Pompi Chatterjee – GPhC Registered Pharmacist Independent Prescriber, Co-Founder, MediGlow Aesthetics & Health.

 

“Botox or fillers – which one do I need?” is one of the most common questions we hear at MediGlow in Thornliebank, Glasgow. It is also one of the most important questions a patient can ask – because choosing between them without a clinical assessment first is how people end up with the wrong treatment for their concern.

The short answer is this: Botox and anti-wrinkle injections address lines caused by muscle movement. Dermal fillers address volume loss and structural changes. Most patients have elements of both – and a good treatment plan accounts for that. The question is not which one is better. It is which one is right for you, and in what combination.

I am Pompi Chatterjee, a GPhC-registered pharmacist independent prescriber and co-founder of MediGlow Aesthetics and Health. In this post I want to explain the clinical difference between these two treatments – what each one actually does, which concerns each one addresses and how we decide which is appropriate at consultation.

 

What do anti-wrinkle injections actually do?

Anti-wrinkle injections – commonly called Botox, though that is one brand name among several – use botulinum toxin, a prescription-only medicine, to temporarily relax specific facial muscles. When a muscle is repeatedly contracting – raising your brows, squinting, frowning – the skin above it creases with each movement. Over years, those creases become permanent lines, even when the muscle is at rest.

Botulinum toxin interrupts the signal between the nerve and the muscle, reducing how fully the muscle can contract. The skin above it smooths. Lines that were being actively created by muscle movement become much less visible.

 

The key distinction

Anti-wrinkle injections work on the muscle. They cannot replace volume that has been lost, fill a fold that is structural rather than movement-related, or improve the quality of the skin itself. When they are used for the wrong concern, the result is underwhelming – not because the treatment failed, but because the wrong tool was applied to the problem.

 

What it treats: Forehead lines. Frown lines between the brows. Crow’s feet at the corners of the eyes. Brow position. Lip lines from repeated pursing. Bunny lines across the nose. Neck bands. Chin dimpling. Masseter (jaw muscle) reduction.

How long it lasts: 3 to 4 months in most patients, after which a top-up is needed.

Important note: Botulinum toxin is a prescription-only medicine in the UK. At MediGlow, it is prescribed and administered by a GPhC-registered pharmacist independent prescriber — no GP referral, no third-party prescription required.

 

What do dermal fillers actually do?

Dermal fillers – most commonly made from hyaluronic acid (HA), which is naturally occurring in the skin – restore volume to facial areas where it has been lost. As we age, the fat compartments beneath our skin gradually deflate. The midface flattens. The temples hollow. The under-eye area becomes concave. The cheeks lose their projection. And the skin above those deflated compartments falls — creating nasolabial folds, marionette lines and jowling that are structural rather than movement-related.

Fillers address this by replacing the lost volume in the correct anatomical layer. A skilled injector is not simply filling the fold itself – they are restoring the structural support underneath it, which allows the overlying skin to lift back into its natural position.

 

The key distinction

Dermal fillers work on volume and structure. They cannot relax a muscle that is creating a dynamic line, and they will not smooth an expression crease that disappears when the face is at rest. Applied incorrectly – to the wrong concern or the wrong anatomical layer – fillers can produce results that look heavy, unnatural or displaced.

 

What it treats: Loss of cheek volume and projection. Hollow temples. Tear troughs and under-eye hollowing. Nasolabial folds (nose-to-mouth lines). Marionette lines (mouth-to-chin lines). Lip volume and definition. Jawline and chin definition.

How long it lasts: 9 to 18 months depending on the area, the product used and individual metabolism.

Reversibility: HA fillers can be dissolved with hyaluronidase — a prescription medicine that Pompi and I can prescribe independently, without referral, if a reversal or complication management is needed.

 

How do you know which one you need?

The simplest test is this: pull the area that concerns you gently and look at it in a mirror. If the line or fold disappears when the skin is held taut – it is likely structural and volume-related, and filler is the more appropriate treatment. If the line appears when you make an expression and fades at rest – it is a dynamic line, and anti-wrinkle injections are the more appropriate starting point. If the line is present both when you make an expression and when your face is at rest — it may have both a muscle and a volume component, and a combination approach could be appropriate.

