Cheaper Fillers: Are They Worth It?

People love a bargain. But if you’re thinking about saving money by injecting your face with knockoff “Botox” or fillers purchased online, experts urge caution.

This do-it-yourself approach is popular on TikTok and Instagram. But it can backfire.

“For Botox® or fillers, turn to an expert, preferably a doctor. A dermatologist really understands facial anatomy, which matters for good results. They’ll use safe, FDA-approved products,” says Ariel Eber, M.D., a dermatologist at the University of Miami Health System. 

“There are many high-risk zones in the face, and everyone’s face is unique. A lot of complications can occur with filler misplacement, including blindness. Infections and the death of areas of skin, or necrosis, can also occur when people treat themselves or turn to an unskilled provider,” she says.

 People who obtain the “cheap” version of filler products from obscure places, online or otherwise, risk lasting damage to their faces.

When you smile or frown repeatedly, you contract certain muscles. Contractions fold the skin, eventually causing lines and wrinkles. Movements aren’t the only factors involved. Smoking, pollution, and sunlight also contribute to wrinkles.

FDA-approved injectables using neurotoxins are sophisticated products.      

Botox® is often said to “freeze” facial muscles. Actually, it temporarily paralyzes them. Injected into the forehead, it can freeze movements that create long horizontal lines. Injected between the eyebrows, it can freeze movements that etch two vertical lines in that area. Botox® can also reduce or eliminate crows’ feet and improve many other places.

Botox® is a neurotoxin called botulinum toxin, a substance that affects nerves. In nature, the toxin is made by a bacterium called clostridium botulinum. It is a medical product regulated by the Food and Drug Administration (FDA). The FDA versions are safe when used appropriately, but counterfeit versions of this neurotoxin can be dangerous. The botulinum toxin has been called “one of the most poisonous biological substances known.”

Four related, FDA-approved products perform similarly. They are Dysport®, Xeomin®, Jeuveau®, and Daxxify®. Botox has the longest track record and is often called the “gold standard.”  The five products behave slightly differently. A physician can advise you about the best choice for you. 

How do fillers work?

With age, we lose the fatty cushion beneath our skin, and our facial muscles and bones lose volume. Injectors use fillers to correct or camouflage these volume losses and gravitational changes, making faces appear fuller and younger.

Fillers are entirely different from products based on neurotoxins. Most fillers use hyaluronic acid. It’s a slippery substance found throughout our bodies, in our eyes, joints and skin.

This acid attracts and binds to water molecules. It also promotes the production of collagen and elastin, proteins that give skin elasticity and bounce. The body naturally absorbs hyaluronic acid fillers over time, so improvements fade, and treatments may be repeated. “But due to the deposition of collagen and elastin, which are both proteins that the body makes naturally, the treated areas never revert fully to baseline,” Dr. Eber says.

Besides hyaluronic acid-based fillers, other fillers on the market act as biostimulators. “They encourage your own body to rebuild some of the collagen and elastin that it’s lost over time. Like HA fillers, many of the same risks apply, and it’s always best to seek care with a skilled injector,” Dr. Eber says. 

Quality injectables aren’t cheap.

When doctors inject Botox® or the other four neurotoxin-based injectables, they use the genuine product made under rigorously maintained conditions to ensure safety and quality.

Hyaluronic acid fillers produce effects immediately. Other fillers prompt the body to produce more collagen, the main building block of skin. These non-hyaluronic acid fillers take longer to deliver results. 

The American Society of Plastic Surgeons says that, on average, fillers last five or six months, but effects sometimes last for years.

Some products sold online are not held to high standards.

“The fake Botox and fillers circulating may well be contaminated. They surely aren’t the same as products made in a controlled laboratory,” Dr. Eber says.

Recently, the FDA issued a warning to health care professionals and consumers that unsafe, bogus “Botox” was circulating in many states, including Florida. Injections of the phony products have caused significant health problems, some requiring hospitalization.

Some troubling symptoms have arisen in people who self-injected or were injected by others using below-grade products. The symptoms are similar to those that may occur when the botulinum toxin spreads throughout the body.

• Blurry or double-vision
• Problems swallowing and dry mouth
• Constipation
• Incontinence
• Shortness of breath
• Weakness, including trouble lifting up one’s head

If you have any such symptoms after an injection of a product made with botulinum toxin, seek medical care.

Fillers are not interchangeable.

