Fillers – Patient 114

A woman in her early 60’s with deep frown lines she dubbed “the Mercedes” because of its shape. She had received
Botox 1 ½ years before in another practice but it hadn’t worked well and caused too much drooping of her medial brows.
She is shown before and again, 2 weeks after treatment with 25 units of
Botox and 1 cc of Restylane.

Discussion: She has more than normal activity of her corrugator supercilli muscles (the main “frown” muscles) , and needs a larger dose than the typical 15 units of Botox that is used here. She also has deep lines at rest- these won’t go away with weakening of the muscle activity alone, and need to be filled with the Restylane. As the forehead deflates with age ,she is more at risk for over descent of her medial brows from Botox, so I avoided the typical treatment to her upper forehead. This gives her improvement but does not cause the medial brows to drop as much. The “Mercedes” and lines of her forehead are dramatically better at rest, with maximum frown and even with smiling. Her friends ask is she has “lost weight”. When you look better in a natural way, it is difficult for others to determine why, so a typical comment is “did you have your hair done” or “did you lose weight” because you look better but people are not sure why.
So, “one key does not fit all locks”, and one treatment pattern does not fit all patients. Her case illustrates how careful analysis of her anatomy and the aging process can help to give us a good result.