How can I get rid of a frown line that cannot be relaxed by Botox? (Photo)

I will use a dermal filler like Restylane Silk, Restylane or Juvederm Ultra to fill in a line or wrinkle that is resistant to a Botox or Dysport treatment.  The results are very natural and you often get a longer lasting effect.  It works very well when you combine it with future Botox/Dysport treatments.

Thank you for your question and photograph.  Frown line wrinkles are difficult problems to address once they become "set."  If the line is gradually worsening, it may be due to the the timing of your Botox. If you are only receiving it twice a year, and its effects are not lasting 6 months, then once the Botox wears off, the movement of the muscles underneath the skin will continue to make the frown line worse.  I would recommend increasing the frequency of your Botox, and should the line remain, additional procedures such as fillers, chemical peels, or laser therapy may be needed to make an improvement.  

Forehead lines can often be filled successfully with Restylane Silk® or Belotero®. Since this is an advanced injection technique, please consult a board certified aesthetic dermatologist for a consultation.

Once lines become deep enough, Botox cannot make them completely disappear. You have a permanent change to the underlying skin and need to volume augmentation to smooth it out. This can be safely done with filler, by someone who has a good understanding of the blood vessels in this area. The location of your particular line is right above some large blood vessels and a nerve coming from your eye socket. Filler would need to be injected superficially here to avoid injecting into the vessels.

This is one of the areas where placing filler has a higher risk of vascular occlusion (see my link).  Make sure the doc has done this area multiple times in the past.  It won't eliminate your need for Botox as well.

Facial wrinkles can be  dynamic (only present with smiling, frowning, or some other action) or static (present at rest).Dynamic wrinkles are effectively addressed with Botox or Dysport, which work by temporarily preventing you from "making the face" that is causing the wrinkles.   Botox or Dysport can also be used to address mild static wrinkles, though this may require more than one injection.Deep static wrinkles (the kind that look like they are "carved in") are better addressed by injectable fillers.  I have had success with the use of Restylane to the glabella (frown lines).

It is common to have deep frown lines. However if you've truly been doing Botox frequently they should be getting better and not worse. Your Botox injections are too far apart. It usually only lasts around 3 to 4 months. Also maybe the dose needs to be higher. That is a discussion That should be done with your doctor. If there is still a residual line  despite every three months Botox at an appropriate dose then filler can be used. Filler can be risky in the glabella that should only be done by very experienced professionals such as a board-certified dermatologist or plastic surgeon. 

Botox cannot correct such frown lines, as you have discovered. The best way to correct such lines is with fractional CO2 laser resurfacing. However, please find someone who is experienced in its use. Neil P.J Walker FRCP in Oxford would be a good person to contact. If he doesn't do it anymore, he should know of someone who does.               jlr

These lines appear from the contstant pulling of underlying muscles which is why, in the beginning, that Botox was effective.  However, over time, a permanent crease in the skin develops.  In this particular area, using ablative or subblative laser treatments in conjunction with Botox can dramatically improve and correct the problem.