Dermal Fillers vs Botox: Which Is Right for You?

"Should I get Botox or fillers?" is probably the most common question patients ask at their first aesthetic consultation. The confusion is understandable — both involve needles, both treat facial ageing, and both get lumped together under "injectables." But they work in completely different ways, treat different concerns, and the choice between them depends on what's actually causing the issue you want to fix.

Here's a straightforward comparison to help you work out which one you need — or whether you need both.

How They Work: Two Completely Different Mechanisms

Botox (Botulinum Toxin)

Botox is a muscle relaxant. It blocks nerve signals to targeted facial muscles, preventing them from contracting. When a muscle can't contract, the wrinkle it creates can't form. This is why Botox works on dynamic wrinkles — the lines that appear when you move your face (frowning, squinting, raising your eyebrows).

Botox doesn't add volume, fill anything, or plump anything up. It simply stops muscles from creasing the skin. Results take 3–5 days to start and 14 days for full effect. For a detailed safety overview, see our Botox safety guide.

Dermal Fillers

Fillers are injectable gels (most commonly hyaluronic acid) that physically add volume beneath the skin. They fill hollows, plump lips, smooth deep creases, and restore volume that's been lost with age. Fillers treat static wrinkles — lines that are visible even when your face is completely at rest — and areas of volume loss.

Results are immediate. You walk out of the clinic looking different from when you walked in. For a complete breakdown of filler types and brands, see our dermal fillers guide.

What Each Treatment Treats Best

| Concern | Botox | Fillers | Best Choice | |---------|-------|---------|-------------| | Forehead lines (horizontal) | Excellent | Poor | Botox | | Frown lines (11s) | Excellent | Moderate | Botox | | Crow's feet | Excellent | Poor | Botox | | Nasolabial folds (nose-to-mouth) | Poor | Excellent | Fillers | | Marionette lines (mouth-to-chin) | Poor | Excellent | Fillers | | Lip volume/shape | Not applicable | Excellent | Fillers | | Cheek volume loss | Not applicable | Excellent | Fillers | | Under-eye hollows | Not applicable | Good (advanced) | Fillers | | Jawline definition | Moderate (masseter) | Good | Depends on cause | | Chin projection | Not applicable | Excellent | Fillers | | Bunny lines (nose) | Good | Not applicable | Botox | | Gummy smile | Good | Not applicable | Botox |

The quick rule: If the line appears when you make an expression and disappears when you stop, Botox is your answer. If the line or hollow is there all the time regardless of expression, fillers are what you need.

Cost Comparison

UK pricing as of 2026:

Botox

• Per area: £150–£300
• Full upper face (3 areas): £350–£500
• Frequency: Every 3–4 months
• Annual cost for full upper face: £1,050–£2,000

Dermal Fillers

• Per syringe (1ml): £200–£400
• Lips (typically 0.5–1ml): £200–£350
• Cheeks (typically 1–2ml per side): £400–£800
• Frequency: Every 6–18 months
• Annual cost for lips: £200–£700

On a per-session basis, Botox is cheaper. On an annual basis, the costs are often comparable because fillers last longer. Many patients budget £1,000–£2,000 per year for a combination of both.

Can You Combine Them? The Liquid Facelift

Yes, and combination treatment is increasingly the standard approach. A "liquid facelift" typically involves:

1. Botox to the upper face — relaxing forehead lines, frown lines, and crow's feet
2. Filler to the mid-face — restoring cheek volume and smoothing nasolabial folds
3. Filler to the lower face — defining the jawline, treating marionette lines, or enhancing the lips

This combination addresses both types of ageing simultaneously: muscle-driven lines (Botox) and volume loss (fillers). A skilled practitioner will plan both treatments together for balanced, natural results. Total cost for a full liquid facelift ranges from £800 to £2,000 depending on how many syringes of filler are used.

Both treatments can be done in the same appointment. Practitioners typically start with Botox, then move to fillers, and the whole process takes 30–45 minutes.

Decision Framework: Which Do You Need?

Ask yourself these three questions:

1. Where is the problem?

• Upper face (forehead, between brows, around eyes) → Botox is almost always the right starting point
• Mid or lower face (cheeks, lips, jawline, nasolabial folds) → Fillers are your primary option

2. What kind of line is it?

• Appears with facial movement, disappears at rest → Dynamic wrinkle → Botox
• Present all the time, even at rest → Static wrinkle or volume loss → Fillers
• Both → You likely need a combination

3. What's your primary goal?

• Prevent wrinkles from deepening → Botox (especially if you're under 35)
• Restore lost volume or reshape a feature → Fillers
• Overall facial rejuvenation → Combination

Key Differences at a Glance

| Factor | Botox | Fillers | |--------|-------|---------| | How it works | Relaxes muscles | Adds volume | | Results appear | 3–14 days | Immediately | | Duration | 3–4 months | 6–18 months | | Reversible? | Wears off naturally | HA fillers can be dissolved | | Pain level | Minimal (fine needle) | Mild (contains anaesthetic) | | Downtime | None | Mild swelling for 1–3 days | | Best for | Expression lines, prevention | Volume loss, contouring, deep lines | | Risk profile | Very low | Low (slightly higher than Botox) |

Common Mistakes to Avoid

Getting Botox for a filler problem. Deep nasolabial folds won't respond to Botox — you need volume replacement. If your practitioner suggests Botox for every concern regardless of the cause, get a second opinion.

Over-filling to compensate for untreated muscle movement. If frown lines are caused by an overactive corrugator muscle, packing the area with filler won't solve the problem long-term. Treat the muscle with Botox first, then assess whether filler is even needed.

Choosing based on price alone. The cheapest option isn't the best value if it doesn't address your actual concern. A good consultation will identify exactly what's causing the issue and recommend the appropriate treatment — which might be neither, or both.

Finding the Right Practitioner

Whether you choose Botox, fillers, or both, the practitioner matters more than the product. Look for someone registered with Save Face (the UK government-approved accreditation scheme), carrying medical indemnity insurance, and willing to spend time on consultation before recommending treatment. Our guide to insurance requirements covers what practitioners should have in place.

Both treatments are medical procedures that carry real (if small) risks. The person injecting your face should have formal aesthetic training, anatomical knowledge, and the ability to manage complications if they arise.

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Dr. Shane McKeown is a medical doctor and the founder of Aestheticc, a clinic management platform built specifically for aesthetic practitioners. He writes about treatments, regulations, and the business of aesthetics from both a clinical and entrepreneurial perspective.