My frowning lines run all through my brows. Is Botox the only way out? It's very expensive and does not last long. (Photo)

I was on steroids for sarcoidosis for 1 year . I had developed a moon face. After it stopped my face sagged. My forehead is in a bad shape, my cheeks are hollow and my jowls have also sagged. Juvederm has not helped lift my jowls. What do I do ?

Doctor Answers 13

My frowning lines run all through my brows. IS Botox the only way out? It's very expensive and does not last long.

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Thank you for your question and your photos. Yes, Botox would be a helpful treatment for your area of concern. 


Toronto Plastic Surgeon
4.9 out of 5 stars 518 reviews

Volume loss and sagging after steroids

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Dear peacheschnappes:

From your photos, it appears you have very strong muscles of the glabellar complex. Relaxing these with one of the botulinum products will improve the appearance of your forehead. The only other way to relax these furrows is a surgical procedure to cut the nerves or radiofrequency ablation to destroy the nerves feeding these muscles, which would be more expensive. An evaluation of your facial volume and skin laxity will be helpful in determining whether you might benefit from dermal fillers such as #Voluma or #Sculptra and/or a skin tightening procedure such as #Ultherapy, #Pellevé, or Thermitight.

Sorry you had to go through this treatment for your sarcoidosis. I have found that chronic steroid use changes the response to some of these treatments. Bruising may be more likely, and the skin can be more fragile. You might want to start with Botox, and then only proceed cautiously with any other treatments untill more time has passed since your steroid use.

All the best,
Dr. Clark

Sheryl D. Clark, MD
New York Dermatologist
4.7 out of 5 stars 10 reviews

Frowning and BOTOX

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Dear Peaches, Fortunately, you have many options available to help you. Your frown lines will respond to BOTOX or Dysport neurotoxin injections. If you have them on a regular basis, then the corrugator muscles between your eyebrows will be relaxed and the lines will not form. Restoration of facial volume can be accomplished with fillers like Voluma, Radiesse and possibly Sculptra. Alternatively, you may be a candidate for a facelift to address to address jowls and skin laxity. I recommend that you have a consultation with an experienced Board Certified Plastic Surgeon who can take a detailed history and physical exam, discuss your goals, review many before and after photos, answer all of your questions and inform you of your non surgical and surgical options. Please carefully consider your options before you proceed.Best wishes, Dr. Richard Swift

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From you pictures, you should see improvement with botox, and I think it will be worthwhile for you to try.  Yu may also require fillers such as juvederm to completely correct established creases such as yours.  Significant lower face excess skin is best treated with surgery, such s a facelift.

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 30 reviews

11 lines

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Botox can help the "11" lines and fillers may help as well if they do not efface enough with botox.  AS for the other issues like jowling, you would need to be assessed in person.  Fillers may help.   Not sure if you are a candidate for a facelift.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Many options for facial changes

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I'm sorry to hear that you have had such significant problems after the steroids, but those types of medications, while extremely helpful and many times life saving, certainly have their downsides with side effects. Regarding your brow lines, the only good options are either Botox plus or minus filler, or a surgical browlift. Botox may seem expensive, but it is incredibly convenient and very safe.

Regarding the loss of volume in your face, you have several options. One is filler, but you will most likely need a LOT of filler (consider the fact that a syringe of Juvederm is 1/5th of a teaspoon!). A second option would be fat grafting where a considerable amount of volume can be placed, much of which will last a lifetime, but there is some unreliability with fat. The third option would be facial implants. They last a lifetime and are guaranteed to give you the volume desired. Ultimately, I would recommend seeing a surgeon that has experience with all three options so you can discuss what would work best for your particular anatomy, finances and expectations.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Botox for frown lines

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Botox is the only and best way to eliminate those frown lines.  The facial hollowing would respond better to Voluma and Thermage would help well with the jowls and skin tightening.  Please consult a board certified dermatologist with an expertise in these injections and lasers for the best cosmetic result.  Best, Dr. Green

Botox for frown lines

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Botox and Dysport injections are still the best options for frown lines on the forehead.  Injections over time can thin the appearance of these wrinkles.  With repeated injections, generally, the muscles become less prominent leading to longer times between injections.  Sagging due to volume loss in the face, especially after high dose steroids, will generally require multiple syringes of filler.  Options to consider would be fat transfer or sculptra treatments.

Kyle Coleman, MD
New Orleans Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

Botox best for wrinkles in forehead/brow

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Botox is still the most effective and safest treatment for treating these wrinkles. It typically lasts about 4 months, and there is a real skill involved in getting excellent lasting results, so make sure you see an expert such as a dermatologist. Fillers are occasionally added for etched in deep wrinkles in addition to Botox.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Post steroid facial changes

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You need to seen by a facial plastic surgeon who has treated people with auto-immune diseases, ie sarcoidosis. Is your sarcoid in remission, do you have any other health issues related to sarcoid, do you understand that Botox and fillers can sometimes impact your sarcoid ? These are some of the questions that should be explored before deciding what needs to be done.

Robert J. Smyth, MD
Cincinnati Facial Plastic Surgeon

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.