Neurotoxin or Filler? Dermatologists Explain How to Decide

Neurotoxin treatments cost $300 to $1,500 per visit and last three to four months; hyaluronic acid fillers start at $500, can run to several thousand dollars, and hold their correction for six to 18 months. Those numbers, laid out by Omaha, Nebraska dermatologist Daniel Schlessinger, MD, frame the most common decision patients face at the injectables counter: muscle-relaxer or volume-restorer?

"If a line becomes more pronounced when you frown, squint or raise your eyebrows, it will generally benefit from a neurotoxin," Dr. Daniel Schlessinger said. "If the concern is lost volume or a contour you want to enhance, filler may be appropriate."

Three board-certified dermatologists — Daniel Schlessinger, MD and Joel Schlessinger, MD, both of Omaha, and Jody Levine, MD of New York — explained the differences between the two injectable categories, covering treatment areas, FDA approvals, cost, longevity and downtime.

What do neurotoxins and fillers actually do?

Neurotoxins — the category that includes Botox Cosmetic, Xeomin, Dysport, Jeuveau, Daxxify and Letybo — relax muscles. Fillers restore volume. But the line between them is thinner than it looks. Neurotoxins can subtly lift areas like the brows or neck by relaxing the muscles that pull them downward, Daniel Schlessinger said.

"Fillers volumize, but they also lift," Dr. Jody Levine said. "A good injector understands how to use both modalities to get the perfect result."

Which areas can each treat?

Neurotoxins have moved well beyond the forehead. They "used to be reserved for frown lines (the '11s'), forehead lines and crow's-feet. Today they are commonly used across the face and neck, including the masseters, the platysma (the 'Nefertiti Lift') and the mouth area (DAO muscle and chin)," Joel Schlessinger said. "These newer areas are more complex and should be treated only by an experienced professional, such as a board-certified dermatologist."

FDA approvals vary by brand:

• All major neurotoxins are approved for frown lines.
• Xeomin is also approved for forehead lines and crow's-feet.
• Botox Cosmetic covers those areas plus platysma bands, making it the only neurotoxin approved for the neck.
• Masseters, the DAO muscle and the chin remain off-label uses.

Fillers restore volume or definition in the cheeks, lips and chin, and are increasingly used on the neck and décolleté, Joel Schlessinger said. The approved list keeps growing:

• Belotero Volume (+) is now approved for the midface; Belotero Intense (+) for the lips; Belotero Balance (+) for facial wrinkles, folds and under-eye hollows.
• Radiesse, a calcium hydroxylapatite filler, was approved in April 2026 for décolleté wrinkles.
• Skinvive by Juvéderm became the first hyaluronic acid injectable approved to reduce neck lines two months later.

Combination treatment is common. "We often combine the two when muscle movement and volume loss both contribute, such as selected lines around the mouth, because the pairing tends to improve both the overall result and its longevity," Joel Schlessinger said.

What about cost over time?

Newer neurotoxins may last up to six months, and some people need fewer units over time, so neurotoxin costs do not change much with age, Daniel Schlessinger said. Fillers work differently.

"I tell my patients that with fillers, you pay for your age, because facial fat diminishes or descends over time and filler is there to correct that," he said. "Filler should be reassessed before adding more, rather than automatically repeated on a calendar." A small number of people also become less responsive to neurotoxins with repeated treatment.

How much downtime should you expect?

Neurotoxin injections "feel like quick pinpricks, usually involve little downtime and begin working within three to seven days, with results generally assessed around two weeks," Joel Schlessinger said. Hyaluronic acid filler produces an immediate change; swelling typically starts an hour or two after treatment and lasts about a day, with two weeks for the product to fully settle. Filler tends to be more uncomfortable than neurotoxin, though numbing helps, and both can feel tight or sore for up to a week. Bruising often depends on the injector's experience.

The practical takeaway: lines that deepen with movement point to neurotoxin; lost volume or a contour to enhance points to filler. Patients who start with a board-certified dermatologist get a diagnosis of the anatomy behind the concern — not just the wrinkle — before the first needle goes in.