Deep/etched wrinkle still present after Botox (Photo)

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question and I am sorry you have not seen satisfactory results from your procedures thus far. This stubborn crease may be best addressed using a combination of Botox to relax the facial muscle and filler to minimize the appearance of the line further. Placing filler in the forehead requires a great deal of precision and skill, so please make sure the injector you choose has the expertise necessary to ensure a safe and successful procedure.

at home peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly, see link) should be started now to prevent further aging. in office you need more than MNRF, everyone should be getting laser every 3-4 months, botox every 2-3 months ,and peels monthly with facials. botox doesnt get rid of all lines it prevents them from coming long term.

For facial rejuvenation, I would suggest a combination approach of
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Botox is best reserved for treating motion-related wrinkles, such as for the crow's feet when smiling; eleven lines when frowning; and for the worry lines on the forehead when the eyebrows are raised. After years of movement, motion-lines, such as the horizontal lines on the forehead can become "etched" into the skin so that they remain present, as in the case, when the forehead is at rest (i.e. a "static" wrinkle).. In this case, the ideal follow-up treatment to Botox is to use a filler to elevate and smooth the etched-in depression, so that it is much less prominent when the area is at rest. Microneedling is best reserved for very superficial, surface irregularities and less effective for actual wrinkles. And RF is more "bells and whistles" with a lot less hard science and a whole lot more marketing hype to support its use. Make sure that you consult with a board certified cosmetic dermatologist and be sure to ask him/her to show you personal befores and afters before agreeing to proceed. Best of luck.

Hi, you may require some filler in the area. Please feel free to book in for a complimentary consultations with one of our experienced nurses to address your concern and properly advise the best treatment plan for you. Thank you, warm regards, The Absolute Cosmetic Medicine team.

After getting Botox and other treatments routinely and still getting that wrinkle in your forehead, this could mean that the existing line is deep that collagen can no longer be produced by the body and additional filler injection is needed. Even after a muscle is paralyzed with Botox, filler may be needed to be injected to fully fill the line. Always consult with a board certified medical practitioner to discuss your options.

Thanks for your question and photos. It is possible that this line is going to be extremely stubborn to completely eliminate. Sometimes moving the Botox to a more central forehead location can help, so you might want to follow up with your dermatologist 2 weeks after your next treatment to see if there is any movement specifically in the upper central portion of your forehead. An experienced injector would know how to place the Botox to specifically minimize movement of the area around the wrinkle. Any extra movement in the center of the forehead might be making this worse. I agree with your plan of tretinion and monthly microneedling. Keep up with good sunscreen and sun avoidance on the forehead, and consider more treatments with the RF microneedling. Please see an expert, and best of luck!

Hello and thank you for your question. It is always best to see you face to face for a consult and examination however in this case it sounds as though you have tried a lot of options. One that you haven't is a very fine skin booster injected very superficially in the line helping lift it directly and hopefully give you a smoother result. I hope that helps answer your question. Always seek an experienced and qualified medical professional for these treatments. Very best wishes