Botox, the number one cosmetic procedure in the world, is a treatment that has been around for decades. It works by reducing wrinkles and lines on the face and neck. This can be done with injections or by removing these lines from your face with laser surgery.
Filler injections are used to correct facial wrinkles and lines, as well as dimples, scars and other flaws in your skin. They are injected into problem areas of your face using a small needle that is placed into the dermis layer of skin. The injection process takes just minutes to complete and will last between 4-8 months depending on the amount used and how much time you have had to heal before getting treatment again. Filler injections are temporary but can give you the appearance of smoother skin for years after getting them done.
You’ll read about botox injections for migraines side effects and how to get botox for migraines covered by insurance in this treatise.
How Botox And Filler Injections Help Migraines
Researchers are eager to learn how botulinum toxin-based drugs help relieve migraine pain. Evidence suggests that the drug interrupts the pathway of pain transmission between the brain (central nervous system) and nerves that extend from the spinal cord.
When you have a migraine, your body releases substances called neurotransmitters and molecules that are associated with pain. Botulinum toxin interferes with the transmission of these substances, typically where the nerves and muscles meet. Researchers think that when the drug is injected into the muscles around the face, head and neck, it is taken up by the nerves and interferes with pain-associated neurotransmission.
The popularity of injectables is on the rise and has been for over a decade. While Botox is still number one, dermal fillers are quickly encroaching on that spot.
Either way, the more pressing issue is selecting the right option for your skin if you choose to give these treatments a try. Knowing the differences between all of your options is a job for the pros, so we called in the experts and asked them to give us all the details.
MEET THE EXPERT
- Dr. Matthew Schulman is a New York City based board-certified plastic surgeon.
- Dr. Dara Liotta is a dual board-certified facial plastic surgeon practicing on the Upper East Side of Manhattan.
- Dr. Munique Maia practices in Virginia and Maryland at Maia MD, which provides non-surgical and medspa services as well as comprehensive plastic surgery services.
What Is Botox?
First things first: plastic surgeon Dr. Matthew Schulman points out that Botox is the brand name of a specific botulinum neurotoxin. There are four FDA-approved neurotoxins available in the U.S.: Botox, Dysport, Xeomin, and Jeauveau.2
So, how does it work? “Botox or any neurotoxin works by temporarily weakening or paralyzing the muscles,” says Harvard and Cleveland Clinic board-certified plastic surgeon Dr. Munique Maia.
“Botulinum toxin is best used in areas of facial expression such as the frown lines, crow’s feet, and ‘11s’ between the eyebrows,” says Dr. Schulman.
Botox, adds Dr. Maia, “treats dynamic wrinkles, though some relatively non-cosmetic uses for Botox are incredibly popular as well: injections in the armpits can help stave off hyperhidrosis (excess sweating), and injections in the jaw muscle can be used to prevent teeth grinding caused by TMJ.3 According to plastic surgeon Dr. Dara Liotta, Botox will start to work between 2-10 days, “depending on your individual reaction to the toxin and which toxin is used.”
What Are Fillers?
“Hyaluronic acid fillers are gel-like products that fill folds and creases and replenish lost volume. They can also contour the face,” Dr. Maia says.
Hyaluronic acid is a naturally occurring polysaccharide found in the human body. It acts as a cushioning and lubrication agent for our joints, nerves, hair, skin, and eyes. When used in skincare, it acts as a moisture binder, which means that it will attach itself to the water in the cells (while also attracting and holding water from the air) making them plump.
Fillers can be of a variety of temporary or permanent materials, and are used to fill lines. Hyaluronic acid fillers like Restylane, Juvederm, and Belotero, and calcium fillers like Radiesse are the most common.4 Dr. Schulman explains, “While both botulinum toxin and fillers are commonly used together, they work differently and are used on different lines.”
Hyaluronic acid fillers, which come in a variety of thicknesses so that the right one can be chosen for each particular skin type, last 5-24 months. “There are other fillers composed of [calcium hydroxyapatite] (like Radiesse), which are better for deep filling and can last 12 to 14 months,” Dr. Schulman says.
Botox vs. Fillers: Which Is More Effective?
The effectiveness of either procedure depends on what you’re in need of. Botox, for instance, can be used preventatively (ie. even before you’re really noticing any deep-set wrinkles).
“I have a lot of patients in their mid-twenties that do preventative Botox,” says Dr. Maia. “They want to prevent wrinkles from forming. They are hyper aware of their faces and want to improve their appearance.”
The most common areas for fillers, meanwhile, are “under eye, cheeks and jawline,” Dr. Maia says. “The choice of each product depends on the area of concern.”
