Glabellar indentation will not go away. Any suggestions? (photo)

Question

I have an indentation in the glabellar area when my face is at rest. I have gotten 25-30 units of Botox every 3 months for the past year. The photos attached are after 1 week of 0.5cc of Restylane. As you can see the indentation is still there. When I touch the glabellar area, I feel the filler but the area to the sides of it are very raised causing the look of the crease (like a donut). If I pull the sides of my forehead it goes away. Do I need more Botox or a tightening treatment?

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for posting your question and photos. You need additional Botox injected carefully to get rid of the glabellar lines. Make sure an experienced injector performs the procedure to avoid complications.Good luck,

Jason Emer, MD · Answer

Needs a combination approach for improvement, including fillers and botox.  Please see an expert for treatment.  Best, Dr. Emer.  Best, Dr. Emer.

Kyle Coleman, MD · Answer

Treatment of the glabellar crease is most commonly done with botox or other neuromodulators.  These treatment decrease the muscle movement and tone in the area making these creases less apparent.  Over time, lines and creases tend to abate from continued muscle paralysis and decreased size of the corrugator muscles.  In patients with significant creases, filler can be used to elevate this crease; however, this should only be done by an expert injector since it carries the rare risks of vascular occlusion and even blindness. If filler is placed too deeply or laterally, it may actually accentuate the crease.  Seek on an expert physician to see if a more superficial placement of filler would be more helpful.

Soheila Rostami, MD, FAAO, FAACS · Answer

As long as you are not able to move the muscles with your neuromodulator, more neuromodulators will not help. They only prevent the movement. Consider the fillers, I believe the placement of the filler may have not been done in the right plane. I would wait until the fillers are resolved and try to have naother injection to resolve the fold in the skin.

Katrinka L. Heher, MD · Answer

As long as you have minimal movement of your brows then your botox dose is strong enough.  I find that patients with a central line or indentation take longer to see improvement than those patients with "11" lines.  Keeping up with botox every 3 months will lead to improvement but may take a couple of years.  If you are frustrated you can have restylane injected into the indentation to achieve a quicker result, but you will still need the botox.  Don't give up and best of luck.

Glabellar indentation will not go away. Any suggestions? (photo)

Answers (7)

Answer: I would wait until the filler resolves and then address it again

Answer: I would wait until the filler resolves and then address it again

Answer: Glabellar indentation

Answer: Glabellar indentation

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Glabellar indentation will not go away. Any suggestions? (photo)

Answers (7)

Answer: I would wait until the filler resolves and then address it again

Answer: I would wait until the filler resolves and then address it again

Answer: Glabellar indentation

Answer: Glabellar indentation

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Recommended reading

Everything you need to know about Restylane

Our mission is to create a world where every investment in modern beauty is Worth It.