LAM FACIAL PLASTICS

I have pronounced frown lines between my eyebrows. I've been botoxing there but they're still pronounced and etched into the skin. I tried Juvaderm but didn't use a lot as it was kind of at the end of the vile and most was used on the marionette lines. My question...how well do you thing Juvey will work there if I use enough?Any other recommendations? Thanks!

the area between the eyes can be a less than safe area. that is why i spend 10 to 15 minutes explaining to a patient the risks and keep on hand nitropaste in case there is a problem when dealing with the area between the eyes (no where else but in this area). the problem is that the skin can slough because it is an area that is sensitive to blood supply. do i do it? yes, i do it only with restylane and juvederm so that i can reverse the area if it is a problem. due to the extremely rare but real risks in this area, there are 3 things you should consider when picking a surgeon to do this sensitive area: 1) do they have experience doing this area? 2) have they warned you about the risks and explained to you what you need to look out for if there is a problem, 3) do they have hyaluronidase and nitropaste in the office to manage a problem should it arise. if the answer is no to any of those 3 questions, i would be careful in having injections in that area done. in general, i think juvederm tends to spread too much so i prefer restylane for discreet areas like that. the carruthers' study looked at the fact that restylane in that area can be doubled as far as longevity with the use of ongoing botox. i agree with that. in general, you can snip the muscles, cut the line out, dermabrade, etc. i think most of these are drastic now that we have botox and restylane. but if the line looks like a crater then botox might be too late and even restylane might be too late. in those circumstances, i cut the line out with a geometric broken line repair (see scar revision faqs for that discussion) but think that is entirely overkill in 99% of cases. i always say let the punishment fit the crime. if you have a fine line then these surgical treatments are too invasive for you. if it is a deep crater, then it might be the only option and worth it. judgment and experience are everything in this case. ongoing botox should soften 90% of bad lines out there. keep on the botox train.

Thanks so much for the in depth reply.l was a little confused because I had the small amount injected by a nurse and saw no difference with it. When I spoke to my derm, he said fillers were a waste of time there because of muscle movement, but hey, I'd botoxed it there which he could plainly see. Before I tried again, I wanted to know your opinion hence the question.The nurse never mentioned a risk.Since it is very deep, maybe I'll keep up with botox and retin-a and see if it calms down. I also had co2 resurfacing with great results and perhaps I'll get some collagen build up there as well.

wishing you the best.

HI!
Just wanted to make sure I understood...
The lines between the eyebrows you speak of (those that, when working around them, have to be handled by expert hands and that preventive measures for complications are needed), are those of the glabella, as in the vertical lines in the forehead that "start" (or end, depending on how you look at it) at the eyebrows close to the nose and then go "up" toward the forehead in a "| |" shape? Or does that "rather dangerous" area include all lines between the eyebrows at the top of the nose whether a bit diagonally or horizontally shaped (like "bunny lines" at the top of the nose and/or lines that are at the top of the nose and only slightly go "up" toward the forehead?

Also...what did you mean that "the skin can slough"?Thx

it can turn dark and die. that is why anyone injecting this area should give proper warning, proper follow-up care, and be experienced. the risk is probably 1:10,000 but it is something that an injector should know about and warn a potential patient. i have many ways to prevent and to correct the problem before it becomes an issue.

Yikes! Did you notice the reply above mine? She wants you to define the danger area more clearly.

did not see that but answered that in a PM. basically anything below the deepest set portion of the nose (top of the nose), you are okay. above that, there is a slight risk.

this is very helpful info! Need to stock up on the nitropaste. Allergan never told me anything about that during training. I avoid using Ultra 3+4 if possible in the glabella region. A few months back I had a client with a very deep glabella line I actually achieved some great results with ultra 3. I was slightly worried because the redness in the area didn't settle for a couple of days, thankfully never having to go as needing hyaluronidase or nitropaste!

I also had another patient who had a deep scar from chickenpox as a kid, resulting in a deep hollow scar on the forehead. Got some amazing results with ultra 2. She was very very happy. But I have since insisted to stick to lower face.

Out of curiosity, what's your recommendation for tear trough fillers? Or do you prefer lasers /surgery for that?

for tear troughs i either use restylane (temporary) or fat (permanent). juvederm has a bit of a risk of prolonged swelling and slight migration. perlane is a bit too thick for my taste in that area although fine for other areas of the face.