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It’s become known as the go-to eraser of frown lines and furrows, yet Botox and other smoothers are still toxins. Fillers, which are basically hyaluronic acids, can do the same thing and, until recently, were considered temporary, with any undesirable outcome being dissolved and reabsorbed by the body in a few days or even within 24 hours. The game continues to change with new players on the roster, and the winner is yet to be determined.


Setting the Pace: The bacteria botulinum produces several toxins: One causes botulism in food, another makes up the active ingredient of Botox and another is the key to Dysport, a new Botox competitor believed to be easier to spread, giving a slightly more even look in the forehead and eye area, although the spreading can also cause droopy eyelids. (Alert: The makers of Botox and Dysport warn that botulinum toxin may affect areas of the body away from the injection site and cause symptoms of botulism, even weeks later.)

Taking on Challenges: Xeomin claims to be the untainted neurotoxin, “purified” of any proteins, so it may reduce the risk of developing antibodies—a major reason injections may have less of an effect or may not last as long. It was recently approved by the FDA, but only to be used for abnormal head position, neck pain and excessive blinking. Cosmetic use, while not illegal, would be considered off-label.

Racing to the Finish: A topical version of botulinum toxin, known in clinical trials as RT001, is designed to reduce crow’s-feet by relaxing the muscles around the eyes. The latest results confirm that the toxin’s large molecules don’t cross the skin barrier to be absorbed into the body. But that also may mean it’s not useful where the skin is thicker, such as the forehead.


Setting the Pace: There are actually fewer fillers now than several years ago, partly because some have stood the test of time medically and some were introduced during the recession. Hyaluronic acid, a synthetic form of a natural substance found in connective tissues, is used in Juvéderm, Perlane, Restylane and the newer Prevelle. Most of these now contain lidocaine to mitigate the discomfort of injection.

Taking on Challenges: Fillers are now being used in what’s sometimes called a liquid facelift, plumping the face without incisions. “It’s almost painless, you get an immediate result and we see little or no bruising,” says Boston dermatologist Jeffrey Dover, M.D. It may be non-cutting, but it’s also temporary (lasting about a year in the cheeks, temple and jawline). After a small amount is injected during the first visit, the patient must return a few weeks later, then every four to six months for touch-ups.

Racing to the Finish: Until recently, all fillers were considered temporary, but more long-lasting results are now available. Semipermanent products include Sculptra (a synthetic similar to the material used in dissolvable sutures), Artefill (an acrylic that’s used in making a shatterproof alternative to glass) and Radiesse (a calcium salt with a consistency similar to toothpaste). All are meant for heavier filling, like for “marionette lines” around the mouth.

According to the American Society for Aesthetic Plastic Surgery, the average cost for Botox and Dysport is $400; for hyaluronic acid fillers like Juvéderm, Perlane and Restylane, $560; for Sculptra, $900; and for Radiesse, $710.


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