If Botox, Dysport and Xeomin don't work anymore can I use Restylane on glabellar lines instead? (Photo)

When you have a very strong glabellar line and a deep furrow  you may need combination therapy. If you have a very strong muscle and have had a depression of your tissue using filters such as Restylane, Voluma or Juvederm will be helpful. Often times paralyzing the muscle is not enough.  Care should be taken when choosing a physician to inject you in this area as complications can occur. 

Hi and thank you for your question! Some patients do develop "tolerance" to Botox and other medications in the group which is associated with reduced effectiveness. While Botox (and Dysport or Xeomin) address different issues versus fillers such as Restylane, in your case when the frown lines are too deep, it is possible to smooth them out to some extent with filler injection. For this area, I suggest using fillers that absorb less water once injected to avoid compromising the local blood flow given the proximity to superficial arteries. I hope it helps and good luck!   

 60 Units of Dysport may not be sufficient to treat the degree of contraction in your glabellar muscles – that's why you are not getting a good result. Before you start considering dermal fillers, go for a higher dose of a neuromodulator. Dermal fillers would only accentuate the bunching of your brow until you can relax the muscles. If you do decide to add in a dermal filler such as Restylane, Juvederm or Beletero please be sure you work with a board-certified dermatologist who has many years' experience treating this area with fillers as you want the most natural results possible.

From the photo you provided, it is doubtful that Restylane or any other HA filler is going to be effective for softening your lines.  As someone who has injected Btx-A products for over 16 years, I have found that some people just need higher doses to see effects and have rarely encountered anyone who has developed actual antibodies to the toxin.  That being said, I would also recommend that you seek out an experienced injector.  It does not have to be a dermatologist but should be someone in the Core Aesthetic Specialities (Plastic Surgery, Dermatology, Facial Plastic Surgery, Oculoplastics) and discuss your concerns with them.  I have personally found that I need higher doses to soften my lines and that the standard dosing recommendations do not always prove effective.I hope that helps and wish you the very best.-Gregory A Buford MD FACSBoard Certified Plastic Surgeon

Thank you for sharing your question and photographs.  Unfortunately with the degree of muscle activation and furrowing currently present filler would only lead to a fuller appearance as you perform this movement.  I would discuss the need for higher doses of Xeomin or Botox with your injector to try to achieve improved paralysis.  Hope this helps.

It looks like your glabellars are really bulky. You need a higher dose of a neuromodulator like Botox or Dysport in order to relax them. Fillers wouldn't help at this point and might even make the frown look worse. Take your time to find a board-certified dermatologist who has expertise using Botox in men and/or in high doses; that will be your first best step.

Botox or Dysport will soften the underlying muscle. Restylane will fill in the wrinkle. They actually work well together but are not interchangeable. In terms of the amount of Dysport that you used, you could go higher. Hope this helps. 

Hello Sgf6,The dose you indicated you used is on the low side.  60 units of Dysport is equivalent to 20 units of Botox which is a starting dose for the area between your eyes.  You can easily go up to 150 units of Dysport in that area.  It is not common for people to need that much, but some people do.  As the line is caused by an active muscle I would recommend you continue with neuromodulators.  There have been cases of blindness and skin loss described when people had filler injected into those lines.I hope this helps and good luck.   

Thank you for your question.  Restylane can help soften the deep lines , however, the combination of botox and filler is your best bet.  

While you may find some practitioners willing to inject your glabellar area with filler, this is not a course of action I would recommend. For safety reasons at our center we typically will not inject in this area due to a high risk for complications. Occlusion of the area can occur, which can lead to issues like skin necrosis. In my opinion, injecting filler in this area is simply not worth the risk. Good luck!