Glandular lines after Botox. Is filler safe? (Photo)

The appearance of vertical lines after Botox is due to its unique utilization and weaving. The corrugator muscle is responsible for creating the inter-brow number “11” creases.The appearance of fine lines and shallow wrinkles will lessen quickly, and deeper, harsher lines and wrinkles will take more than 14 days to fade. Around 14 days, all the treated areas will look smoother, fuller, and more youthful. Wrinkles and fine lines will disappear or appear smaller and softer.The best products to achieve “nonsurgical eyelid lift” is Belotero or Restylane, which are reversible products made of hyaluronic acid gel (natural molecule in the skin).

Thank you for your question and posting an appropriate picture. Injectable, fillers are safe provided by an expert injector in this area. Alternatively, you can have PDO threads as a scaffold for your own body to build collagen in this area. You would need a few treatments to achieve good results. Best to have a consultation either in person or virtually to discuss options.

Hi @Tessymaria77. Thank you for your question. You can get smooth PDO threads placed into your 11 lines.

Best of luck,

Dr. Nima

What's needed is the proper choice of HA filler, an appropirate injection technqiue & an experienced injector and yes, the glabella eleven lines can be elevated and smoothed using filler. I have been personally been performing it for patients for years and even periodically do it for myself for this problem standing in front of the mirror in my office. One needn't disenfranchise oneself from this time tested treatment. You would be wise to consult an experienced, board certified cosmetic dermatologist injector. Hope this helps.

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Botulinum toxin decreases these lines in two ways. The first is to stop the movement of the muscles that causes the lines to form. The other way is to cause the muscle to shrink over time. In order to cause the gabellar muscles to atrophy, you need to get treated regularly and before the movement fully comes back. I do not see any etched in lines in your photos, so If you follow this strategy, you should continue to see more improvement over the course of multiple treatments. Your doctors are correct in telling you that this is a very risky area to use fillers. If filler is injected into a blood vessel that communicates with the retinal artery, you can permanently lose vision. Just compression of the blood supply in this area can cause skin necrosis. Having said that, I would not say that I never use fillers in this area. A very experienced injector, preferably a physician, can use a very thin filler such as RHA Redensity, Restylane Silk, Belotero Balance or hyper dilute filler very superficially right under the creases. Only a tiny amount of filler is needed to do this and if you stay very superficial, you can actually see the needle under the skin so there is very little chance of injecting into an artery. Again, this should only be attempted by very experienced injectors and this should only need to be done once. After the filler, you should stay on top of the botulinum toxin treatments so that the creases do not come back.

Yes, blindness is a potential complication of filler placement into the area of your concern. Your lines are quite wide and look to be directly over the course of the supratrochlear artery which can lead to a potential complication to the retinal artery. Newer Ultrasound devices have made identification of the vessels in this area more accessible so having the procedure performed with this device is a safe alternative.

Hello, and thank you for your inquiry! While Botox treats the animated lines it will not add volume to fill in a crease. By adding a very fine and thin filler to this area it can help minimize that shadow. In addition to adding filler to this area I would continue to get your routine Botox. Good luck on your journey!

Indeed, using filler in this area can be dangerous. However, the right product can be cautiously applied very superficially with the tiniest needle, taking necessary precautions and ensuring readily available options for dissolving the filler if needed. Additionally, there is a possibility to tighten the skin using microneedling/lasers in order to smooth the wrinkles. Feel free to contact us for a quote.

Let me tell you that you should definitely be examined in person by a plastic surgeon, either myself or anyone else for that matter to see if the muscles of frowning have really been taken out of place here. Unfortunately, too many people inject frown lines exactly the same way, not changing the function of the muscles in the area. If you assume that the muscles have been frozen properly, then you can definitely have fillers placed into the area, but with the use of cannula eliminating risk for any kind of injury or blindness completely. This area gets treated in the older individuals rather frequently with fillers in our practice. I hope this helps and good luck from New York City Plastic Surgery.