What is the best laser resurfacing option for set glabella wrinkles? (Photos)

Question

Female, 31, skin type is acne prone / oily. I have wrinkles at rest between my brows (glabella / 11 lines). I have tried Botox and Dysport before but they didn’t really soften my wrinkles much and my last Dysport injections gave me ptosis in one eye (I believe my injector injected too many units). Worried about potential for scarring as I do scar relatively easily. I’ve looked into Co2, Clear + Bright, Pico but am not sure what would be the best option for me. Wrinkles are somewhat deepset, at rest I can feel the grooves of them and am extremely self conscious about them. If possible to provide general range in pricing for the best laser resurfacing treatment, that’d be great as well. Thank you!

Nelson Lee Novick, MD · Answer

It is important to understand that the overactivity of the frown muscles after years of repetitive use will ultimately etch the lines into the fabric of the overlying skin, the way repetitive folding of a piece of paper can permanently crease the paper. This may explain the persistence of the lines following your two prior neurotoxin treatments.
So, in order to achieve optimal improvement, BOTH the dynamic muscular component must be addressed (typically with Botox or with other neuromodulators) and then the creases that have have already been formed can be elevated and smoothed with the use of a low viscosity, malleable, cohesive HA filler properly injected by an experienced, board certified cosmetic dermatologist injection expert. I have personally employed this approach for this very common problem for three decades with very gratifying results.

Michael S. Mall, MD · Answer

You stated that Dysport and botox did not help resolve the glabella lines, however, it can take multiple treatments to resolve those lines. Perhaps up to 18 months of not using those muscle to resolve those lines. That would be my first recommendation. If after multiple consecutive botox/dysport treatments with adequate doses to prevent movement, and retreat before full movement returns, then I would consider laser treatments. Simple collagen building non-ablative skin tightening treatments would be first line. Titan XL ( infrared bulk heating) from Cutera lasers, or RF laser devices such as Venus brand would be a good start to tighten the skin. The Titan is usually 3 treatments $750-$850 per full face treatment, and the Venus RF would be 10 treatments at $250 each. I would reserve the microfractionated CO2 laser like Ultrapulse/Accupulse from Lumenis as a finishing treatment depending upon the results of the other modalities first. The Accupulse treatment for the entire face can be from $2000-$3500 depending upon provider, and just the forehead could be around $700-$850. Those recommendations are based upon 20 years of experience with injecting Botox/Dysport, along with the aforementioned laser devices.

What is the best laser resurfacing option for set glabella wrinkles? (Photos)

Answers (2)

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