Frown lines Botox Treatment

How to get rid of frown lines with Botulinum toxin

Botox for frown lines

Pronounced frown lines can be disturbing. In German, frown lines are called “Zornesfalte” (anger lines), which is a good hint for what kind of facial expression they can convey. However, frown lines can be treated very effectively with Botox. Because frown lines are a classic case of mimic wrinkles, that are caused by muscular tension. Frown lines typically come from long, strained vision.

The main reason for frown lines is the constant pull of the mimic muscles between the eyes. Why are they called “anger lines” in German? Because deep frown lines can leave a grim effect on many people, primarily when on men. And this is precisely where the problem lies: frown lines can create an unsympathetic impression. Often to such an extent that it burdens those affected. For good reason, they then ask themselves how they can get rid of frown lines.

And my answer is Botox. Treating frown lines with Botox is the easiest and least risky way to deal with the issue. At least in most cases. It is true that frown lines can also be treated dermal fillers, for example. But using Botox to smooth frown lines usually provides the best results with the lowest risk.

In this blog article, I want to explain why.

These are the topics:

Zornesfalte glätten mit Botox - LIPS and SKIN Ästhetische Medizin, München
Frown lines typically come from long, strained vision and certain facial expressions, such as during heavy concentration.
What are frown lines, and how do they come about?

Frown lineS – Causes

The term frown lines is used to describe clearly visible wrinkles in the Glabella. The glabella is the area of the forehead located between the eyes at the upper base of the nose. The muscular tension of the glabella causes the frown lines. Most often in the form of two vertical lines.

The glabella is under tension during concentrated vision. At a young age, when the skin is still elastic, frown lines are typically barely visible. But with increasing age, they become more and more apparent. And permanently visible.

Frown lines that dig deep into the forehead frequently leave a negative emotional impression. Especially on males. But even in women, pronounced frown lines can disturb the otherwise harmonious appearance of the face.

Computer work creates frown lines

The rapid spread of frown lines is also a sign of the modern age. Many people suffer from muscular hypertrophy in the glabellar region. This means, in simple terms, that their muscles are too strong. As a result, their strong pull during facial expressions creates frown lines that are deep and that become clearly visible at an early age.

The reason for this lies in the accumulation and duration of concentrated vision that the modern working world entails. Especially long work hours in front of the computer. But also concentrated reading, watching television or playing on game consoles from an early age. Strained vision leads to an involuntary attempt to draw the brows protectively in front of the eyes. Thus, frown lines should actually be called “concentration lines”.

Individual Frown line patterns

Frown lines can vary greatly in appearance. This is because their pattern depends on various factors, including gender, age, or ethnicity. Differences in anatomy and typical facial expressions also create muscular patterns that vary from person to person.

These patterns are clearly visible in people with concentrated vision. On the one hand, they create a variable visual impression. Some shapes are more disturbing than others. On the other hand, they need to be considered in the treatment with Botox, as they require slight adjustments to the positioning of injection points.

Recent studies suggest that five patterns are typical for frown lines. I present them below, with the respective injection points for Botox marked in white:

The “U” shape

The textbook case with 2 vertically centred lines. Botox injections follow the standard protocol.

U shape frown line
Frown lines – “U” shape

The “V” shape

Lines and bulges at the edges of the procerus muscle. Botox is injected along an elongated “V”, usually with 2 additional injection points.

V shape frown line
Frown lines – “V” shape

The “Omega” shape

Similar to the V-shape, often recognizable as an indistinct omega. The transition to the treatment of forehead lines is fluid in this case.

Omega shape frown line
Frown lines – “Omega” shape

The “Inverted Omega” Shape

Strong downward muscular traction relocates the injection points deep into the base of the nose.

Frown line inverted omega shape
Frown lines – “Inverted Omega” shape

The “Converging Arrows” Shape

A variation of the U-shape with only a weak downward pull. Central injection into the procerus muscle can often be omitted.

Wrath fold in the form of converging arrows
Frown lines – “Converging Arrows” shape

Muscles involved in the formation of the frown line

The shape of the frown lines varies because several muscles are involved in their formation. The M. corrugator supercilii, the M. procerus, and the M. depressor supercilii are primarily responsible. The roles of the two most important among them are illustrated below:

M. corrugator supercilii

M. corrugator supercilii and its role in the formation of the frown line.
The muscle, known in German as the “Stirnrunzler”, is located above the eyebrows. It has the shape of a narrow muscle band. When tense, it pulls the brows down and inward. It contributes the vertical portions to frown lines.

M. Procerus

M. procerus and its role in the formation of the frown line.
The procerus is located between the brows above the root of the nose. It extends into the forehead, where its fibres cross with those of the frontalis (“forehead”) muscle. The procerus muscle pulls the skin down. It thus contributes the horizontal portions to frown lines.
When frown lines leave a negative impression – on others and oneself

No sympathy because of frown lineS?

As mentioned at the beginning of this article, strong frown lines are often associated with negative appearance. This is especially true for men. One of my first Botox patients was such a man. He was in his mid-40s at the time, his physical appearance bulky and strong. His face was masculine and visually appealing in itself. Between his brows, however, stood a thick furrow. It was testimony to long hours in the office. In front of the computer. Even when relaxed, his frown lines were clearly visible. They transported an unfriendly, uninviting impression. Even when he was laughing, there was something grim about it. The patient suffered from this a lot. The feedback he received from his social contacts hinted to a perceived “lack of empathy” but he was just not able to understand where this was coming from. He thought of himself of actually being a very emphatic, friendly person. Because of this incongruence, he was very unhappy.

