Botox or Laser on Deep, Vertical Forehead Creases?

It's hard to visualize what your wrinkles look like or which dynamic muscles might be causing them without an in-person consultation or at least seeing photos. Deep creasing does suggest that you may need laser resurfacing and/or hyaluronic-acid-based dermal fillers to even out the furrows. However, Botox could be a first good step because it may be able to quiet the muscles that are causing the wrinkles sufficiently that the skin smooths out. Depending on how deep your wrinkles actually are, Botox might actually be the only step you need. Please consult a board-certified dermatologist to have your wrinkles evaluated and find out which cosmetic procedures can best treat them.

From your description, it sounds like you would benefit most from combination therapy to even out your deep forehead creases. Laser resurfacing will improve your skin quality, stimulate collagen, and smooth out your creases to some degree. If the creases are caused by dynamic muscles, Botox can stop the muscles from contracting, allowing the overlying skin to smooth out. If the creases persist, they can be filled in with Voluma, Juvederm, or another dermal filler. But the only way to know whether you need one of these therapies or all of them is to meet a facial plastic surgeon in person. I hope this helps

It’s hard to imagine your condition without seeing a photo. Normally, if the forehead creases are related to motion of the underlying muscle, then laser won’t help much as the lines come back as you continue to move the muscle despite the smoother skin surface from laser. Botox would help in this situation but , the areas of insertion needed to improve your lines might involve areas we normally don’t inject so as to avoid producing an unwanted droop. A filler might be a better treatment. See a physician who is experienced in laser, Botox and fillers. Many dermatologists and plastic surgeons would be very capable to evaluate your condition.

If your creases are as deep as you describe, you will probably need to use several different therapies to smooth out the area enough to satisfy you. Laser resurfacing can erase wrinkles and creases to some degree, but if the creases are deep, that will not be sufficient. Botox would then be used to relax the muscles that are causing the crease, helping it smooth out. If you can still see the creases at this point, I'd recommend adding in a hyaluronic-acid-based filler such as Juvederm or Restylane to fill in the wrinkle. Please consult a board-certified dermatologist, as your wrinkles sound like they require a great deal of expertise to treat. 

It's hard to visualize what your wrinkles look like or which dynamic muscles might be causing them without an in-person consultation or at least seeing photos. Deep creasing does suggest that you may need laser resurfacing and/or hyaluronic-acid-based dermal fillers to even out the furrows. However, Botox could be a first good step because it may be able to quiet the muscles that are causing the wrinkles sufficiently that the skin smooths out. Depending on how deep your wrinkles actually are, Botox might actually be the only step you need. Please consult a board-certified dermatologist to have your wrinkles evaluated and find out which cosmetic procedures can best treat them.

It sounds like you would need a dual approach to resolve your vertical forehead wrinkles. First, I'd relax the underlying muscle with Botox, so the furrows can smooth out. If necessary, hyaluronic-acid based dermal fillers can finish the job by filling in whatever is left of the crease. You will need to repeat the Botox every 3 to 4 months and the fillers every 4 to 12 months to maintain your results. Please consult a board-certified dermatologist who can discuss in depth with you the best options for taking care of this problem.

Deep wrinkles on the forehead do require multiple treatment modalities. I would first start off with Botox, maximizing the amount on the forehead. Botox , or even Dysport, will relax the muscles and smooth out the lines, however they will not completely eliminate them. After 2 weeks, I will re-evaluate again. I love the fractional CO2 laser and I typically do it 2 weeks after Botox injection. The CO2 will help but do not completely remove the lines either. 6 weeks after the fractional CO2, I re-evaluate again. Sometimes, I repeat the fractional CO2 (touch-up) or at this point consider adding Juvederm to the area. Out of all the treatment  mentioned above, the CO2 is the one with the longest lasting results. Its important to emphasize that if you want to get a fractional co2 for the creases, I would strongly advice Botox 2 weeks prior to the procedure. Your final results will be much improved. Dr Behnam, Santa Monica.

I'd love to see a picture, but when someone has very deep and etched lines, Botox, then fractional CO2 2 weeks later, then filler like Restylane or Juvederm about 3 months later can be the trifecta of non-surgical shaping , smoothing and rejuvenating. Of course, I'd need to see your skin type and get a good history to make a recommendation for your unique needs.

I would suggest Botox either at the same time or preferably followed 2 weeks later by hyaluronic acid filler (Restylane or Juvederm).  The Botox is for the "dynamic" component of the wrinkles (with movement) and the filler is for the "static" component (wrinkles at rest).
Good luck.

Botox would likely be the better choice (especially if the creases are between the eyebrows). You may also be a great candidate for a brow lift, which will take care of the problem long term.
The vertical wrinkles are due to muscle pull (dynamic wrinkles), while laser is better at treating static wrinkles (wrinkles not associated with muscle pull). You may ultimately benefit from all of the modalities, but would recommend Botox and possibly brow lift.
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