How to fix this static wrinkle? Botox didn’t work. Only 36 years old (Photo)

Question

Hi! I am really self conscious about this static wrinkle on my forehead. I had three rounds of Botox within 2 months - went once, then a touch up 2 weeks later, then another round of Botox 4 weeks after that, with minimal improvement, if any. I read online that most doctors will not do fillers on the vertical frown line between eyebrows due to health risks (blindness, artery location, etc.). Could it be a bad Botox injector technique? Is there another procedure you recommend? Please help! Thx!

Nelson Lee Novick, MD · Answer

This is a fairly common problem, and I personally use HA filler to treat vertical creases in the glabella region and horizontal "worry line" creases across the forehead. You see there are two components to the development of these kinds of creases (and others on the face, as well). The underlying cause is repetitive movement of the underlying muscles of facial expression (thousands of times on a daily basis over years) that eventually leads to permanent creases in the overlying "fabric" of the skin. Once the deep creases are formed, then simply quieting the underlying muscles with Botox can only diminish further damage to the overlying skin, but can do little for the damage already done. For this, an appropriate low viscosity, cohesive, malleable HA filler properly injected can be used to elevate and smooth the crease. Since this an area of treatment that should not be left to the hands of inexperienced, novice non-core physician injectors or non-physician providers, trained basically to inject simple smile lines with ordinary Restylane or Juvederm, it is hardly surprising that there are many non-physician or non-core aesthetic physicians who shy away from treating these regions. You would be wise to seek consultation with an experienced, board certified cosmetic dermatologist filler injector. In experienced hands, the procedure takes about five minutes. Hope this helps and best of luck.

Berlin Beauty Medical Aesthetics · Answer

Botox is a neuromodulator that is primarily used to treat dynamic wrinkles, which are caused by repetitive muscle movements. It temporarily relaxes the muscles, reducing the appearance of lines and wrinkles. However, it may not be as effective for static lines, which are visible even when the facial muscles are at rest, as these are often caused by factors such as sun damage, loss of collagen, and natural aging.
Microneedling is a minimally invasive cosmetic procedure that involves the use of a device with fine needles to create controlled micro-injuries in the skin. These micro-injuries stimulate the body's natural healing process, promoting collagen and elastin production. This collagen and elastin production can help improve the appearance of static lines over time. Here's how microneedling can help improve static lines:
Collagen Stimulation: Microneedling triggers the production of new collagen in the skin, which can help plump and smooth out static lines. Collagen is a protein that provides structure and elasticity to the skin.
Skin Texture Improvement: Microneedling can help improve the overall texture of the skin, making it appear smoother and more youthful. This can minimize the appearance of static lines and other skin imperfections.
Enhanced Product Absorption: The microchannels created during microneedling allow for better absorption of topical skincare products, including serums and creams. This can further support the skin's rejuvenation and improve the appearance of static lines.
Gradual Results: While Botox provides quick results by temporarily relaxing muscles, microneedling works over time as collagen production continues. Multiple microneedling sessions may be required to achieve the desired improvements in static lines.
It's essential to consult with a qualified dermatologist or aesthetic professional to determine the most suitable treatment approach for your specific concerns. In some cases, a combination of Botox and microneedling may be recommended to address both dynamic and static lines effectively.

Lara Clinic · Answer

In order for there to be an improvement in static lines, you have to be completely "frozen." The touch-up sessions were likely to get to a point where there's less movement between the brow and help freeze this muscle. The less movement there is, the less the skin will fold in this area.
Because the line is so prominent, you'll have to be consistent with coming in every 2.5-3 months and having injector freeze this area. If you are frozen and the static line is still present, its going to take some time for the skin to catch up. Sometimes it may be a full year of consistent botox to appreciate the improvement so treatments that address the skin may be beneficial as well.
Smooth pdo threads can be placed in the area stimulate collagen which will strengthen the skin over this area and help reduce static lines. Prescription strength retinol (tretinoin) will also accelerate cellular turnover and help overall appearance.

Darryl J. Blinski, MD · Answer

Nicely posted photos. I treat cases as yours with Botox fresh mixture (about 15-20 units) with 0.5 cc HA filler injected via 22 gauge cannulae only using ultrasound guided injection techniques.Sometimes under local anesthesia I release the dermal bands to the deeper fascia via small incisions. Fees fro $2,000. Best to virtual consult with....

Thomas Spalla, MD · Answer

Toxin treatments to that area can help to soften that line. This is the least invasive and least risky option for this. If you continue such treatment, you should be able to shrink down the size of the bellies of the corrugator muscles which is responsible for this. This can take up to a year and needs to be maintained.

If this doesn't resolve the issue, or if you're looking for a more immediate result, fillers or fat grafting can be considered, but are risky, as you're aware.

Resection of the offending muscles can be performed as well, but this is a more extreme method of correction that is occasionally done during a browlift.

Leonard Grossman, MD · Answer

Poorly administered, Botox could be the culprit here. But there is absolutely no reason why you cannot have a filler placed into the area as well. Using a proper technique and a cannula, fillers can be injected into the frown area quite easily. Revaluation and administration of Botox would actually be highly advised. I hope this helps and good luck from New York City Plastic Surgery

How to fix this static wrinkle? Botox didn’t work. Only 36 years old (Photo)

Answers (6)

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