Hyaluronan vs. Botox®

Hyaluronan vs. Botox - A comparison of the two most popular wrinkle treatments


Hyaluronan vs. Botox®

A comparison of the two most popular wrinkle treatments

Botox® is probably the most prominent wrinkle treatment around. Not only Hollywood stars are completely hooked on the neurotoxin that promises to keep the wrinkles in check and slow down the visible ageing process. The world over it is the number one cosmetic procedure. However, not everyone wants to exchange wrinkles for a motionless face. Hence, hyaluronan, also known as hyaluronic acid, presents itself as a great alternative as it does not paralyse the muscles.

Both Botox® and hyaluronic acid are highly effective. To help you pick the right solution for you, we took a close look at both wrinkle treatments in detail.

 Origins and production of the two most prominent ways to smoothen your face

Botulinum toxin

Botox® is actually a brand name. The drug that is injected under the skin is called botulinum toxin type A. It is a bacterial toxin. It was originally discovered in sausage cans that had been stored too long. Although it is often claimed that botulinum toxin is a snake venom, this is just a myth. Botulinum toxin is a drug made from a toxin produced by the bacterium clostridium botulinum.


Hyaluronan or hyaluronic acid is a polysaccharide that occurs naturally and can be found almost everywhere in the human body. It is a transparent, gel-like substance that makes the skin elastic and is responsible for its resilience. In the synovial fluid, it serves as a lubricant and is also found in the bones, intervertebral discs, as well as the vitreous body of the eye. Hyaluronic acid can be produced using biotechnological processes (vegetarian hyaluronan) but it can also be extracted from rooster combs.

Areas of application of botulinum toxin and hyaluronan

Botulinum toxin

Botulinum toxin is not only used to combat wrinkles, but is also used in clinical medicine. It is a versatile clinical tool for a number of conditions such as twitching eyelids, chronic headaches or muscle cramps. It can even help excessive sweating when injected into the armpits, blocking the nerves that cause sweating. Botulinum toxin type A weakens and even paralyses muscles and is also able to block nerves, so that muscles can no longer be contracted. Cosmetic uses for botulinum toxin type A include the treatment of strong expression lines such as squint lines at the corners of the eyes (crow’s feet), the vertical lines between the eyebrows (also known as glabellar lines or forehead furrows) as well as nasolabial folds around the mouth.


In orthopaedic medicine hyaluronic acid is used to help combat osteoarthritis amongst other fields of applications. In aesthetic medicine hyaluronic acid is used for breast, butt and lip augmentation, and is an extremely popular dermal filler to combat wrinkles. Hyluronan is the ingredient of choice in anti-ageing creams and serums. Unlike botulinum toxin, hyaluronan does not inhibit the natural movements of the face. Its ability to store large amounts of water supplies the skin with moisture, which visibly rejuvenates the skin and gives it that extra fresh look.

Sometimes hyaluronic acid and botulinum toxin type A are used in combination in order to combat particularly pronounced wrinkles. Whilst the paralysing effect of botulinum stops the movement of the face causing the deepening of the facial lines, hyaluronan is used as a dermal filler to fill in the existing wrinkles.

How long do Botox® and hyaluronan last?

Botulinum toxin

Some 2-3 days after the treatment first effects become visible. However, it takes some 1-2 weeks for botulinum toxin type A to unfold its full effect, peaking at 10 days. The paralysing effect wears off over time. How fast this happens differs from patient to patient. Generally it takes about 4-6 months before you will need to be injected again if you wish to continue treatment.


The effect of hyaluronic acid, when injected, lasts about 6-9 months before it is fully metabolised by the body. However, it also depends on the type of hyaluronic acid used, which in turn depends on the depth of the wrinkles and the skin type of the patient. The effect of the treatment is visible immediately.

If hyaluronic acid is used as an ingredient in anti-ageing creams and serums, it totally depends on the product. While some products visibly rejuvenate the skin as quickly as one hour after its application, others have to be used for weeks or even months, before any results become visible.

How much do Botox® and hyaluronic acid treatment cost?

