Which Product Do I Use for Vertical Lines? Botox or Restylane?

I have two sort of deep vertical lines right between my eye brows. Which procedure would be better, botox or restylane. Or should one have both procedures on the same site? I am not sure if you can see the vertical line on my picture. I am the one on the right. Thanks.

Doctor Answers 29

Botox for corrugator muscle lines

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Texasmom:

Thanks for providing the photo to help our answers. I think the active muscle lines between the eyebrows (corrugator muscle lines) would be ideal for Botox. In fact, that is the area for which the parent company obtained FDA approval for the marketing of Botox. Many of the initial studies were done for that area.

If you did not achieve satisfactory improvement after 2 treatments and 6-8 months time, you might add a filler in addition to Botox. I would not suggest filler alone. Good luck. I think you'll look great.


Greenville Plastic Surgeon

Botox and Restylane

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Botox stops the movement of the muscles causing your frown.  Restylane fills in the depressions.  You can have both the same day and if you keep up with regular Botox injections, your Restylane may last for years.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

Botox first for glabellar frown lines

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These are the corrugator muscles - when they contract, they form what we call 'glabellar frown lines', these vertical lines of wrinkles. The thing to do is to relax these muscles with Botox. Start there and see what it looks like before you pay for any fillers. Good luck. It should cost somewhere between 250-400 dollars depending on how prominent these muscles are in your case.

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Botox for frown lines

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Thank you for your question and for sharing your photograph texasmom. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.

It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information here is helpful.

The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.

The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.

Although 20 units is a good standard dose to start with, some people require a higher dose because of higher muscle volume. This is common in mature patients, in those with large bulges from expressive faces, and in men. I find that Botox still works in these cases, just a higher dose is required. I have used up to 40 units in the glabella.

Some people have lines at rest (that is without facial expression) which get deeper with facial expression. In these cases, the wrinkles often do not go away completely. However, I find that if patients continue treatments every three months as recommended the wrinkles smoothen out after approximately one year.

With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution.

In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Most importantly are muscles required to perform various functions. The muscles that are treated with Botox around the eyes are close to the muscle that lifts the upper eyelid. If this muscle is affected it can lead to a temporary droopy eyelid (blepharoptosis). The duration depends on the placement of the product and the dose used. Usually it resolves in 2 weeks, but it can last up to 4 months. Blepharoptosis can be treated with apraclonidine 0.5% ophthalmic solution (also known as iopidine) and various other medications. The incidence of blepharoptosis is reported to be approximately 1% but in my experience, I find it to be about 0.1%. This is likely due to the fact that when these studies were initially performed injectors may have not been as aware of this adverse effect nor been taking extra precautions to avoid it. To avoid this side effect, I place the product at least 1 cm from the orbital rim. When placing product between the brows I pinch the area to be treated and lift it so that the product is placed in the muscle and is less likely to diffuse around the bone into the orbital space. Diffusion into this area may also be caused by other preventable things. For this reason, I recommend that my patients follow the aftercare instructions described below. This may be a reason for the low incidence of side effects in my practice.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Botox is what we call a neuromodulator. This means that it controls nerves to relax the muscles by preventing them from contracting. Botox is the most popular neuromodulator available, has been the most studied, and is cleared for the most number of indications. Other neuromodulators available in the United States include Dysport, Xeomin, and Mybloc. Overseas many others are also available. Each product has slight differences, but all of them work. The majority of our patients find that they like the results of Botox the best. Additionally, Allergan, the maker of Botox, offers the Brilliant Distinctions Program. This is a rewards program where patients receive points from their Botox treatments which can be used toward discounts at subsequent treatments. Points are also received when patients purchase other treatments in the Allergan portfolio including Juvederm Ultra, Juvederm Ultra Plus, Voluma, Volbella, Vollure, and Kybella or products such as Latisse or Skin Medica products.

I find that combining Botox with other treatments or skin care regimens enhances the results and allows patients to enjoy their results for longer. One specific topical product our patients have found to be outstanding in conjunction with a Botox (and filler) treatment is our Hydrating Serum, which contains hyaluronic acid. Hyaluronic acid draws water into the skin and helps to fill in fine lines and wrinkles.

Please consult with a doctor for specific recommendations. Good luck!

Botox

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Botox will relax the muscle of facial expression which cases the wrinkle.  While very effect some deeper wrinkles may require a combination of Botox and filler as you have suggested.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 56 reviews

Vertical Line treatment

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Botox helps relax the muscles pushing from above your eyebrows towards the center of your brows (corrugators).  The muscles, when not relaxed, forming these vertical line.   Occasionally these lines are very deep and someone may want filler to 'fill' the crevice.  When considering filler in this area, I would consult a specialist to discuss the risks, benefits, and alternatives.

Sean Paul, MD
Austin Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

For shallow "11" lines, start with botox and add restylane later

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Botox will relax your muscles and over a few months, you may find that the lines disappear by themselves.  If they do not, or you want a more immediate result, you can combine Botox with Restylane.  Restylane will fill the depression.  If you get Botox regularly, the Restylane can last a very long time. 

Botox or Restylane for frown lines

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Thank you for your question. The frown lines between the brows can be address two different ways:
1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest.
2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression.
For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together.
I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.

Botox or Restylane for Glabellar Lines?

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Botox is very effective for lines between the eyebrows. As a neuromodulator it works directly on the nerves that innervate the corrugator and procerus muscles of the glabella region (i.e., the vertical and horizontal lines that form between the eye brows).

Botox

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Thank you for your question. The general algorithm is that Botox is effective in the “upper ⅓” of the face: forehead lines, crow’s feet, and lines between the eyebrows. These lines are “dynamic” lines, caused by underlying muscle contractions. By relaxing the associated muscles, Botox smoothens the upper ⅓ of the face. “Static” lines in the lower face, such as the nasolabial folds, are amenable to facial filler.
Hope this is helpful. Best wishes. Dr. Shah

Anand G. Shah, MD
San Antonio Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.