Botox In The Frown Line At A Glance
Botox is a neurotoxin that can weaken the muscles in the glabella region and thereby smooth out the frown line.
The effect of Botox typically becomes noticeable within a few days, but it is temporary. It usually lasts for 4–6 months, after which the treatment needs to be repeated.
In general, patients do not experience pain when Botox is injected into the frown lines. Therefore, anesthesia is only rarely necessary.
Typical side effects of Botox injections into the frown lines include redness, swelling, and bruising. These side effects usually subside within 2–3 days.
Botox injections into the frown lines do not require any downtime. You can resume your regular activities immediately after the procedure.
The initial Botox treatment session for frown lines typically lasts between 30-45 minutes, while follow-up appointments usually take a maximum of 15 minutes.
Everything About Botox in the Frown Line: The Topics
Types of Frown Lines
The frown line can vary greatly in its appearance. It is influenced by various factors, including gender, age, or ethnicity. Differences in anatomy and typical facial expressions create muscular patterns that differ from person to person. To achieve optimal treatment of the frown line and glabella with Botox, it is important to consider these individual differences.
Studies suggest that there are five typical forms of the frown line, which are illustrated below. I have marked the points in white where Botox should be injected into the frown line to achieve optimal results.
U-Shape
The textbook case with two vertical, central lines. The standard protocol for injecting 5 doses of Botox into the frown line is based on this type.
V-Shape
Lines and bulges at the edges of the procerus muscle. Botox is injected along a stretched “V” shape, typically at 2 additional points.
Omega-Shape
Similar to a V-shape and often recognizable as an indistinct omega symbol. The transition to the Botox treatment of forehead lines is fluid in this case.
Invert. Omega
In the case of the inverted omega shape, strong muscular tension pulls down the injection points for Botox, reaching deep into the base of the nose.
Conv. Arrows
A variation of the U-shape with only weak downward tension. In many cases, the central injection into the procerus muscle can be omitted.
The Muscles Involved in the Frown Line
The shape of the frown line varies because multiple muscles are involved in its formation. To maintain a harmonious balance between the treatment of the frown line, forehead, and eye area with Botox, it is important to consider the individual muscular characteristics. The primary muscles involved include the corrugator supercilii muscle, the procerus muscle, and the depressor supercilii muscle. The roles of the two most important muscles are as follows:
M. corrugator supercilii
M. Procerus
When The Frown Line Causes Psychological Distress
As mentioned earlier, a pronounced frown line often accompanies a negative aura, especially in men. One of my first Botox patients was such a man. He was in his mid-40s, with a sturdy and strong appearance. His face was masculine and visually appealing. However, there was a deep furrow between his brows, a testament to long hours spent in the office, in front of the computer. Even in a relaxed state, the frown line was clearly visible. It gave him an unfriendly and unwelcoming look. Even his laughter had a grim undertone, and he was deeply affected by it.
Could the Frown Line Be a Career Killer?
Adding to his distress was the fact that he had been unemployed for months. He applied for many jobs and even had interview invitations. However, all he received were rejections. He was eloquent and professionally qualified. “100 applications and 20 interviews, all rejections,” he lamented. He had tried everything possible, even started reading books on body language. But without success. What could be the reason?
I only needed to share my own observations with him, and he understood that his appearance could be the cause. After a brief examination, I advised him to consider treating his frown line and forehead with Botox. In one session. He had already thought about smoothing out his frown line before but had refrained from doing so out of fear of Botox.
It took two sessions in the end, and a significantly higher dose than usual to weaken the strong tension in his glabella. But the results were remarkable: His expression appeared relaxed again, his gaze friendly and inviting. And perhaps it was a coincidence, but a few weeks later, he found success in his job search.
How Botox Can Alleviate Frown Lines and Depression
What may sound far-fetched has been supported by research: The frown line can evoke negative emotions in others and in oneself. Studies have shown that people suffering from depression felt better after Botox was injected into their frown lines.
The exact connection is not yet fully understood, but “facial feedback” likely plays a significant role. Simply put, it means that one feels better when one looks better. “Better” in this context does not necessarily mean “more beautiful,” but rather “more likable.” It appears that the frown line plays a significant role in the perception that others have of oneself and in one’s own self-perception.
Treatment Video Botox in the Frown Line
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Treatment Process
The Botox treatment of the frown line in my practice in Munich follows a fixed protocol consisting of five steps. Patient safety and the quality of the results are always my top priorities. Since no face is the same, I allocate sufficient time for each patient and plan the procedure individually.
Consultation
The first step involves a detailed discussion of the patient’s initial situation and aesthetic goals. What exactly does the patient want to achieve with Botox in the frown line? Is the goal realistic? What are the costs involved? Are there any risks? If all questions are satisfactorily answered, the patient will then sign a consent form for the treatment and a fee agreement.
