Dear Dr. Langdon:

I had botox done about 2 1/2 weeks ago on forehead and bunny lines. The middle area of my forehead is “frozen” but I can still see faint lines. Is this normal? Will they go away in time? My doctor said to exfoliate the area because it is the new skin coming in that will be void of lines. Is this correct? And if so how long do I have to wait before exfoliating? (I had my touch up on Tuesday) Thank you!!

Dr. Langdon Says:

Dear Faint Lines:

Istock_000006621356medium-lBotox relaxes the facial muscles that are the cause of wrinkles, but it has no direct effect on the skin. Wrinkles that are visible when the underlying muscles are fully at rest are “etched in the skin” and will not improve unless the skin is directly treated by other modalities. Injection of a filler substance such as hyaluronic acid (Restylane, Juvederm) into the skin will temporarily smooth the wrinkles, but long-lasting improvement requires skin resurfacing, which is best done by a laser.

Laser resurfacing can be achieved through a series of fractional laser treatments (most often Fraxel laser at 1550 nm wavelength or Fractional CO2 laser at 10,600 nm wavelength), or through a single treatment of “traditional” (non-fractional) laser resurfacing (either erbium laser at 2940 nm or CO2 laser). The “traditional” approach is the most effective and can result in complete smoothing of the wrinkles.

The best strategy of all is combining Botox and laser resurfacing. Continued use of Botox can prevent the wrinkles from recurring after the resurfacing. I have personal experience with this combo, having had laser resurfacing of my frown lines in 1995 followed by continual injections of Botox (3-4 times a year). After 15 years, my frown lines have not returned, and should never return as long as I prevent them with Botox.

Robert C. Langdon, MD