40 y/o - Botox, filler, or laser for (really) angry 11s? (Photo)

Thank you for your question in regards to Botox.From your picture and your description of what your goals are, filler will not be necessary. Botox is a perfect place to start. Be sure to discuss with the injector what your specific goals are. A minimal amount of Botox ma be added for the first time. After two weeks, follow up with the injector. At that time, you may love it or may want a few additional units. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.I hope this helps.

I like to start with the most conservative treatment I can, soI would recommend using Botox as the first line of treatment.  The 11's are caused by muscles flexing your skin so the Botox will paralyze those muscles so the skin can't be flexed.  Without continued flexing of the skin the 11's should get better.  If the 11's don't resolve to your satisfaction a filling agent could be added to fill in the depressions.  I don't start with a filler as the first line of treatment because if the muscles causing the problem are still active, the muscles will still crease the skin even with the filler in.  Laser treatments are not likely to do anything.

Botox will soften the look of the Glabella region by weakening the muscle movement that create the lines. Depending on severity, the addition of a dermal filler such as Restylane or Juvaderm can also help fill in these deep creases. A consultation from a Board-Certified Expert Injector is needed to fully evaluate your needs. 

Thanks for the question, its a complicated one but perhaps this may help. I inserted a link below to a news story on Good Morning America in which I was featured. It discusses some of my research into wrinkle reduction with Botox. Also, if you look on my blog (the link) you will find an article I wrote discussing the difference and effects of Botox versus fillers. I have a feeling you will find this helpful,Dr James P. Bonaparte
Facial
Cosmetic and Reconstructive Surgery
Ottawa,
Ontario, Canada

Hello, Botox would be my first choice as it is generally safe, minimally invasive, and very effective. I would not pursue fillers or a Laser treatment to help with this. I recommend you see a board certified Plastic Surgeon. Good Luck.