Botox advice - glabella lines are noticeable in bright sunlight. Will these relax over time? (Photos)

Question

I’ve had Botox and it has worked great on my forehead and crows feet however not great on my glabella lines. Been back for two top ups and my provider won’t give me any more and also won’t give me filler as my glabella lines only have clear lines when I’m outside in bright sunlight. She has advised to keep coming back for regular appointments and over time the glabella will relax. I’m very frustrated as it looks great indoors but not outdoors. Do I continue with regular appointments?

Ella Fedonenko, MD · Answer

I would follow advice of your provider. These lines will gradually improve with regular Botox injections. I don’t recommend injecting fillers into glabellar area.

Kenneth D. Steinsapir, MD · Answer

If you are not getting everything that you need from your current service provider, try someone else. Believe it or not, not every injector is the same. How the product is placed makes a difference. Not every line can be ironed out with Botox. The glabellar area is highly vascular and is considered a high risk area for the injection of filler product so be aware of this. Best.

Anna Chacon, MD, FAAD · Answer

It's understandable to feel frustrated when results aren't meeting your expectations, especially when the issue is noticeable in certain lighting conditions. Here are some points to consider regarding your treatment plan:

Effectiveness of Botox on Glabella Lines: Botox is generally effective for dynamic lines caused by muscle movement, such as those in the glabella area. However, if the lines are visible at rest, they may be static lines, which can be more challenging to treat with Botox alone.

Cumulative Effect: Your provider's advice to continue with regular Botox appointments is based on the idea that consistent treatment can lead to muscle relaxation over time, potentially reducing the appearance of lines even in bright sunlight. This is because repeated treatments can weaken the muscles, leading to less pronounced lines.

Lighting Conditions: It's not uncommon for lines to appear more prominent in bright sunlight due to the way light accentuates shadows and textures. This doesn't necessarily mean the treatment is ineffective, but rather that lighting plays a significant role in how we perceive skin texture.

Alternative Treatments: Since your provider has advised against fillers in the glabella area due to safety concerns, you might want to discuss other options such as laser treatments or microneedling, which can improve skin texture and help with static lines.

Consultation with Your Provider: It's important to communicate your concerns and frustrations with your healthcare provider. They can reassess your treatment plan, consider adjusting dosages, or explore alternative treatments if appropriate.

Ultimately, maintaining open communication with your provider and adhering to their recommendations while exploring additional options can help you achieve the best possible outcome.

Glenn Murray, MBBS · Answer

Hi there, 
Frequent treatments with dosages on the higher side might continue to soften these 11 lines over time.

Good luck!

Viva Eve Dermatology - New York · Answer

Hi!
This is correct, as you continue with subsequent treatments, your lines will soften over time. The reason why these lines are still present at rest is because the skin has been used to creasing for years prior to Botox, and now needs to try to be "undone" as best as possible. Think of a folded piece of paper trying to be smoothed back out - it takes time!
Some other tips to help you achieve your goals: incorporate microneedling into your skincare maintenance routine (a series of 3 is best), followed by maintenance treatments every 6 months. Medical grade skincare can help reduce the appearance of fine lines, so a retinol/exfoliating topical product will also aid in the cellular turnover. Moisturizing the skin and keeping it hydrated can help reduce the appearance in certain lighting, as well.

Connie Hiers, MD, FACS · Answer

Yes, continue with Botox in that area and gradually your muscles may relax. This is not a safe area for fillers. You can also do micro-needling to help the lines.

Camille Cash, MD · Answer

If you are still able to animate then you could benefit from more Botox in that area.  If Botox isn't fully working you could try a different neuromodulator like Dysport.  Some patients feel one works better than another for them.  Make sure to always see an experienced injector.

Botox advice - glabella lines are noticeable in bright sunlight. Will these relax over time? (Photos)

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