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Ronald Shelton, MD answers: Which product do I use for vertical lines? Botox or Restylane?

I have two sort of deep vertical lines right between my eye brows. Which procedure would be better, botox or restylane. Or should one have both procedures on the same site? I am not sure if you can see the vertical line on my picture. I am the one on the right. Thanks.


Ronald Shelton, MD
9 months ago

Most physicians would agree that Botox is the treatment of choice for your “11” and if the lines improve only partially, then you can consider having a filler injected. Be certain that you see a qualified experienced physician as there is a risk if too thin a filler is injected into that area. The safer ones to use are Juvederm and Restylane. Try the Botox first. Realize that the lines are there from years of frowning and the skin developed these creases from the accordion-like motion of the underlying muscles. Once the muscle stops moving and you don’t frown, it will take time for the skin to lose its crease.

The Botox will take a couple of weeks to reach its effect and may last for several months. Don’t rush in for a filler until you give it a while; otherwise you might be spending more money than needed. On the other hand, if you have a reason to reduce the line quickly, such as an important social engagement or photograph shoot,  I would still do Botox after the filler, but don’t do the filler just a few days before the event in case you bruise.

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A: You just need Botox

George J. Beraka, MD
9 months ago

To texasmom,

Hi! Your lines do not look "etched".  You have a youthful face ant the "glabellar" lines are not very deep.  25 units of Botox injected in a flattened V pattern between your eyebrows will do the trick.

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A: Both would do the trick - I would start with Botox

Arash Akhavan, M.D.
8 months ago

Judging by your picture, I think you would do great by starting with Botox as the first line of therapy.  Botox would work to soften the vertical lines, and may or may not eliminate them completely. 

Over time, with repeated injections of Botox, any permanent creases that you have in the area may soften to a point that you are very pleased with the results. 

If not, certain fillers, such as Restylane or Juvederm, can be injected by a physician with experience injecting specifically in this area. 

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A: Both Botox and a Dermal Filler for vertical lines

David Shafer, MD
9 months ago

Based on the picture, it looks like you need both Botox Cosmetic and a Dermal Fillers (Restylane, Juvederm, or Evolence). The Botox will decrease the stress on the overlying skin by paralyzing the underlying muscle. The Dermal Filler will fill the missing volume. You have moderately deep vertical lines, while appear that they would be there even at rest. The Botox only works on dynamic lines. That is why you need Botox and a filler.

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A: Botox for the vertical lines

Kenneth R. Francis, MD
9 months ago

Texas Mom,

If your a gambler you got that one. Thank you for identifying yourself in the picture. Your daughter could pass for a slightly younger friend, seriously. On closer inspection of the photo I did appreciate the vertical lines (11). The appearance of these lines is the result of decades of facial animation and emotion expression. Yours do not appear to be all that deep, so there's hope. I would recommend a trial of Botox only for your first treatment.  If you maintain yourself with serial Botox treatments, that is every 3-4 months, or as long as it lasts for you, then your skin volume loss directly involved with the lines will correct itself over time.  illers in the area will give you a more immediate result, but there are some risks to their use, which you can discuss with your board certified plastic surgeon. Good luck!

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