Fillers for Glabellar Lines?

Juvederm can be a nice filler for the glabellar region.
However, there are reports of severe complications from injections of filler materials to the glabella, with tissue death of small patches of skin. The reason for this is unclear.
Some doctors have speculated that the blood supply is decreased to the glabella. This is probably not the reason, as the supratrochlear neuovascular bundle is very near to the area and has a tremendous blood supply.
More likely, filler material embolized (travels through a vessel) and clogs it, causing in effect a "heart attack effect" to local tissues in the glabella.
If the filler is conservatively applied (i.e. not too much), and doctors are careful not to inject into blood vessels, this rare complication can be minimized.

In the vast majority of patients with glabellar frown lines,
the treatment of choice is Botox.This
product works by decreasing the ability of the forehead muscles to
contract.When strategically placed, it
can impact the glabellar muscles and minimize vertical glabellar frown lines.Unfortunately,
Botox may not totally alleviate these frown lines when they are of long
standing duration and deeply etched into the forehead.Under these circumstances, injectable fillers
may be effective for treating this problem.In most
cases, we utilize hyaluronic acid fillers.These include Juvederm, Restylane, and Perlane to name a few.These products typically last about 6 to 9
months.In patients who want more permanent
solutions we utilize Radiesse.All of
these products are associated with excellent clinical results and high levels
of patient satisfaction.If
Botox hasn’t adequately addressed vertical glabellar frown lines, consultation
with your physician is appropriate.Your
physician should be able to formulate a treatment plan that may use injectable
fillers to address this problem.

Hi Gregory,
I have found that vertical glabellar lines are best treated with both Botox and Hyaluronic Acid filler (Restylane, Juvederm, or Preville Silk).
The Botox may be injected ten days before the filler, or in patients who are unable to return for a second appointment, the two may be injected at the same time.
The two in combination work better than either alone. Amazingly in many patients the vertical line doesn't return even after the Botox has worn off.
Good luck and be well.
Dr. P

Botox will prevent the muscle that wrinkles the brow from contracting and making the lines. A filler of Juviderm will fill in the depression that may still remain after Botox. Some patients just don't like the idea of Botox and are quite happy with fillers alone. Juviderm lasts up to a year.

The glabellar area looks the way it does when you lose volume in this area as you age. Botox is a temporary fix to paralyze the muscles for a 3-6month period. This keeps the muscles from working and creating and deepening the wrinkles in this area. Botox doesn't improve the volume loss. If you look at infants and children you will notice that the glabellar area is quite a bit fuller than the older individual and really the whole forehead is much more volumized in youth.
Fillers and Fat injections are a great way to improve the glabellar region and the lines that form in this area. The filling removes the muscles from the skin and makes it harder for the muscle to actually create the wrinkles. Fat injections also help break up the fibrous tissue that can sometimes hold down the wrinkles in their current wrinkled state.

Botox is great to improve the lines. If they are still indented a bit, then fillers may help. But, be careful because in the past, collagen was not recommended for this area because of risks of skin necrosis.