The practical difference between Restylane and Botox Cosmetic is where each one is approved to go. Restylane is a family of hyaluronic acid fillers with approvals granted area by area — lips, cheeks, chin, hands, temples and the hollow under the eye. Botox Cosmetic's cosmetic approvals cover three upper-face areas and, since 2024, the bands in the neck.
Restylane adds volume. Botox Cosmetic relaxes muscle. A filler takes up space so the tissue above it is pushed out. A botulinum toxin blocks acetylcholine release at the nerve ending so the injected muscle stops contracting fully. Neither one does the other's job.
"Restylane" is a family name, not a product. Restylane, Restylane-L, Lyft, Silk, Refyne, Defyne, Kysse, Contour and Eyelight each carry their own FDA approval for their own named area, and a figure from one does not apply to another.
No trial has compared a filler against a botulinum toxin, for any area. What follows is a map of what is approved where, which is the question people are usually really asking.
Three separate approvals cover the family, and each product sits under one of them as its own supplement.
Restylane and Restylane-L — facial wrinkles and folds such as nasolabial folds, plus lip augmentation (2011 and 2012). Restylane Lyft with Lidocaine — nasolabial folds, cheeks and midface (2015), the back of the hands (2018) and the chin (2025). Restylane Silk — lips and perioral lines (2014). Refyne and Defyne — nasolabial folds (2016); Defyne also the chin (2021). Restylane Kysse — lips and upper perioral lines (2020). Restylane Contour — cheeks and midface (2021) and temple hollowing (2026). Restylane Eyelight — infraorbital hollowing (2023).
Glabellar lines (12 April 2002), lateral canthal lines, which are crow's feet (11 September 2013), forehead lines (2 October 2017) and platysma bands (18 October 2024).
Restylane, Restylane-L, Silk and Kysse carry lip indications. Lyft, Refyne, Defyne, Contour and Eyelight do not. No Restylane product carries an indication for crow's feet, jowls, gummy smile or named marionette lines.
The four cosmetic indications above are the full cosmetic list.
Syringes are supplied at 0.5 mL and 1.0 mL depending on the product; Restylane Eyelight is supplied at 0.5 mL.
20 Units for glabellar lines, 24 Units for lateral canthal lines, 40 Units total for forehead and glabellar lines together, and 26, 31 or 36 Units by band severity for platysma bands.
Restylane in the lips: 92.6% combined responders at week 8 falling to 59.3% at week 24, where the trial stopped. Lyft in the cheeks: 88.7% at month 2 and 75.7% at month 12 — though the untreated control group scored 57.4% at month 12, which says a lot about how soft these scales are. Kysse in the lips: 88% at week 8 and 60% at week 48. Defyne in the chin: 86.1% at week 12 and 73.7% at week 48. Eyelight under the eye: 87.4% at month 3 and 63.5% at month 12. Contour in the temples: 91.2% at month 3, with follow-up scheduled to 18 months.
It acts within minutes to hours, and repeat dosing is normal. In laboratory testing, Restylane Lidocaine fully degraded with 100 units of ovine hyaluronidase after 50 minutes at one dilution, while some other brands needed 300 units for degradation within an hour.
The clean way to hold this in your head is that Restylane's approvals are anatomical and Botox Cosmetic's are muscular: Galderma sought approval for the lips, the midface, the chin, the back of the hands, the temples and the infraorbital hollow, one product and one trial at a time. Allergan sought approval for the muscles that fold the skin of the upper face, and later for the platysma bands of the neck.
Two of these areas came with an unusual condition attached. Restylane Eyelight may only be distributed to injectors who have completed an FDA-approved training programme, a labelling requirement added in December 2023. That is a rare restriction and it is worth asking about.
There is one area where the two families face each other directly, and the answer is not ambiguous. Crow's feet are lateral canthal lines. No Juvederm or Restylane product carries an indication for that area, and filler used there is off-label - which is legal and routine, but it means no pivotal trial was run there. Botox Cosmetic has held that indication since 2013 at a label dose of 24 Botox Cosmetic Units. If crow's feet are the complaint, the toxin is the evidenced answer.
Injectors use both products outside their approved lists all the time — Restylane in marionette lines, in the temples with a product that has no temple approval, or along the jawline; toxin in the masseter or the lower face. That is legal and routine, and it is not a scandal. What it does mean is that no pivotal trial was run in that area for that product, so the numbers quoted from the trials do not apply there.
For some off-label areas the position is stronger than "untested". Marionette lines are not named in any US filler approval, but the standard wording — "correction of moderate to severe facial wrinkles and folds, such as nasolabial folds" — is an example rather than a limit, and marionette lines plausibly sit inside it. Jowls and gummy smile are different: no US hyaluronic acid filler names either, and for a gummy smile a botulinum toxin, not filler, is the better-evidenced minimally invasive option, even though that use is off-label too.
No trial has ever compared a filler against a botulinum toxin, and the trials that do exist within each family are mostly non-inferiority designs: A non-inferiority result sets out only to rule out a difference bigger than a pre-set margin. It is not a demonstration that a product is better.
Restylane Contour's cheek trial is a good example, and it is one of the better-designed comparisons anywhere in this field: 270 subjects, 17 US sites, evaluator-blinded, with Contour tested directly against Juvederm Voluma XC. It met non-inferiority at week 12. Nobody won. The Refyne and Defyne nasolabial fold trials went the same way — both met non-inferiority against an approved hyaluronic acid comparator, and in raw responder terms the comparator was numerically higher at every timepoint.
No professional society currently publishes a per-syringe price: The American Society of Plastic Surgeons stopped reporting fees for minimally invasive procedures after 2023. Its last figure for hyaluronic acid fillers was $715 for 2023 — a physician fee only, counted per procedure rather than per syringe, pooled across more than ten products and every facial area. RealSelf's crowdsourced Restylane page gives an average of $1,168, from self-selected patient reviews, last updated 9 March 2023. No current published figure exists for Botox Cosmetic.
These signs can mean filler has entered a blood vessel. That is a rare event, and it is a medical emergency where time matters in hours.
Any change in vision — blurring, a dark patch, double vision or loss of sight in one eye, during or straight after an injection
Pain that is far worse than the procedure should cause, or pain that keeps building
Skin that turns white or pale in a patch soon after an injection, then goes dusky, blotchy or net-like
Weakness, drooping, slurred speech or confusion
Published guidance treats suspected blockage of the artery to the eye as a same-hour emergency and suspected skin blockage as a same-day emergency. In a review of 511 published blindness cases from 1906 to 2023, 68.2% of the 318 people with a recorded outcome had no recovery of vision, and no treatment used was significantly associated with improvement. Do not wait to see if it settles, and do not assume pain will warn you — in a survey of 52 experienced injectors, pain was mild or absent in 47% of the blocked-vessel events they described.
Swelling is still growing three or more days after treatment instead of settling
A lump appears and will not settle, or one appears weeks or months later
Redness spreads outward from the injection site, or the area becomes hot and tender
Tenderness, firmness or swelling turns up weeks after treatment, sometimes after an illness, a vaccination or dental work — this is a recognised delayed reaction
The product looks like it has moved out of the area that was treated