Thank you for your question. You’re 28-years-old and you state that you have these forehead lines since you were about 13 to 14 years old and you’re concerned, although this is a family trait and this is something you recognize, that your lines are present even when your forehead is relaxed. And then you describe in very good detail your concerns on Botox™ may not be adequate because the lines are still present and you’re asking is there a potential role for a filler to help this horizontal lines improve. Well, I can certainly give you some guidance in this question. I’m a board certified cosmetic surgeon and a fellowship trade oculofacial plastic and reconstructive surgeon, practicing in Manhattan in Long Island for over 20 years and certainly Botox™ was one of the first, our specialty was one of the first to use Botox™ so I have been helping patients with Botox™ since 1993.
So that being said, I want to help you first understand some terminology and this terminology as follows: dynamic versus static wrinkles. Dynamic wrinkles are wrinkles that occur when there is activation of muscle and in the forehead lines that you are describing the muscle is called frontalis muscle. So when that muscle contracts, the forehead lines form. Then there are static wrinkle. Static wrinkles are wrinkles that are there even when there is no active contraction of a muscle.
So what you are concerned about is that even with Botox™ which you know relaxes muscles that the lines are still there so you are dealing with dynamic and static lines situation.
In our practice, we do commonly address both issues can concurrently in a lot of people. A common strategy would be to use Botox™ to relax muscle, a filler such us Restylane to help add volume and not just the horizontal lines in the forehead and as well as use something called as platelet-rich plasma to stimulate collagen to build back the collagen that’s lost and the dermis which is why these static lines become so obvious. Think of the dermis as a foundation that keeps the skin smooth and if there is a fault in the foundation, then you would want to try to restore the strength of that foundation.
I would say that in your situation as a younger person whose skin is relatively thick that there is a challenge in a couple of ways.
First is you don’t want your forehead to become completely paralyzed because if your forehead is completely paralyzed as a younger male, it’s going to be very obvious and people will be able to say that you have Botox™. In my practice for someone like yourself, I would do amount of Botox™ and let the muscle still work but allow a baseline tone to be diminished so that there is less creasing of the skin.
Now it’s been my observation that with consistent use of Botox™, those lines can soften up significantly without doing the injectable because someone who is younger, you’ll probably be fine as long as the lines soften and don’t continue to get deeper. Now if after certain period of time you still want to improve the static element of those lines then you can consider these other options. I think it’s important to also understand that there is unlikely that you will be able to erase the lines completely.
This is a genetic family trait and that at a young age developing them, I think management has certain value but you also have to think of the cost, logistics and time that it would take to address these lines and you may want to simplify the things and start with Botox™ first or do something like Botox™ and platelet-Rich Plasma (PRP).
So I think it’s important that you meet with qualified, experienced physicians who routinely perform these procedures. Learn about your options and think about the risk and benefits and expenses. And what’s nice about these procedures, they are pretty low risks and they are not surgical procedures. If you don’t like something whether it’s Botox™ or filler, it goes away and platelet-Rich Plasma (PRP) it’s your own blood and that is a very low risk from that end as well.
So I hope that was helpful and wish you the best of luck. Thank you for your question..