Which dermal filler is best for glabella lines ?

Question

Hello ,I had botox done for my whole forehead it's seems to have worked well for my worry lines but my 11 lines are still deep,My doctor recommends fillers ,which would be safe as well as long lasting ?

Nelson Lee Novick, MD · Answer

Most wrinkles on the face have two components--a dynamic component, i.e. the wrinkling that comes from movement of the muscles of facial expression, and a static (at rest) component, or the "etching" or creasing of the overlying skin that results from years of folding the underlying expression muscles. The latter are often referred to as "expression lines."  Improvement in wrinkles can be achieved by treating the static or the dynamic component, but are most improved by addressing both issues. Neuromodulators, such as Botox, Dysport, or Xeomin work fine for the dynamic muscular component, and fillers, particularly Belotero Balance or diluted Restylane L are particularly effective for the superficial overlying wrinkling. Belotero Balance possesses the added advantage of having little tendency to result in the bluish Tyndall effect that is sometimes seen with other hyaluronic acid fillers when they are injected superficially as they must be in order to improve very fine lines. To save time, I personally recommend performing both types of treatments during the same treatment session. However, if so desired, neuromodulators can be used first followed a couple of weeks later by the filler treatment. .

Martin Jugenburg, MD · Answer

Neuromodulators such as botox, when used every 3-4 months do a great job to smooth out glabella lines.  If you still feel like the lines are deep and would prefer to have a filler in combination with the botox i would recommend restylane.  Be sure that your injector is highly qualified.  Good luck

Paul S. Nassif, MD · Answer

In general, it is best to use Botox or Dysport for the glabella. Using filler in this area is dangerous, and I would advise against it. When having Botox or Dysport in the glabella, I would recommend seeking the advice of a board certified facial plastic surgeon, plastic surgeon, or dermatologist. Each is a fantastic choice. I hope this helps, and I wish you the best of luck.

Steven J. Pearlman, MD, FACS · Answer

For patients who get Botox or Dysport, sometimes there still is a dent from active muscles that have built up over the years. Hyaluronic acid fillers such as Juvederm, Restylane or Belotero work well, but are not FDA approved. These can be used sucessfully, but must be used carefully since complications ahve been reported.

Nissan Pilest, MD · Answer

The lines
that you make when showing expression will be improved with Botox injections,
if you have lines at rest then they will soften with Botox. If you wanted more
improvement to the deeper “11” lines then the addition of filler would give you
best results. If you just fill the line without the toxin the muscle
contraction will break down the filler very quickly. The combination of the two
will give the best longest lasting result. I like to inject Juvederm, but Belotero
and diluted Restylane are also good options. Consult with a Board Certified
Dermatologist to see which option will work for you.

Michele S. Green, MD · Answer

Sometimes when your wrinkle is deep in the glabella area there are two possible ways to correct. The first way is to actually use Botix and delicately freeze some of the forehead to give it an extra freeze. The second choice are fillers like Boltero or Restylane which can help full a deep line.  Make sure to find an experienced dermatologist for this procedure.

Tatiana Khrom, MD · Answer

No matter how deep the glabellar lines, I always start with a neuromodulator (Botox, Dysport, or Xeomin) to prevent further exacerbation of these dynamic lines of facial expressions.  Typically, with regular treatments, even the deeper prominent lines will diminish over time.  However, for those patients, who exhibit these lines even at rest (without frowning), the lines have become static and a neuromodulator alone is inadequate treatment for someone, who wants to get rid of them completely.  Although not an FDA approved treatment, small amounts of Belotero ( a hyaluronic acid filler that can be placed quite superficially into the wrinkles) or a thinned out preparation of Restylane (another hyaluronic acid filler that I thin out for this tricky area) produces very pleasing results.Good Luck and I hope this helps

Steven Wallach, MD · Answer

I usually start with neuromodulators like botox. Then using fillers is done off-label if a patient desires.  Preferably with one of the hyaluronic acid products.

Ramona Behshad, MD · Answer

First and foremost, this a very risky area to inject filler due to the anatomy; therefore, an experienced physician injector is your best bet. In addition, only hyaluronic acid fillers should be used because they are reversible. The injection should be kept superficial because the blood vessels are deeper. Because of superficial injection, I use Belotero or Restylane with great results.

Alexander Ovchinsky, MD · Answer

None of the fillers are FDA approved for the use in glabellar area. However, this is a common area for off label filler use. Most commonly, hyaluronic acid based fillers (Juvederm, Restylane, Belotero) are used for this area.

Which dermal filler is best for glabella lines ?

Answers (13)