Botulinum toxin or hyaluronic acid: Which treatment is used for which types of wrinkles?

Both procedures are carried out using an injection and are both used to treat wrinkles. That is where the similarities end. They work in completely different ways and are therefore intended for different purposes. This article explains what the difference is and what factors influence the choice between them.

Key points at a glance

• Botulinum toxin temporarily weakens muscle activity. Hyaluronic acid fillers restore volume. These are two different approaches, not alternatives for the same purpose.
• The decisive factor is whether a wrinkle is caused by facial expressions or remains visible even when the face is relaxed.
• Neither of the two procedures is fundamentally better. Which one is suitable depends on the cause, the region and the findings.
• Some changes to the face cannot be effectively treated with an injection at all.

Two different mechanisms of action

• Mechanism of action: Botulinum toxin: temporarily blocks signal transmission to the muscle; hyaluronic acid fillers: restore volume in the tissue
• Typical query: Botulinum toxin: wrinkles caused by facial expressions; hyaluronic acid fillers: loss of volume, contours, wrinkles at rest
• Legal classification: Botulinum toxin: a prescription-only medicine; hyaluronic acid fillers: a medical device; purely aesthetic fillers are considered products without a medical purpose
• Effective date: Botulinum toxin: initial changes usually appear within one to two days; full results are generally seen after around three to ten days; hyaluronic acid fillers: results are visible immediately; final results are seen once the swelling has subsided
• Duration of action: Botulinum toxin: in the upper face, predominantly around three to five months in studies, varying from person to person; hyaluronic acid fillers: no universal figure; depends on the area, product and quantity
• Main risks: Botulinum toxin: effects on neighbouring muscles, such as drooping eyelids, lowered eyebrows or asymmetry; hyaluronic acid fillers: lumps, swelling, infection, displacement of the filler material, rarely vascular occlusion

The table already shows why a direct comparison is misleading. The question is not which procedure is more capable, but which is appropriate for the specific cause in question.

Expression lines and static wrinkles

Expression lines are caused by muscle movement. They appear when you furrow your brow, squint or laugh, and smooth out again when you are relaxed. They are caused by the repeated folding of the skin due to the underlying muscles.

Static wrinkles are visible even when your face is completely relaxed. Their causes lie elsewhere: a loss of skin elasticity, loss of fatty tissue, changes in bone structure and the effects of gravity over the years.

This distinction is idealised. In practice, the two components overlap, because skin that has been repeatedly creased over the years can, over time, develop a permanent line. This is precisely why the question of the most suitable method cannot be answered simply by the name of the wrinkle, but only by assessing your face both at rest and in motion.

Which question is appropriate for which procedure

Botulinum toxin is typically considered where muscle activity is the decisive factor. This applies primarily to the upper third of the face, which is also the area covered by the products’ marketing authorisation. The effect is achieved by reducing the intensity of the triggering movement, not by filling anything in. If treatment is carried out outside the authorised areas, this is done off-label and must be discussed accordingly.

Fillers are used where volume is lacking or where a contour needs to be altered. This tends to apply to the middle and lower thirds of the face, as well as areas where a loss of volume explains the visible change. The effect is immediately visible because material is injected.

In some situations, both procedures are combined, for example when both muscle activity and volume loss contribute to the findings. Whether this is appropriate and in what order is a medical decision and not a matter of choosing a package of services.

Important to note: Both procedures have a limited duration of effect, albeit for different reasons. With the medication, the body restores signal transmission; with fillers, the material is broken down. For botulinum toxin, study data are available primarily for the upper face, with the effect generally lasting around three to five months. No comparable general figure can be given for fillers. In both cases, the duration varies considerably from person to person.

When an injection isn’t the answer

Not every change in the face has a cause that can be effectively addressed with an injection. These include pronounced sagging of the skin, significant excess skin, or changes that are primarily due to sun damage and skin quality.

The area under the eyes is another common example. What is perceived as a shadow can have a wide variety of causes, ranging from the anatomy of the bone to skin texture and swelling. Fillers are only suitable here in certain circumstances, and the area is considered challenging, partly because it is one of the areas with an increased risk of vascular complications.

A reputable consultation will highlight such limitations and, where appropriate, suggest alternative approaches – such as treatments to improve skin quality – or advise against the procedure. Any offer that responds to every query with an injection should make you wary.

Why the choice of method requires investigation

Two people with a wrinkle that looks similar may have different underlying causes and therefore require different treatments. It is necessary to assess how your face moves, which muscles are involved and to what extent, where there is a loss of volume, and what the skin texture is like. This cannot be determined from a photograph or a description online.

There is also the question of whether there are any contraindications at all: pre-existing conditions, medication, inflammation in the treatment area, pregnancy and breastfeeding, as well as previous treatments and their outcomes. Furthermore, both procedures are restricted to adults.

A good consultation therefore includes an examination, an explanation of which procedure is being recommended and why, and a frank discussion of what can and cannot be achieved with it. Find aesthetic medicine practitioners near you

Frequently Asked Questions

Which method is better?

It is not possible to answer this question because the procedures address different causes. A filler cannot address the underlying cause of a wrinkle caused by muscle activity, and botulinum toxin does not replace lost volume. The relevant question is which procedure is best suited to your specific condition.

Can both procedures be combined?

This occurs when several factors interact. Whether a combination of treatments is appropriate, and to what extent and in what order, is determined by the examination. More procedures do not automatically lead to a better outcome.

Which lasts longer?

Both procedures have a temporary effect, with significant individual variations. Studies predominantly report a duration of approximately three to five months for botulinum toxin in the upper face. There is no comparable general figure for dermal fillers, as the area treated, the product used and the amount administered determine how quickly they are broken down. A blanket comparison is therefore of little significance.

How can I tell what type of wrinkle I have?

A first point of reference: take a look at the wrinkle when your face is relaxed. If it remains clearly visible, causes other than facial expressions are at play. However, this is no substitute for a proper assessment, as both factors can overlap.

Classification

The difference between the two methods is not one of degree but of principle: one acts on movement, the other on volume. Those who understand this distinction can better contextualise consultations and recognise more quickly when a treatment option does not address the actual cause.

A consultation with a doctor will determine which procedure is suitable for you, or whether an injection is the right course of action at all. View aesthetic medicine practitioners by region

Fact-checking as at 20 August 2026. Core topics reviewed: Onset and duration of action of both procedures in accordance with AWMF S1 Guideline 013-077 (as at 15 May 2022) and product information, legal classification of medicinal products versus medical devices in accordance with Regulation (EU) 2017/745, Annex XVI, risk profiles of both procedures, comparison of the table with Articles 13 and 14.