Ask a doctor

Which Product Do I Use for Vertical Lines? Botox or Restylane?

I have two sort of deep vertical lines right between my eye brows. Which procedure would be better, botox or restylane. Or should one have both procedures on the same site? I am not sure if you can see the vertical line on my picture. I am the one on the right. Thanks.

Doctor Answers 22

Botox for corrugator muscle lines


Thanks for providing the photo to help our answers. I think the active muscle lines between the eyebrows (corrugator muscle lines) would be ideal for Botox. In fact, that is the area for which the parent company obtained FDA approval for the marketing of Botox. Many of the initial studies were done for that area.

If you did not achieve satisfactory improvement after 2 treatments and 6-8 months time, you might add a filler in addition to Botox. I would not suggest filler alone. Good luck. I think you'll look great.

Greenville Plastic Surgeon
4.5 out of 5 stars 2 reviews

Have a question? Ask a doctor

Botox and Restylane

Botox stops the movement of the muscles causing your frown.  Restylane fills in the depressions.  You can have both the same day and if you keep up with regular Botox injections, your Restylane may last for years.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 19 reviews

Botox first for glabellar frown lines

These are the corrugator muscles - when they contract, they form what we call 'glabellar frown lines', these vertical lines of wrinkles. The thing to do is to relax these muscles with Botox. Start there and see what it looks like before you pay for any fillers. Good luck. It should cost somewhere between 250-400 dollars depending on how prominent these muscles are in your case.

Botox versus Restylane for vertical lines

I usually suggest my patients try Botox in this area first, since Botox usually provides good results.  Fillers also have a role in filling deep furrows between the eyebrows but I usually reserve them for patients who want additional improvement after trying Botox.  

Botox is great

If your wrinkles are only there when you make a facial expression, like frowning, then Botox would be good. If the wrinkles are there permanently, even when your face is neutral then restylane would do the trick. Some deeper creases can be treated with both. Either way, make sure you do the Botox first.

Vertical lines on forehead requires Botox or Dysport first

Vertical lines on forehead are due to combination of dynamic and static wrinkles. I would consider Botox or Dysport first for dynamic lines which are caused by involuntary muscle contraction then followed by judicious placement of filler if necessary for the static lines due to loss of volume in affected area.

William Ting, MD
Bay Area Dermatologic Surgeon
5.0 out of 5 stars 9 reviews

Botox/Dysport and Restylane/Juvederm can be a great combo!

For the vertical frown lines between the eyebrows, the combination of Botox AND filler can work better together than either alone. The Botox works to weaken the muscles creating the wrinkle, and the filler works to immediately lift and smooth the line that would otherwise take months and months and months to smooth out just with Botox alone preventing creasing.

If the line is mild, and your budget has limits (whose doesn't?), it's a good plan to try the Botox first and see after a round or two if the line is smooth enough. If not, then add filler.

Starting with filler alone is an option (especially for someone nervous about Botox) but it's important to know that the gel filler will physically lift the line but NOT stop the muscles from continuing to try to crease that skin, ultimately leading to a deeper line and the need for more filler sooner than if Botox were there too.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.5 out of 5 stars 41 reviews

Frown lines and treatment

For the vertical glabellar lines or frown lines I usually start off with Botox. If they are very etched in, I will add a filler after I see the affects of the Botox.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Botox is the First Choice for Frown Lines

It looks like in your picture that you would be better suited for Botox. While the lines may seem deep, they look like they would be effectively addressed with Botox and that it would not be necessary to use Restylane.

We only suggest Restylane in this situation if Botox has failed to do the job of smoothing the area.

Try Botox first and if there are still some wrinkles left, then try Restylane. Make sure you choose your practitioner based on his/her experience with these procedures before starting.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox mostly

Probably the best procedure would be to adminster Botox. These are dynamic lines and respond to Botox (treatment of these lines, the glabella lines, are still the only cosmetic approval for Botox). Two weeks later you could come back to the office and see whether Restylane might be needed to fill in the slight more superficial lines that remain.An alternative is to have the fillers plased first and then have Botox injected ( in this order so the Botox does not obliterate the lines).

Make sure your physician is experienced at injecting this area. I would absolutely not let a physician out of the cosmetic core of physicians (plastic surgery, dermatology, oculo-plastic surgery) inject this area. The injections required should be done superficially, slowly with serial puncture technique to prevent embolism into the retinal artery or ischemia . Sometimes filler can intrude and push the vessels closed causing ischemia (lack of blood flow) and necrosis. Rare but it happens.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.5 out of 5 stars 10 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.