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What is the best filler for deep glabellar lines? (photos)

I am only 37 years old, and my glabellar lines are so deep it appears that they are now causes pits (for lack of better word) under the lines. These pits are noticeable even when I am not frowning or squinting. Is it to late for botox only? What filler would you recommend for them- and will a filler help not only the wrinkle that goes from my eye brows up, but also the issue between my eyes.

Doctor Answers 19

Try BOTOX First

Hi Steph. The first thing that should be done is to inject BOTOX to reduce the muscle activity. That will greatly improve the lines in that area, as well as the rest of the forehead. If the lines have been permanently etched into the dermis, then a hyaluronic acid filler can be used to soften those. Care must be taken, and the filler must be injected superficially in that area. Blindness is a severe and permanent complication from injections in that area, so make sure you go to a board-certified plastic surgeon who has a good understanding of the anatomy in that region. Good luck with your injections!

Botox is your answer

This is a common question among patients who suffer from lines between the brows an area called the glabellum. Filler is not the first line of defense for these lines as it will only mask the true origin of the wrinkle. The glabellum is a muscle group that contracts and causes "elevens" or "furrows" between the brows. A conservative injection of Botox cosmetic at five anatomical locations will allow the muscle to relax, and the furrow to subside.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 66 reviews

Glabellar Rhytids

You have a very common problem and one that is easy to correct so long as you take the proper approach and stick with it.........First you need to use a neuromuscular modifier to prevent both the active and resting tension in the forehead,  brow, and glabellar muscles. This will help the muscles relax and greatly slow down the formation of permanent lines in all these areas. You need to do this as often as necessary; which is when the muscle action begins to return. In some people this is 3 months and in others it may be as mush as 9 months. The two drugs I use in my practice are Botox and Dysport....both are excellent.
    Second after the muscles are relaxed the residual rhytids or creases then need to be filled with an approved filler such a restylane. Juvederm, or Perlane. Each had a particular period of duration Juvederm and its various preparations lasting longer than Restylane and Perlane .Each has a particular thickness and a prescribed ideal depth of placement. Restylane being the thinnest and the best in very superficial placement and fine thin superficial rhytids. Juvederm is better for wider rhytids, larger dropoffs such as the Nasolabial folds and in the glabellar area.
    For your specific problem and photos I would use a combination of Dysport and Juvederm Ultra XC and would see you every 4 months or so to manage the problem as needed

Combination Treatment for deep glabellar lines

The lines between the eyebrows, frequently referred to as the "11s", are formed by the repeated actions of the frowning muscles of facial expressions. In our teens and twenties, these lines are only apparent when we frown.  However, as time progresses, these lines may become "static".  In other words, they may become visible even when we do not frown.  Some people may never experience this problem; however, others can notice this phenomenon as early as their thirties. 

The first line of treatment is injecting the frowning muscles between the brows to prevent the frown from getting worse.  These tiny injections with a choice of Botox/Dysport/Xeomin will temporarily halt our tendency to frown. If despite these injections, the frown creases are still visible at rest, your doctor may consider injections of a light hyaluronic acid filler into the stubborn remaining crease. I specifically chose the word "light" due to certain precautions that must be taken during these injections.  You must choose an experienced injector, who fully understands the anatomy of the forehead region, for there are blood vessels running under certain anatomical landmarks that must be avoided during these injections.  Inadvertent injection into a blood vessel can lead to dire complications. Therefore, it is very important to seek the right practitioner to avoid these complications and achieve the most aesthetically pleasing and long-term results.

Good luck!

Tatiana Khrom, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

11 Lines

If you were my patient, I would start with Botox and see if that resolved the lines.  If not, then I would offer filler BUT it must be done carefully due to the risk of blindness in this area.

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 31 reviews

What is the best filler for deep glabellar lines?

Botox is a great alternative to help prevent future line/wrinkles and can help soften lines on the forehead if they're not to deep to start, its best you seek a reputable Board certified physician for an in-person evaluation to see what may be best for your aesthetic desires.

Permanent Glabella Lines

With permanent lines in the glabella, you need Botox to stop the muscle function and a filler to elevate the crease. Since you do not appear to have a dermal break, a filler under the dermis (the skin support layer) should be adequate. I prefer something that is relatively long lasting an strong like Radiesse. If the dermis were broken, then a filler would need to also be placed within the dermis to eliminate the whole crease . For this I like Belotero since it does not cause a blue line when injected superficially. See an Expert Injector.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Glabella lines

Boitox can help soften the lines and minimize the "etching."  Filler can be placed "off-label" to soften the lines as well. 

Steven Wallach, MD
New York Plastic Surgeon
4.5 out of 5 stars 21 reviews

Best filler

That is a great question!  I would first recommend you have a botox or dysport treatment.  Many times this is all that is needed.

There are many fillers on the market.  It is more important to find a physician who is very skilled and trained in the injectables(ie botox, dysport, restylane, juvederm, teosyl, belotero, etc).  They will help guide  you to the proper treatment. 

This can be a "tricky" area, so you want to see someone who knows the anatomy(ie dermatologist or plastic surgeon).

Good luck with everything.

Dr. Daniel Radin, Windsor, ON, Canada, dermatologist

Daniel Radin, MD
Windsor Dermatologist

Treatment of deep glabellar lines

Hello Steph. I would definitely try Botox first if you have not done that yet. You may get the results you want with Botox alone. If after 2 weeks of Botox you still have some deep lines remaining then a very small amount of filler can be used to help reduce the appearance of deep lines. I like using Belotero for this because it is a lighter compound that can be injected superficially. This is a very tricky area for filler injection, therefore, it's important that you choose an injector (preferably a surgeon) who has an excellent knowledge of the anatomy of the area. Hope this helps!

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 5 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.