Follow-Up: Botox and Dysport not smoothing my 11's. What are my options? (photo)

It's hard to say for sure without an in-person evaluation, but very stubborn frown lines can often see improvement through a combination of BOTOX and injectable fillers. Injectable fillers add volume and fill in deep lines and indentations, while BOTOX temporarily paralyzes the muscles so the filler stays put and isn't displaced by normal facial expressions. Be sure to visit a highly experienced injector for the best results.

Botox and Dysport only relax the muscle that cause the 11 lines between the brows, they don't immediately make the depressions better. You may want to consider some filler to the depressed areas to create a flat glabella. If you keep up with the Botox or Dysport, the filler usually lasts "forever" since the tissue will remodel and if the muscles are relaxed the depression don't usually return. See someone with extensive experience since the glabella is an off label area for filler and can be tricky.Andrew Campbell, M.D.Facial Rejuvenation Specialist

Hello,  in some cases the muscle is so strong it may need a filler instead.  If filler isn't an option, may I suggest a type of radio frequency treatments.  Some of the top machines are Pelleve'.

Best wishes to you.

Hi Lisa. Depending on the age of the patient and how active the muscles between the eyes are, we sometimes have to offer dermal fillers after injecting Botox (or Dysport) to completely resolve the 11 lines.  This is the situation in your case.  You need a small amount of Restylane or Juvederm to smooth out the area between the eyes.  Take a look at the case at the link below to get an idea for what that will look like.

Deep wrinkles can be improved with a combination approach of Botox with lasers, microneedling/prp and fillers. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Hello and thank you for your question. Looking at your photos it appears as long you are actively frowning, there is obvious movement showing the muscles contracting. Based on this, and if you were recently treated, leads me to believe you simply require a higher dose to achieve full relaxation of the glabella complex.  With a 1:1 ratio of Botox dilution, the average patient requires 30 units to relax this these frown lines and in some cases may require more.  Botox and Dysport both work very well in this area and adequate dosing is essential to achieving desired results. I would also recommend retreatment every 3 months to keep on top of it.  Hope this helps!

Assuming that your dosage of Botox and Dysport was adequate to treat your 11's, it is possible an injectable filler could be used to obtain further improvement.  I would discuss this option with the physician who is treating you.

If you are still bothered by your frown lines even after Botox and Dysport, you might consider filler to this area to give you additional volume improvement.  As you know, frown lines occur from dynamic movement but with aging, there is also some volume loss.  Consult with an experienced and board-certified cosmetic physician.

Hi Lisa,
It appears that you still have muscle contraction causing the frown lines.  I would recommend having more botox injected.  If you have no muscle contraction and still have the frown lines then I recommend filler to smooth out the lines.
Hope this helps,
Nancy Kim, MD

Based on the photo, it still looks as though you have muscle movement in the glabella leading to these frown lines. That suggest to me that the Botox or Dysport dose may need to be increased. I would followup with your injector to discuss your results and to determine if a higher dose may help. In some cases, fillers may need to be combined with Botox/Dysport to fully treat the frown lines.