Help with SINGLE frown line, not a number 11. It is 1 inch long. Plastic surgeon said it was a split muscle & should be removed?

Question

Attached is a 2 pictures, one relaxed and one contracting my muscles. I am worried about the side effects of resectioning the muscle, I hear its risky. Will Botox work if I get it every 3 month religiously? And maybe add laser resurfacing? I am 45 and it gets worse everyday.

Robert M. Tornambe, MD · Answer

I understand your concern! Usually Botox is the silver bullet for such a problem, but it doesn't always work when the muscle is as thick as yours. If the Botox treatments are effective, that remains your best option. If less than effective, Botox plus filler, or a more aggressive approach would be direct excision of the line and debunking the muscle through a more "open" approach. Less chance of complications, like bleeding, but you are trading for a permenent, yet probably unobtrusive scar in the region. Seek the advice of a board certified plastic surgeon.

Lu-Jean Feng, MD · Answer

Your frown line is not due to a split muscle. It can be treated without surgery, using a combination of Botox, fillers, and laser resurfacing. Your line is due to the activity of the corrugated muscle, which over time has weakened the collagen structure under the skin. It is important to first weaken the muscle with Botox or Dysport. If this still leaves a dent, then fillers should be used next. Once filled, if you want to improve the texture of the skin in the wrinkle itself, a resurfacing laser will be very helpful

David Hansen, MD · Answer

Just adding a filler won't do much since the skin is adhered down tightly. Subcision followed by an implant to permanently fix the problem is 1 solution.

Afshin Farzadmehr, MD · Answer

I have successfully treated these lines for over 10 years using fillers.  Surgery might not be the solution.

Jason Emer, MD · Answer

this is actually an "11" line although one side is stronger than the other.  This will need botox and then I would wait 2 weeks to see if filler would help as well.  You may need both as a combination.  I suggest seeing a cosmetic dermatologist with experience, as we see this quite often in our practice and get great results.  Best, Dr. Emer.

Yuly Gorodisky, DO, FACOS · Answer

Botox is a good start.  You can also try some filler after the botox takes effect. Going straight to surgery seems too drastic. If you get improvement, then you could continue that regimen instead of surgery.

Harold J. Kaplan, MD · Answer

Hi Leann.  Surgical intervention may be a good option for you as your line is very deep.  Even after this surgical procedure, you may still need Botox to relax the muscles in the area.  If you are opposed to surgery currently, then find an injector that is willing to do Botox, then wait 1-2 weeks and use dermal fillers.  This is a viable alternative to surgery, but some injectors do not like to use fillers in the area between the eyes.  To see an example of before and after pictures very similar to yours when both Dysport and Restylane were used, click the link below.

Austin Hayes, MD · Answer

It's a good question. Vertical frown lines result from activation of the corrugator muscles. These muscles work to furrow our brow to show facial expression. Over years the activation of the muscle creates permanent creases in the forehead. Botox will likely soften the line, but you may require filler to plump the area to make the crease less noticeable.I would consider having Botox treatment and seeing how the line looks in one to two months. If you're satisfied, then continue with Botox. If you would like further correction, then you can consider using filler to plump the line and make it less noticeable.

Farzad Yaghouti, MD · Answer

Hi LeannP, in my experience, your Glabellar line should improve in appearance with a combination of Botox and Filler but will not completely go away-even with multiple applications of Botox and filler. So the answer to your question, will it work, is yes, but only partly.

Sam Goldberger, MD · Answer

You will probably need a combination of treatments to correct the line.  Botox and fillers could be a good start.  Laser resurfacing could be used later, depending on the result from the injections.

Help with SINGLE frown line, not a number 11. It is 1 inch long. Plastic surgeon said it was a split muscle & should be removed?

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