Some are more suitable for certain areas of the face than others. It takes expert knowledge to choose correctly.

An expert injector directs the correct filler to a specific anatomical plane for safety and the desired look. “If I want to volumize the cheek, I might pick one that’s slightly bouncier. That region has a lot of heavier tissue. The filler has to hold up, and the goal is to have more volume,” Dr. Eber says.

“For fine lines around the mouth, I’d choose something smoother or softer. And in that area, I’d inject more superficially because there are some danger zones deeper down.”

“You want someone who is not only a safe injector but also has a refined technique and an aesthetic that you like,” says Dr. Eber.

What to look for in a filler provider.

Some skilled injectors aren’t doctors. “But it’s hard to know who’s who and what’s what. People list all sorts of credentials, but what do they mean? Some of these injectors have done a two-day course,” she said.

In contrast, a dermatologist does at least three years of training in that specialty after four years of medical school and an internship that lasts one year or longer. Some, like Dr. Eber, then do a fellowship. Hers was in Advanced Cosmetic Dermatologic Surgery and Lasers.

Seeking fillers abroad is risky.

Dr. Eber has seen problems in patients who had filler injections outside the United States. “Some of these products may not have been FDA-approved. They seemed to have been contaminated with different bacteria, including mycobacteria. Over months, patients can develop abscesses and ulcers,” she said.

Boiled flaxseeds are not Botox®.

Online content creators promote using a gooey mixture produced by boiling flaxseeds in water as “do-it-yourself Botox.” One Los Angeles woman has received more than 6 million views for her video recommending the approach.

Boiling flax seeds produces a gel that people apply to their skin. When the gel dries up, the skin may feel tighter, but no research supports this approach.

Eating flaxseeds may help your skin.

Some research supports the notion that flaxseed oil in the diet may boost the skin’s appearance. A small German study compared the appearance of the skin of women who took flaxseed oil versus safflower seed oil. With flaxseed oil, the skin appeared smoother and better hydrated.  Women who took safflower oil experienced some improvements, but the effects were less pronounced.

Flaxseed oil degrades quickly, though, and whole seeds just pass through the digestive tract. The best source of the beneficial ingredients in flaxseed is freshly ground flaxseed. Supplements on a shelf lose potency quickly.

You can grind flaxseeds with a coffee grinder, blender, food processor, pepper mill, mortar, and pestle. To ensure their potency, store ground flaxseeds in the refrigerator and use them within a week.

Basic daily self-care affects your appearance.

“A person’s wrinkles look different day to day. One day, they look more etched than another day. Sleep and hydration are big factors,” Dr. Eber says.

She advises getting ample sleep and staying hydrated. Also, avoid strong sunlight and use sunscreen consistently.

Motivations matter.

When Dr. Eber first meets with someone who wants cosmetic procedures, she explores their motivations and expectations. She wants to ensure the person has realistic expectations and their desired results are achievable.

“I ask questions to see if they’re struggling with body dysmorphia. Are they perceiving themselves in a way that no one else would see that isn’t in line with reality?” she says.

If a person seems to have concerning ideas about their looks, she urges them to consult a mental health expert before she does any procedures.

Be realistic.

If you get neurotoxin-based injections or fillers, temper your hopes for better looks with a solid grasp of what is possible with non-surgical treatments.

“We can do certain things, but we aren’t magicians. After a dermatologic procedure, people sometimes look in the mirror and say, ‘I don’t see anything different,'” Eber says. Those expecting dramatic changes may feel dissatisfied.

Avoid disappointment.

Ask the professional to tell you frankly what changes to expect and to show you before and after pictures. Seek an honest professional who will let you know if what you desire would be better achieved through surgery and won’t perform a procedure on you for the sake of doing it.

Your differences make you beautiful. 

“People who feel good about themselves show up better for their families, colleagues, and themselves,” says Dr. Eber.

Yet many recent studies suggest that the concept of beauty is changing in a way that concerns Dr. Eber and others. “Today, people seek these enhancements not only because of the fear of aging. Now, many people want to look more like people on social media.”

With altered faces often looking so similar, much is lost. “We’re losing our identity, the things that make us special and unique,” Dr. Eber says.

“The best injector makes you look exactly like you, but better. It takes experience.”

Milly Dawson is a contributor for UHealth’s news service.

Tags: alternative face fillers, Botox, Dr. Ariel Eber, face injections, reduce wrinkles, skin care in Miami, smoother skin