According to the Restylane website, Restylane may be used to decrease both the horizontal lines across the forehead and vertical line between the eyebrows. Can Restylane be used in place of Botox successfully?
Does Restylane Work Like Botox on Forehead Lines and Wrinkles?
Doctor Answers 12
Restylane & Botox | A Winning Team
Hi Mal - Great question. Dermal-fillers like Restylane, Perlane, Juvederm and Radiesse work differently than Botox or Dysport. Dermal-fillers treat the wrinkle by restoring lost volume to the area. Botox and Dysport are treatments that suspend muscle movement; essentially freezing the muscle from making the frown or crease.
I often treat patients with both products for optimal facial rejuvenation without surgery. I would not choose one over the other, as the treatment compliment each other and are not interchangeable,.
Best wishes on your treatment.
David C. Mabrie, M.D., FACS
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Restylane versus Botox in the forehead
Restylane is a very popular and effective hyaluronic acid-base dermal filler. It has been used widely throughout the face for the correction of deep lines and wrinkles. Restylane works very differently from Botox. Botox is a medicine that can help the muscles relax and prevent wrinkles that are caused by contracting muscles. Restylane is a dermal filler and can fill the area underneath the wrinkle to plump up. In the forehead, we typically recommend that the patients began with Botox to help relax the forehead muscles and smooth their brow. In some patients who continue to have prominent forehead lines after Botox, a dermal filler such as Restylane or Juvederm may help.
Both Restylane and Botox have a critical role to play in the modern approach to facial rejuvenation
When we talk about bothersome lines in the face, they can be broadly divided into anatomic areas of tissue loss with time, such as marionette lines, the nasolabial folds, or the tear trough under the eyes, or functional lines from hyperactive muscles, such as the glabellar frown lines, forehead lines, Crow's feet, etc. I like to conceptualize the anatomic "depressions" as the valleys, and the hyperactive lines as the mountains, both of which cause wrinkles. Fillers such as Restylane are best used to "fill-in" the anatomic valleys, and Botox is used to relax the muscular "mountains". The best approach is to use each product in different areas of the face depending on the individual problem...
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Restylane usually not the first choice for upper face
The horizontal lines of the forehead and the vertical lines between the eyebrows are dynamic in origin, meaning they are caused by hyperactive muscles of expression. Because Botox and Dysport work to relax the muscles, they treat the cause of the wrinkles in a way that dermal fillers such as Restylane can't.
However, in some cases the wrinkles are etched in from years of squinting or frowning, so fillers might be used in addition to Botox in those situations, but not typically as a first line choice.
Restylane not commonly used for forehead lines
Although it is not commonly used in the forehead and between the eyes, Restylane is an option in these areas. Restylane is not FDA approved for the forehead, but can be effective to fill larger wrinkles and folds that have not or will not revolve completely with Botox.
Botox is the standard for the upper face because muscle activity causes most of the lines around the eyes and forehead. With that said, we do use it sparingly in between the eyes for very deep vertical lines.
Restylane for forehead
Restylane can be used for the forehead when the lines/wrinkles are deep. Because the wrinkles/lines are due to excessive movement over time, BOTOX is the mainstay of treatment. For deep lines, combining BOTOX with fillers is a great way to get rid of the lines faster. The BOTOX also allows the filler to stay in place longer without breaking down.
Botox is far better for dynamic forehead lines
The lines that form on the forehead are a result of muscle activity over time. Minimization of activity of these muscles helps give the forehead a more relaxed, smoother appearance. Botox is a form of chemical neurotoxin that minimizes communication between the motor nerve and the muscle. The reason Allergan has been so successful is that Botox really works!
Restylane is a hyaluronic acid based filler that is injected to lift up facial lines. In my opinion it is more appropriate for lower facial and lip lines, volume enhancement of the lips, and nasolabial folds.
Restylane: small bit part; Botox: the Star
Forehead lines respond much better to Botox. However, if there are traces of forehead lines, after an adequate Botox injection, some Resylane can be injected into these areas. Occasionally, Restylane can be used in the glabellar area.
Please make sure your injector is experienced. Injections can adroitly be placed into these areas, but can be a bit risky. Necrosis with large areas of the face scarred, can occur. Injections should be performed slowly and this complication watched for. In the event of signs of blanching or pain, Hyaluronidase should be injected. This is especially true in the glabellar area.
Restylane and Botox do not replace one another
Restylane and Botox complement one another -- they do not replace one another.
Forehead lines are caused by contraction of the Frontalis muscle in its raising the brows. This is best treated with Botox. If once the muscle has been relaxed with Botox, lines persist owing to an element of permanent creasing of the soft tissues under the lines, the remaining lines would be FURTHER improved by placement of Restylane under them.
Comprehensive approach to wrinkles and lines require understanding of causes
In order to choose the best therapeutic option(s) for wrinkles, it is helpful to understand the underlying reason(s) behind these lines of maturity. Forehead, crows feet lines are mostly due to excessive and involuntary contraction of facial muscles and thus is better treated with botulinum toxin such as Botox or Dysport. Whereas smile lines around the lips along nasolabial folds and the corners of the mouth are mostly due to loss of facial volume and immediate gratification can be provided by fillers such as Restylane, Juvederm, Evolence or Radiesse. On the other hand, most of the sagging of our cheeks, jowls is due to loss of bony support that we used to have in our youth along brows, upper cheeks and the mandibles. If you are not quite ready for face lifts, Sculptra can be a wonderful option to restore a more rejuvenated facial contours and the cosmetic benefit may last couple years.
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.