Botox vs Filler for forehead crease? (photo)

Question

Why would someone choose botox over fillers for the forehead for a deep crease? I feel like botox has a chance to cause the forehead to feel heavy/sag whereas a filler could simply plump out the crease without that possible side effect. Can someone help clarify why filler isn't the primary recommendation for deep forehead creases?

David E. Kent, MD · Answer

Botox is ideally used for forehead creases and is safer than injecting filler into this area as it has a higher risk of adverse events. Patients have no down time and the results typically last between 3-5 months. Botox will not make your forehead feel heavy

Jonathan Kulbersh, MD · Answer

Thank you for providing a photo along with your question. Botox relaxes lines that are commonly created by facial expressions such as smiling or frowning. Therefore, Botox is best used in treating forehead lines, crow’s feet, and the “11s” between the eyebrows. Dermal fillers, on the other hand, work to plump up the skin by filling in static wrinkles –specifically those lines found around the nose, the corners of your mouth, or around your jawline. To learn more about these injectables and their purposes, as well as to find out the best treatment (or combination of treatments) for your concerns and goals, I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon, particularly one with extensive experience with injectables. Your surgeon can also ensure you achieve the best possible results.

Jason Emer, MD · Answer

Neuromodulators (such as Botox, Dysport, Xeomin, and Jeuveau) and soft tissue fillers like Belotero can improve the appearance of the forehead by reducing lines, wrinkles and folds. Deeper lines and wrinkles need a combination approach with Botox, fillers, lasers, and microneedling/PRP. I recommend getting a formal evaluation with a cosmetic dermatologist to develop a treatment plan that works for you. Best, Dr. Emer

Nelson Lee Novick, MD · Answer

Very simply, during early youth, facial muscle movements lead to furrows and wrinkles only with motion of the muscles and hence are called "dynamic wrinkles."  With the passage of time, however, and especially when aging leads to tosses in both the quality and quantity of collagen and elastic fiber tissues that provide resistance to muscle movements, the skin becomes creased (like the crease seen in paper after it is folded) at rest, a condition known as "static wrinkles." So, in order to properly take care of the forehead furrows in this instance, Botox would be needed to quiet the muscular movements that were the underlying cause, AND filler would be needed to elevate and smooth the static wrinkles/furrows that have already been caused. What's more, if both treatments are performed that is a synergistic effect whereby the results of each treatment last longer when performed together than each would last performed alone Hope this helfps.

Camille Cash, MD · Answer

For these type of wrinkles that are caused from muscle activity, Botox is the correct treatment.  Botox is a neuromodulator which affects the ability of an injected muscle to contract, resulting in the relaxation of the affected wrinkles.  You can also use Morpheus8 in conjunction with Botox which works by improving overall skin tone and texture.

Brandy Segura, MD · Answer

Hi Jim,Botox (a neuromodulator) consistently can help lessen the depth of the forehead wrinkles and prevent worsening. If you don't inhibit the muscle from moving, the creases will get worse. If someone were to use filler to fill in the creases, but did not "freeze" the muscle with a neuromodulator, the muscle would likely cause the filler to move over time and still create the creases, now with filler causing plumper areas above and below the creases.Filler is often NOT placed in the forehead because it is considered a "danger zone" for vascular occlusions leading to skin necrosis and blindness. For patient safety, neuromodulators are the first and only choice for forehead lines.

Leonard Grossman, MD · Answer

You clearly have a case of a hyperactive frontalis muscle. The best treatment is Botox or similar products like disport , Xeomin and so on. I hope this helps and good luck from New York City Plastic Surgery

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Hi there,

Filler in that area would move and bunch up without paralyzing the forehead muscle.  Best to Botox!

Best of luck!

Robert T. Buchanan, MD (retired) · Answer

Botox and fillers have different uses but can both be useful in treating static wrinkles like yours. Botox will never, on its own, eliminate the wrinkles but can stop the muscles from worsening them or fighting what you are doing to reverse them. You do, however, have to be very careful that you do not reduce the muscle function when it is what is holding your brow up (occasionally why you developed the lines in the first place). Filler is very useful in filling the lines and, thus, reducing them. However, you should also be using tretinoin (Retin-A) to stimulate collagen from the hyaluronic acid of the filler and Obagi's ELASTIderm to stimulate elastic tissue. You can also use micro needling to further stimulate collagen production and reduce the times you need to inject the wrinkles to permanently erase them.

Botox vs Filler for forehead crease? (photo)

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