ボトックスとヒアルロン酸ってどう違う？順番や同時施術の注意点を専門的に解説

Forehead wrinkles, marionette lines, and sagging corners of the mouth become more noticeable with age. Many people will come across the terms "Botox" and "hyaluronic acid" in their search for ways to improve them.

However, surprisingly few people have an accurate understanding of the differences between the two, their purposes, and the order in which they are performed. In some cases, people are concerned about which one they should choose and whether they can use them together.

Here, based on the knowledge of cosmetic dermatology and plastic surgery, we have comprehensively organized the mechanism of action of Botox and hyaluronic acid, duration of effect, indicated areas, order of treatment, and risks and cautions for simultaneous treatment. We support you in selecting a convincing cosmetic treatment based on correct, evidence-based information.

 

What is the difference between Botox and hyaluronic acid? Let's sort out the effects, actions, and indications.

Botox injections and hyaluronic acid injections are representative cosmetic treatments for wrinkles and sagging skin. Although both are widely known as "injection-based treatments," there are essential differences in their mechanisms of action, areas of application, and effects.

For those who are not sure which one to choose, the first important thing is to properly understand why they are different. Here, we will carefully organize the characteristics of each type of injection, its indications, and the differences in effectiveness from a professional perspective.

What is Botox injection? Injection therapy that works on muscles

Botox (formally known as botulinum toxin type A) is a drug that inhibits muscle movement by temporarily blocking the transmission of signals from nerves to muscles.

This "suppression of muscle movement" calms the muscle contractions that cause expression lines in the forehead, between the eyebrows, and at the corners of the eyes, thereby preventing the formation of wrinkles. Note that Botox is a procedure that "suppresses wrinkle-causing movements" rather than "fills in wrinkles," so it may not be suitable for deep grooves when the patient is stationary.

On the other hand, the procedure is short and requires relatively little downtime, making it popular among people of all ages for wrinkle prevention purposes.

What are hyaluronic acid injections? Injection therapy to supplement volume

Hyaluronic acid is a moisturizing component that originally exists in the human body and is widely used in aesthetic medicine as a highly safe filler.

The main objective is to plump, lift, and tone wrinkles and sagging skin that are prominent due to skin depressions and volume loss from within. It can be applied to a wide variety of areas, including nasolabial folds, marionette lines, rounding of the temples and forehead, tear troughs, and lip volume enhancement.

It can be used from "for shallow wrinkles" to "contouring" depending on the hardness of the formulation and the size of the particles, and it also offers excellent designability of the finished product. However, the physician's experience and skill largely determine the safety of the procedure, as there are serious risks (e.g., blood flow disorders) due to the bulging sensation caused by over-injection and by intravascular injection.

The comparison chart shows! Sort out the differences between the two

To summarize the difference between the two in a few words, Botox prevents wrinkles by stopping muscle movement, while hyaluronic acid supplements and tones volume from under the skin. The following comparison chart summarizes the differences more clearly.

(data) item	Botox injection	hyaluronic acid injection
mechanism of action	Blocks nerve transmission and inhibits muscle movement	Volume correction and shaping by injection into depressions and grooves
Main Indicated Areas	Forehead, between the eyebrows, corner of the eyes, chin, corners of the mouth, gills	Legal lines, marionette lines, cheeks, temples, lips, forehead, etc.
Duration of effect	Approx. 3-6 months (individual differences)	Approximately 6-18 months (varies by formulation and site)
down time	Internal bleeding and swelling may occur.	Swelling and discomfort may occur for a few days to a week.
Risk of side effects	Stiffness of facial expression, left-right difference, ineffectiveness due to antibodies	Avascular embolization, skin necrosis, over-expansion, lump formation, etc.

Both Botox and hyaluronic acid have their own specialties. Botox is more effective if you are suffering from "wrinkles caused by movement," while hyaluronic acid is more suitable if you want to cover the aging impression caused by "sagging and indentation.

In addition, in actual treatment, there are a great many cases where the two are combined, and the order of treatment, the amount of injection, and the selection of the formulation used will greatly affect the total result. In other words, it is important to determine the nature of your problem and the indications, rather than simply choosing one or the other.

 

Should Botox or hyaluronic acid be injected first?

The previous chapter summarized the basic actions of Botox and hyaluronic acid and the differences in their indications. Because they have different purposes and mechanisms, they are often used in combination. However, the order of treatment is important at this time.

At first glance, the order may not seem to make a big difference, but designing the proper sequence is extremely important in the physician's judgment because the naturalness and long-term stability of the finished product is greatly affected by the order of the injections.

This section details the basic concept of order, exceptional patterns, and the effect of order on effectiveness.

