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I am 36 and have fairly deep lines across my forehead: Should I have Botox or Filler? (Photo)

I have an expressive face when talking. I would like to reduce their appearance and have been told by a professional that I may not be happy with the results of Botox and that filler would be more effective. I am worried about going straight to filler when I haven't even had Botox before. I will be happy if the the lines could appear finer and I don't want the Botox/filler to stop my facial movements, freezing my brow and it then appearing heavier than normal, changing the way my face looks.

Doctor Answers (11)

Botox and Filler Combination

+2
From your picture it looks like you need a combination of Botox and filler. The lines that you make when showing expression will be improved with Botox injections, if you have lines at rest then the addition of filler would give you best results.

Your at rest lines need to be filled to improve the depression. If you just fill the line without the toxin the muscle contraction will break down the filler very quickly.

Alternatively, you could start with Botox and see if you are happy with the softening of the lines. A Botox treatment will inhibit some of the muscular contraction causing the lines to improve, while still allowing facial expression.

If you are not satisfied with the amount of improvement from Botox alone then you can always add filler for better results, the combination of the two will give the best longest lasting result.

It is best to consult with a Board Certified Dermatologist to see what option is best for you.


Irvine Dermatologic Surgeon
5.0 out of 5 stars 9 reviews

A combination approach can work wonders.

+1
BOTOX® and dermal fillers don’t have to be mutually exclusive. In fact, combining these two treatments is not only common but very effective. As an example, the dynamic wrinkles across your forehead are caused primarily by repeated muscle movements during everyday facial expressions. BOTOX® relaxes the muscles, allowing these lines to smooth away. At the same time, age causes some volume loss that can also contribute to the appearance of wrinkles. Dermal fillers can fill in deeper lines, but the muscle movement would end up forcing the filler to migrate too quickly. Injecting BOTOX® initially ensures that the muscles are temporarily paralyzed, and then following up with dermal filler is more effective.

Joseph J. Castellano, MD
Tampa General Surgeon
4.5 out of 5 stars 6 reviews

Botox then Fillers If Necessary

+1
You may need BOTOX to relax the lines on your forehead, and filler to "fill them out". You can start with BOTOX to see how the results look, and then fillers if you want more rejuvenation. Best of luck!

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 51 reviews

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Botox for transverse forehead lines

+1
The Botox would probably give you a desirable result although you may have to tweak the dosage amount on subsequent treatments.  In patients with deeply etched lines a follow up treatment with laser after the Botox has taken effect would help.

Richard O. Gregory, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 4 reviews

Botox or filler for deep forehead lines

+1
I would recommend starting with botox first. The dose can be tailored so that you maintain some movement for expression, but the muscles are still weakened sufficiently to soften the lines. Your lines will not disappear completely as they are present at rest, but they may improve enough for you to be satisfied. However, treating the forehead in isolation will make your brows droop and look heavy, so this will need to be balanced by also treating the muscles in the frown (glabella) and "crows' feet" areas, which relax to lift the brow upwards. If you do not like the effect that botox has on your muscle expressions, it will wear off and you will go back to normal. I would only consider fillers as a second option, if the botox has not softened the lines to your satisfaction, or if you do not like the effect of botox. As already mentioned, consider also the preventive aspects of botox. Regular botox will prevent your current lines from getting worse in the years to come.

Roy Ng, FRCS(Plast)
London Plastic Surgeon
4.5 out of 5 stars 5 reviews

Deep forehead lines, Botox will help

+1
Botox, Dysport or Xeomin would all be helpful and will relax these lines making them less deep and less noticeable. I think that they will get better with time and improve more after each set of injections as they are like the crease from an old hem. Takes a few washings to really get it out. You can use a little filler but I prefer to try to fix without fillers and to be a little patient

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 12 reviews

Both

+1
The Botox will stop the dynamic lines.  But you will be left with those lines at rest.  
I would start with the Botox, and see how happy you are after a month.  I'm sure it will be better, but you may not be completely happy.
Botox will also halt the progression of those lines... if you think about 10 years from now, they will only be deeper unless you start getting Botox now.
If after a month of Botox, you see some improvement but you are frustrated with the lines at rest, then add some filler.  Or do an upper face Ultherapy treatment which will tighten that skin as well.
Botox is definitely the most important step.  
Best, Dr. McNeill

Anne Marie McNeill, MD, PhD
Newport Beach Dermatologist
5.0 out of 5 stars 1 review

Forehead creases

+1
Thanks for the photos!.  Usually a neuromodulator like Botox, Dysport or Xeomin does the trick. If the lines are still pretty deep (more common in men), then filler may soften it a bit as well..

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Botox or Fillers for forehead lines?

+1
Hi Lucy. The wrinkles in your forehead are a result of years of muscle use. In order to get the best results the muscles need to be weakened with Botox. Very deep lines and wrinkles may not completely go away with Botox treatment alone. In these situations a little Filler can help in addition to the Botox to smooth out whatever lines remain. Hope this helps!

Michael A. Zadeh, MD, FACS
Encino General Surgeon
5.0 out of 5 stars 3 reviews

Forehead lines, botox

+1
This area is ideal for Botox and will yield a far superior result then filler. Not only will botox help you now it will help prevent them from getting deeper and more fixed into the skin. You don't have to be frozen or expressionless. Discuss your concerns with your surgeon. Start with small conservative amounts and then add more in a week or two if you want a more dramatic effect. Good luck.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.