CO2 Laser, Dermal Fillers, and Botulinum Toxin [How to Choose?]

Do You Know the Difference Between CO2 Laser, Dermal Fillers, and Botulinum Toxin—and Their Main Indications?
If not, check out this full article and learn how to differentiate each of these procedures focused on facial rejuvenation.

CO2 Laser, Dermal Fillers, and Botulinum Toxin: Is There a Difference?

Yes. When it comes to facial rejuvenation—especially in the upper third of the face—the typical recommendation is botulinum toxin as a therapeutic approach.

For example, when a person frowns, the muscle strength involved in expressions like frowning, looking surprised, or a strong smile causes expression lines. And there’s only one treatment that can soften these lines: botulinum toxin.

Botulinum toxin blocks these muscles and reduces their strength so they contract less and don’t form deep lines over time. If the toxin is not used, the tendency is for deep wrinkles to form on the skin—once these are present, a different treatment, such as the CO2 laser, will be required.

So, when someone notices deep skin creases while making expressions, botulinum toxin becomes indicated—even for younger patients.

However, a common confusion among patients is the difference between the indications for CO2 Laser, Dermal Fillers, and Botulinum Toxin.

Why Is There a Difference in Indication?

Usually, when we talk about skin laxity or collagen loss, CO2 laser is the gold standard treatment for rejuvenation—not fillers, as many people think. But how can you tell?

A simple test helps: tilt your head downward and gently move your hand over your face. If the skin feels loose or saggy, the treatment should be CO2 laser. This is the best treatment, the gold standard for rejuvenation, especially when we aim to firm up that entire region.

In our clinic, we often see patients who were recommended to get fillers in the upper face to fix sagging in the lower face—an indication that may be incorrect.

Using too much filler in the upper face creates excessive volume, leading to an unnatural look. You’re trying to fix one problem with an inadequate solution. Each treatment must be correctly indicated to achieve harmonious, natural-looking results without an artificial appearance.

When Is Filler Indicated?

Fillers are recommended when there is volume loss in the face. Starting around age 30, it’s common to experience volume loss—especially in bone, muscle, and fat.

This loss is more noticeable in the malar and zygomatic regions. These areas begin to sink. If you take a side photo of yourself in the mirror, you’ll probably notice this hollowness.

The first step with fillers is to restore volume in this region. If you try this yourself in the mirror—gently lifting the area—and notice an improvement, it’s likely that you’re a candidate for fillers.

Fillers can also be used in the upper third of the face. Typically, we add some support points to subtly lift the skin. This must always be done within what the patient’s face can tolerate—nothing artificial, or it won’t look good.

In our clinic, we apply filler in this area to create a lifting effect. That’s the first step.

After that, we evaluate each patient individually. Depending on the case, we may also add a bit of filler to the jawline. Enhancing the jawline structure—especially in women—is often a sign of youthfulness.

Where Can Fillers Be Applied?

Fillers can be applied to several areas of the face: the chin, nasolabial folds, among others. But the approach has changed over the years.

In the past, filler was mainly applied to the nasolabial area. Today, we focus on the malar region structure using techniques like MD Codes to provide facial support.

Many patients (and even other clinics) still confuse the indications and suggest fillers to treat sagging, which is not ideal. Trying to fix all facial laxity with fillers alone leads to disproportionate and artificial results.

At our clinic, we combine various techniques—CO2 Laser, Dermal Fillers, and Botulinum Toxin—to achieve the best possible outcome. The CO2 laser is applied to the entire face. It improves overall skin quality and provides firmness, especially in the jawline and lower eyelid areas.

We combine the laser to treat sagging, filler to add the necessary support points and balance facial harmony, and botulinum toxin to block muscle activity—enhancing both sagging treatment and overall skin quality.

Contact:

Clínica de Pele has specialized in dermatological treatments in Rio de Janeiro for over 60 years, since 1969. Dr. Ronaldo Szerman has over 20 years of experience and teaches other doctors.