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How Safe is It to Use Restylane Between the Eyebrows?

Could Restylane affect vision or cause a reaction or swelling in the eyelids?

Doctor Answers (16)

How Safe is It to Use Restylane Between the Eyebrows?

+1

 The best way to soften unwanted lines and wrinkles in the Glabella (between the eyebrows) is with an injection of a neurotoxin like Botox, Dysport or Xeomin.  Using any filler in this area runs the risk of the filler occluding the vein which can cause necrosis and scarring the size of a quarter in the center of the forehead.  This is a well known complication that has been documented for years.

Web reference: http://www.drfpalmer.com

Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Can Restylane be used between the eyebrows?

+1

Dysport and Botox are the first part of the treatment plan in relaxing the underlying condition (muscle contraction) that is leading to the lines, wrinkles, and furrows.  

If the lines are still present after two weeks, the lines may be considered "static" or permanent regardless of the muscles being put to rest.  At that point, using smooth HA fillers ( Juvederm/Restylane) may be a good option to soften and fill these areas.

Many injectors agree that a combination treatment approach is sometimes best but to make best use of your time and finances, fillers should only be secondary if the Botox or Dysport did not meet your goals.  

Although using the filler in this area is "off label", it is an accepted standard of practice.  As with all techniques, an experienced injector will be able to approach this with safety and efficacy.

 

Web reference: http://www.celibre.com/restylaneTreatment.aspx

Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Restylane is safe for use between the eyebrows

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With an experienced provider, Restylane and Juvederm are very safe in the glabellar area (the area between the eyebrows) to reduce the furrows some patients have between the eyebrows from repeated frowning or furrowing of the brow. Often, botulinum toxin (Botox or Dysport) is used to soften the lines as well.

Dallas Dermatologic Surgeon
4.0 out of 5 stars 4 reviews

Restylane - How Safe is It to Use Restylane Between the Eyebrows?

+1

Reasonably safe, but not without potential complications - and it's not what I'd recommend for that area, anyway.

First of all, I generally recommend Botox or Dysport for that area, as I believe that it addresses the major issues more effectively.  Those lines are due primarily to the contraction of the glabellar muscles. Filling the lines is difficult and doesn't address the CAUSE of those lines.  Botox or Dysport do and so, for that reason, that's what I'd go with.

Furthermore, with the original collagen products, injecting the thicker material (Zyplast) in this area was actually contraindicated in the product insert (if I remember correctly).  This is because there is a higher incidence of problems related to increased pressure.  The filler is being injected into a space that is effectively between a rock and a hard place - in between the bone of the skull, and relatively thick and unforgiving skin overlying it.  The risk of pressure phenomena - tightness, compression of the blood vessels, diminished blood flow of the skin - is higher there than for almost any other area that is typically injected.

So - for that and other reasons - I generally recommend filler below the eyes, Botox or Dysport at or above the eyes.

I hope that this helps, and good luck,

Dr. E

Web reference: http://www.bodysculpture.com

New York Plastic Surgeon
5.0 out of 5 stars 140 reviews

Safety of restylane between the eyebrows

+1

Most practitioners, including myself, will recommend that Botox or Dysport be performed first to treat the frown lines between the eyebrows (known as the glabella area), as these are dynamic or movement wrinkles. Once the movement of this area has been treated, then restylane or another hyaluronic acid filler (juvederm) can be used to fill in any remaining wrinkle that is still there. In regards to the safety of filler in this area, injector technique is very important as there is a superficial artery that lies below the frown lines and it must be avoided or complications can occur such as bleeding, bruising, or rarely necrosis of the skin. Thus, you should only have it done by someone who has experience in treating this area with filler.

Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Safety of Restylane between the eyebrows

+1

It's safe,  but you have to be careful.  That is because the risk of embolizing (getting filler into a vessel)  one of the small arteries that supplies the skin between the eyebrows seems to be higher in this area.  If one of these vessels gets occluded by intravascular injection of restylane or any filler, an area of skin between the eyebrows will die, leaving a wound that has to be dealt with, obviously not a desirable situation.

