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

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.

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.

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.