Do not want to use fillers, only Botox, for permanent frown lines. Is it possible?

I am 38 and have deep permanent/static frown lines between my eyes which I have noticed getting worse over the last few years. I would like to start Botox treatment however I am nervous about using fillers (which I know helps with the static/etched in lines). Is it possible for a significant IMPROVEMENT to be noticed in the static/etched in lines a period of time (could be years) while using only Botox?

Doctor Answers 24

Botox alone will definitely help the appearance of frown lines, especially when done over time

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Thank you for the question. You’re 38-years-old and ask if you can make a significant improvement in static lines between your eyes by using Botox™ alone. You also ask if it’s possible to make a significant difference over years without using fillers, which you are aware are beneficial for static lines.

I can certainly give you my perspective on this - I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been practicing in Manhattan and Long Island for over 20 years, and I was one of the first groups of doctors who used Botox™ back in the mid 90s. In the absence of your photo and a physical exam , it is a bit difficult to answer your question,  but I will give you some idea about the effect of Botox™ on these lines.

Dynamic lines are lines that occur when you activate a muscle, so when you frown which you describe as frown lines. The repetitive actions on the muscle cause an etching of the skin and those lines are referred to as static lines. Static lines are there at rest, meaning even when relaxed and not frowning those lines are present.

When someone like you comes to my office, I always think of a global approach for improvement. The challenge with frown lines, which are often referred to as number 11 lines, is people want to do something about them because they make them appear angry. If Botox™ is used to relax the muscles, but the static lines are still present, you may still give the impression you are angry.

The fact you are willing to be patient and wait over years is definitely meaningful. With continuous use of a neurotoxin like Botox™, Dysport, or Xeomin can relax the muscle so the skin is no longer creased, so those lines can soften. To answer your question, it’s likely you will benefit from just using Botox™ alone, but there is some exception to that. As you get older, you are going to lose collagen, fat volume, and soft tissue volume so this area can still become deeper. Often in my practice, I tell my patients  Botox™ is your first step, so we’ll see how you do with Botox™ and do it consistently. Typically, people come for Botox™ injections about every 4 months.

With the different layers of skin, there are alternative treatments to treat these issues. For example, we use platelet-rich plasma (PRP) in our practice to build up collagen in the dermis, which is technically not a filler because it is derived from your own blood to use the growth factors necessary for wound healing that stimulates collagen. This alternative is embraced by a lot of our patients because they like the idea of it being natural. For other areas of the face, you can consider non-ablative or ablative lasers. These are are all part of the many solutions available for your doctor to customize.

Often, people want to figure out everything they need before they go to the doctor, and do a lot of research, but the reality is there are so many options and opinions, so it’s very hard for a person who is not a physician and not in this field to come up with the game plan that is likely to succeed for them. When you go to different doctors, you will get different opinions. It is best for you to meet with doctors, and find the doctor you are comfortable with because it really makes a difference for a doctor who gets to know you, your skin, and what works for you, and have records of your photography to show how you’ve been progressing over time. I think you are off to a good start because you’ve learned a lot and thought this through, but start how this works out for you. If you feel after a certain amount of time you want to do something more, there are additional options for you. I hope that was helpful, I wish you the best of luck and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Botox will definitely help

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Starting Botox would be a great idea. Your muscles relax with the use of Botox therefore, the appearance of those static frown lines will improve. Botox typically lasts about 4 months. I always tell my patients if you are consistent with your treatments every 4 months the weaker your muscle will get over time. If your desired results are not achieved a thin filler such as Belotero can be used to soften your frown lines in addition to the Botox.

Botox for frown lines

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Yes, Botox will help eliminate frown lines.  Those lines are in an area referred to as the glabella, and are a result of the action of a muscle called the corrugator supercilii when you frown. This is the area that Botox initially gained FDA approval for cosmetic use.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

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Combination treatments maybe best in your case

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A combination of Botox and fillers such as Belotero or Juvederm maybe best given that you describe DEEP frown lines also seen at REST (static). If you do not want to use fillers, you may also consider combination treatment with Botox and a resurfacing procedures such as a nonablative or ablative laser or microneedling.

Botox and frown lines

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BOTOX is a muscle relaxer. It doesn’t work on lines. It reduces frown lines because they are caused by muscles. If the BOTOX relaxes the muscle and the lines are deep, the lines will still be there, but they will appear less deep.  If you maintain your Botox treatments every 3-4 months reducing the muscle activity in the area, your skin will be able to remodel itself improving overall appearance of the frown lines.  It might take a long time but the difference could be significant.  

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

Botox for dynamic wrinkles only

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Botox is for dynamic wrinkles, which are those that appear when you make facial expressions. Once you’ve got static frown lines, Botox is far less effective at rejuvenating your appearance than fillers. However, it may still result in a bit of an improvement, although it would be difficult to say by how much. You could start with Botox to see if you like the results. With repeated treatments, it may even help the area by preventing your current static wrinkles from getting worse.

Botox for frown lines

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Yes! It’s a great idea to start Botox treatments to rest the muscles and prevent new wrinkles from forming. A couples ways to get improvement of already exciting lines without using filler are by microneedling treatments and chemical peels. Microneedling works by using a tool (microneedling pen) to induce controlled (minor) injury to the face, stimulating a new growth of collagen and elastin. Collagen and elastin are essential components of this skin which keep it looking youthful and firm. This procedure will help smooth out wrinkles and fine lines, making deeper lines less prominent. Chemical peels work to remove the top lay of dead skin cells, leaving behind more youthful and bright complexion. Continually removing those dead cells helps with fine lines and wrinkles.

Justin Harper, MD
Columbus Physician
5.0 out of 5 stars 24 reviews

Botox and frown lines

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Yes, Botox can help the frown lines between the eyes. If performed regularly, over years, the skin will remodel and that will help to improve or even eliminate the lines. It does take regular Botox treatments and a year or more, but you can get great improvements if you are patient and persistent. See an experienced injector.
Andrew Campbell, M.D.Facial Plastic SpecialistQuintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

"11" Lines -- Botox, Fillers, Lasers, Microneedling/PRP

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Botox shows a significant amount of improvement to this area. Skin improvement with microneedling/PRP and lasers also help. Sometimes fillers are needed to get the final improvement. I suggest consulting with an expert for evaluation. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Frown lines

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Yes, I often start with Botox. If they do not flatten as much as you like, after a few weeks, then fillers can be used.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.