Career killer frown lineS

All the more so because he had been out of work for months. He applied for new jobs a lot. He also had invitations for interviews. But thereafter he always received rejections. He was eloquent. Professionally qualified. “100 applications and 20 interviews, but only rejections,” he lamented to me. He had already tried everything possible. Even started reading books on body language. But, unsuccessfully. What could be the reason?

I only had to describe my impressions to him, and he understood that his appearance could be the reason. After a brief examination, I advised him to treat his frown lines and forehead with Botox. Having his frown lines smoothed out had crossed his mind before. However, he had thus far refrained from having the treatment done for fear of Botox, “the poison”.

It took two sessions and a higher dose than usual to smooth his frown lines and conjure a friendly look back up on his face. But the result was impressive: at long last, his facial expression was relaxed again. His look friendly and inviting. And it may be a coincidence, but a few weeks later it worked out in the job search as well.

frown line Treatment alleviates depression

What may sound a bit far-fetched here has been proven many times by research: The frown lines can cause negative emotions. In others and also oneself. For example, studies have shown that people suffering from depression felt better after their glabella was injected with Botox. The exact connection is not yet fully understood, but facial feedback is likely to play a significant role. The facial feedback theory says, simplified, that people who look better also feel better. “Better” in this context does not mean “more beautiful,” but rather “more likeable.” According to this theory, it seems perfectly plausible that frown lines have a significant role in the image others have of you, and you have of yourself.

Botox frown lines treatment at LIPS and SKIN

Video: Botox for frown lines

In this clip we jump right into a treatment of frown lines with Botox. The injections follow the standard protocol, with 5 injection points, into each of which four units of toxin are injected. In total, therefore, 20 units. Botox treatment of the frown lines takes very little time, in this clip under 40 seconds.
Botox frown lines treatment in 5 steps

treatment process

Botox treatment of frown lines in my practice in Munich follows a fixed scheme in five steps. My top priority is always patient safety and quality of the result. And since no two faces are alike, and frown lines, as shown above, typically require an individual approach for best results, I take the time it takes to do it properly.


The first step is a detailed discussion of the patient’s initial situation and aesthetic goals. What should be achieved with the treatment? Can Botox improve the condition? What are the costs? What are the risks? Complications after Botox are rare, but they do happen. Are there any contraindications that need to be considered? If all questions are answered satisfactorily, then the patient signs a consent to treatment and a fee agreement. This bindingly records the costs of the treatment. Subsequent “surprises” are thus not possible. This step takes 15–30 minutes for first-time patients. For follow-up appointments, it takes much less time.

Cleaning and disinfection

Thorough cleaning and disinfection of the treatment area are essential to exclude bacterial infections. Therefore, traces of makeup must be removed. I then disinfect the face with a skin-friendly disinfectant. The initial state is then documented with a few photographs. This step takes 5 minutes.

Local anesthesia

Local anaesthesia is usually not necessary for Botox frown lines treatment. If desired by the patient, I could numb the glabella with lidocaine cream. It requires a contact time of 30 minutes. However, I have not yet encountered this case.

botox injections into the glabella

The actual injection of the glabellar muscles with Botox then goes quickly. As can be seen from the video of this post, it takes less than a minute.

Aftercare and control

After the injection we take a look into the mirror together, perform a short check if everything is okay and the result meets the expectations – and we are done! See you at the follow-up appointment in 14 days. In case of any complications between the treatment and the control appointment, however, you need to contact me immediately. You have my phone number precisely for that.

Prices of Botox frown lines treatment at LIPS and SKIN

How much does botox for frown lines cost?

In my practice in Munich, the Botox treatment of frown lines costs around €290. Please note this price is indicative, as the actual treatment is billed according to the German Medical Fee Schedule (GOÄ).

What patients want to know about Botox frown lines treatment

Frequently asked questions

Are there risks associated with Botox frown lines treatment?

In addition to the general risks associated with injections (abscesses) and Botox-specific risks of allergies or cross-reactions with certain medications, the proximity to the eyes poses a potential risk with glabella injections. Overdosage or leakage of the toxin in this region can on the one hand have aesthetically undesirable consequences, foremost a drooping of the eyebrows; on the other hand, however, it can also trigger temporary visual disturbances, up to and including diplopia (double vision). Although these consequences are reversible, they cause significant distress during their occurrence. Therefore, I can only advise to have the treatment performed exclusively by doctors who are experienced in Botox treatment.

Is Botox frown lines treatment safer than dermal filler?

Clear answer: Yes. The glabella region is criss-crossed with blood vessels, some of which are important for supplying the eyes. Accidentally puncturing and clogging such an artery with dermal filler can have devastating consequences, including permanent blindness. Although such complications are rare, the glabella must be considered one of the riskiest facial regions for filler injections. I therefore revert to Botox for frown lines treatment whenever possible.

Are headaches normal after Botox frown lines treatment?

Yes. Mild headache after Botox injections into the glabella is reported relatively frequently. However, they are usually neither strong nor do they last more than a few hours. They may occur together with mild nausea.

Attractive at every age

LIPS and SKIN Aesthetic Medicine

Eva Maria Strobl, MD
Herzog-Heinrich-Strasse 34
80336 Munich