Basic procedure sequence: Botox first, hyaluronic acid later.

In general, the recommended order of treatment is to inject Botox first, followed by hyaluronic acid. This is because there is usually a time lag of several days to a week before Botox's main action, "the effect of suppressing muscle movement," appears.

This is because contouring with the muscles immobilized allows for more precise placement and amount of hyaluronic acid and greater stability of the finished product.

In particular, Botox prior is considered effective in the following cases

• Improvement of expression wrinkles (forehead, between eyebrows, corner of eyes, etc.)
• Reduction of sagging impression caused by marionette lines and submucosa
• Relief of tension in the jaw plum line (mastoid muscle) and facial lines

The advantage of stopping movement is that hyaluronic acid can be fixed without being affected by movement.

[Exceptional order] Hyaluronic acid precedes hyaluronic acid in the forehead and contouring areas.

On the other hand, Botox is not necessarily injected first in all areas. Hyaluronic acid may be injected first in areas related to aesthetic modeling, such as rounding of the forehead, correction of temple indentations, and contouring of the facial lines.

This is because it is better to first secure and form the necessary volume in areas where shape is important, and then balance the facial muscles as necessary, leading to a highly finished result.

In particular, the forehead is a delicate area that requires careful planning, as adjustment of the depth of injection and left-right difference directly affects the finished product. Therefore, the order of treatment should be considered flexibly depending on the area and the problem.

Why is the order so important? Directly related to shape retention and finish accuracy

Completeness and durability of injectable treatments are completely different depending on "where", "in what order", "to what depth", and "with what formulation".

In particular, the change in muscle tension caused by Botox can affect the position of the overlying skin and hyaluronic acid.

For example, if skin loosening occurs after Botox, it can be taken into account when injecting hyaluronic acid to create a more natural line. Conversely, if hyaluronic acid is injected first, there is no risk of losing shape due to changes in muscle contraction.

Thus, "order" is not merely an operational convenience, but a very essential element in the overall blueprint of the injection treatment.

Reference table by site! Recommended Pattern of Treatment Sequence

Below is a summary of the recommended order of Botox and hyaluronic acid treatments for the most commonly treated typical areas.

part	Recommended treatment sequence	supplementary point
Forehead (horizontal wrinkles + rounding)	Hyaluronic acid → Botox	Priority is given to modeling, so volume is secured first.
temple (of the forehead)	Hyaluronic acid → Botox	Expression control after left-right difference adjustment
Lines and cheeks	Botox → Hyaluronic acid	Facial muscle movement suppression followed by shaping
marionette line	Botox → Hyaluronic acid	DAO muscle suppression + volume compensation
Jaw (dried plum wrinkles)	Botox → Hyaluronic acid	Correction after control of the ocularis muscle is effective
Lips and tear troughs	Solely hyaluronic acid use	Due to less muscular impact.

The order of procedures is an often overlooked element of cosmetic medicine, but it is a very delicate and important part of design. Rather than simply assuming "Botox first" or "hyaluronic acid later," the best planning should be based on a comprehensive diagnosis of one's facial features, concerns, muscle movement, skin thickness, and other factors.

That is why an individual consultation with a physician familiar with facial muscles and anatomy is essential when considering injection therapy.

 

Can Botox and hyaluronic acid be taken at the same time? Benefits and Risks Explained

In the previous chapter, I explained the reasons why Botox and hyaluronic acid should be given in which order and the recommended patterns for each area. However, in actual consultations, we often receive the question, "Can't I have both procedures done at once?" We also see many consultations asking, "Can't I have both procedures at once?

In conclusion, it is possible to receive Botox and hyaluronic acid on the same day if the physician has the appropriate judgment. However, it is not recommended in all cases and there are risks involved.

In this section, we will organize in detail the advantages and cautions of simultaneous treatment, as well as the criteria for determining the indications.

What are the advantages of simultaneous treatment? Shorter downtime and synergistic effects

The greatest advantage of combining Botox and hyaluronic acid on the same day is the efficiency of the treatment schedule and the synergistic effects of the procedures. The three main advantages are as follows

1. Reduced number of visits: Easier to adjust the schedule as it is completed in one visit rather than on separate days
2. Consolidation of downtime: one risk of internal bleeding and swelling
3. High degree of perfection in overall finish: Facial muscle movement and contour correction can be planned at the same time, making it easy to balance the entire face.

For example, in the improvement of marionette lines and mouth corners, Botox injections into the DAO muscle plus three-dimensional correction with hyaluronic acid injections can be performed at once to take care of sagging and concave areas all at once, creating a more natural change in appearance.

