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Dermal Filler in Frown Lines

Author: Dr Naomi / 27 Oct 2015

When a frown line is being assessed, an important factor to look for is: Is the frown line or fold etched in at rest (ie when the patient is frowning).

If the frown line/ fold is etched in at rest, then if the patient wants a completely smooth area between the brows, then muscle relaxing injections won’t be enough to give that result. Dermal filler will also be required for the frown line. See blog post

The frown line is a very common area to be treated on the face. Patients hate having deep and etched in frown lines. Their family and friends always say

“are you upset”

“what’s wrong”

“are you ok”

These questions can get beyond annoying over time. Those patients with deep frown lines/ folds also hate that it gives them a cranky or negative appearance.

Frown line treatment with dermal filler will make patients look more relaxed and younger and fresher

The frown line is genetically determined and also affected by how much we frown. It will often run in families. Some patients wake up to a deep line because they frown in there sleep all night.

Some people were born to have minimal frown lines, and others were born, destined to have deep vertical crevices between their brows.

For those who weren’t lucky enough to start muscle relaxing injections early enough, it is so simple to just inject dermal filler them to improve the appearance of the etched in lines.

We always encourage patients who have deep frown lines / folds at rest to have some dermal filler injected into the area. It will make them be happier overall with their muscle relaxing injections for the frown line

TREATMENT WITH DERMAL FILLERS 

Choosing the dose of dermal fillers

The dose required for frown line filling would typically be between 0.5 – 1ml

The doctor will assess the face and decide on the best dose after taking a history and examining the patient. If a patient has a history of complications with dermal fillers, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen to start with.

With frown line injecting, a typical  plan for frown line  improvement is the following:

Inject muscle relaxing injections

2 weeks later inject up to 1ml of dermal filler

3 months later inject frown line with muscle relaxing injections

2weeks after muscle relaxing injection, inject frown line with dermal filler

repeat this process once more and then after that continue with the muscle relaxing injections every 3-4 months. Often the dermal filler in the frown won’t be required again for several years

Pain relief during treatment

A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.

Local aneasthetic may be injected into the area

There is local anaesthetic in the dermal filler

Ice is always used to decrease pain and to reduce the risk of bruising.

Very rarely patients will use Penthrox for dermal filler in lips

Nitrous oxide (happy gas) is available for patients to use

What happens during the dermal filler in frown line treatment itself?

The face will be cleaned with alcohol.

Local anaesthetic may be injected into the frown line area

Ice will be applied to the area briefly before treatment The doctor will inject using a very fine needle. Then pressure with gauze will be applied.

Multiple injections are often required in this area

Technical considerations for injecting

Injecting can be quite difficult, as placement has to be spot on. If the injections are too deep, they won’t lift the frown, but if they are too superficial, the dermal filler will come out the pores while injecting. In cases where this is proving difficult, we will have to inject through many more injection points from different directions etc, to get better filling of the line. This can lead to increased redness and swelling.

Another consideration is that the body does not like to go from having a deep fold / crease / line to  immediately being smooth. It must be slowly opened up over time, with partial improvements. Often this is the case with dermal filler in the frown, so it can take up to 3 sessions of injecting dermal filler to get to that flat appearance.

How will I look after dermal filler in the frown line?

There may be redness and swelling.

If many injections are required, sometimes the forehead can have the appearance of having been “scratched” with 1-2 red lines down the frown lines

Side effects /risks with dermal fillers

Bruising occurs in a significant number of cases.

Swelling in the injection area will occur. This will last for at least 48 hours

Asymmetry: Sometimes one side is better treated than the other, this is usually because the patient is asymmetrical to start with.

Infection is a very rare complication, but always a possibility when the needle goes into the skin.

Necrosis (blood vessel being blocked, interfering with blood supply to the skin) is very rare. This could lead to scarring.

Need for further treatment: Often with lips, it will take several syringes of product to get to where the patient wants to be.

Instructions for care afterward

No makeup for 4 hours

No heavy exercise that day

No acid face products for 24 hours

No spas no saunas, no hot yoga for 1 week post treatment

If there is the “scratched appearance with associated redness down the frown lines that is prolonged, the doctor may suggest using a steroid cream

What to expect after a dermal filler  treatment?

The effect of the dermal filler will be obvious immediately

Most of the swelling from the dermal filler will have resolved by 2-3 days after the procedure. There may be a small amount of swelling for even 2-4 weeks after the procedure.

What if I get asymmetry at some time before the 2 week point? Do I call the doctor?

No. No need to call the doctor. Sometimes asymmetry will occur because one side is more swollen or bruised. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be examined at the review appointment. There is no point in coming in early for treatment of asymmetry as there is often swelling associated and so the final result cannot be seen until at least 2 weeks. Treating asymmetry too early could lead to further asymmetry

How long will the treatment last?

Dermal filler in the frown line seems to behave a little differently to dermal filler in the rest of the face, maybe because we always relax the muscles associated with the line/fold. Often after 3 treatments are performed, the procedure won’t be required again for several years. Muscle relaxing injections must be continued for this to be a possibility

Cost of dermal filler in frown line:

Cost is per syringe. $450- $600

Before and after anti wrinkle injections and dermal filler frown lines

Before and after anti wrinkle injections and dermal filler frown lines

Before and after wrinkle injections and dermal filler to forehead

Before and after wrinkle injections and dermal filler to forehead

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