Neurotoxins first and then filler if needed
I usually treat the "11" (Glabellar lines) with neurotoxin injection first, usually 20 Units for a man. then I wait about 2 weeks to see how much they have faded. then I offer to use a filler to fill them out.
If you do the fillers before the neurotoxins, the risk is that the filler will form a ridge due to the muscle activity.
Make sure that you are going to a well experience injector,since the risks of filler injections in the glabellar region are not null.
Botox or filler or both in the glabellar
If you have the "elevens" at rest as well as when you make a frown, it is unlikely that Botox alone will fully erase them. You would be a good candidate to have both Botox and filler. Filler is safe in this location when the treatment is done by an experienced board-certified cosmetic physician and when done with a hyaluronic acid filler. Incidences of complications in this region with filler have been seen with use of inappropriate fillers such as Radiesse and poor injection technique. I usually recommend starting with the Botox first, and waiting a week or two, to decide on filler if you are still concerned.
Combination of Botox and filler for chronic frown lines
Botox can relax the frown muscle so the skin won't bend but the existing crack in the skin will only improve by filling it, so combination of Botox and filler is the best for optimal improvement. Filler injection would be safe if injected very superficial.
For the angry 11 lines...start with Botox. This will keep them from getting worse and soften your look dramatically. As you are no longer deepening those wrinkles on a daily basis with the Botox, you'll likely see the 11's improving with time.
If you don't see enough improvement, a filler can easily be used to filler in deeper furrows.
Botox and deep glabellar lines
The lines in your glabellar area are quite deep. I would start with Botox and wait two weeks to see the full effect. If after two weeks they are still deep you can then add a filler like Restylane to the area. For the best cosmetic results please consult a board certified dermatologist with a great deal of experience with Botox and facial fillers.
Addressing deep glabellar dynamic and static rhytids
As you've hinted at, Botox is excellent for addressing dynamic wrinkles - those that are created from the movement of your facial muscles. Movement of the muscles causes the overlying skin to wrinkle, and with constant wrinkling can cause the skin to become permanently creased. While Botox will help soften your creases, it may be necessary to also have some filler injection to fully address them.
start with botox - it should ease the lines.
If you don't think the result post botox is enough - judicious use of a softer filler like restylane / juverderm may be required.
Botox or Fillers? Maybe both in your case.
Hi Sparky. As Dr. Truong points out, we always start with Dysport (Botox). If the smoothing effect achieved with Dysport alone is not enough for the patient, then we proceed to a dermal filler and we prefer Restylane in this area because it is a softer, smoother gel. Make certain to find an injector well versed with injecting off label areas with fillers (like between the eyes). Good luck.
You should definitely try Botox first to the glabella and in about a week, have your glabella reassessed for presence of the static wrinkles (rhytides). If they are still present, then you should consider fillers. Make sure the procedure is performed by a board-certified dermatologist or plastic surgeon as the glabella is a high-risk area with potential for complications.
Static 11 lines - Botox or filler
I would suggest Botox first. It will definitely help soften the lines. Over time it may be able to resolve them entirely, with several rounds of treatment. This is a riskier place for fillers, but expert injectors can handle the area just fine. Always shop for experience and not price!
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