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