Many patients want that crease between the eyes to go away, and if is well-formed, long-standing and deep, Botox alone will not take care of it. All Botox can do is stop the creasing over time and maybe the crease will improve or not get worse as a result.

When filler is used between the eyebrows, care should be taken to inject very slowly and smoothly and inject while withdrawing the needle. This technique lessens the chance that some filler will get injected into a vessel. Another precaution I take is to put a finger over the orbital rim to put pressure on the vessels. That will prevent any filler from going back toward the eye and collapse the vessels in the area to be injected, lessening the chance that filler will get into them.

Mountain View Plastic Surgeon
5.0 out of 5 stars 23 reviews

Fillers in non-FDA approved areas

+1

Frown line injections are not uncomon and complications related to those injections are extremely rare.

Filler products, just like botox receive FDA approval for particular sites of treatment. Restylane is approved for volume enhancement in the folds.

Injecting into other areas is common medical practice but is, by the book, off label use of the product.

With that being said, typical complications are essentially the same as filling other areas of the face - irregularity of fill, erythema reactions, and skin injury. One specific concern for glabellar frown filling is injection into an artery or vein, which is very difficult to do. An experienced injector would stay superficial to those vessels when filling that area. Occular complications can only theoretically occur with inadvertent intravascular injections.

I use filler products in the frown area to assist in smoothing after botox in many situations and patients tend to be very happy with their results.

Find an experienced injector and chances are you will be too.

All the best

 

Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

How Safe is It to Use Restylane Between the Eyebrows?

+1

Agree with Stephen Prendiville, MD, but make sure you fully understand the risks before having the injection done. 

Miami Plastic Surgeon
4.5 out of 5 stars 55 reviews

The Safety of Restylane Injections Between the Eyebrows

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Fortunately, it is extremely rare to see complications from filler injections into the glabellar area between the eyes. I frequently do filler injections into this area when necessary if the lines are too deep for Botox alone to work. In over 25 years of doing these injections I have never seen this complication and only heard about it rarely. I believe it is due to the physician injecting the filler much too deeply, thus reaching the level of the larger blood vessels. The risks of serious side effects such as these can hopefully be minimized by the skill and experience of your physician injector.

 

Web reference: http://www.dorsetstreetdermatology.com/cosmetic-dermatology/restylane/

South Burlington Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Risk of adverse effects of Restylane injection in glabella is low

+1

Dynamic (absent at rest, present during contration of muscles of facial expression) glabellar lines are best treated with Botox.  When the lines become static, meaning the wrinkles are present when the face is at rest, they will not be smoothed out by just Botox alone.  Here a combination of Botox and filler is best.  In fact, when this combination is used the results tend to be more long lasting because Botox is preventing the muscle contraction that would eventually decrease the amount of filler in the lines.

However, there are blood vessels in the glabella that are at some risk when filler injections are done in the area.  These complications include compression of the blood vessels with a decrease of blood supply to the skin and potentially injecting filler into a blood vessel which can potentially travel to the eye and cause visual defects or blindness.  This happens very rarely. In an article in Dermatologic Surgery 2009 Oct;35  "The spectrum of adverse reactions after treatment with injectable fillers in the glabellar region: results from the Injectable Filler Safety Study." the incidence of adverse events in the glabella after injection of various fillers was seen in 40 out of 139 patients.  With hyaluronic acid fillers, serious adverse effects were seen in only 2 of 139 patients.  Authors concluded that "adverse reactions seen in the glabella are overwhelmingly product associated and to a lesser extent location associated. Vascular complications with necrosis and ulceration were rare."

Since this is considered a high risk area for injection of fillers, please make sure that the procedure is done by a board certified dermatologist or plastic surgeon with training and experience in this procedure.  Technique and a thorough knowledge of anatomy go a long way towards decreasing the risk of complications.

Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 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.

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