Eric C. Cappiello, MD

While true allergies to Botox are very uncommon, they can occur. It is important to let your practitioner know, as well as the manufacturer of Botox (Allergan). If this is a true Botox allergy, I would recommend avoiding Botox in the future. You may want to consider seeing an allergist (a doctor who specializes in the treatment of allergies), to try to determine what component triggered your reaction.

Botox is a great option to produce a slight brow lift. Juvederm would be used for different purposes, such as filling in areas that are hollowed out and need more volume. Make sure to obtain a facial evaluation from a practitioner who is experienced in the placement of both Botox and fillers so that they may devise the perfect treatment strategy to obtain the results you desire. Botox does inhibit muscle contraction so that you are less likely to develop wrinkles created by constantly using those muscles, so yes, it does help with the prevention of fine lines and wrinkles. However it is most important to have a good skin care regimen that includes plenty of sunscreen because the sun’s damaging rays are the biggest contributor to fine lines and wrinkles.

While I do not know the particular reason your Botox injection has not worked for you this time, a few potential issues come to mind. It may be that the concentration of Botox that you received during this treatment was less than what you received before (even if the total volume was the same). Botox should come in a concentration of 4 units per 0.1 ml. If there are fewer units per ml then you may have received less Botox overall. Also, although it is quite rare, some people can develop a resistance to Botox through the body’s production of antibodies to the Botox. If this is indeed the case, an injection of Xeomin could be used instead. Xeomin is very similar to Botox but has had all of the extra proteins removed from it so that it is less likely to stimulate antibody production in patients who receive it.

Dermal fillers would be a good option to help fill out the smile lines and to fill in hollowed out areas around the eyes and cheeks. Depending on the type of filler used, the results can last up to 18 months. Another good option to decrease the fine lines and increase the overall plumpness and texture of your skin is microneedling. It is a procedure that essentially stimulates collagen growth beneath the skin to give the skin a plumper, firmer appearance, and help to eliminate the fine lines.

Hello and thank you for your question. First of all, fillers would be an excellent treatment to help balance out any facial asymmetry (such as a receding chin). They can also fill in hollows around the cheeks, eyes, and help plump up the lips. I would recommend, however, that you have a formal facial consultation to determine the best combination of surgical and non-surgical treatments for your particular areas of concern.