Criteria for determining indications! In what cases can same day treatment be performed?

Not all patients are suitable for simultaneous procedures. Same-day procedures can be considered safe and effective when the following three factors are present

checkpoint	Description of Contents
Physician experience and skill	Highly specialized in injection therapy and knowledge of facial anatomy and formulation?
Compatibility of formulations	Is the combination of hyaluronic acid and Botox used a combination that does not affect each other?
Dispersibility of injection site	Is the treatment to different areas rather than duplicate injections to the same site?

Only when these conditions are met can simultaneous procedures be a very effective treatment strategy. Conversely, if the physician determines that there is even a slight risk, the medically correct response is to perform the procedures on separate days.

Simultaneous Botox and hyaluronic acid treatment is an effective and time-efficient treatment method, but it is by no means an "easy method for anyone, anytime. Especially in cosmetic medicine, not only the beauty of the finished product, but also the accuracy of safety and risk management are of utmost importance.

Risks and Precautions! Doctor's diagnosis and skills are key.

On the other hand, simultaneous treatment also entails certain risks. In particular, there are the following concerns

• Possible difficulty in achieving the ideal result due to misalignment of the injection position and swelling
• Risk of serious side effects (avascular embolization, skin necrosis, etc.) if blood vessels and nerves are not accurately located
• If hyaluronic acid is injected before Botox takes effect, the shape may change later due to muscle movement

These can be counterproductive unless the practitioner is familiar with the anatomy of the face and has the ability to determine precisely "where," "how much," and "in what order" the injections should be made.

Therefore, it is a prerequisite that simultaneous procedures be performed by a physician who has extensive injection experience and medical judgment.

 

What is the best treatment choice for each area such as marionette lines, forehead, corners of the mouth, etc.?

In the combined treatment of Botox and hyaluronic acid, it is very important to design the area-specific design of where, for what purpose, and how to combine the two.

In the previous chapter, we touched on the possibility and conditions of simultaneous treatment. In actual practice, the treatment plan is determined based on a comprehensive assessment of the anatomical structure of each area, muscle movement, and the effects of fat and skeletal structure.

This section details the best options for each procedure and examples of combinations, focusing on the marionette lines, forehead, corners of the mouth, and facial lines, which are particularly frequently consulted by patients.

Marionette lines｜Combined treatment of sagging skin and muscles

Marionette lines are a type of "sagging lines" that extend from the bottom of the corners of the mouth to the chin, and are caused by a combination of age-related subcutaneous fat drooping and excessive muscle contraction.

Therefore, mere hyaluronic acid injections are not sufficient; both Botox injections for the muscle (submucosa muscle) and hyaluronic acid three-dimensional correction for sagging skin are required.

• Botox: injected into the submucosa muscle to inhibit the movement that pulls the corners of the mouth downward
• Hyaluronic acid: Three-dimensional supplementation around the corners of the mouth to the chin to plump up shadows and depressions

This combination can effectively alleviate the appearance of sagging, grumpiness, and aging. One or the other is sufficient for mild symptoms, but in many cases, the combination is recommended for moderate or more severe changes.

Lateral wrinkles on the forehead and 3D effect｜The order of treatment and the depth of injection are the key points.

Horizontal wrinkles on the forehead are caused primarily by contraction of the frontalis muscle. In younger people, they often appear as "expression wrinkles," but as the skin thins with age, a mixture of wrinkles plus indentations can occur.

In these cases, great care must be taken in the sequence of treatment and depth of injection.

• Botox: Shallow injection into the facial muscles (frontalis muscles). Prevents and improves horizontal wrinkles by relaxing muscle contraction.
• Hyaluronic acid: injected in the middle to deep layers to form a rounded forehead (too shallow and there is a risk of unevenness and tindal phenomenon)

The forehead also influences the movement of the eyebrows and eyes, so an incorrectly designed balance may result in an unnatural look or drooping appearance. Therefore, it is necessary to use both "shallow and wide injection techniques" and "deep shaping techniques," and the skill of the physician directly affects the finished product.

Angle of mouth drop and face line｜Lateral difference and influence of facial expression muscles are also considered.

The corners of the mouth drop and the facial line falters not only because of the loosening of the supporting tissues due to aging, but also because of the left-right difference in facial muscles and the imbalance in muscle strength.

• Lowering of the corners of the mouth: If tension is strong in the submucosa and micturition muscles, Botox can be used to reduce the force of the pull down.
• Facial line: For those with strong gills, Botox for masseter muscle to clear them and hyaluronic acid for contouring.

In this area in particular, diagnosis prior to treatment is extremely important because of the many factors involved, including muscle and fat condition and skeletal asymmetry.

