Rene Garcia, MD

Injecting a dermal filler in the forehead is an advance technique and is not a common procedure even for an experienced injector, but yes it is possible.

We have 2 types of wrinkles. Dynamic and Static wrinkles. Botox works well in dynamic wrinkles. Those that shows with emotions or expressions. For deeper wrinkles results are not effective. What type of wrinkles do you have?

Botox is a muscle relaxer. It works well only in dynamic wrinkles. In static wrinkles can improve the appearance. You mention that you have been getting botox for the last 18 years. Botox works wonderful when we are younger, as we get old we need additional treatments to stimulate collagen and elastin. As we age we loose bone structure, we have loose of elasticity of the ligaments we loose muscle mass and fat. In addition we suffer a re-distribution of the face fat. I know is not nice, but the goal is to try to delay this process. You may need something else beside botox.

Dandruff can play a factor for your hair loss. Definitely, you need a healthy scalp to prevent hair loss. Then you have to look for other predisposing factors for hair loss such as age and hair loss patter, hair loss classification, genetics, habits, diet if hair loss continues.

Different factor play a role in androgenic hair loss. Genetics is a main one from the X chromosome of your mother side. In this early stage, I will recommend to start with a more conservative management such as PRP with at least 4 sessions. There are other treatments that can be very helpful and are evidence base medicine such as nutraceuticals from nutrafol or ISDIN, oral meds such as finasteride, topical minoxidil and LED therapy for hair loss.