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Can Juvederm or Restylane Be Injected on the Forehead?

Is getting filler such as Juvederm or Restylane in the forehead for a deep crease an off label procedure and what are the risks associated with putting the filler in this area?

I have had Botox already and the deep line is still pronounced and hasn't decreased at all. My dermatologist won't put filler in this area because of the risk of necrosis. Please help with what are my choices and the risks are for this problem. See attached photo (this is after Botox treatments).

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forehead wrinkles

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15 Doctor Answers | Asked by trish1975 in Milwaukee, WI

Doctor Answers (15)
Community Comments (1)

Restylane/Juvederm in glabella (forehead)

Yes, it can be done. The risk of necrosis is a real risk. However, it can be minimized if not eliminated by injecting without pressure. It should be done in small amounts. Also, the doctor performing this should be familiar with the signs of vascular compromise that usually happens immediately causing white colored blanching of skin. She/he needs to be trained in how to treat it by aggressive immediate massage, applying Nitroglycerin, squeezing some of the material out by making a small... more

Filler for Forehead Wrinkle

Since I danced for Milwaukee Ballet and did my undergrad as well as medical school there I am a true Wisconsinite. I often have to add filler for forehead wrinkles after Botox. If Botox is injected for a year or more without return of muscle function and the skin continues to show the wrinkle then it's time to add filler. Any of the hyaluronic acid fillers is an excellent choice to reduce the appearance of these wrinkles.

Juvederm/Restylane Injected in Vertical Forehead Lines, Better When Done Concurrently with Botox

Hi Trish, Both Juvederm and Restylane can be used "off-label" to fill the vertical forehead lines between the eyebrows (glabellar lines). In fact, when Botox and either Juvederm or Restylane is used concurrently in this area, there is a synergistic effect that creates a very long lasting (many times permanent) elimination of the lines, even when the Botox wears off. If your dermatologist is uncomfortable injecting in that area, certainly do not have him/her inject you. You do... more

Michael A. Persky, MD

21 reviews

Los Angeles Facial Plastic Surgeon

drpersky.com

Restylane of Juvederm for vertical forehead wrinkles

I agree with other physicians. The use of fillers in this area is indeed "off-label", as it is in the lips, cheeks and many other areas. Yet, we use it frequently and it is can be a very rewarding procedure for the patients and physicians. I would only use a hyaluronic acid filler, such as Restyalne or Juvederm. Filler combined with Botox or Dysport in this area usually lasts for about 6 months or longer. There are many nuances to the technique. Since you really cannot tell... more

One should use caution for Juvederm or Restylane on the forehead

Dear Trish While injection into the glabellar area can cause necrosis. The key is subdermal placement without overfill. By monitoring the capillary filling disturbances in the circulation can be treated with the enzyme hyaluronidase. My best recommendation is don't make your dermatologist do something they are not comfortable with. Consider looking at the liquidfacelift.com website for the name of an experienced injector in your area.

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Filling the "11's"

Your photo shows a prominent vertical forehead wrinkle, which presumably remains after your botox has "set up". Your dermatologist is prudently cautious in avoiding this area because it is considered an "off label" (not approved by the FDA) indication for the hyaluronic acid fillers. The conservatism stems from the fact that the blood supply here is a "watershed" or very limited. So if an injector inadvertently injects some filler into a vessel, the area... more

Lavinia Chong, MD

22 reviews

Orange County Plastic Surgeon

www.chongmd.com

Restylane for forehead crease

Hi Trish, The risk of necrosis in this area is higher than other areas of the face. But just like all "off label" uses of injection products, the results and potential for side effects will depend on the skill of your practitioner. We certainly respect the choices your physician is making in regard to injecting the forehead, but we believe Restylane is a good option for your problem and an option that we have used in many cases like yours. Good luck.