This is an area that requires millimeter-by-millimeter design adjustments, such as fine-tuning the amount of Botox on one side of the face or varying the amount of hyaluronic acid injected on either side.

 

How Long Do the Effects Last? Duration and Side Effects of Botox and Hyaluronic Acid

In the previous chapter, we discussed in detail the best Botox and hyaluronic acid treatment strategies for each problem and area. However, when it comes time to consider the procedure, many people are wondering, "How long will the effects last? Is there a risk of side effects? and "Are there any risks of side effects?

Cosmetic treatment is not something that can be completed with a single treatment, but requires a long-term perspective that takes into account continuity and safety. Here, we will carefully explain the approximate duration of Botox and hyaluronic acid, the differences between each formulation, and the risks of side effects and how to avoid them, based on medical evidence.

Duration of Botox and Hyaluronic Acid

First, the following is a general guideline for the duration of the effect.

• Botox injections: about 3-6 months (individual differences)
• Hyaluronic acid injections: 6-18 months (range depending on formulation)

Since the effects of Botox gradually diminish, regular maintenance is recommended every 3 to 4 months.
On the other hand, hyaluronic acid degrades at different rates depending on the hardness and molecular structure of the formulation, resulting in differences in duration depending on the injection site and the formulation used.

Duration comparison by formulation! JUVIDERM, VOLUME, etc.

Among hyaluronic acid preparations, the "JUVIDERM series" manufactured by Allergan, approved by the Ministry of Health, Labor and Welfare, is recognized worldwide for its safety and durability, and is used by many medical institutions in Japan.

The following table summarizes the differences between typical formulations.

Formulation name	Characteristics / Areas of use	Approximate duration
JUVIDERM VISTA® VOLUMA XC	Hard, indicated for deep areas such as contouring, temples, midface, jaw, etc.	Up to about 24 months (average 12-18 months)
JUVIDERM VISTA® VOLIFT XC	Intermediate hardness, for use on the laugh lines and marionette lines	About 12-18 months
Duviderm Vista® Volbella XC	Soft, suitable for shallow injections such as lips and tear troughs	Approx. 12 months
JUVIDERM VISTA® Ultra XC	Relatively soft and versatile	Approx. 9-12 months

In the area of Botox, Allergan's Botox Vista® is the only type A botulinum toxin product approved by the Japanese Ministry of Health, Labor and Welfare, and is often chosen for its effectiveness and safety.

Side effects and risks｜Choose a safe treatment with correct knowledge.

In cosmetic medicine, Botox and hyaluronic acid are both medical procedures and carry zero risk. Although the frequency of side effects is not high, if they do occur, they can lead to serious problems, so a proper understanding in advance is necessary.

Type of risk	Description of Contents
allergic reaction	Swelling, redness, itching, etc. after injection (very rare)
Internal bleeding/swelling	Minor internal bleeding or swelling may occur at the injection site
Avascular embolization and skin necrosis	Risk of tissue necrosis and visual impairment if hyaluronic acid is accidentally injected into a blood vessel (extremely rare)
Diffusion of Botox	Temporary left-right difference in facial expression, drooping of eyebrows and corners of the mouth, etc. may occur.
Ineffectiveness due to antibodyization	Frequent and large doses of Botox can create antibodies that make it less effective.

In order to minimize these risks as much as possible, it is essential that the procedure be performed by a physician with a thorough knowledge of facial anatomy. In particular, hyaluronic acid injections can be life-threatening in the worst case scenario if the physician does not have an accurate understanding of the running of blood vessels and the layered structure.

 

summary

Botox and hyaluronic acid are both effective injectable treatments for wrinkles and sagging skin, but the appropriate choice depends on "purpose," "action," "site," and "sequence. Incorrect sequence of treatment or combination of treatments based on one's own judgment may not only fail to achieve the expected effect, but may also lead to side effects and discomfort in the finished product.

The important thing is to have a proper medical understanding of the characteristics and risks of each preparation, and to choose the procedure that best suits your concerns after receiving a thorough explanation. If you have any concerns, it is of utmost importance to have a consultation with a specialist at a reliable medical institution, such as a cosmetic dermatologist or plastic surgeon, to confirm the appropriate proposal and treatment plan.

At Aladdin Aesthetic Clinic, based on our many years of experience in cosmetic medicine and cosmetic dermatology and the knowledge of our doctoral degree, we provide counseling that aims to be "only one", offering the best treatment for each person we meet. We offer only the necessary treatments without any unnecessary information or suggestions.

Feel free to use our official LINE account for 24-hour counseling and reservations. Please feel free to contact us for free counseling for the first time or if you have any concerns.