How to Treat Vertical Line Above Middle of Eye. Worsened After Several Botox Treatments for Frown.

Vertical line/wrinkle that appeared middle of eyebrow area after several rounds of botox to frown. Line is both above and below eyebrow. Is this common? Can you use filler like juvaderm ultra to fill this line safely below eyebrow?

Doctor Answers 4

These are called "recruitment lines".

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Over time, injection of Botox between the brows may lead to the formation of recruitment lines...usually above the brow off to the side of the forehead. These lines arise because the glabellar area has been calmed and the eye brows naturally lift up a bit, and that is a desired outcome. However, sometimes the lines that arise above the brow become much more noticeable, and can be softened with tiny injections of Botox just above the area. In other instances, any Botox at all in that area will cause the brow to drop. If there is a risk that the brow will drop, your doctor will probably suggest injection of a dilute HA, such as Restylane. Another area where we will often see recruitment is at the root of the nose..patients will develop what we call "bunny lines..horizontal lines between the tear ducts and the bridge of the nose". Bunny lines are corrected with a little additional Botox to the sides of the top of the nose.

Alpharetta Dermatologic Surgeon

Fillers for frown lines

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Botox will eventually soften the frown lines but the lines will still be there especially if these were deeper to begin with. Fillers for frown lines are commonly done. this is also a very dangerous zone for filler complications such as skin necrosis (localized skin destruction, which can be permanent!) chose your injector wisely

Misbah Khan MD, FAAD, FACMS
New York Dermatologic Surgeon
4.9 out of 5 stars 32 reviews

The answer is to try a different BOTOX treatment paradigm.

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You might look up my microdroplet BOTOX treatment.  This pattern of botulinum toxin to the brow leaves the forehead untreated.  This creates lift without causing unnatural recruitment lines.  Can fillers be done in the sub brow area-absolutely.  My preference for this is not Juvederm but Restylane.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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Filler for forehead lines

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I am not sure why you are now noticing a skin crease in your eyebrow or whether it is due to the Botox injections.  I can say that it is VERY common to use Botox and fillers together to get an optimal result.  Juvederm is an extremely versatile filler which can be used virtually anywhere, and would be a good choice to treat this area.  Make sure you go to a skilled, experienced injector.

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