Under-eye lines: Botox or filler?
Under the eye, it all depends on the type of line: there at rest, or only when you smile. A mirror test is often enough to tell.
There is a sentence we hear a lot in consultation: "I had injections and my jawline looks exactly the same." That person was not treated badly. She got a very good procedure, for a problem she did not have.
Because under the word "aging" there are really three different things. They show up at the same time, on the same face, and they do not answer to the same tools. Until you separate them, you are paying for a result you will not see.
Three things we all call "aging"
Look at your face and ask the question differently. Does a line carve itself in when you talk? Has a spot gone hollow, as if something underneath had been taken away? Or has everything slid down half a centimetre, without any one line bothering you?
Those three observations have three names:
- The expression line, which comes from a muscle contracting.
- Volume loss, which comes from support that has emptied out.
- Laxity, which comes from skin that has lost its spring.
| What you see | What it is | What answers it |
|---|---|---|
| A line that shows up when you move | An expression line | The neuromodulator, given by a nurse |
| A hollow, a flat cheek, a dropping mouth corner | Volume loss | Filler, placed by a nurse |
| A softer jawline, looser skin | Laxity | Deep heat, handled by a medical esthetician |
Three causes, three layers of the face, three procedures. That is why an excellent treatment can change nothing about what actually bothers you.
An expression line only exists when you move
The forehead that creases when you raise your brows. The line between the eyes when you concentrate. The folds at the corner of the eye when you smile. These marks are made by a muscle contracting, thousands of times a day, for years.
The neuromodulator relaxes that muscle temporarily. The muscle pulls less, so the skin creases less, so the line softens. It is an injection, given by our nurse.
Here is the part where the disappointment happens: the neuromodulator works on movement. It does not make skin firmer, it does not lift anything, it does not replace what has melted away. It calms a facial gesture, and that is plenty when the gesture is what bothers you.
Volume is support that emptied out, not skin that fell
Over the years, the fat pads of the face thin out and shift, and the bone itself remodels. The result: the temple hollows, the cheekbone flattens, the fold between nose and mouth deepens, the corner of the mouth drops.
The mechanism is easy to picture. When the support underneath shrinks, the skin that sat on top suddenly has too much surface for what it covers. It creases and it slides, not because it is tired, but because what it was covering got smaller.
Hyaluronic acid fillers put that material back where it is missing, and it is our nurse who places them. Done well, the result does not read as "a filled cheek": it reads as a face people find rested without knowing why.
Here too, we have to say what it does not do. Restoring volume does not tighten skin, and a face filled beyond its own volume does not look younger, it looks like someone else.
Laxity is the skin itself losing its spring
The third case is the sneakiest, because it does not come down to any one line. You cannot point at anything: the whole thing has moved. The jawline is less defined. The skin of the neck is softer. When you lean toward the mirror to put on makeup, everything drops a little more than it used to.
What changed this time is the weave of the skin. Collagen and elastin, the fibres that keep it taut, thin out and lose their order. The skin gets finer, looser, and gravity handles the rest.
No injectable repairs that weave. That is the job of energy: radiofrequency heats the deep dermis to tighten the collagen already there and restart production. That handpiece is not a nurse's by default, it is our medical esthetician's, and it is the procedure that matches what our facial laxity page describes.
And the honest limit, the one we tell you before we start: no energy device removes skin. When there is real excess, surgery is what gives the result, and we would rather say so at the first appointment than after a series of sessions.
The mirror test: still first, then moving
You can do a first sort at home, in two minutes, with good side lighting.
- Face perfectly still. Whatever still shows is not a muscle story. It is volume or laxity.
- Then move: raise your brows, smile, frown. Whatever appears only then is an expression line.
- Finally, lie down for a few minutes and look again. What improves once gravity stops pulling sits on the laxity side. What stays hollow lying down is more likely missing volume.
This test does not replace an assessment, it gives you the vocabulary. Walking in saying "it only shows when I smile" or "it is there even when I am not moving" changes the whole conversation.
Why your injections did nothing for your jawline
Back to the sentence we started with. Someone treats the upper face, loves the result on the forehead, and comes back six months later saying the lower face has not budged. That makes sense: the procedure addressed a forehead muscle, and what bothered her was the jawline, which is a matter of support and firmness.
The reverse happens too. We treat slackening skin with heat, the jawline sharpens, and the line between the brows is still there, because no device relaxes a muscle.
Nobody did poor work in either case. The sorting simply had not been done first. That is why we always start by looking, describing and naming before we propose anything.
When you have all three, the order matters more than the amount
Past a certain age, most faces show a bit of all three. The answer is not to do everything at once, and definitely not to do everything at the first visit.
What sets the order is not a package, it is two questions. What bothers you the most when you look at yourself? And what takes the longest to deliver its result?
That second question surprises people, and it is very useful. Filler shows right away. The neuromodulator settles in over a few days. Firmness rebuilds over weeks, because we are asking the skin to make collagen, and that cannot be rushed. When firmness is part of the plan, we often start it early, so time can work while we handle the rest.
This is not a cross-sell. Some people leave with a single procedure, others with a single piece of advice and an appointment a year out.
The three do not arrive at the same age, and that changes the plan
These three phenomena do not start together and do not move at the same pace. That is why at thirty-five and at fifty-five, the same person does not have the same conversation with us.
Expression lines show up first, because they depend on a movement you have always made: someone very expressive will see them early, even with perfectly healthy skin. Volume loss settles in later and more quietly, since nothing appears, something disappears. Laxity follows the gradual drop in collagen, and years of accumulated sun speed it up considerably.
One practical consequence: what bothered you five years ago is not necessarily what bothers you today. A plan that worked beautifully for years can stop being enough, not because it stopped working, but because a second phenomenon arrived on top of it. So we redo the sorting at every assessment, instead of renewing out of habit.
Who does what, and why we tell you upfront
The law is clear in Quebec, and it is not an administrative footnote: it decides who you see.
- Injections (neuromodulator, fillers) are given by a nurse. A medical esthetician does not touch them.
- Devices (radiofrequency, laser, peels) are handled by a medical esthetician. A nurse can do them too: the rule only runs one way.
Here, the assessment starts from what you see, not from whichever device is free. We tell you which layer your concern belongs to, what we are suggesting, what we are not suggesting, and why. You do not have to come and check: we say it upfront.
Your questions
Does the neuromodulator firm the skin?
No. It temporarily relaxes a contracting muscle, which softens a movement line. It does not act on the fibres that keep skin taut. Slackening skin calls for a different procedure.
Can filler lift a jawline?
It can restore support where the face has emptied out, and that support changes how the skin falls. That does not make it a facelift, and on genuinely lax skin, adding more does not improve the contour. The assessment exists exactly to sort that out.
Can I have radiofrequency if I already have filler in place?
That is a question to ask before the session, not after. We ask at the assessment what you have had, where, and when, and that is where we decide how to proceed. Mention it even if it was a long time ago, and even if it was done elsewhere.
Where do I start when I have all three?
With whatever bothers you most in the mirror, keeping in mind that firmness takes longer to respond than injections. We set the order together, and nothing says everything has to happen in the same year.
Is it the same person for both?
Not necessarily. The injection is given by a nurse, the device is handled by a medical esthetician, and a nurse can hold the handpiece too. You will know who you are seeing before your appointment.
What we tell you before we start
Naming the problem is not a vocabulary detail: it decides whether you will like your result. A movement line, a hollow and slackening skin are three different conversations, and a serious assessment starts by separating them.
If you have already walked away disappointed from a treatment elsewhere, it is worth saying so when you arrive. Nine times out of ten, that is where the explanation is.
