What Can I Do With My Deep Wrinkle Between My Eyebrows If Botox Didn’t Work?

Q: Dr. Eppley, you have done some Botox for me in the past. We discussed that I was one of the few people who didn't respond very well to the Botox. You said maybe because my forehead muscles are too strong or some other reason. Whatever the case may be, I would like to know what option I have to get rid of the deep “angry eyebrow” wrinkle. Is the only option to go under the knife?? Thanks.

A: To review your forehead/glabellar furrow issue, it is not that  Botox didn't work. Botox always works but its mechanism of action (muscle weakening) was unlikely to correct what is now the main problem with your furrow, it is so deeply indented from years of muscle overactiivty that the skin is now permanently etched or grooved. This is beyond being ideally treated by muscle weakening (although it was worth seeing how much of a difference that could make) but now requires some form of skin management for improvement. For patients with these very deep grooves or furrows in which Botox fails to provide any significant improvement, the furrow can be treated by a variety of options. The simplest and most common is an injectable filler (e.g., Juvederm) to plump it out and soften its depth. This is often done either after Botox has 'failed' or in combination with it. (the filler lasts longer if it is not pounded on by the muscle movement that caused the problem in the first place) All current injectible fillers are temporary and do not create a permanent filling result.  Another filler approach is to place a small tubed implant under the skin to create a permanent filler. The tubed implant, Permalip, is the same type of permanent implant that is used in the lips, nasolabial or labiomental folds. Another permanent option is to excise the furrow and treat it like a geometric scar revision. By cutting it out and putting the skin back together in an irregular fashion, the furrow is made smooth. All of these treatment options can be done in the office under local anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana