Can Hyaluronic Acid be used for forehead wrinkles and crows feet if Botox doesn't work?

Thank you for your question. Hyaluronic acid injectable fillers are used for adding volume to facial areas. Hyaluronic acid will not relax the muscles. An in person assessment is required to evaluate if you are a candidate for filler to the frontalis. 

Botox and other neurotoxins such as Xeomin and Dysport remain the gold standard for treating dynamic wrinkles such as those found on the forehead and crow's feet. When there is resistance to these neurotoxins or when lines remain despite their maximum effect then Hyaluronic Acid fillers can be used to help further soften the lines and wrinkles. My preference in these situations are Belotero and Juvederm. Sometimes in cases of resistance to Botox, the other neurotoxins (Dysport and Xeomin) may still work for you. You might want to give them a try before writing off all neurotoxins. Hope this helps.

Thank you for sharing your concern. Hyaluronic Acid is a natural humectant capable of holding 1,000 times its own weight in water, making it an excellent moisturizer when applied topically. SkinCeuticals H.A. Intensifier is a multi-functional serum proven to amplify and maintain the skin’s hyaluronic acid levels to restore the natural appearance of plumpness, smoothness, and firmness. It is also an ideal at-home complement to professional injectable treatments and visibly smoothes skin texture. Please consult a board certified physician if you are considering the use of injectable fillers to address your skin concerns.

Dear drumlatin:Great question particularly since Botox has now been used for so many years.Botox is a wonderful drug to relax muscles causing skin lines and folds or rebalancing facial expression. Continued suppression of the same muscle will cause the muscle to atrophy or weaken to a point of minimal or no activity. Add to this that aging also affects the skin and laxity of the forehead or lateral brow will cause passive lines, folds and wrinkles and Botox just won't give you the pizzazz you once got from it. Your options include:firming the skin with "lasers", retinoids, Sculptrafilling the skin and wrinkles with fillersredraping and removing skin excess with lifts (brow / forehead).Your concerns should be evaluated by a well experienced Board Certified Plastic Surgeon or Facial ENT with expertise in all these options so they are not biased by skill limitations. I hope this has helped. I wish you the best!

If a patient is resistant to neuromodulators such as botox/dysport/xeomin, a hyaluronic acid filler may be beneficial. Consult with 3 experienced and expert physician injectors to understand your options as this is an advanced injection technique.

You may want to try the other neuromodulators (Dysport and or Xeomin). I have found that patients who do not respond to one may respond to the others. You may also consider hyaluronic acid fillers, I recommend Belotero, once you have tried the other neuromodulators. I prefer for patients to do neuromodulator then filler, if needed especially for the forehead and eye areas. Keep in mind, however, that fillers will not soften your ability to contract your forehead or around the eyes.  I also recommend that you only entrust your care to a board certified dermatologist or plastic surgeon. Good luck.

Dear Drumlatin,In general, fine lines on the forehead that don't respond to neurotoxins like Botox can be softened with hyaluronic acid fillers. Belotero is generally the best bet for this indication. The same goes for crow/s feet. A fractionated ablative or nonablative laser may help as well. I'd recommend looking up a local dermatologist who does Belotero and going from there. Hope that helps!

drumlatin,First of all, it is unusual to develop resistance to botulinum toxin based on immune response due to chronic exposure. If you are having problems with Xeomin, or with Dysport, you should probably first try Botox (name brand) again, especially with Dysport, which requires different dosing. All such injections also require expertise, so consider whether you are getting it somewhere else than where it used to work. Lastly, inquire about the dilution factor, as a certain number of units are needed for response, and the volume used is thus determined by the dilution of the toxin when it is reconstituted. Injectable forms of hyaluronic acid (JuveDerm and Restylane) do not have the same effects as Botox. Rather than address wrinkles caused by dynamic motion (Botox paralyzes the muscles eliminating dynamic motion wrinkles), fillers are designed to address static wrinkles, or wrinkles that are visible at rest, and worsen with motion. If you are able to fill the wrinkles that are visible at rest, they will still be visible during dynamic muscle motion during facial animation. Thus Botox and JuveDerm can compliment each other, but neither will replace the need for the other. I hope that this helps.Best wishes, Tom DeWire, MD, FACS    Richmond, VA    

Simply stop Botox for 6 months and usually the resistance passes. My wife and other patients have had this and it goes away.   Yes Juvederm can be used on the forehead.   My Best,  Dr C