Laura Schilling, MD

Botox can definitely be used to treat "bunny lines" - those smaller, pesky wrinkles that appear on either side of the nose, especially when scrunching.  I typically start with 2 units on either side of the nose to treat these wrinkles. They should soften but may not go away completely, and can require higher doses or more injection points.  As with other areas treated with Botox, the results typically last 3-4 months. "Bunny lines" aren't a problem for everyone...Some people can unknowingly use the muscles in this area with various facial expressions much more so than others - leading to more severe wrinkles. See your board-certified provider to see if this treatment is right for you. Bye bye bunnies! 

Juvederm Vollure is one of my favorite fillers to use. Vollure (referred to as Volift in Europe) is a hyaluronic acid filler that has been FDA approved since early 2017 for the treatment of moderate to severe facial wrinkle such as the nasolabial folds (lines that extend from the nose to the corners of the mouth). Like most fillers, it can be used off-label to treat many areas of the face.  Personally, I find that Vollure is one of the smoothest, most natural, and most versatile hyaluronic acid fillers.  It is one of the newer "Vycross" products from the Juvederm line, in addition to Voluma and Volbella, and can last up to 18 months. Everyone is unique with different needs, so visit with your board-certified dermatologist for your personal evaluation to see if it might be the right filler for you!

Botox is a fantastic way to treat your "11s" or frown lines (also referred to as the glabella), and the exact amount needed depends on the size and strength of your muscles in this area.  20 units is a perfectly reasonable dose to treat this area, especially if it is your first treatment. Those with very faint lines (or those looking for a subtle, very natural softening) may require slightly less, while those with deeper lines or stronger muscles may require more (25-30 units). Importantly, the effect of Botox is not immediate - it starts to work its magic in a few days and doesn't reach its maximum effect until closer to 10-14 days. At the 2-week mark, feel free to reach out to your injector about any questions or concerns you may have... it's easy to add more units or perform a few tweaks, if necessary. Try to trust your provider - we want you to have fantastic results and be your very best self!

Botox, or other neuromodulators (such as Dysport or Xeomin), is your best option for treating the "11" lines.  Botox is a very well tolerated, and relatively low risk, procedure that provides extremely satisfying results. Serious side effects would be very rare, especially when being treated by a well-trained and experienced injector.  Even if you were to have the rare and unfortunate side effect of eyelid drooping, this is only temporary (and there are ways to make it less apparent in the meantime, if necessary). I would recommend having a consult with your provider to review the treatment, discuss expectations, and address any more specific concerns you have regarding the risks (to hopefully ease your mind!).

Other options would include injecting hyaluronic acid fillers into the area. However, this is a high-risk area for filler injections, and you would definitely need to see an experienced injector with in depth knowledge of facial anatomy. In my opinion, Botox is a much superior option (especially in younger patients with likely less severe wrinkles) than filler for this area due to its lower risk, high satisfaction, and preventative benefits. Fillers would only treat, not prevent, these lines. Less common options for the "11" lines would be resurfacing lasers or microneedling - but, again, I say neuromodulators such as Botox remain the gold standard for this area. good luck!

It is very common to have multiple areas of concern at once! Simply put, there is no one best filler.  The decision of which filler to use importantly depends on the specific area that you are treating, the volume needed to treat the area, the thickness or quality of the patient's skin, and several other factors. I would try not to have your heart set on a particular filler prior to your visit and discussion with your provider. And often times you need a combination of different fillers to properly address multiple areas. And remember, the technique and experience of your injector can often influence the result much more than the filler choice itself. 

In general, I favor hyaluronic acid fillers - they are safe and effective at rejuvenating and enhancing various areas of the face.  There are many hyaluronic acid fillers available now that vary slightly in their characteristics (eg: thickness, how long they last, etc).  Many injectors have his or her own preferences, but most knowledgeable providers have experience in many (if not all) of the filler options and should be able to choose what is right for each individual scenario - no patient is the same! Marionette lines can vary dramatically from one person to the next, and a variety of fillers could be appropriately used in this area. In most instances, I prefer Volbella to help with vertical lip lines - this is a very fine filler that works well in this delicate area. You don't want to be overfilled here and look ducky! Combining your fillers with Botox (or other neuromodulators) can also help to optimize your treatment - a few units can help soften those vertical lip lines AND help upturn the corners of your mouth to prevent that constant frown.

Happy and safe filling :)