Juvederm for Frown Lines

Thank you for your question. The frown lines between the brows can be address two different ways:1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest. The effects typically last 3-4 months depending on the dose.2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression. This can last for a year or more when used in conjuction with Botox.For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together. I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.

There is a dermal filler called Belotero which has been specifically designed to fill fine surface lines close the the skin. Juvederm, on the other hand,  requires much deeper injections as it may produce clumping. Also since it is a clear particulate suspension, light rays will pass through it under the skin and bend, producing a bluish color (i.e. the Tyndall effect). Since Belotero is a continuous substance, it will not do this. Here is a female patient from my office at the Dr.U Clinic who opted to fill in her frown lines with Belotero since she did not want Botox as well.

Hi Moises,

You will likely only need up to 0.2 cc (about 1/4 of a syringe) of Juvederm to fill your glabellar forehead line.  Though you do not wish to have Botox, we have found that the simultaneous use of hyaluronic acid filler (Juvederm or Restylane) with Botox allows much greater effect of the filler.  So much so that even after the Botox has worn off, and the filler should have worn off, the deep furrow in many patients does not return.  It is thought that the collagen stimulation from the filler is more effective when the forehead muscles do not move for a few months.

Good luck and be well.

Dr. P

Botox is just as safe, if not safer, than a filler in this area, and tends to work better.  Cost will be comparable for most people.  It will keep the area from creasing when you frown (scowl) but a filler won't, and you will still see a line there when you make that expression.  Botox can also train you not to make the expression and sometimes you can reduce your dose or treat the area less often after you have used Botox for some time.  Sometimes both products need to be used if the line is extremely deep, but yours does not sound as if it is.

Glabella frown lines are often best treated with Botox first. I will sometimes use a filler afterwards if the Botox does not improve it enough.

Hyaluronic acid fillers can help to fill glabellar frown lines, due to years of muscle activity in the area.  One syringe will certainly be enough to help improve lines in this area.

Botox works even better to prevent these lines from worsening and relax the lines currently present.  For best results a combination of Botox and fillers is ideal.

However, you need to see a dermatologist or plastic surgeon in person to have your unique situation evaluated and treated.

Frown Lines are caused by years of repeated contraction of the undergoing Corrugator muscles which leads to thinning of the overlying fat and skin. In the early states, Botox by itself would smooth such wrinkles but in established wrinkles the lost fat needs to be replaced with a filler to push up and smooth the collapsed wrinkle.

Juvederm is a great filler in this location but it will not last long if Botox is not used as well. Without the Botox the muscle will contract a lot of the Juvederm out of the area reversing a good correction.

Another source of concern is the location. This happens to be a watershed blood supply area where fillers occasionally are related to death and scabbing of the overlying skin. Fillers must be used with care in this area.

Yes, you can have filler to fill the frown lines but you need to see an experienced injector as the risk is much greater there for something called necrosis (when the blood supply to the area gets cut off).  The injector needs to have vitrase available if injecting in this area to reverse this potential side effect.  Dermatologists with experience using both of these products are who you want to see.  Hope that helps!

See a Board Certified Plastic Surgeon and discuss all your options. The internet is not a good medium for procedure consultation without a physical exam.