How Effective is 1.5cc Radiesse for Deep Glabellar Lines?

Question

I am scheduled for radiesse filler on glabellar lines, upper eyelid blepharoplasty and secondary full face CO2 laser. Is Radiesse best option for between brows? Would it be advised to be doing all three procedures together? Brow area was not affected with full face laser 10 months ago.

Sam Naficy, MD, FACS · Answer

Radiesse is an excellent filler. However, for treating deep frown lines, a combination of Juvederm and Botox will likely produce the best and most natural looking, and feeling results. The Juvederm will work to fill the existing furrows, and the Botox will work to relax the muscle to preclude the muscle from moving - which caused the wrinkles in the first place. Adding Botox will also have the added benefit of possibly causing your filler to be longer-lasting, as the muscle will be relaxed.

Ron Shelton, MD · Answer

There have been rare cases reported of blood flow compromised by the injection of thick fillers in the glabella. Back int he days of collagen injections, Zyplast, the deeper product compared with Zyderm I or II, was not used because of this risk. Radiesse is a more viscous or thick product than Restylane or Juvederm so the Radiesse may increase the risk of ulceration of the skin of the forehead, not just the glabella. It is not known if this is because the filler gets in the vessel or if the filler constricts the vessel from the outside compression. If there is a sudden sign of such a complication, Resylane and Juvederm can be dissolved by adding hyaluronidase but one can't do this with Radiesse. Other products to avoid in this region are Perlane and Juvederm UltraPlus (Juvederm Ultra is fine).

William Ting, MD · Answer

Filler injection can be performed in glabellar areas with or without botulinum toxin such as Botox or Dysport but this is considered an off-labelled indication. Ideally hyaluronic acid filler such as Juvederm or Restylane should be done before Radiesse in case reversal is necessary as hyaluronidase is available to completely to dissolve hyaluronic acid filler. The key is to have procedure be done by an experienced board certified aesthetic physician who knows what to do to avoid and/or treat complications such as bumps or pending skin necrosis due to compromise in circulation.

Toby Mayer, MD · Answer

Unless the lines are very deep, I prefer Juviderm (lasts a shorter time but is more forgiving than Radiesse) in combination with Botox.

Harold J. Kaplan, MD · Answer

Hi anon.  We do not use Radiesse in the glabella area.  Rather we reach for hyaluronic acid based fillers, including Restylane Juvederm or Perlane.  

	We would also opt for waiting until after the surgery as that may affect how this area looks and the amount of product needed.

Grant Stevens, MD · Answer

It is always difficult to advise on the best course of treatment without seeing you and evaluating how deep your glabellar furrow is. Regardless of depth however, the first thing I would do is a neurotoxin like Botox or Dysport. If necessary, once the neurotoxin has taken effect to soften the lines and relax the muscles, a filler could be used to help smooth the crease further but I would suggest something like Restylane or Juvederm (softer and more pliable than Radiesse for this area and dissolvable in case anything happens and the product needs to be removed)

Kristin Egan, MD · Answer

Radiesse is a great filler for deep lines and to improve the volume of areas of the face such as the cheekbones. Botox and other neuromodulators are better for lines in the forehead region as they paralyze the muscles. Radiesse is better for nasolabial and deep lines.

Emily Altman, MD · Answer

Radiesse is an excellent volumizing filler, however, it should not be used in glabellar lines due to high risk of side effects.

	The most worrisome side effect of injecting Radiesse in the glabella is the risk of compressing the blood vessels in that area, leading to necrosis and ulceration.  The other, less likely possibility is that Radiesse may be injected into a blood vessel and block it.

	Hyaluronic acid fillers are much better suited to the glabellar area.  Although the same risks apply, hyaluronic acid fillers can be quickly dissolved with hyaluronidase, should compression of the blood vessels occur.

	When used in the glabellar area, the combination of hyaluronic acid filler, like Juvederm or Restylane, with Botox works very well.  The filler is used to elevate and smooth the static wrinkles and lines in the glabella (ones that don't disappear when the face is relaxed) while Botox relaxes the muscles that formed these wrinkles in the first place.  This combination has excellent longevity in the glabellar area.

	Please make sure your injecting physician has proper training and experience with filler injections in the glabellar area.

Francis R. Palmer, III, MD (retired) · Answer

No, no thick fillers should be placed in the Glabella. Fillers can restrict flow of the thin walled vein traveling in the notch, by the head of the eyebrow, within each side of the Glabellar area. This complication has been reported and if vein constriction does occurs, a quarter sized area of skin, of the forehead turns black, dies and you're left with a hole that takes months to heal...leaving a nasty scar. Some MD's ignore this and place fillers here but you should not take that risk. Botox...fine.

Richard W. Fleming, MD (retired) · Answer

I use a filler such as Radiesse combined with Botox to treat deep glabellar lines. It is safe to do this and the blepharoplasty and CO2 laser at the same time.

How Effective is 1.5cc Radiesse for Deep Glabellar Lines?

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