Q: Dr. Eppley, I’ve had this horrible deep line between my brows that drives me insane. I recently tried Botox which I knew would not be a fix and I have contemplated fillers but I know fillers are not permanent. Words cannot express how I feel everyday about having this deep crease on my face. I have had side swept bangs for years and I’m tired of hiding behind my hair and wearing hats all the time. This is border line ruining my everyday life and has completely crushed my confidence. I took a few pictures for you to see my problem.
A: Thank you for sending your pictures. What you actually have are three distinct vertical glabellar lines, the central one is just the most deep. It is important to know that the ‘standard’ treatment would be a combination of Botox and injectable fillers. Botox to stop the cause (muscle movement) and injectable fillers to fill the defects. While this would definitely provide improvement it is probably not going to be a lifelong treatment strategy.On the opposite end of that approach is a surgical one with endoscopic muscle release and fat injections. In between the two lies the placement of a dermal fat graft or allogeneic dermis graft threaded into each one of the glabellar grooves.
As you can see the treatment of your glabellar lines is not an easy problem to solve. But at least there are a variety of different options to treat it.
Dr. Barry Eppley
Q: Dr. Eppley, I had an extremely pronounced (Stage 4 I think) single glabellar line that was treated with Juvaderm and Botox multiple times back in 2007/2008. The single line is now gone but significant 11 lines that have formed around it. My current dermatologist has a concern with fillers and the glabellar region due to the blindness risk. Do you do Acellular Dermal Matrix Insertion? Is that a viable option? Is it an expensive procedure? What are my options for glabellar implants?
A: I have placed about every conceivable graft material into glabellar lines. Acellular dermal matrix (ADM) is just one example and there are many other options including synthetic implants. The most common form of ADM would be Alloderm, which is an allogeneic cadaveric dermal product which has been around for years. It is placed in the office as a simple office procedure done under local anesthesia. But other implant types, such as synthetic Permalip implants can be used, which has a guaranteed volume retention. And are just as easily placed as any other glabellar graft or implant material.
While blindness is an extremely rare complication from the use of injectable fillers around the eyes, the way to completely negate that concern is a non-injectable implant placement.
Dr. Barry Eppley