Does my forehead have to be completely paralyzed with Botox for a filler to work best or will a filler be enough? (Photo)

Five weeks ago I had 28 units injected in the glabella area, for the first time, because I have a deep one inch vertical wrinkle. Weeks later and I'm still able to move some muscles. I went back yesterday and the doctor said the muscles right above the pupil line were a bit strong and that she could inject me with an additional 16 units but it could cause some ptosis. I'm aware that I would have an optimal effect with a filler and I'm interested in fillers.

Doctor Answers 12

Does my forehead have to be completely paralyzed with Botox or filler to work best or will a filler be enough?

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Thank you for your question and your photograph. Neurotoxin in the glabella area is a well-regarded treatment for frown lines. Filler injected into that area must be very superficial and done by a very conservative certified injector with much experience. I wish you the best of luck.

Botox and fillers for forehead

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Hi Sandeebs,

28 units into the glabella area is quite a lot, I would suggest trying with 10 more units max and then a week after that if you're still seeing a major line there, doing filler there. As we age we lose volume in the face which causes lines like the one you are seeing, and when they can't be corrected with Botox filler is a good option. This is something we do pretty commonly at my practices in NYC and Ohio.

Justin Harper, MD
Columbus Physician
5.0 out of 5 stars 24 reviews


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Thank you for your question in regards to Botox. It appears that you would benefit more from additional units of Botox. Once that has taken affect, if a strong line is still prominate at rest, fillers can be used to help soften the appearance of the line.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.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Botox and Belotero for glabella

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You could likely use more Botox to this area.  If a line remains even after doing more Botox, you could consider filler injection.  My preferred filler in the glabella is Belotero injected very superficially.  The glabella is considered a higher risk area for fillers so it is extremely important than you see a conservative, experienced injector.
Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 28 reviews


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In my opinion, you can benefit more from additional units of Botox on your corrugator and  orbicularis oculi muscles that are doing most of the frowning, than using a filler. The filler will not stop the frowning, and at the end you may have a small bump in between your brows, that in a woman does not look very good.
Try the botox, it does not seem that you need that much, and it can be safely done.

Botox in combination with fillers

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Dear sanders, 

Did you get all 26 units into the glabella area? Or did you get some on your forehead used as well? I would recommend having some additional Botox to decrease the muscle movement and going back to your doctor in 10 days to remove that pronounced crease in the glabella area with some Belotero or Restylane Silk.

Valentina Lyssova, DDS
New York Dentist

Forehead Wrinkles and Crows -- Botox, Lasers, Fillers, Needling

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Botox before fillers is best.  Wait 2 weeks after botox treatment to consider how much filler is needed.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Still moving following Botox injections

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Thank you for discussing your problems and posting your photos. When performed properly, the glabellar region will not move so much and the line will be improved. You need extra Botox strategically placed. 
Good luck,

Filler in forehead to smooth lines

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Dear  Sandeebs,

Thank you for writing in. I would continue to get botox in the glabellar area and a touch in the forehead. After a few treatments, the lines will get less and less over time as your muscles are not able to crease the skin. After a few treatments you can add a tiny bit of filler- I would recommend getting an injector that uses a cannula for the line in between your eyebrows and there are case reports of blindness if injected in the vasculature in that area. Getting filler in the area without having botox first is a waste because you will crunch the filler out of the creases if you can move the muscle.

Hope that helps.

Best of luck!
Dr. R

Morgan Rabach, MD
New York Dermatologist

What can be done for my frown lines?

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I treat most frown lines between the eyebrows with botulinum toxin.  I'm surprised that just after 5 weeks you can still squeeze so strongly, but some patients need upwards of 36 units or rarely more for the strong glabella muscles (corrugators, procerus, and depressor supraciliaris).  Filler can be placed into the deep line/fold, but this is a danger zone and needs to be done carefully.  The use of a cannula to inject the filler makes it safer, but vascular occlusion can occur that could cause skin necrosis/scarring and rarely even vision loss if it gets into a vessel during injection.  I would suggest only an experienced injector for this area, use of cannula, and likely a hyaluronic acid filler such as Restylane so an enzyme could be injected to dissolve it in the unlikely event of a blood vessel blockage.  It is okay to ask an injector about their experience for this particular indication.  I've injected this area with fillers for about 12 years, and have seen 2 cases of temporary skin necrosis that fortunately healed well.  I have not seen any skin necrosis since switching to an cannula technique for this area, but it is still possible.  I would say it is about a 1% risk in my experience.  

It is true that giving higher amounts of botulinum toxin into the forehead can lead to your brows drooping, but when done properly this is quite rare.  Avoiding blood thinners prior to your injection by about a week can lessen bruising and unwanted dissemination of the toxin.  I think the combination of filler to "fill" in the folds and lines in conjunction with botulinum toxin to work on the muscles that cause the folds/lines work best together and one is not necessarily a replacement for the other.

Best regards.  

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 17 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.