I usually treat the "11" (Glabellar lines) with neurotoxin injection first, usually 20 Units for a man. then I wait about 2 weeks to see how much they have faded. then I offer to use a filler to fill them out.
If you do the fillers before the neurotoxins, the risk is that the filler will form a ridge due to the muscle activity.
Make sure that you are going to a well experience injector,since the risks of filler injections in the glabellar region are not null.
If you have the "elevens" at rest as well as when you make a frown, it is unlikely that Botox alone will fully erase them. You would be a good candidate to have both Botox and filler. Filler is safe in this location when the treatment is done by an experienced board-certified cosmetic physician and when done with a hyaluronic acid filler. Incidences of complications in this region with filler have been seen with use of inappropriate fillers such as Radiesse and poor injection technique. I usually recommend starting with the Botox first, and waiting a week or two, to decide on filler if you are still concerned.
Botox can relax the frown muscle so the skin won't bend but the existing crack in the skin will only improve by filling it, so combination of Botox and filler is the best for optimal improvement. Filler injection would be safe if injected very superficial.
For the angry 11 lines...start with Botox. This will keep them from getting worse and soften your look dramatically. As you are no longer deepening those wrinkles on a daily basis with the Botox, you'll likely see the 11's improving with time.
If you don't see enough improvement, a filler can easily be used to filler in deeper furrows.
As you've hinted at, Botox is excellent for addressing dynamic wrinkles - those that are created from the movement of your facial muscles. Movement of the muscles causes the overlying skin to wrinkle, and with constant wrinkling can cause the skin to become permanently creased. While Botox will help soften your creases, it may be necessary to also have some filler injection to fully address them.
start with botox - it should ease the lines.
If you don't think the result post botox is enough - judicious use of a softer filler like restylane / juverderm may be required.
Hi Sparky. As Dr. Truong points out, we always start with Dysport (Botox). If the smoothing effect achieved with Dysport alone is not enough for the patient, then we proceed to a dermal filler and we prefer Restylane in this area because it is a softer, smoother gel. Make certain to find an injector well versed with injecting off label areas with fillers (like between the eyes). Good luck.
I would suggest Botox first. It will definitely help soften the lines. Over time it may be able to resolve them entirely, with several rounds of treatment. This is a riskier place for fillers, but expert injectors can handle the area just fine. Always shop for experience and not price!
"This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."
Always try Botox first. Consider filler next if you are not satisfied with the amount of improvement. Fillers are riskier in that area but doable. The injector needs to be more careful (inject small amounts at a time and look for signs of arterial occlusion).
This is a great question. Often, these imprinted lines will improve with Botox only. However, this can take 3-6 months or more. The advantage of Botox is that it is cheaper than filler and addresses the actual problem - muscle movement. You can always add filler later if necessary if those lines don't completely soften. This is a more risky area for filler placement so please seek a Plastic Surgeon or Dermatologist injector for this area. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon