What can I use on my Glabella when Botox and Infini are NOT effective?

Dr. Dean Kane Q & A. shutterstock_57824869 Q. I have a deep line in the Glabella area. I have a darkening of pigment there as well. In the past, my dermatologist filled it with Juvederm and this was very effective. She told me it is no longer safe to fill the Glabella due to the risk of necrosis. I have tried Botox and 3 separate treatments of Infini in this area and we aren’t seeing any results. Are there any other treatments or procedures that might mimic the filler, but be safe when used in the Glabella? ​ ​A. As you know, non-surgical facial contouring is possible with a variety of fillers. Restylane and Perlane, a jelly-like clear skin filler to fill lines and wrinkles. Juvederm and its longer lasting “cousin” Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial (“parentheses”) and marionette folds, the brow (“number 11”) lines. Voluma has great projection to fill and lift the cheeks and lateral brow or chin. All the fillers come with numbing anesthetic! Silk, introduced into the US in January of 2015 has taken off explosively due to its smoothing character without plumping. It’s used extensively now for fine lines around the lips and eyes and smoothing skin folds like those of the cheek and forehead. Botox and Dysport too have been found to reshape the nose, re-balance excessive facial expression and provide a non-surgical brow lift and lip lift as well as reducing wrinkles! ​ ​The use of all fillers are off-label for injection into the depression between the eyebrows. Despite this, the risk of skin necrosis is rare when performed correctly. It is the risk of progressive thrombosis or clotting of the blood vessels which join with the vessels to the eye and brain that is a more grave complication. Again, when performed properly, that risk is also rare. You may consider the use of fat grafting. This is technically demanding as the fat will not enter the dermal skin but must be placed in the muscle or subcutaneous tissues under the skin. It too has risk and will require several sessions of improvement. ​ ​Infini, a radio-frequency thermal skin procedure, if it works will provide skin shrinkage by heating the collagen within the dermis. In my hands, all thermal devices have been underwhelming. Please consider Dr. Obagi’s new, second generation Skin Health programs for skin texture and pigmentation improvement. They may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smooth and even the color of your skin. ​ ​You may wish to obtain a consultation from a well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon who performs a significant amount of facial enhancement procedures. ​ ​I hope this has been helpful! All the best!
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