Dermal Filler Without Botox - for Frown Lines?

Question

I have a single, static frown line between my brows at rest. I do not frown during the day, and wear tape over the lines at night to prevent me frowning as I sleep. I understand I will need a dermal filler to plump out the folded skin. My question is, in my case, what is the point of having Botox as well as the Dermal filler? It seems like Botox will be a waste.

Luis Villar, MD, FACS · Answer

Frown lines develop from muscle contraction whether you are aware of it or not. Before Botox, we would fill the lines with filler, but the muscle action would tend to force the filler out.  After Botox, we paralyze the muscle first and inject the filler a week later if convenient in a perfect world.

	If the wrinkle is soft and pliable in the early stages, a filler may work very well.  If the wrinkle is very deep etched, save your money.  Fillers are disappointing, but the Botox may prevent it from worsening.

Jason Emer, MD · Answer

"​For glabellar lines (or frown lines / ""11"" lines), we inject Botox, Xeomin, or Dysport into the muscle, causing the muscle to weaken and improving the appearance of the lines. These work by binding to receptors that send nerve signals for muscles to contract. Since your body makes new receptors and neurotransmitters all the time, it needs to be maintained otherwise the wrinkles will slowly return as the muscle regains function over time. Neurotoxins take 2 to 4 weeks to start working and lasts for up to 6 months.

For deeper glabella lines or strong 11s, I use a combination of Botox with fillers, lasers and microneedling with PRP. I suggest getting a formal evaluation with an experienced cosmetic dermatologist and expert in lasers and fillers. Best, Dr. Emer
​"

Young R. Cho, MD, PhD · Answer

Thank you for your question.  The frown lines between the brows can be address two different ways:
1)  Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression.  The treatment may even soften the lines that are present at rest.
2)  Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression.
For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together.  
I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines.  They continue to see the static lines even though the dynamic lines have softened considerably.

Sam Naficy, MD, FACS · Answer

Using both Botox and filler will do two things: stop the musculature that helps to create or form the line, then filler to provide immediate volume back to the crease.

Jennifer Parker Porter, MD, FACS · Answer

Adding Botox to that area will help to diminish the line. There are muscles on either side of the line that push the skin together. Botox is usually my first choice, adding filler only if the line is too deep to be overcome by Botox alone.

Michael I. Echavez, MD · Answer

It's difficult to give you precise advise without seeing you or at least seeing pictures of you. In general, when treating the frown lines, sometimes Botox and a filler can give the best result. If the lines are not very deep, then in most instances, just Botox will be enough. The Botox works to weaken the muscle that causes the lines with frowning. If the line or lines are deeper, then sometimes a filler can be used to fill in the depression. It is possible that just the filler would help, but in most cases, the best result is obtained with doing both the filler and the Botox, as then the muscle and the skin are both addressed.

Hal Michael Bass, MD · Answer

At this point, you definitely need a dermal filler to plump out the crease across your forehead. However, that crease was etched in your skin by ongoing muscle contractions of which you’re likely unaware. It is this constant movement – while awake and asleep – that causes the furrow. So if you merely fill it up, without restricting the muscle movement, the furrow will only return and deepen. Botox injections every 3-5 months will keep your brow smoother longer and reduce the severity of the line when it starts to reappear. That, in turn, will make less filler necessary.

Donna Bilu Martin, MD · Answer

Lines in the glabella (between the eyebrows) are caused by movement. A neurotoxin, such as Botox, Dysport, or Xeomin is almost always indicated in this area to relax lines. Occasionally, lines can be so deep that they are present even after the neurotoxin is working. In this case, an additional superficial injection of a hyaluronic acid (juvederm, restylane, or belotero) can be a good choice. This is an off-label injection that should be performed by an experienced cosmetic dermatologist or plastic surgeon. There are risks when injecting filler in this location, which should be discussed prior to treatment.

Martie Gidon, MD, FRCPC, FAAD · Answer

The frown line has been caused by movement. If you feel you no longer frown, you can try only filler and see if you like the result and how long it lasts. If you continue to frown, the filler may only last a few months. With Botox maintenance treatments, the filler may last indefinitely. Please see an experienced dermatologist or plastic surgeon for the treatment.

James Southwell-Keely, MD, FRACS · Answer

Hello,

	 

	While you may be able to achieve a good result with Botox alone, depending on the depth of the line a filler may be needed to reduce the depression and smooth the skin.

Dermal Filler Without Botox - for Frown Lines?

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