Harold J. Kaplan, MD

4 reviews

Los Angeles Facial Plastic Surgeon

www.celibre.com

Juvederm or Restylane are often used to treat forehead wrinkles with Botox

Juvederm or Restylane are facial fillers which can often be used in conjunction with Botox to treat forehead wrinkles. Having said this, Botox for most people works great by itself; and is used for the horizontal forehead wrinkles, the vertical lines between the brows and the crows feet lines around the eyes. However, sometimes, the vertical lines between the eyes are very deep and entrenched. That is when you know one of the facial fillers may be necessary. While complications can occur,... more

Restylane or Juvderm can be used in your forehead lines

Juvederm or Restylane to fill in forehead lines is off-label like many other uses of these products. I routinely use fillers in forehead lines that do not respond completely to Botox. I have used Juvederm, Restylane, Radiesse, Evolence, Elevess on scores of patients with no complications. I think the risk of skin necrosis (barring intravascular injection) is extremely small if the product is injected intradermally by an injector experienced in this area.

James C. Marotta, MD

9 reviews

Long Island Facial Plastic Surgeon

www.marottamd.com

Forehead, eyebrow shaping

Dear Trish You have a very good question and are correct about the 'off label' use of fillers in the forehead but it can be done safely. The combination of the fillers and Botox can give a very long lasting and pleasing result. With Warm Regards, Trevor M Born MD

Fillers and the forehead

Your dermatologist is correct that there is a risk of ulceration or necrosis (death) of the skin surface. This can happen in this location if too much filler is used, or if too thick a filler is used. It is done without complication, but, this risk does exist in all cases.

Juvederm and Restylane to the forehead

I agree with the other responders to your question. You need to be aware of the real risk of necrosis (tissue death) in this area as a result of the tenuous blood supply to the skin between the eyes. Keys to decrease the risk of this feared complication is injection with small volumes of material under low pressure, avoiding injection directly into a blood vessel, and avoiding injections that are too deep. During the procedure, the practitioner needs to watch carefully for early signs of... more

Restylane for vertical forehead groove

Hi! A lot of filler use is off label, so that in itself should not stop you. In New York, we often treat these forehead lines with small amounts of Restylane safely. But complications have been reported. I think good technique and a conservative approach are the key.

Fillers for lines on forehead

Your dermatologist is correct to be cautious with injecting the forehead with fillers. It would be considered an "off label" use of the filler. However, filler can be very effective for these areas when used correctly and conservatively. Also, give the Botox a chance. When you significant static wrinkles, it often takes several treatments with Botox before you see a change. The dynamic wrinkles, however, you should see a positive change with the first treatment of Botox. more

Forehead filler

The risk of skin necrosis from forehead or glabella region restylane injection is real but very minimal, if injected correctly (superficial, slow injection), avoiding vessels. Botox treats dynamic lines, not static lines such as the vertical crease in your forehead.

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Comments (1)

reparata 31 Aug 2012

I just wanted to mention that I played top tournament tennis for many years, in the hot sun, and all the stress of competition, and the sun, left me with deep forehead creases that went all the way across. I have very oily skin, and the rest of my face looked much younger with hardly not wrinkles at all. At age 40, I decided to try Botox, but it didn't help get rid of the lines, so I had botox in conjunction with restylane. It took nearly a half hour for the doctor to install the restylane into the deep forehead creases. She did it with a very fine needle and did it very slowly. It was just one siringe of Retalyne, that costed $400.00. that was installed on week after botox. It did wonders, and almost completely removed the forehead lines for nine months. I look 10-15 years younger without the forehead creases After nine months, the lines started to appear, but not nearly as strong. The second time, I didn't get the Botox, I just got restylane in the forehead lines that started showing again. It has been ten months, and now the lines are becoming visiible again, but don't look bad. I plan to get botox, and restylane, in conjunction again this time. Most doctors told me that restylane cannot be used in the forehead area, and not even allowed. This doctor has done it for many years and she does a perfect job. Her name is doctor Brenda Schultz from Michigan.. She was working for an office in Livonia, but has now transferred to Ann Arbor. She is easy to find in internet searches.

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