The simple rule? “Lines of expression need botulinum toxin. Lines at rest need filler.” Dr. Schulman says that while Botox is a great choice for hitting those “crease points” where muscles contract, fillers are best for deep lines that are present even when facial muscles are not contracting. Check out the chart below for a guide to the lines on the face for which botox and fillers should be used, respectively.
Botox Injections For Migraines Side Effects
- Bruising or swelling at the injection site
- A bluish cast to the skin
- Acne-like bumps under the skin
“The fillers currently available and FDA-approved in the United States have been tested extensively and are safe,” says Dr. Dara Liotta.
The most likely side effects of either Botox or filler are bruising and pain at the injection site—the same as any injection, not exactly a toxic reaction.2 If you’re experiencing something like eye dryness, a crooked smile, drooling, or a drooping eyelid, this is not normal. Per Dr. Liotta, “Under no circumstances are trouble seeing, speaking, or breathing reasonable reactions to Botox.” If you experience any of these symptoms, you need to contact your board-certified injector immediately.
The solution in Botox and other brands like Myobloc is a very, very diluted form of botulinum and the formula itself is honestly the last thing you should be worried about. At the top of your list should be getting a qualified doctor, because that’s the easiest way to avoid any negative side effects.
Side effects specificially from filler include the Tyndall effect, which Dr. Liotta explains is the appearance of a bluish cast to the skin, and “can occur if thicker hyaluronic acid fillers are injected too superficially beneath the surface of the skin. The Tyndall effect can be treated by injecting a small amount of hyaluronidase (the enzyme that dissolves hyaluronic acid filler) into the area.”
Dr. Liotta continues, “Acne-like bumps beneath the skin are an exceedingly rare complication. Much more common are bruising, tenderness, and mild swelling at the injection sites that may last up to 2 weeks.”
Keep in mind that the more severe “side effects” like the Tyndall effect and bumps beneath the skin are not actually true side effects, but rather complications that occur from improper injection.4 That’s why it’s crucial to only receive injections (whether medical or cosmetic) from a board-certified injector.
The average cost of Botox injections is $466, according to 2020 statistics from the American Society of Plastic Surgeons. The cost, of course, can vary, and is generally based on how advanced wrinkles are (and therefore how much product is needed) and the qualifications of the person performing the procedure.
The price of fillers varies widely depending on the product. The most recent statistics from the American Society of Plastic Surgeons found the average syringe of Radiesse was $717, while hyaluronic acid fillers such as Juvederm and Restylane were priced at $684.
How To Get Botox For Migraines Covered By Insurance
You may need to meet certain criteria to get Botox approved by your insurance company. This can include things like:
- History of chronic migraines (15 or more headaches each month for at least 3 months)
- Tried at least two other treatments without any improvement
To confirm this, they may ask that you work with your healthcare provider to submit a prior authorization form.
Like with any prescription medication, it’s important to work with your healthcare provider and insurance company. They can help you see what part of your treatment is covered and what you will be expected to pay out of pocket.
The Final Takeaway
Botox and fillers have more impact on quality of life than we initially thought, explains Dr. Maia, and could have impacts that go further than skin-deep. “The impact of these products in facial appearance and facial expressions are much more complex than what it appears. For example, there is a new concept that fillers can modulate the action of muscles of facial expressions resulting in improvement of facial appearance. Botox has a wide range of indications that goes beyond wrinkle reduction. It can reduce sweating, teeth grinding, headaches and more recently there are studies showing that it may lessen depression.”
Of course, both fillers and Botox come with their own risks and sets of advantages, and they’re not really used for the same thing. While botox is used to deal with wrinkles, it does so by paralyzing the muscles surrounding them. Fillers, on the other hand, do exactly what they sound like by filling in the areas they’re injected into.
“The best thing to do is to see a board-certified plastic surgeon or a dermatologist,” Dr. Schulman says. “They will be able to evaluate your skin and help you select the best treatment for your skin, desires, and pocketbook.”
Botox vs Filler: Which one is better?
It depends on your area(s) of concern. As Lines Dr. Schulman, a handy guide is: “Lines of expression need [botox]. Lines at rest need filler.” Filler would also be appropriate for any areas of the face that you want more contoured.
How much is Botox? Filler?
Prices will vary based on how many units are used, as well as the qualifications of the professional performing the treatment. The price of Botox injections in 2020 averaged $466, while the average cost for a syringe of Radiesse was $717 and hyaluronic acid fillers, such as Juvederm and Restylane, were priced at $684.
Which lasts longer: Botox or filler?
Once again, it depends. Hyaluronic acid fillers, which come in a variety of thicknesses so that the right one can be chosen for each particular skin type, last 5-24 months. Botox can last around 3-6 months.