Botox in Upper Part and Fillers on Lower Part of Face?

Question

I am 42 and have had Botox 4 years ago with a good result, but now I hate looking at my wrinkles. I need my brows, crows feet, smile lines, and my top lip is very liney. Do I need fillers in the lower part of my face and Botox in the top?

Jeffrey J. Roth, MD, FACS · Answer

Typically one places Botox in the upper part of the face, and filler agents in the creases in the lower half. Each patient is different. Seek out an experienced injector. They will be able to take you through the process.

Ron Shelton, MD · Answer

In the past, Botox was used in the forehead and crows' feet near the eyelids. Fillers were used in the smile folds and lips. During the last decade +, there has been great advance in the understanding of the aged face.  Fat atrophy is responsible for the lack of support and drooping of the face.  
Botox is used for wrinkles related to muscle movement and the skin that folds above this motion repeatedly. Once the muscle doesn't move, the skin doesn't act like an accordion and eventually the lines diminish if not disappear.  Lower facial lines are treated better wtih fillers because inhibition of muscle movement would cause an inability to correctly smile, speak or eat.
Lately we have started to add fillers to the upper face. Temple wasting, lateral eyebrow support to recreate a youthful appearance and help elevate a droopy upper eyelid, and cautious filling superficially of the "eleven" in the glabellar region of the forehead (between the eyebrows) are a few of the upper facial filling areas.
Botox has been used to diminish the gummy smile, minimize nasal tip movement with speech in some people who have this trait, lessen a dimpled appearance of the chin, and help elevate the corners of the mouth, and even the jowls by treating the DAO and platysma muscles, respectively.  These off-label uses should be done by an experienced physician.

Trevor M. Born, MD · Answer

Dear Caris, Thank you for your question.  Botox and fillers are the first steps in restoring facial shape and reversing the signs of aging.  They can be used in combination or separately with great resuts. How much of each and where they are placed is the key ingredient.  The addition of other non-surgical techniques such as Thermage, IPL and General skin care will also help to freshen up your appearance!
With Warm Regards,
Trevor M Born MD

William P. Mack, MD · Answer

BOTOX and fillers work very well together to achieve outstanding aesthetic
results, although their indications are different. BOTOX will relax the muscles
and soften the wrinkles created by movement. Fillers are used to fill where
volume has diminished in the face. As far as your brows, forehead  and crows feet, BOTOX would be recommended to
diminish the lines. Smile lines in the nasolabial folds around the mouth would
be best treated with facial fillers, such as JUVEDERM, with the goal to fill in
the crevices where the volume has decreased. The lines above your upper lip can
be treated with either BOTOX or filler, or a combination of both depending on
the severity of the lines. I highly recommend a consult with a physician who is
experienced and knowledgeable with the inticate facial anatomy to achieve the
optimum cosmetic results.

Ken Landow, MD · Answer

into both the upper and lower face...it all depends on your specific needs...certainly when the materials came on the market, botox was only for the upper face and fillers were used mostly in the lower face at the nasolabial crease...now as we've gained more experience, there are no more hard and fast rules...botox is regularly injected into the lip area, the chin, the jawline and the lower lids...and fillers are often injected into the forehead, between the eyes and into the crow's feet area...so talk with your doctor about the most appropriate way to achieve your wishes...should be an easy task...

Martie Gidon, MD, FRCPC, FAAD · Answer

Botox is used to stop dynamic movement and fillers are used to replace volume. These treatments complement each other and both can be used in the upper and lower face by an experienced injector to give a youthful, natural result. Please consult a board certified dermatologist or plastic surgeon who has experience in treating the face with Botox and fillers.

Michele S. Green, MD · Answer

That combination of Botox in the upper part of your face, forehead, glabella, and crow's feet are ideal for fixing those wrinkles around your brows that you don't line. Fillers are best for the lower part of the face to fill in depressions, lines, and wrinkles around the mouth. The top lip can also benefit from the Fraxel laser to soften and resurface those fine lines around the mouth. This is a good example that a combination of modalities can be used for the best results.

Sigmund L. Sattenspiel, MD · Answer

Exactly! I employ BOTOX to reduce the muscular function of the forehead and crows feet regions in order to give smoother skin contours. I employ fillers for creases and depressions in the lower part of the face as well as any other regions of the face where there are creases, wrinkles or depressions. I do not like to use BOTOX on the lower part of the face. Injecting BOTOX in the region around the mouth runs certain risks of disfigurement including a pouty “duck-like” look of the upper lips and possible weakness of the corners of the lower lips.

William P. Coleman III, MD · Answer

Traditionally Botox or Dysport are used in the upper face, and fillers in the lower face. But now both are used throughout the face. Artfully administered by an experienced dermatologist or plastic surgeon, combining these approaches can give the best results

Steven Wallach, MD · Answer

Botox or dysport is a great way to treat facial lines of animation of the upper 1/3 of the face.  Fillers such as restylane, juvederm, or radiesse are great to fill lines of the lower face.

Botox in Upper Part and Fillers on Lower Part of Face?

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