Permanent Frown Lines Solution?

my sister said that permanent forehead lines need more than just Botox. i would need restaylane or juvaderm at the same time. that seems really expensive and lots of needles. is that the best way to deal with correction of the lines?

Doctor Answers 8

Permanent Frown Lines need Not Botox but Laser Resurfacing or Fillers

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Your sister is probably correct. Boxtox relaxes the muscles that cause Facial Lines like Frown Lines.

After years of repeated muscle contraction, sun damage ad aging, the Frown Lines can become permanently etched into the skin. When this happens, Botox will not remove the lines.

Plumping the Frown Lines with facial fillers like Restylane, Juvederm, Perlane, Radiesse and Sculptra will help. Combined laser resurfacing is a more permanent solution for Permanent Frown Lines

Frown line options

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Thank you for your question. The frown lines between the brows can be address two different ways:
1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest. The effects typically last 3-4 months depending on the dose. I generally use between 15-40 units of Botox (30-120 units of Dysport) in the frown area depending on the strength of the muscle and the degree of frown reduction we are trying to achieve.
2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression. This can last for a year or more when used in conjuction with Botox.
For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together.
I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.

Botox and filler

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Botox stops movement of the muscles and filler adds volume to creases.  If the lines are still deep after your Botox injections, you would require filler to plump them up.  If you continue regularly with your Botox injections, the filler may last for years.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

Maybe not

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The longer forehead lines remain the more memory the skin develops for those lines. It's like a piece of paper that gets folded by a book falling on it-if you get the book off right away there is only a minor fold but if the book stays there for years the fold will be severe and difficult to erase.

Likely the reason you have these lines is that you continuously elevate your brows. This is usually done unconsciously. The brain realizes that you can see better with your brows elevated so it raises the brows. So you need a brow lift.

I like to approach this by first paralyzing the forehead with Botox. I allow this to work then about 1-2 weeks later I perform a brow lift. This should significantly improve the lines but as I said the skin has significant memory and it may take more Botox treatments or dermal fillers. It just depends on how the skin readjusts.

Frown lines, Botox and Restylane

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Dear GG

The frown lines can be stubborn!! Botox will help weaken the muscles creating these lines but may not get rid of them. Use of Restylane with Botox is very effective and is generally only needed once as long as you continue to use Botox to keep the muscles relaxed..... so the first treatment may be more expensive but you will have a great result over the long term.

With Warm Regards,

Trevor M Born MD

If you have deep lines between your eyebrows at rest, then Botox alone may not work.

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In our practice in Manhattan, about 10% of Botox patients also have the vertical lines between the eyebrows filled with Restylane.

Try Botox alone first to see how much improvement you get. If you need Restylane, that typically has to be done twice a year.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Try Botox First

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My suggestion would be to have Botox injectioned first. You may be surprised at how effective this is for eliminating forehead wrinkles.

Then at your two week return appointment, you and your physician can discuss adding one of the hyaluronic acid products. Oftentimes, this is not necessary. However, Restylane does come in a .5 cc dose which would cut your cost.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Frown lines

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Botox will relax the muscles that, when contracted, cause the frown lines. Many people have, in addition to the lines that form during muscle contraction, wrinkles etched into the skin from years of animating. Fillers like Restylane add volume and help correct these wrinkles. So, Botox and Restylane work very well together.

Edmond A. Zingaro, MD
San Francisco Plastic 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.