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

I am 40 and have deep angry 11's I absolutely HATE. I want to soften them significantly but not so much that it's glaringly obvious or that I can't make expressions (i.e. don't want frozen face the Real Housewives of Anywhere). What do you recommend? I've never done Botox or anything else before. Do you think I will need filler in addition to Botox or could laser treatment work? What's safest and most effective? The pic is face at rest. :( Thx.

Doctor Answers 27

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

Hello Ducky75,

Botox is where I would recommend you start.  It won't improve the line that is always there but it will weaken the muscle and prevent the line from getting worse.  If the line disappears at when the muscle isn't flexing then Botox would be all you need.  

Depending on the result of that you can consider a resurfacing procedure such as a laser or chemical peel to help with the line at rest.  Fillers can be used in that area but be careful as some of the very serious risks of fillers have a higher incidence in that area (such as skin loss and blindness).  

I would recommend you consult with a facial plastic surgeon, dermatologist, or plastic surgeon to go over your options in person.  

The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Botox for 11s

Thank you for your question ducky75. Botox is a purified protein used to address wrinkles associated with facial expression such as the vertical lines seen when one frowns, sometimes called the frown lines of elevens. The pivotal studies demonstrated that when using a dose of 20 units in the area (glabella) the peak effects are seen 14 days after the treatment and most people enjoy their results for 3-4 months. Please consult with a doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 3 reviews

Botox is generally considered the best option for treating frown lines between the brows.

 Botox is generally considered the best option for treating frown lines between the brows. If you have it done by a skilled, board-certified dermatologist, there should be no problem with a frozen look; an experienced enough injector can smooth out the lines while still allowing for a natural-looking expression. If your lines are deep enough that the Botox doesn’t get you the results you want, then you can consider filler or laser treatments. 

Karen Beasley, MD
Baltimore Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Start With BOTOX

Thanks for your question. BOTOX is the first line of treatment because the cause of the 11s are muscle contraction, and BOTOX will weaken those muscles. If you have permanently etched lines in that area, then a laser can help to soften those lines. Any depression that is still present after BOTOX treatment can be treated with fillers. Care should be taken with fillers because blindness is a possibility when injecting in that area. I think BOTOX will give you a significant improvement and you probably won't need or want anything more.

Louis C. Cutolo, Jr., MD, FACS
New York Plastic Surgeon
4.6 out of 5 stars 13 reviews

Combination treatment

I see this commonly.  I use Botox or Dysport plus a filler like Radiesse placed deep.  We cannot eliminate the creases completely but can often improve them.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 25 reviews


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.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Achieving a natural look

An experienced injector can usually smooth out your 11’s without getting that "shiny" look. The key is that you still want to have expression which a skilled injector should be able to achieve. Very often using Juvederm in addition to Botox helps flatten the grooves in the frown lines. 

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 66 reviews

Correcting the 11"s of your forehead.

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.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 98 reviews

Combination Botox and Dermal Filler Treatment

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. 

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.8 out of 5 stars 95 reviews

What is the best treatment for the Angry #11's

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

James Bonaparte, MD, MSc, FRCSC
Ottawa Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.