How much could Juvaderm help with deep creases between the brows (without using Botox)? (photo)

I had a serious issue from Botox and due to a medical error am left with deep creases between my brows that I'd like to have cosmetically fixed. I've previously used Juvaderm for upper lip creases and wondered if this might be a good option to avoid Botox but help the between-brow issue I'm left with now.

Doctor Answers 12

How much could Juvaderm help with deep creases between the brows (without using Botox

Hi there, 

It is terrible that you have had serious issues with Botox in the past. Optimal therapy in this area would be a combination of toxin and filler. It is an off label use for Juvederm and would have to be done by a board certified dermatologist with a great deal of experience in this area. Additionally, you could do Thermi Rase which disables your nerve endings so you cannot frown, but you will still need to have your Juvederm done. This will eliminate the need for Botox. Good luck, Dr. Downie.


Montclair Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Filler between the brows

Hello! Thank you for your question, and for sharing your pictures. Generally speaking, when patients present to my practice with a forehead like yours, I do a two phase treatment: Botox for 6-9 months, followed by filler after the muscle has had time to atrophy, or shrink. If you cannot use Botox, filler can be used to correct that problem, with two caveats. 

(1) Filler will not last as long without the paralyzing effect of the Botox, and 

(2)  This area of the face has several arteries which can be damaged by filler injection. 

Make sure that if you do proceed with filler in your forehead, that you choose a reputable practitioner who has experience injecting in this area.

Treatment of deep glabellar creases

Your photo suggests that you have brow ptosis/drooping and intact action of the procerus and corrugator (frown) muscles. Deep creases are chronic dynamic wrinkles, and - in that area - related to the heavy frontalis and brow tissue and hereditary facial features. Filler is NOT a good option for several reasons: 

1) it would add to the bulk of the tissue, 

2) it is a high risk area for injection because of neurovascular bundles

3) the creases are chronic and deep. 

Surgical brow lift combined with CO2 Laser skin resurfacing would help the heavy glabellar area, but it is not realistic to expect a complete resolution of these wrinkles. You may want to see an Oculoplastic surgeon for evaluation and treatment. Best wishes for improvement.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

How much could Juvaderm help with deep creases between the brows

It is an off label use of the filler, but a good correction should be able to be achieved with a filler in that area. I would estimate the filler will last about 3 months or so, depending on the amount of motion in the area.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

Glabellar Lines -- Botox, Fillers and Lasers

I find that glabellar lines to better with a combination approach. I suggest you see an expert for treatment options.  Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 168 reviews

Belotero Balance Works Well For Deep Static "Eleven Lines" Between The Brows

I am very sorry you had some problem with your previous Botox treatment. The so-called "eleven lines" (aka scowl lines, frown lines) between the eyebrows are a very common problem that is ideally treated by addresses both the underlying dynamic problem, i.e. the overactive and repetitive motion of the muscles--the corrugators and procerus muscles--that control this region and the static component, i.e. the creases, as you clearly demonstrate, that result from years of folding of the skin 1000+ times/day, every single day. Botox (or the other muscle relaxants, Dysport and Xeomin) is the ideal means for reducing the muscular overactivity that leads to the development of these lines. But, since this is not an option for you, the resultant lines can be easily treated and smoothed, via the use of a filler, such as Belotero Balance, which possesses little to no propensity to give rise to the unwanted, bluish Tyndall Effect when injected relatively superficially, as needs to be done, in order to elevate and smooth lines such as yours. Juvederm, in my experience, possesses a great deal more tendency to hold on to water and to engender the Tyndall Effect. When Botox is combined with filler treatment, the result often last about a year. When filler is used alone, and the muscles below are permitted full activity, the results tend to less about six to eight months, since the repetitive motion of the muscles mechanically accelerates the breakdown of the injectable filler. Best of luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 24 reviews

Filler for frown lines?

My first, second, and third choice for frown lines is Botox/Dysport. Don't write these off because you had a bad experience. It was most likely a poor injection. Remember that movement is not inhibited by fillers, only the grove that is present at rest. Keep in mind that this area is at risk for vascular occlusion and eye injury when fillers are used. I would try a more experienced injector with the neuromodulator before moving on to fillers. One recent study showed that after 3 treatments, even the deep furrows can be nearly eradicated with Botox.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Fillers

Deep creases can be softened and not completely eradicated with filler. Small amounts of Botox in this area can help as well. More details of your issues with Botox are obviously important to review.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

How much could Juvaderm help with deep creases between the brows (without using Botox)?

When a frown crease is too deep for Botox Cosmetic® treatment alone, Juvederm Ultra Plus® is a great option. Since you have had issues before, please consult a board certified aesthetic dermatologist for a consultation. 

Manjula Jegasothy, MD
Miami Dermatologist
5.0 out of 5 stars 8 reviews

Deep crease between eyebrows

I am not sure what your complication was from the Botox. Generally I would use Botox first in the area to relax the muscles and then a month later would conservatively inject Juvederm to fill the residual crease. Juvederm is not approved for this area because there are large blood vessels under this area that if the filler was placed in them could cause serious complications including loss of tissue. The other option would be surgically severing these muscles which would be more permanent. You need to see a oculoplastic/ facial plastic or plastic surgeon to get an evaluation in person to pick the best option for you.

Byron A. Long, MD
Marietta Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.