Post Botox 11s Lines Still Slightly Appearing, How To Treat This?

Question

My main issues to which I resorted to getting Botox was my glabella "11" lines. in my particular case, its really "1" since one muscle is predominantly stronger than the other. it took 35 units to finally get the area frozen. i am happy with the results however, i still see a "line" in the area. its not a deep wrinkle at all... it just looks like a shadow of where the line was is still there a bit. granted, when i grown, that mark is still there.any ideas how i can lighten that mark???

Ron Shelton, MD · Answer

If your Botox was only done in the last few days, you may get more muscle relaxation during two or more weeks after the treatment. Therefore, you may see further improvement. Some people have very deep lines because they have scrunched the skin together so many times over so many years that the lines stay etched in the skin for a while after the muscles do get relaxed from the Botox. It may take several sessions of maintaining the Botox treatment so that the muscles never "wake up" and allow the skin to continue to not crease and let the lines fade away. If there is a big social function coming up for which you want to look your best and can't afford the patience of time, then sometimes, a small amount of not-too-thick a filler can be used, such as Restylane or Juvederm in this area to fill out the line. It doesn't mean that the filler would have to be repeated when it wears off in a year or so just as long as the Botox treatment is maintained every three to four months. Injections of fillers in this area has a risk of circulation compromise and there have been reports of big scabs forming and even scar formation when very thick fillers or fillers injected with high volume were placed in the glabella so speak to your dermatologist or plastic surgeon about this prior to having the injections. The advantage ofusing Restylane or Juvederm in this area is that if there is a problem, the filler can be dissolved by injecting an enzyme, hyaluronidase.

Richard Baxter, MD · Answer

Since the vertical lines between the eyebrows are caused mostly by hyperactivity of the underlying muscle, treatment with a relaxer like Botox or Dysport is the first step. However, if they have been there a long time then the lines become "etched" into the skin. So if you still see a line there after the Botox has taken effect, the next step is a dermal filler such as Juvederm, Restylane, or Radiesse.

Kenneth D. Steinsapir, MD · Answer

Unfortunately the glabellar area where the 11 lines form is highly vascular. Filler treatments in this area can cause local circulatory problems with necrosis of the skin. Treatment in this area must be very superficial to stay out of the subdermal vascular plexus to avoid problems associated with putting filler into the circulation.

David Shafer, MD, FACS · Answer

If you still see a line/wrinkle even when the area is completely frozen with Botox Cosmetic, it means that you have dermal atrophy that may be improved with a filler such as Juvederm.  Botox Cosmetic works primarily on dynamic wrinkles - those wrinkles that appear with movement of the underlying muscle.  Static wrinkles are those that are there at rest and are caused by years of stress on the skin from movement causing dermal atrophy.  Over several treatments of Botox Cosmetic, you may see improvement of the static lines as well, but you may also need a filler such as Juvederm to "fill in" the line.

	I hope this is helpful.  Good Luck.

Melissa Chiang, MD, FAAD · Answer

After you have furrowed your brows many, many times, an 11 crease can persist, even when your face is at rest. People generally notice that the crease diminishes with time and repeated injections. If it persists, an experienced injector can fill it with hyaluronic acid.

Esta Kronberg, MD · Answer

It sounds like your Botox worked beautifully but you still have a bit of a fixed line.A little bit of filler (Restylane or Juvederm) should diminish this line for you. Many patients also have to use Botox and a filler in this area to get the correction you want. These do come in 1/2 cc syringes so that would help keep your costs down.

Channing R. Barnett, MD · Answer

Botox is an injectable neurotoxin that improves lines (wrinkles) that are dynamic, meaning secondary to muscular movement. Fillers improve lines (wrinkles) that are static, meaning visible at rest. In the glabellar area (area between the eyebrows), it is always best to address the frown lines (11 lines, dynamic lines) first with Botox. If there is still a trace of a line seen when frowning, you can try adding a little more botox; however, if the line is seen only at rest (static), then you can very conservatively fill that line with filler. I recommend you return to the physician who did the botox treatment for evaluation and for possible further treatment.

Darryl J. Blinski, MD · Answer

Either add a little more or use a filler like Restylane. Or both. Return to your chosen injector, I hope it was a doctor.

Ted Brezel, MD · Answer

The problem of a persistent line after adequate Botox is usually a result of dermal atropthy from years of frowning.. Botox is effective for what we term dynamic lines i.e. lines when the muscles below are contracting. Botox is left effective for static lines i.e. when the muscles are relaxed. For those cases its helpful to inject a filler such as Restylane or Juvederm.

Tal T. Roudner, MD, FACS · Answer

Treatment of the frown lines may take a significant amount of neuromodulator units usually around 20-30units in women and 30-40 in males. If it is your first time around it and you have deep lines it may take 3 to 4 treatments seperated 3-4 months apart for each treatment to see full correction. At times the need for a filler is required when the lines are very deep.

	Good luck !

Post Botox 11s Lines Still Slightly Appearing, How To Treat This?

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