I want a smooth forehead & to get rid of frown lines. Would you recommend Botox, Dysport, Juvederm or any other filler? (Photo)

Question

I make a LOT of facial expressions and now I'm noticing a lot of deep lines formed on my forehead even when I'm not scrunching it. Static lines? Do I get Botox or Dysport? Or would I need to get fillers? I'm not big on injectables but I want to smooth out my forehead and the lines between my eyebrows asap. I've heard of horror stories about droopy eyebrows, people getting bags under their eyes, etc. Do I go to a Facial Plastic Surgeon? I'll include embarrassing pics that I just took, lol.

William Groff, DO · Answer

Botox would be my first choice for this. I would wait at least a couple of weeks and then re-assess to see if you may benefit from a filler in the glabellar crease.

Kristin M. Baird, MD · Answer

The most appropriate treatment for your forehead lines and the crease between your brows is Botox or Dysport. They will both be very effective in softening those lines since the lines are prominent upon muscle contraction. After Botox/Dysport treatment you may consider filler, particularly for the crease between your brows if it is still noticeable. I am confident you will get a very nice result from the neuromodulator treatment. Please consult a board certified dermatologist or plastic surgeon experienced in aesthetic injectables. Best wishes.

Dana Goldberg, MD · Answer

Lines on the forehead and the glabella are due to muscle motion. You'll notice the lines begin to smooth out about two weeks after treatment with Botox or Dysport. Treatment will probably cost between $400 and $700, and most patients need to repeat treatment 2-3 times a year to maintain a smooth result. I save fillers for patients whose wrinkles do not resolve with Botox or Dysport alone. If you want to augment the results, I'd make sure you are using a good sunscreen and consider adding Retin-A or other vitamin A products to increase collagen and to minimize the buildup of dead skin cells on the skin's surface. There are other skincare products and treatments (like laser) that can also increase collagen and smooth skin, but for you Botox or Dysport is the best place to start. Good luck!

J. Jason Wendel, MD, FACS · Answer

Thank you for your
question.Botox and Dysport are very similar products. Either of these would help soften the lines on your forehead and between your brows. Fillers are not needed for what your concerns are. To be sure what is best for you, see two
or more board-certified providers in your area for a complete evaluation to
make sure you are a good candidate and that it is safe for you to have
treatment.

I hope this helps.

Dean P. Kane, MD, FACS · Answer

Dear Nbevins:Thanks for sharing your photos! It illustrates many of the active or dynamic lines we all create:Central vertical creases ("11's" between the brows) from the corrugator musclesThe adjacent vertical brow creasing (recruitment lines toward the center) from the orbicularis oculi muscleHorizontal line (across the top of the nose) from the procerus muscleOblique mini crease (along the inner corner of the eye) from the depressor supercilii muscleThe horizontal bilateral forehead wrinkles (raising the brows) from the frontalis muscleand, the central forehead "gullwing" creases made from the passive lift of the frontalis or active contraction from the ?procerus muscle extending from the nose up into the mid-forehead.There are other lines which your young face does not show radiating from the lateral brow and orbit called "crows feet" from the orbicularis muscleThese lines are created by actively creasing  the muscles of expression in the forehead or the muscles of protection around the eyes.With aging, weather, UV light and thinner skin heritage, the dermis of the skin thins, losing collagen, elastin, hyaluronic acid and other molecules which retain the elasticity, resilience and hydration of the skin. This allows the repetitive creasing by the muscles to etch a line into the skin. Allowing a muscle relaxer like Botox or Dysport properly injected into appropriate muscles to achieve their optimal effects will provide you the residual skin waviness which may benefit from fillers. Passive "lines" are similar in their lack of resistant dermal molecules. These are not "wrinkles" because you are not actively bending the skin and muscle relaxers will not help. The big difference is they are made by the continuous laxity and folding of skin as it folds downward against an immobile edge like:the cheek making the tear trough or nasojugal foldthe nose and upper lip making the nasolabial foldthe corner of the mouth and chin making a marionette fold. There are many fillers and each has its own characteristics. They vary from a very liquidy smoother, to a thicker volumizer,  to a firm and projecting gel.  It is up to your well skilled injector to select which filler and at what depth is best for the lines, wrinkles and folds you wish to smooth. Yes, it's complicated so it is best to consult with a very experienced, Board Certified Plastic Surgeon, ENT Facial Surgeon or Dermatologist to examine you and review what is best for you. All the best!

Inessa Fishman, MD · Answer

Botox and Dysport are neuromodulators, or muscle-relaxing medications.   They are appropriate in the treatment of dynamic lines, or lines appearing with muscle contraction/ expression.  Either one would be a great first step in the treatment of your frown and forehead lines.  Your photos suggest that neuromodulators may be all you need; however, if your frown line is etched into the skin and apparent at rest, this would be better treated with both filler (to plump it from the inside out) and neuromodulator (to prevent the line from getting deeper).  Seek out a plastic surgeon, facial plastic surgeon, or dermatologist who performs regular cosmetic injectable treatments, and develop a treatment plan with him/ her.  Review before and after photos, discuss risks, benefits, and follow-up, and proceed when you feel comfortable.  Good luck!

Adam L. Basner, MD · Answer

BOTOX would be a very appropriate treatment for what you describe.  Of course seeing a plastic surgeon is important to determine if it is actually the best option.

Manjula Jegasothy, MD · Answer

Lines that are caused primarily by muscles of facial expressions can be very effectively erased with Botox Cosmetic®, Xeomin® or Dysport®. Consult a board certified aesthetic dermatologist for a consultation.

Richard Ort, MD · Answer

Yes I agree that Botox, Xeomin, or Dysport would likely work well to diminish the lines and soften your look.  I would use less units, probably 30 units to begin with for the forehead and glabella.  The goal is to soften the lines and give a natural look, not to give a frozen look.  You can always add more units later if desired.  Treatment in my hands is fast, almost painless, and has an extremely high satisfaction rate.

Fredric Haberman, DO · Answer

You are a very good candidate for Botox or Dysport. There is a relatively new product, Xeomin, that can also be usedI would not recommend fillers for you.Some of the side effects that you describe do exist . However if you go to an experienced procedural dermatologist or plastic surgeon  it will greatly reduce the chances of this occurring i would use approximately forty units of Botox and have you return in 10days to two weeks for a complementary look at the results and if you need additional BOTOX

I want a smooth forehead & to get rid of frown lines. Would you recommend Botox, Dysport, Juvederm or any other filler? (Photo)

Answers (16)

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