Botox
Q: I want to get rid of forehead “Worry Lines,” but I don’t want surgery. Is there something I can do besides getting an operation?
A: Non-Surgical treatment of your forehead lines depends on whether those lines are seen at rest or in motion (e.g., when you raise your brows).
For many patients, Botox treatment of the forehead does a great job of relaxing lines in motion. Great results usually occur when this is performed by a Doctor with experience in treating forehead lines with Botox. Sometimes, lines at rest may improve with Botox, especially in younger patients - and I emphasize the word sometimes! Botox normally just helps with lines due to muscle contraction. If lines at rest improve as well, consider it a “bonus,” but don’t bet on it happening.
What about lines at rest? These can be improved by several types of treatments, including chemical peels and laser resurfacing. Although deeper chemical peels were used in the past and still are used somewhat today, they are generally less reliable than laser skin resurfacing.
Fractionated lasers are being used more frequently to treat lines at rest. Older lasers would vaporize the majority of the treated area’s surface at once, leading to significant downtime. Fractionated lasers treat only a fraction of the skin during one treatment - the result is a less dramatic improvement and, frequently, a need for multiple treatments. The advantage: significantly less downtime and side effects.
Remember- It’s Your Face! For best results, consult with an experienced Medical Doctor who treats patients him- or herself.
Q: Ok, but can you Restylane instead for forehead lines?
A: It’s not as effective for lines in motion, and usually doesn’t work well there.
People often confuse Botox with skin fillers like Restylane. Here’s an easy explanation:
Botox stops lines in motion, like forehead lines, frown lines and crow’s feet.
Restylane fills lines or folds at rest
In general, I use Botox more on the upper face to treat lines in motion on the forehead, between the eyes, and on the sides of the eyes. I use Restylane more for the lower face, especially for smile lines, marionette lines (from the corners of the mouth down), and to increase lip fullness.
Of course, there are exceptions. I think Restylane yields great results for vertical lines between the eyes when they are deep and visible at rest. Many patients, however, benefit from Botox treatment in this area as well. This is because the muscles that caused this line in the first place will still contract if Restylane is placed in deep frown lines, so the lines are usually still there when you frown. To stop these muscles from moving, Botox is used. This way, we’re treating the etched-in lines at rest, as well as relaxing the muscles that cause frown lines in motion.
The same can be said of horizontal forehead lines. However, if there are many lines at rest, patients may need a lot of Restylane to fill them. I normally recommend Botox as a first line treatment to improve horizontal forehead lines. Although Restylane can be used, thin forehead lines at rest often do well with laser skin resurfacing - and the results last significantly longer.
Remember - It’s Your Face! Make sure to seek out a medical doctor who treats patients him- or herself for best results!
Q: How old should you be to get Botox or Restylane?
A: In general, at least 18 years old.
There is an FDA-approved minimum age for Botox, Restylane, and many other injections. But, more importantly, each patient’s history and individual concerns must be taken into consideration.
The FDA answer
Botox is FDA-approved for individuals aged eighteen to sixty-five and it is a relatively safe procedure with minimum side effects.
In one section of the 2003 FDA approval documents for Restylane (see link below), the labeling information states that “The safety of Restylane for use during pregnancy, in breastfeeding females or in patients under 18 years has not been established.”
The Real Life Answer
In practice, I have treated patients in their mid-20s with Botox for “wrinkles in motion”. If a patient has bothersome “wrinkles in motion” (especially on the forehead, between the eyes or at the “crow’s feet”), and has no medical problems that Botox would worsen, then patients from the 20s to mid 60s usually respond well. Treatment of lines in motion with Botox should be discussed with an experienced Medical Doctor after a proper evaluation.
Young patients may want to stop wrinkles from ever showing up. However, although Botox may slow the “etching-in” of lines in motion that occurs over time, it won’t stop the “etching-in” process. This is simply normal skin aging.
Should everyone in their 20s get Botox? No. If you feel Botox is right for you after discussing treatment with your doctor, you will usually have great results in experienced hands. But it doesn’t mean everyone should start as early as possible - it’s a personal decision for each patient.
And what about Restylane? This filler contains hyaluronic acid, and can fill lines and give volume to lips. Hyaluronic acid, unlike Botox, is found normally in our skin and joints.
I normally treat patients 18 and older with Restylane. In most cases, younger patients are looking for more volume in their lips. Younger patients might also have scars that may be treatable with Restylane. Younger patients normally don’t have “smile lines” from the nose to the corners of the mouth, or “marionette lines” from the mouth corners down - these lines are more problematic with age. These lower facial lines are common treatment areas for older patients.
Can Botox and Restylane be used in patients under 18? Although this would be considered “off-label” for Restylane, improving scars for patients under 18 is not unreasonable when patients have been evaluated properly by an experienced physician. In my practice, I don’t use Restylane for lip augmentation or Botox for cosmetic procedures for patients under 18. Botox is used in patients under 18 with cerebral palsy to relieve muscle spasms by pediatric neurologists. However, I don’t know of any doctors who are using Botox for cosmetic reasons on patients under 18.
A word about the term “off-label”: this doesn’t mean “wrong” or “illegal.” What this means is that the prescribing Doctor, after evaluating the patient, feels that the “off-label” use of a medication has greater benefit than risk, and recommends use for that patient’s individual needs.
Remember - It’s Your Face! Seek out an experienced medical doctor who treats patients her- or himself for best results!