Will Bellafill work for deep frown lines? Botox failed. (photo)

Putting a nice soft eptfe implant under the skin in the deep grooves can fill in the areas and may be permanent and is easy to do.

Dear patient, Bellafill is only FDA approved for the treatment of Acne scarring and deep naso-labial folds. Treating the deep lines between your brows is technically an off-label indication. I have treated this area on many occasions with bellafill and achieved excellent results. I always inform my patients that this is an off label indication. This area is also a lot of vascular than the naso-labial folds or deeper rolling acne scars. There is always a very small chance that Bellafill is injected into a large blood vessels and travels deep in to the underlying tissue. There have been very rare cases of blindness and necrosis from such occurrence. This can obviously happen with any filler (Juvederm, Restylane, Radiesse and more). But if it happens with Bellafill it is theoretically more difficult to reverse. I have a hand held laser called Accuvein. I always use it to map the larger blood vessels in the area. Also when injecting bellafill I use either a cannula (possibly safer) or inject in small amounts and look for blanching. In summary; please find an experienced injector who is Board Certified in Dermatology or Plastic Surgery and has a lot of experience injecting Bellafill for your treatment.

Botox combined with fillers, lasers and microneedling/prp will improve this. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

In general, glabellar lines are treated with Botox. Even if it didn't respond in one treatment, serial treatments will improve this. However, if fillers are needed, it is probably best to use a reversible filler because this is an area of higher risk for vascular occlusion. My favorite for this area is Restylane Refyne on a BD syringe with injections into the dermis, serial punctures. Small aliquots with multiple punctures is best. Botox is needed as well.

Botox will only relax the muscles. Once you form deep wrinkles, they need to be filled with a filler. Botox and filler are two completely different products. I use Bellafill to fill deep wrinkles as it lasts for 5 years and my patients are happy with the savings in cost. 

Although resistance to Botox is debatable in some circles, I would recommend switching to Dysport.  Laser skin resurfacing can diminish the depth of these wrinkles.  Bellafil is an excellent product to use as an adjunct to fill these lines and give you a softer and longer lasting result.  It is an off label use of the product but it can be used to fill in most areas of the face (with the exception of just under the eyes and lips).

Wrinkles in motion need Botox or Dysport to relax the motion. Valleys that remain at rest can be filled with Bellafill once the motion has been addressed. This is a potential danger area for fillers as permanent blindness , while rare,and tissue death have been reported. unresponsiveness to Botox can sometimes be due to technique.