When Botox isn’t enough, when to use filler for DEEP forehead lines

If a patient attends your clinic complaining about a frown line, they are often not concerned about the crease in their skin but are more concerned about looking cross or angry when they do not feel that emotion. This represents the underlying problem that humans want to convey the correct messages; if they a feeling a certain way, that is how they want to be perceived. But, if something is miscommunicating, it disrupts their ability to form and maintain relationships.

In this blog, Dr Tim Pearce explains how frown lines can unintentionally convey negative emotions, impacting a patient’s psychosocial interactions. He discusses how and when you can consider treating a frown line with dermal filler in combination with botulinum toxin.

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Miscommunicating emotions can be detrimental to human success

To make a human healthier and happier over a lifetime, aesthetic clinicians must understand what faces are for; they are for building relationships and collaborations. If you have a frown line that is persistently visible (at rest) it will make other humans think you are angry or displeased, when you are not. This could disrupt human connections which are an important part of health and longevity – which at a base level of survival, can save your life, notes Dr Tim.

He reflected on his first-ever patient – a 92-year-old lady – he remembered thinking there was nothing he could do to make her look younger, which he believed was the main goal of an aesthetic clinician when he first started his career; however, this patient helped him immensely to see the bigger picture.

She shared important insight into her motivation for seeking treatment. Having arrived by bus, she explained that she wanted to have more conversations with people she met (on the bus) but felt that frown lines made her look cross. She lacked the confidence to approach other people and perceived that they were avoiding approaching her because of her outwardly angry face. The situation was increasing her loneliness, a common struggle for the elderly, and hampering her ability to make friends or get assistance.

Humans need each other to survive and collaborate and our faces are designed to help us connect, reinforces Dr Tim. The importance of both the psychology and the social context – how the patient feels and their ability to connect with others – is the domain of health and well-being aligned with medical aesthetics. Understanding this will help you to help your patients live longer, happier lives, by offering treatments that can mitigate psychosocial problems, as well as cosmetic ones.

Grading and treating frown lines with Botox and dermal fillers

The average age of an aesthetic clinic patient is approximately 43, explains Dr Tim. This is when ageing becomes much more apparent to the average person. They are not necessarily looking for signs of ageing but become aware of a drift in their natural appearance which starts to disrupt their sense of identity, altering the connection with their perception of their true self.

When assessing frown lines, it is important to understand the severity and depth of the frown line because there are so many ways of treating them, he points out.

Most patients in their early 30s, with a light frown line, do not need a full botulinum toxin treatment to improve the line. You can sometimes get a great result by increasing skin moisturising because using a professional skin care product can significantly improve fine lines and wrinkles at a young age.

As a frown line becomes more part of the skin, treating it with a muscle relaxant like botulinum toxin will allow most lines to disappear, even if they seem quite ingrained.

Learn more in this blog, Botox: safe injection points for frown lines (glabella).

Once the line has formed a three-dimensional shape, a curve or dip, different to a crease, it will need more significant treatment. Dermal filler can be placed underneath the line; hence, the three-dimensional shape of the glabella will no longer have a furrow in the middle.

Combining botulinum toxin and dermal filler in such cases is merited because relaxing the muscle alone will not unfold the shadow at the glabella. Using dermal filler in isolation would mean retreatment more often because the muscle will be strong enough to reform around the wrinkle; thus, a combination is the best formula. If you use dermal filler once, in this combination, you may never need to treat again with filler if you use botulinum toxin on the patient regularly, asserts Dr Tim.

Other treatments that work to improve skin quality may also be appropriate.

Dangers of treating the glabella with dermal fillers

Dr Tim acknowledges that treating frown lines with dermal filer is somewhat out of favour because of the awareness of blindness as a potential side effect. However, he believes you can break down every technique into multiple different steps, making all of them as safe as possible, thus, decreasing the overall risk until it is negligible.

Some of these ‘safety’ steps include injecting away from the eye, using a cannula, compressing the location of the arteries, using a light dermal filler product, injecting superficially, aspirating, and using an ultrasound scanning device before treatment to determine vascularity.

Clinicians often ask Dr Tim about the optimal order for performing the treatment. He prefers to do dermal filler first, followed by botulinum toxin because injecting dermal filler around the botulinum toxin is a little bit more likely to cause a pressure effect and disrupt where you have placed the toxin. It seems easier to avoid this by placing the botulinum toxin after the dermal filler and waiting for the result to take effect for the patient.

For optimal results, aesthetic clinicians should adjust their botulinum toxin technique and dose according to the patient’s anatomy and muscle strength at the glabellar complex.

Pay attention to what your patients say about their whole experience, their goals, and how it improves their confidence or social interactions after treatment. Good communication including educating patients during the consultation on the likelihood of bruising following more significant intervention at the glabella with a combination treatment will also help avoid negative experiences from unexpected side effects and allow them to manage negative reactions from loved ones who may feel concerned that something has gone wrong.

Get it right and your patients will feel more confident in their day-to-day activities, and you will see the value you bring to their lives when they tell you the impact after treatment. Aesthetic clinicians are part of the solution to optimising better social connections and helping people feel healthier, so they get on better at work, form better relationships, and even live longer.

For additional guidance on botulinum toxin treatments, read:

• Best tried and tested BOTOX® injection patterns and mistakes to avoid
• Injecting the glabella: Botox injection points & safety advice
• Dr Tim Pearce’s 26 essential injection patterns for botulinum toxin

For more insight and top tips, you can find Dr Tim Pearce on Instagram.

Want to learn how to perfect your toxin technique and deliver consistent results patients will love? Sign up for the latest webinar from Dr Tim where he will show you the secrets to effortlessly tailor your botulinum toxin techniques to each patient’s unique anatomy, deliver stunning results with complete confidence, and become the go-to expert your patients cannot stop raving about.

Aesthetics Mastery Show

When BOTOX isn’t enough. When you should use filler for DEEP forehead lines!

Dr Tim says:

“In this episode I demonstrate how and when you should use dermal filler to treat forehead lines, in combination with toxin.”

Watch the full Aesthetics Mastery Show here.

This episode has received comments and feedback from clients/patients as well as practitioners – check it out on YouTube.

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BOTOX (Botulinum Toxin) eLearning Courses

If you want to increase your confidence in botulinum toxin injections, or learn how to avoid and handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:

• BOTOX® Foundation Course
• Botulinum Toxin Complications Mastery

Both give CPD and certificates on completion.

In addition, browse our FREE downloadable resources.

Botox® is a registered trademark of Allergan Aesthetics plc.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.