This is a rough guide — not a diagnosis. A proper clinical assessment accounts for far more than this: muscle strength and activity, fat compartment volume and distribution, skin quality and thickness, facial symmetry and anatomy, and your own goals and preferences. That is what the consultation at MediGlow is for.

 

Can Botox and fillers be done at the same time?

Yes – and in many cases a combined approach produces better results than either treatment in isolation. A patient who has both active frown lines and some midface volume loss will benefit from anti-wrinkle treatment for the former and fillers for the latter. The two treatments address genuinely different concerns and do not conflict.

However, the sequencing matters. At MediGlow we typically perform anti-wrinkle injections first and schedule fillers at a separate appointment a few weeks later – once the muscle activity has settled and we can see how the face responds. Combining both at the same appointment is sometimes appropriate but depends on the areas being treated, the products being used and the individual patient.

Your consultation will determine whether a combined or staged approach is right for you.

 

What about skin boosters and Profhilo?

Skin boosters and Profhilo address a third component of ageing that neither anti-wrinkle injections nor dermal fillers can treat: the quality of the skin itself. When collagen and elastin production slows, the skin loses its bounce, becomes drier and develops a rougher texture. It looks dull even when well-hydrated.

Profhilo – which contains a high concentration of non-cross-linked hyaluronic acid – biostimulates fibroblasts beneath the skin, prompting your skin to produce more of its own collagen and elastin. It does not add volume. It improves skin quality. Many patients at MediGlow combine Profhilo or skin boosters with anti-wrinkle injections and fillers as part of a comprehensive anti-ageing protocol.

 

Why does the prescriber matter for these treatments?

Botulinum toxin is a prescription-only medicine under UK law. That means it must be prescribed by a registered prescriber — a doctor, dentist or independent prescriber — before it can be administered. At many clinics, that prescription comes from a GP who has not met the patient, not seen their face and taken no responsibility for the outcome.

At MediGlow, Lalit and I are both GPhC-registered pharmacist independent prescribers. We prescribe and administer every treatment ourselves, at the same appointment, with full clinical accountability. We also review every patient’s full medication list — blood thinners, immunosuppressants, antidepressants — before any treatment is agreed. And if a complication arises with a filler, we can prescribe and administer hyaluronidase to dissolve it on the spot. A non-prescribing aesthetician must refer. That difference is not trivial.

 

FAQ – Quick answers

 

Is Botox or filler better for nasolabial folds?

In most cases, dermal fillers are the more appropriate treatment for nasolabial folds (the lines from nose to mouth). These folds are primarily caused by the loss of midface volume that normally supports the overlying skin. Restoring cheek volume with filler allows the fold to lift naturally. Anti-wrinkle injections cannot address structural volume loss and are not typically the right tool for this concern.

 

Can filler make forehead lines go away?

No — and this is a common misconception. Forehead lines are dynamic lines caused by the contraction of the frontalis muscle when you raise your brows. They are not caused by volume loss. Filler placed in the forehead area can temporarily plump the skin but cannot prevent the muscle from contracting. Anti-wrinkle injections are the appropriate treatment for horizontal forehead lines.

 

At what age should I start anti-ageing treatments?

There is no universal answer. Some patients in their mid-twenties use anti-wrinkle injections preventatively – to reduce the deepening of lines before they become permanent. Others in their fifties are addressing significant volume loss for the first time. The right time to start is when a concern is affecting your confidence and a clinical assessment confirms treatment is appropriate. A consultation at MediGlow is the right starting point – there is no obligation to book treatment at the same appointment.

 

Pompi Chatterjee is a GPhC-registered pharmacist independent prescriber and co-founder of MediGlow Aesthetics and Health in Thornliebank, Glasgow.

She holds an MSc in Pharmaceutical Analysis and an MBA from the University of Strathclyde, and qualified as an Independent Prescriber at Robert Gordon University.

Pompi trained at the Derma Institute London – a provider that accepts only qualified medical professionals – and holds Cutera laser certifications. She has over 10 years of NHS and hospital clinical experience.