specialists are some of California’s best. Visit us at our Glendale or Encino office or use our telederm platform for your initial consultation.

Book your appointment today!

Sources:

1. Bellows, S. and Jankovic, J. (2019, August 26). Immunogenicity Associated with Botulinum Toxin Treatment. Toxins. 11(9). https://doi.org/10.3390/toxins11090491 
2. Donofrio, L. M. and Ellis, D. L. (2019). Chapter 215: Soft Tissue Augmentation: Hyaluronic Acids. Fitzpatrick’s Dermatology, 9th ed. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210447284 
3. Funt, D. and Pavicic, T. (2013, December 12). Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clinical, Cosmetic and Investigational Dermatology. 6. 295-316. ​​https://doi.org/10.2147/ccid.s50546
4. Glogau, R. G. (2019). Chapter 216: Botulinum Toxin. Fitzpatrick’s Dermatology, 9th ed. McGraw Hill.  https://accessmedicine.mhmedical.com/content.aspx?bookid=2570&sectionid=210447387
5. Small, R. (2014, August 1). Botulinum Toxin Injection for Facial Wrinkles. American Family Physician. 90(3). 168-175. https://www.aafp.org/pubs/afp/issues/2014/0801/p168.html
6. Viscusi, K. S. and Hanke, C. W. (2017). Soft Tissue Augmentation: Hyaluronic Acid. In R. Baran and H. I. Maibach (Eds.) Textbook of Cosmetic Dermatology (5th ed, pp. 473-476). Taylor and Francis Group. https://dl.pezeshkamooz.com/pdf/dglibrary/book/medical/dermatology/cosmetic-dermatology.pdf 

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.