Q. I'm in my late 30s and many of my friends are talking about the injections they've received to look younger. I'm new at this and don't have too much money to spend. Should I ask for a filler or a toxin? How do they differ?

A. These are great questions. Even though these products have been out there for so many years, lots of people are still confused about what exactly they do.

First, let's start with fillers. Fillers do just that -- fill in wrinkles and depressions that cause people to look tired or older. A doctor injects a material into an area of your face to fill in areas that have loss of tissue or are prominent because of overactive muscles. The areas most commonly ``filled'' are the nasal-labial folds, the frown lines between the eyebrows, lips and the cheek area. Other areas that may be filled to enhance and enlarge include lips and earlobes.

Fillers come in different forms. The classes of fillers I most commonly use are hyaluronic acid gels, including Restylane, Perlane and Juvederm. Their duration of action is approximately six to nine months. Radiesse is a filler that is composed of calcium material that works well and has duration of up to one year. Evolence is a new filler that is made of porcine collagen and has duration of action of approximately six to nine months. A newly FDA approved drug for soft-tissue filling of the face is Sculptra. This also has a duration of approximately one year. Each filler has very specific uses and very specific nuances for its use. Your doctor knows best which one will fit your small and young imperfections.

Toxins are much easier to decipher. There are two, Botox and Dysport. Both are botulinum type-A toxin and have a similar mode of action. The toxins are approved for relaxation of wrinkles in the area between the eyebrows. There is, however, a large number of off-label uses for each. If injected properly, the toxins can lessen the muscle action of the face, which removes wrinkles that form as a result of those muscles' actions. Both toxins have a good safety record with many years of use. The studies indicate that Dysport may start to work sooner and can last for up to four months. Botox has a long history of great results with millions of satisfied patients.

So what's a patient to do? I would discuss your concerns and desires with your physician. The most important thing for you to consider is the experience of your doctor, not so much the type of filler or toxin you use.

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