Author and medical review: Piotr Rak, MD, PhD – general and oncological surgeon, physician performing aesthetic medicine procedures

Date of publication and most recent review: 20 July 2026 • This educational material does not replace an in-person facial assessment.

Botox versus hyaluronic acid – comparison table

“Botox” is the trade name of one product, but the term is commonly used to describe treatments with botulinum toxin type A. Hyaluronic acid, in turn, is an ingredient in many fillers with different structures and properties. The name of the substance alone is not sufficient to select a specific product.

How does botulinum toxin work?

Botulinum toxin weakens signal transmission from a nerve to an appropriately selected muscle. The muscle becomes less active, so the skin is folded less intensely during facial movement. The purpose of a well-planned procedure does not have to be complete immobilisation of the face, but rather a reduction in the activity of the muscles responsible for a specific problem.

It is most commonly considered for:

• wrinkles between the eyebrows, known as glabellar lines;
• selected horizontal forehead lines;
• crow’s feet;
• other indications depending on anatomy and the approved indications of the specific product.

Botulinum toxin does not fill a deep fold, rebuild bone or fat pads, or directly improve skin quality. If a line is also established at rest, reducing facial movement may soften it over time, but may not remove it completely.

When might botulinum toxin not be the right choice?

• when the main problem is loss of volume rather than facial movement;
• when excess skin requires a surgical assessment;
• when weakening a particular muscle could worsen brow drooping or eyelid function;
• when there is an active infection at the injection site;
• in certain neuromuscular disorders or when taking medicines that affect neuromuscular transmission;
• when the expected outcome involves a permanent result or an increase in volume.

How does a hyaluronic acid filler work?

Hyaluronic acid occurs naturally in the body, but an injectable product is specially manufactured and is most commonly cross-linked to provide specific properties. The fact that an ingredient is “natural” does not mean that its injection is free from risk.

A filler may be considered when the aim is to:

• restore volume to the cheek or another selected part of the face;
• shape the lips and improve their proportions;
• correct selected folds or hollow areas;
• shape the chin, jawline or other areas following an anatomical assessment.

Different products behave differently. A product suitable for the delicate and mobile lip area may not be appropriate for deep tissue support. The injection plane and the vascular anatomy of the area are also important.

When might HA not solve the problem?

• when the wrinkle is caused primarily by excessive muscle activity;
• in cases of significant skin laxity and excess skin;
• when adding more volume would create a heavier or unnatural appearance;
• when there is an active infection, inflammation or an unexplained skin lesion;
• when the patient expects an identical result to that seen in another person;
• when a previously injected filler is unknown or there are lumps, swelling or migration requiring diagnosis.

What should you choose for the forehead, glabellar lines, crow’s feet, lips and cheeks?

The table below indicates the direction of the discussion and does not constitute an online medical assessment.

Can Botox and hyaluronic acid be combined?

Yes, if two different problems are present and each method has its own indication. For example, botulinum toxin may reduce the formation of a dynamic wrinkle, while HA may restore volume in another area. This does not mean that combination treatment is necessary for everyone or that all procedures should be performed during a single appointment.

A staged approach may be beneficial because it makes it possible to:

• assess the result of the first intervention before adding another;
• reduce the risk of overcorrection;
• separate adverse effects and determine their cause more easily;
• spread out swelling and recovery time;
• adapt the plan to the patient’s budget without pressure to purchase a package of procedures.

What does a proper medical assessment involve?

1. Defining the problem. The physician asks what the patient wishes to change and in which situations the feature is visible.
2. Assessment of the face at rest and during movement. Facial expressions, proportions, eyebrow position, skin quality, volume and asymmetries are evaluated.
3. Medical history. This includes medical conditions, medicines, allergies, previous products, dental procedures, infections and healing patterns.
4. Comparison of options. The patient should be informed about alternatives, including skincare, laser treatment, biostimulation, surgery or no treatment.
5. Discussion of risks. Risks should be discussed separately for botulinum toxin and fillers, together with a management plan in the event of a complication.
6. Documentation and informed consent. These should relate to the specific product, area and treatment objective.

Read our broader guide to skin rejuvenation methods if the problem is not limited solely to facial movement or volume.

Safety of botulinum toxin

The most common effects after injection may include pain, redness, swelling, bruising and headache. Effects related to the injection site may lead to asymmetry, drooping of the eyebrow or eyelid, a change in the smile or temporary weakening of an unintended muscle.

Botulinum toxin products carry a warning regarding the possible spread of the toxin’s effect beyond the injection site. Difficulty swallowing, speaking or breathing, generalised weakness and double vision require urgent medical assessment.

Safety of hyaluronic acid

Common reactions include swelling, tenderness, redness and bruising. Lumps, asymmetry, infection, inflammatory reactions, migration or delayed swelling may occur. Adverse events may also develop weeks or months later.

The most serious rare risk is unintended injection into a blood vessel or compression of a vessel, resulting in ischaemia. This may cause skin necrosis, visual impairment, blindness or stroke. The level of risk varies depending on the area, anatomy and technique, but it is not zero.

What cannot be guaranteed?

• perfect symmetry;
• a result identical to that shown in another person’s photograph;
• the absence of bruising, swelling or a need for a follow-up appointment;
• the exact duration of the result;
• complete reversal of every undesirable change;
• the complete absence of complications;
• an improvement in self-esteem or interpersonal relationships.

A good treatment plan is not about performing the greatest possible number of procedures. Sometimes the best option is a limited treatment, a staged approach or a decision not to proceed with injections.

First identify the mechanism of the problem, then choose the procedure

During a consultation, Piotr Rak, MD, PhD, assesses the face at rest and during facial movement. This makes it possible to distinguish a wrinkle caused by muscle activity from volume loss, laxity or sun damage. Only on this basis can botulinum toxin, hyaluronic acid, another method or no treatment be considered.

This approach is consistent with the philosophy of Wyspa Medycyny Przyjaznej: patients should receive a clear explanation and time to make a decision, without pressure to undergo a more extensive range of procedures.

Author: Piotr Rak, MD, PhD.

FAQ – Botox or hyaluronic acid?

Medical sources

1. U.S. Food and Drug Administration: Dermal Fillers (Soft Tissue Fillers).
2. FDA: BOTOX Cosmetic – Prescribing Information.
3. American Academy of Dermatology: Botulinum Toxin Therapy – Overview.
4. American Academy of Dermatology: Fillers – Frequently Asked Questions.
5. American Academy of Dermatology: Wrinkles – Botulinum Toxin and Fillers.

Date accessed: 20 July 2026.

Medical information: approved indications, contraindications and warnings depend on the specific product. Before the procedure, ask for the name of the product and the manufacturer’s patient information.