How do I fix these indents between my brows? (Photos)

I have tried Botox twice now (20 units each time), chemical peels, and months of retinol cream. None of that has made any improvements. I have met with a few more doctors that just say I need to keep trying Botox, but I am getting very discouraged because I feel like it's not working. I am not squinting in either photo, that's how it is when my face is relaxed.

Doctor Answers 20

Amount of Botox needed between the brows can be more than 20 units

Thank you for your question a.jones. Botox is a purified protein used to address wrinkles associated with facial expression such as the frown lines between the brows. The pivotal studies demonstrated that most people enjoy the results of a Botox treatment between the brows for 3-4 months when 20 units are used. In my experience this is the case for the majority of patients. Some people, however have stronger muscles and higher doses may be needed, sometimes up to 40-50 units. Alternatives for those who do not see results with Botox include Dysport and Xeomin. Please follow up with your doctor for specific recommendations. Good luck!


Encino Physician
5.0 out of 5 stars 1 review

Botox

Thank you for your question in regards to Botox. It appears that your glabella muscles are quite strong and would require a higher dose of Botox rather than just 20 units. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 150 reviews

Treating indents / 11s between the eyes

I would advise a higher dose of Botox, perhaps 30-36 units, and add a filler as well (filler should be strongly considered when indents/wrinkles are present at rest as in your case). Best to see your dermatologist for optimal results & safety.

Benjamin Barankin, MD
Toronto Dermatologic Surgeon
4.9 out of 5 stars 44 reviews

11 Lines on Forehead -- Botox, Filler, Lasers/Microneedling

This needs a combination approach with fillers, lasers and microneedling along with botox.  I suggest seeing an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 168 reviews

Deep frown lines still present after Botox

Dear a.jones11:

This is one of those situations where you can be advised much more intelligently via an in-person consultation. There are two possible explanations:

 1. You had no muscle relaxation whatsoever from Botox, in which case you should consult a board-certified advanced injector, a dermatologist or plastic surgeon, who performs these procedures daily.
 2. You have developed these deep furrows from years of contracting your brows strongly, and relaxing them will not smooth them over unless you keep up the injections every four months (or just before the effect wears off) so that the muscles have an opportunity to become smaller over time. (Think of what happens when you cast a broken arm--because the muscles have not been contracting, they are smaller when you remove the cast.) If this is the case, which I think is more likely, you can have a filler carefully injected in the folds to smooth them over in the meantime.  You can also consider having Ultherapy to the skin above the brows, which will help to tighten and lift the skin permanently.

It may be hard for you to tell which explanation is correct. Try frowning as hard as you can. Are your frown lines less deep when you do that than they were before the treatment? In that case, the second explanation is more likely.

All the best,
Dr.  Clark

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

"Brow Indents"

It sounds like you are frustrated by the persistent fullness and indents despite treatment with Botox.  In order to answer your question completely there are several additional questions to ask.  First, while pictures are helpful, they are with just a snapshot, and when you are trying to evaluate how effective a Botox treatment is, watching which muscles are functioning is much more helpful.  This should be done by an experienced injector in order to understand why the treatment didn't have the desired outcome.  Assuming that you were injected appropriately with sufficient good quality Botox you have either had an incomplete response or no response.  If it is an incomplete response, regardless of how many units received, you can be treated with either more units or in a more effective fashion.  If you truly have no response, then you may be a non-responder, which occurs occasionally and it would be reasonable to try either Dysport or Xeomin to see if they are more effective,  There may be a role for fillers in the area but that would be an off-label use and carries with it some additional risks.  Furthermore, if the muscles are still contracting they will break down the filler and the benefit may be short lived.

Isaac Starker, MD
Morristown Plastic Surgeon
5.0 out of 5 stars 5 reviews

Belotero for indent between brows

I would consider injecting a filler into the indentation.  My preferred filler in this area is Belotero which is injected in small amounts superficially.  This is considered an advanced area for filler injections.  Make sure to see an experienced physician injector.
Regards,
Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

"Brow indents"

Hi,


A small number of patients are Botox "non-responders".  In those patients where botox fails and patients also don't respond to Xeomin or Dysport (other types of neurotoxins), soft tissue fillers can be used in this area above the nose called the glabella.  These can be very effective, but this area is know to have a higher incidence of vascualar complications compaired with most of the rest of the face so a very experienced injector is a must. 

I will often do a procedure called a "glabellar myectomy" either at the same time as a brow lift, face lift, or simply as a stand alone procedure.  This involves surgically weakening the muscles in this area with or without a combination of some filler or implant.  This will generally smooth out that area nicely with a relatively simple procedure and be long lasting. Laser resurfacing can also be added to smooth the skin out.  Often this combination of approaches is the best, most economical approach in the long run to get the most improvement you can.

Sincerely,

Roger Dailey, MD, FACS




Roger A. Dailey, MD, FACS
Portland Oculoplastic Surgeon
4.0 out of 5 stars 4 reviews

Correcting a depression on the forehead with botox and filler

If this is a scar in this area of your face, Botox would not be effective. Since you have tried Botox before and have not had results, I would suggest a combination of filler and Botox. I would treat you with Botox to de-activate the muscle in the area and then filler to improve the contour. Fillers such as Restylane and Juvederm would possibly correct the scar/plump up the depression.

Michael T. Somenek, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Deep glabellar lines?

Deep glabellar lines? Your can try increasing the strength of the Botox. If that does not work the muscles can be cut as part of a brow lift done by a very experienced brow lift surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

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.