Botulinum toxin

The price depends on various factors: the quantity that needs to be injected, the doctor performing the treatment (the more prominent the doctor – or his patients – the more expensive) and the product/brand used. The price of the treatment starts from € 200. The price of botulinum toxin type A is calculated in units. Some 15 units are needed to combat crow’s feet, whilst about 20 units might be necessary for forehead wrinkles. Each unit costs approx. €12-18.


Hyaluronic acid is calculated in millilitres. 1 ml costs about € 350-400, depending on the manufacturer. The deeper the wrinkles, the more hyaluronan needs to be injected. While only about 0.5 ml of hyaluronic acid are needed for upper lip wrinkles or chin folds, a cheek augmentation requires 3 ml, making it much pricier.

For external use, you can also go for anti-wrinkle creams and serums that are applied to the surface of the skin. They differ in price, depending on the manufacturer.

For both botulinum toxin and hyaluronic acid, cheaper is never better. Extremely cheap deals can mean that the products used are unauthorised and illegal, which can have serious medical consequences.

Side effects – Looking younger and wrinkle-free may come at a higher cost than you are willing to pay

Botulinum toxin


Botulinum toxin type A is considered the strongest lethal toxin and can even used as a bio-weapon. Hence, getting your wrinkles treated with this neurotoxin can have undesired side effects. It is therefore of utmost importance that you seek professional advice from a specialist before undergoing treatment. Typical but less dramatic side effects include mild swelling, haematomas and redness at the puncture site. The injection itself can cause a slight burning sensation.

In case of an overdose or if botulinum toxin enters the bloodstream, the patient may get a dry mouth, headache and nausea, dysphagia and even respiratory muscle paralysis may occur. In such a case, an antiserum must be administered immediately. The patient must be ventilated artificially, as it takes a while for the antiserum to work.

Celebrity Botox-Disasters

But that is not all. Doctors do not have 100% control over where the botulinum toxin goes, once injected under the skin. If injected too close to the eyelid or if the doctor is not very experienced, you can end up with a droopy eyelid, an asymmetrical appearance or a “frozen face”. Bad news is: there is no antidote for badly injected botulinum toxin, you just have to wait until it wears off.


As with botulinum toxin, hyaluronic acid may also cause harmless side effects such as mild swelling, haematomas and temporary redness at the puncture sites. In the short term, hyaluronic acid dermal fillers can lead to a slightly stronger swelling or even nodule formation. However, these typically disappear within a few hours or days.

Since hyaluronic acid is an endogenous substance, allergic reactions are highly unlikely but can occur. The success of a hyaluronic acid treatment depends on the skills and experience of the doctor who performs the treatment. The more experienced he/she is, the more beautiful and natural the result. When hyaluronic acid is applied externally, as a cream or serum, allergies or side effects are virtually unheard of, unless you are allergic to any of the other ingredients of the product you apply.

You should not have injections of either botulinum toxin type A or hyaluronic acid when pregnant or breastfeeding.

So which one to pick? Are both wrinkle treatments equally effective?

Both botulinum toxin and hyaluronic acid live up to their promise. They will both help you achieve that younger look, stop new wrinkles and can reduce even deep expression lines.

Although hyaluronic acid is slightly more expensive, it is definitely the safer option.

Instead of having hyaluronic acid injections, it can also be applied externally as an ingredient of an anti-wrinkle skin care cream or serum. You can easily incorporate the application into your morning or evening routine. It is much less costly and has even fewer side effects than an injection.

No matter what you decide: Given the numerous and sometimes serious side effects of botulinum toxin, you should consult with a qualified medical practitioner before you seek treatment. By the way, beauticians and estheticians are not legally allowed to inject botulinum toxin in Europe, only licensed people are. Regulations are less strict on the use of hyaluronic acid, however, given the damage you can do by injecting it wrongly, you better seek an equally trained medically trained individual as you would with botulinum toxin. Alternatively, you can always use an anti-wrinkle cream or serum that gives you the smoothing effect without side-effects. 

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