Botox doesn’t seem to erase my glabellar crease - What will? (photo)

Question

I’ve been getting Botox consistently for the past two years for my glabellar. While it has helped with stopping the muscle I notice there is still a crease between my brows under certain light and angles. I just don’t know what else to do. I am scared of filler because of the potential risk for blindness. Any recommendations that would get rid of this crease? I’m have a really strong muscle and get about 25 units.

Ella Fedonenko, MD · Answer

Expressive glabellar lines may have some static component to them. This component unfortunately cannot be corrected with Botox. I would continue with Botox injections since they at least improve the appearance of your glabellar lines and it will also prevent them from getting worse in the future. I don’t recommend fillers in this situation because of the risks associated with injections in this area.

Carey Nease, MD · Answer

Well unfortunately you are blessed with very strong corrugator muscles between your brows. Botox (or any of the other neurotoxins) should help considerably, but may not get rid of the line completely. I do not recommend filler in this area. RF microneedling may help some (Virtue, Morpheus, etc). Hope that helps!

Zoran Potparic, MD · Answer

What you seem to have is a depression, permanent crease in the glabella which will diminish but not completely disappear after neurotoxin injection. Injection of filler or fat graft in the area will correct it. Good luck.

Nelson Lee Novick, MD · Answer

I have routinely been treating this very common problem for many years with very gratifying and durable results. Glabellar "frown lines" result from two underlying causes, both of which should ideally be treated in order to achieve satisfying and durable results.
The underlying cause of these lines is typically the daily repetitive movement of the muscles of expression located there, which we tend to use numerous times each day. Over the years, especially as we enter midlife, the overlying :"fabric" of our skin becomes permanently etched and creased, so that even when the underlying muscles are at rest, the skin continues to show the "frown lines."  as is the case here.
So, for best and more durable cosmetic improvement, a two-pronged approach is used. Botox can be used to address the movements of the underlying muscles (The intent is not to "freeze" the muscles so that you cannot emote, but rather to diminish their overactivity), and a low viscosity, malleable, cohesive HA filler can be used to elevate and smooth the creases in the "fabric" of the skin. 
In the hands of an experienced, board certified cosmetic dermatologist filler expert, the very superficially placed injections needed to achieve elevation and smoothing of the etched lines typically poses little risk. 
Please note: unfortunately, the hard science to promote the use of so-many of today's expensive, here-today-gone tomorrow light and energy-based gizmos, like fraxel lasers, RF devices, etc, lags woefully behind the heavy marketing and social media buzz that hawks them. So, you would be wise to exercise a whole lot of  "buyer beware" when being presented with these types of options  Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

I understand your concerns about the persistent glabellar crease despite regular Botox treatments. Here are a few recommendations to consider, keeping in mind your understandable caution regarding fillers:

Combination Therapy: While Botox effectively relaxes the muscles to prevent further deepening of dynamic lines, it may not fully address static lines or creases. A combination of treatments can often provide better results.

Microneedling: This minimally invasive procedure can help improve skin texture and stimulate collagen production, which can soften the appearance of lines and creases.

Laser Resurfacing: Fractional lasers or other laser resurfacing options can smooth out the skin and improve the appearance of fine lines and creases by promoting collagen remodeling.

Chemical Peels: Medium to deep chemical peels can help reduce the appearance of creases by exfoliating and encouraging new skin growth.

Topical Treatments: Incorporating retinoids or peptides into your skincare routine can enhance skin elasticity and reduce the appearance of fine lines over time.

Consultation: It's crucial to have a detailed consultation with a board-certified dermatologist or plastic surgeon who can assess your unique situation and provide personalized advice. They can discuss the risks and benefits of each option, including the potential use of fillers, and ensure that any treatment is performed safely.

Each treatment has its own set of benefits and considerations, so working closely with a professional will help you make an informed decision that aligns with your comfort level and aesthetic goals.

Best wishes on your journey to achieving your desired results.

Tulsi Kotecha, MD · Answer

Great question! Botox is fantastic for preventing movement-based wrinkles, but when a crease is deeply etched into the skin, it becomes a static wrinkle&mdash;which means Botox alone won’t fully erase it.
Why? Botox relaxes the muscle, but if the line is still visible at rest, it’s due to collagen loss and repetitive folding over time.
 Dermal Filler (RHA, Juvederm, or Belotero) - A tiny amount of soft, flexible filler can plump the crease to smooth it out while maintaining a natural look. When done correctly, it’s safe and effective.
RF Microneedling or Resurfacing Treatments - Boosts collagen and skin remodeling over time to soften the crease naturally.
Smooth PDO Threads → Can help lift and tighten the skin while encouraging collagen growth.
I understand concerns about filler, especially in this high-risk area. The key is seeing an experienced injector who understands safe techniques&mdash;like using a cannula for precision and minimizing vascular risk. I personally use the least amount necessary for a subtle, natural result.

Stefan Weiss, MD · Answer

The only thing left would be filler to correct the minimal volume loss post botox. However, you are correct in your concern about the adverse events of filler in that area.

Benjamin Barankin, MD, FRCPC · Answer

There are a couple options for you. One is more units of Botox (e.g. 30-36units), possibly in a couple different areas than you've had done. Another option is carefully placing some filler in that area. In either case, seeking care from an expert physician injector (e.g. dermatologist) should solve the problem for you.

Camille Cash, MD · Answer

If you are still able to animate the area between your brows after your Botox treatment then additional units of Botox may help.  If you are not you can consider other options to improve facial contours such as lasers or Morpheus8.  I've included a video that I hope you find helpful.

Botox doesn’t seem to erase my glabellar crease - What will? (photo)

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