Crease is still there after Botox and Restylane. Is there anything else I can do? (Photo)

Question

I treat my glabellar lines with Botox (every 3 months). The pictures are 1 week after .5cc Restylane right in the glabellar furrow (red line down the middle) but the area still looks indented. I used concealer bc there is a bit of pigmentation so that helped a little but STILL there seems to be some type of uneveness that is causing a shadow. Sort of like a donut: where the sides are raised causing the middle to look recessed. Is there anything else I can do?

David J. Myers, MD · Answer

Often using both a neuromodulator (Botox, Dysport etc) and a filler can help with a glabellar wrinkle.  Sometimes it doesn't fix it completely with one treatment.  Complete correction of a deep crease with one treatment is often hard to obtain and can be risky.  The glabellar furrow will likely soften over time.  In addition, if this was a deeper crease to start with, additional small amount of filler, could help you get the look you want.  Good Luck, Dr. Myers.

Jason Emer, MD · Answer

Often botox is needed to be combined with fillers to get the full improvement in this area. I suggest a formal consultation with an expert.  Best, Dr. Emer.

Dean P. Kane, MD, FACS · Answer

Dear httes223:Thank you for sharing your photos. Glabella lines, creases and folds like those elsewhere change dynamically with age and the anti-aging options you choose. Weakening the muscles with Botox which produced more permanent changes in the underlying fat, dermis and skin of the crease is the first step in improvement.Filling the volume loss in the fat and the dermis with filler is the second step.A continuously anti-aging step to consider as well are retinoids and newer hyaluronic acid producing enzymes and stimulators in Obagi ZO Skin Health products and injectables such as Sculptra. Your donut analogy is a good one. In order to reduce the shadow, you must elevate the concavity to a convexity and reflect light. Stimulation of the structural proteins in the dermis is your next level of care. Please seek a Certified and well trained Obagi ZO Skin Health physician and team. I hope this is helpful. All the best!

Suneel Chilukuri, MD · Answer

Thank you for sharing your photos.  You are correctly addressing your deep frown lines by first treating with a neuromodulator (#Botox, #Dysport, #Xeomin) and then utilizing a hyaluronic filler (#Restylane, #Emervel, #Voluma, #Juvederm, #Volift).  Two weeks after your last injection, you may need to layer further filler to continue restoring structure to the glabella.  For deep lines, you may need a filler that provides greater support.  Other options to further include collagen induction therapy utilizing #Microneedling with radiofrequency, #Exilis Ultra, #Pelleve, or #Frax 1540. Best of luck,Suneel Chilukuri, M.D.Houston, TX

Michele S. Green, MD · Answer

The glabella area may still need  a bit more Botox as well as the upper forehead area.  I would consult a specialist who is an expert in Botox for another opinion.  Best, Dr. Green

Melvin Elson, MD · Answer

There are a number of things that can be done. an increase in the dose of Botox may help, but also it is important to inject all areas that are causing the glabellar complex so that the injections should include the lateral parts of the corrugator muscles. additionally, sometimes there is recruitment and other muscles take over and make the area worse so looking at the face with maximum frown will show these and they should be injected also

Crease is still there after Botox and Restylane. Is there anything else I can do? (Photo)

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