What type of fillers will fix my 11 lines if Botox isn't working? (Photo)

Question

I've used Botox in the past and they're not working for my 11 lines in between my eyes can I use fillers and what kind. Will a fillers work to improve my 11 lines in between my eyes because Botox hasn't worked in the past and what kind of fillers would be placed into this area

Sean R. Weiss, MD, FACS · Answer

When Botox is not enough to eliminate glabella lines (11’s) treating with fillers such as restylane, juvederm, or belotero can help. I like to combine them his with microneedling, fractionated laser and PRP for enhanced outcomes. Thermi raise is another alternative for longer lasting results. Best regards, Dr Weiss

Jason Emer, MD · Answer

Botox can be used to improve the 11's and forehead wrinkles. Deeper wrinkles need a combination approach with Botox and lasers, microneedling/prp and fillers. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

David Shamouelian, MD · Answer

Hello and thanks for the questions, I take a preventative approach when it comes to botox especially with the elevens of the glabella. I encourage individuals in their late 30s and 40s to prevent the deep lines.  If the lines are deep and long standing botox may not completely smooth out the lines. The problem with filler in the glabella area is two fold. First - Safety: The area is very vascular and is typically considered a danger zone for injectables. An experienced provider and the use of canulla as opposed to needles might reduce the risk but it is still something to be aware of. Vascular compromise can result in skin necrosis  and even blindness. I mention these risks to all patients who want filler in the brow area. Second: filler in the glabella area may result in an ape-like or neanderthal like appearance. It is difficult to erase the 11s and pumping the area up to eradicate the lines may render an unnatural and peculiar appearance. Be cautious with filler in the glabella areaGood Luck and I hope This HelpsDr David IG @AllureBH

Richard Ort, MD · Answer

You can consider filler injection to the 11 lines but this area should be injected only by an expert because there is an increased risk of injecting into a blood vessel.  I have used Belotero with great results in the glabella but I almost always prefer to start with Botox to relax the muscles which cause the lines.  If there are still etched-in lines after Botox, then careful filler injections can be considered.       Regards,Dr. Ort

Jesse E. Smith, MD, FACS · Answer

I agree that you need to ensure that your Botox dose is appropriate.  If this fails, then you can try fillers in the area, but be careful.  This area carries the risk of necrosis, if the blood supply is injected.  Find an experienced injector if you chose to go that route.

Vibha Gambhir, MD · Answer

Hi. To treat the 11 lines the first thing you need is a good dose of Botox that minimizes contraction of the muscle and that lasts 3-4 months. If your current Botox dose is not lasting this long or if it still allows for a lot of muscle movement then I would advise a higher Botox dose. Filler can be used in addition to Botox in this area. The filler for the 11 lines would be Volbella which will last around 6-9 months as long as you also have Botox injections quarterly. The reason we do not inject filler alone in this area is because if you do not have Botox and thus have full contraction of the muscle then the muscle will metabolize the filler very quickly due to the pressure and will not provide results for the 6-9 months that it can with Botox. Hope this information was helpful!

Shaun Patel, MD · Answer

I think first thing to do is figure out why the Botox is not working. It maybe that the dose needs to be higher. Regular Botox treatment every 3-4 months should improve these lines. Etched in or static lines may need to be treatment with microneedling or fractional laser resurfacing. I reserve filler into the frown lines for only the most resistant cases because this is a relatively risky area to treat with fillers even in experienced hands given the increased vascularity in this area.

Lawrence Janowski, MD · Answer

Yes, fillers are an excellent compliment to Botox in this area, as Botox alone may be insufficient to resolve deeper lines.  I would use a firm product such as Restylane or Restylane Lyft.  I recommend a microinjection technique using insulin syringes directly into the dermis for best results.

Spa 35 - Boise · Answer

Has botox worked at all? It is possible that you need an increase in units. It looks like you have strong muscles there. Also, your lines are at rest, so is the botox might be helping a little, but the lines are still present at rest. You can definitely have an HA filler injected to help pop those lines out, but maybe consider trying Dysport or Xeomin if botox didn't work for you, since you'll want to protect your investment (the filler) with a neuromodulator. Good luck!

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