Local Anesthesia
In most cases, local anesthesia is not necessary when injecting Botox into a small area like the frown line. However, exceptions can be made for patients who are more sensitive to pain. In such cases, I may apply a topical lidocaine cream to provide superficial numbing.
Cleaning & Disinfection
Thorough cleansing and disinfection of the frown area are essential to prevent bacterial infections. Therefore, any traces of makeup and other impurities must be removed. Afterwards, I disinfect the area using a skin-friendly disinfectant.
Injecting
Injecting Botox into the frown line takes only a few instants. Even when treating the forehead and eyebrows as well, the injections typically do not take more than 5 minutes.
Post-Treatment Care
After the Botox injections, we will take a moment to examine the treated area together in the mirror to ensure everything looks as expected and meets your expectations. This quick check is done to ensure the desired outcome has been achieved. We will schedule a follow-up appointment in 14 days for a routine check-up. If any complications arise between the treatment and the follow-up appointment, please contact me immediately. You will have my contact number for any urgent concerns or questions.
Alternatives to Botox
Although Botox is considered the first-line treatment for the frown line, there are other options available as well. In particular, hyaluronic acid fillers and laser resurfacing are well-known alternatives. Each procedure has its own advantages and disadvantages. I will briefly discuss them below.
Treating the Frown Line with Hyaluronic Acid
Fillers made of hyaluronic acid (commonly referred to as hyaluron) are a popular alternative to Botox. In this procedure, hyaluronic acid, a natural substance found in the skin, is injected into the frown line. This serves to fill the wrinkle and smooth the skin. The effect can last between 6 and 12 months, depending on individual skin characteristics and the product used.
However, injecting hyaluronic acid into the glabella is not without risks. Serious complications, although rare, can occur, including blindness. Important blood vessels run through the glabella, and if hyaluronic acid is accidentally injected into them, it can interrupt the blood supply to the eye. Such a case represents a medical emergency that must be treated immediately. In many cases, the damage to the eye is irreversible.
Laser Resurfacing
Another alternative is laser resurfacing. In this procedure, a laser is used to remove the top layer of skin and stimulate the underlying layers to produce new collagen. The result is tighter, smoother skin. However, this method can cause temporary redness, swelling, and occasionally skin discoloration. In some cases, the pigmentation disturbance can persist as a long-term issue. Additionally, the skin needs time to fully regenerate after the procedure.
Compared to Botox, both hyaluronic acid fillers and laser resurfacing are more expensive and time-consuming. Moreover, they carry more risks, with hyaluronic acid fillers being significantly riskier.
Therefore, whenever possible, I choose to treat the frown line with Botox. It provides a quick, cost-effective, and relatively low-risk method to achieve a smoother and more youthful appearance.
What is the Cost of Botox Treatment for the Frown Line?
Botox treatment for the frown line in my practice in Munich costs approximately €290. Please consider this as a guideline for orientation purposes only. The individual billing of a treatment is based on the German Medical Fee Schedule (GOÄ) and may therefore differ from the mentioned price.
In most cases, a full vial is not required to adequately treat the frown line and glabella with Botox. I advise my patients to use the remaining amount of toxin for the treatment of the forehead or eyebrows. As I do not keep opened vials, I always charge for a full vial when injecting Botox into the frown line. Any unused leftovers are disposed of.
Please note that the costs for Botox treatment of the frown line are not reimbursed by insurance providers.
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Frequently Asked Questions
In addition to the general risks associated with injections (abscesses) and Botox-specific risks such as allergies or cross-reactions with certain medications, injecting the frown line in the glabella area carries a potential risk due to its proximity to the eyes. Overdosing or improper distribution of the toxin in this region can result in aesthetically undesirable outcomes, particularly eyebrow ptosis (drooping), and can also cause temporary visual disturbances, including diplopia (double vision). Although these effects are reversible, they can cause significant distress while they persist. Therefore, I can only recommend having the treatment performed by experienced medical professionals with expertise in Botox administration.
Definite answer: Yes. The glabella region is traversed by blood vessels, some of which are important for the supply to the eyes. Accidentally puncturing and obstructing such an artery with hyaluronic acid can have serious consequences, including blindness. Although such complications are rare, the glabella area is considered one of the riskiest facial regions for filler injections. Therefore, when it comes to smoothing the frown line, I opt for Botox whenever possible.
Yes, mild headaches after Botox injections in the frown line are relatively common. However, they are typically not severe and do not last longer than a few hours. They may be accompanied by mild nausea.
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About the Author:
Dr. med. univ. Eva Maria Strobl is the owner of LIPS and SKIN Aesthetic Medicine practice in Munich. She is a trained specialist in general medicine (MedUni Vienna) and has over 10 years of specialization in non-surgical aesthetic procedures. Dr. Strobl is a member of the German Society for Aesthetic Botulinum Therapy e.V. (DGBT), the German Society of Anti-Aging Medicine e.V. (GSAAM) and of Network Global Health. She publishes regularly on her blog and on DocCheck.
