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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 (20)

Get Botox first

+2

Most physicians would agree that Botox is the treatment of choice for your “11” and if the lines improve only partially, then you can consider having a filler injected. Be certain that you see a qualified experienced physician as there is a risk if too thin a filler is injected into that area. The safer ones to use are Juvederm and Restylane. Try the Botox first. Realize that the lines are there from years of frowning and the skin developed these creases from the accordion-like motion of the underlying muscles. Once the muscle stops moving and you don’t frown, it will take time for the skin to lose its crease.

The Botox will take a couple of weeks to reach its effect and may last for several months. Don’t rush in for a filler until you give it a while; otherwise you might be spending more money than needed. On the other hand, if you have a reason to reduce the line quickly, such as an important social engagement or photograph shoot, I would still do Botox after the filler, but don’t do the filler just a few days before the event in case you bruise.


Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Botox for corrugator muscle lines

+2

Texasmom:

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.

Sutton Graham II, MD
Greenville Plastic Surgeon
4.5 out of 5 stars 2 reviews

Botox first for glabellar frown lines

+2

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.

Hratch Karamanoukian, MD, FACS
Buffalo General Surgeon
4.5 out of 5 stars 5 reviews

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Botox and Restylane

+1

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 16 reviews

Vertical lines on forehead requires Botox or Dysport first

+1

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 8 reviews

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

+1

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
5.0 out of 5 stars 40 reviews

Frown lines and treatment

+1

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 17 reviews

Botox is the First Choice for Frown Lines

+1

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

+1

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
5.0 out of 5 stars 7 reviews

Both would do the trick - I would start with Botox

+1

Judging by your picture, I think you would do great by starting with Botox as the first line of therapy. Botox would work to soften the vertical lines, and may or may not eliminate them completely.

Over time, with repeated injections of Botox, any permanent creases that you have in the area may soften to a point that you are very pleased with the results.

If not, certain fillers, such as Restylane or Juvederm, can be injected by a physician with experience injecting specifically in this area.

Arash Akhavan, MD
Manhattan Dermatologic Surgeon

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.