Updated: Jan 6, 2021
So you're thinking about treating those pesky lines between your brows. This is by far the most common area to get tox.
Botulinum Toxin works between the brows by relaxing the muscles in the glabellar complex. The glabellar complex consists of muscles that pull your brows together (corrugators) and a muscle that pulls the lower forehead down (procerus).
What is Botulinum Toxin?
Botulinum toxin is a neurotoxin that has been prepared to relax or fully paralyze specific muscles they are injected into. How does the paralysis happen? The muscle contracting transmitters can't get out of their uber to get to the muscle, so they go back home. This causes no damage to any structures of the nervous or musculoskeletal system.
Botox, Dysport, Xeomin, and Jeuveau, are Botulinum Toxin Type A brands for cosmetic indication to treat the glabellar complex. Just like Kleenex, we often refer to the treatment as the brand name, Botox. "I'm going to get Botox." "Pass me the Kleenex." What we mean to say is, "Pass me the tissue," or, "I'm going to get Botulinum Toxin type A injected in certain muscles to relax them so they do not create wrinkles."
How Does Tox Make Frown Lines Go Away?
Botox relaxes muscles. Botox does not remove lines directly, but stops skin from creasing, which softens the wrinkles. For example, if I crease a bedsheet every day for years, a tight crease will form. If I iron the sheet, but I don't stop creasing the sheet, the crease will not go away because the sheet keeps getting creased. We need to stop creasing the sheet. This is what Botox does.
Will My Line(s)/Wrinkles Go Away?
If your skin only creases when you contract the muscles, Botox will relax the muscles, stopping the creases made by those muscles. Lines only visible by contracting the muscles are called dynamic lines. Lines visible at all times when the muscles are fully relaxed are called static lines. Static lines will soften with time depending on a variety of factors.
If your skin has static lines, your sheet (or skin) will need some ironing treatments (skin resurfacing ie. retinol, chemical peels, lasers, microneedling), in addition to stopping the creasing (Botox). The quality of your skin (younger, older, sun-damaged, sun protected), and how long the crease has been present will determine how long it will take for the line to go away. Some wrinkles or deep creases may never go away. This is why preventative Botox, or Baby Botox, is on the rise. It stops the creasing before it happens. If the line is present at rest, the treatment is no longer preventative.
What Are The Risks of Botox Between The Brows?
Injection Site Reactions
Injection site reactions are the most common risk. This includes bruising, swelling, minor pain, and sensitivity. Bruising does not commonly happen between the brows. Swelling does not commonly happen between the brows. Pain is very limited, though sometimes I compare the pain to plucking a thick hair in the area getting treated.
The scariest risk in this area is the risk of a ptotic, or droopy eyelid. If the fluid is injected too quickly, too low, too deep above the brows, or you have anatomical variations that make you more susceptible to this adverse event (very rare), a droopy eyelid is possible. If this happens, an experienced provider will be able to prescribe eye drops to help open the eyelid, and/or inject Botox into the eyelid to relax the sides of the eyelid to lift it (more advanced). Your provider can avoid this risk by using proper technique, techniques that decrease this risk, and injecting slowly. The total time to inject is still about 30 seconds to 2 minutes between the brows.
If the provider injects too deep above the sides of the eyebrows, your eyebrow may feel heavy. This is not a droopy or ptotic eyelid, but this can be referred to as a ptotic brow. With a ptotic eyelid, you will not be able to fully open your eye. With a ptotic brow, your eyebrows will be more difficult to lift, or the skin below your eyebrow may feel heavier on your eyelid.
Google-able Scary Side Effects
If you google "Botulinum Toxin Side Effects" or Adverse Effects, you may read some scary reactions like difficulty swallowing, breathing, or talking, severe muscle weakness, or loss of bladder control. These are systemic results that can occur when upwards of 300-400 units of tox are used. Botulinum toxin is also used for hypertonic muscle conditions, like dystonias. Full limbs are treated with multiple hundred units of tox. The likelihood of a scary adverse event happening is extremely unlikely with cosmetic dosages of tox.
With this said, most patients will never experience any of the above adverse effects.
How Much Will Frown Line Botox Cost?
Some clinics charge by unit, while some clinics charge by area.
Most places charge by unit, and the price per unit or per area will vary based on the specialty, location, and many other factors.
Between the brows, Botox, Xeomin, and Jeuveau are FDA approved to last 3-4 months at a dose of 20 units. Dysport is FDA approval dose for 3-4 months is 50 units. 1 unit of Botox, Jeuveau, or Xeomin is compared to 2.5-3 units of Dysport.
Most men and some women with strong muscles will need more units. 30-50 units of Botox is not uncommon between the brows alone. The stronger the muscle is, the more units it will need.
What Should I Do Before My Frown Line Botox Appointment (Pre Care)?
The area between the brows is one of the least likely areas to bruise, but avoiding blood thinners to prevent the risk of bruising is a good idea. Common blood thinners are alcohol, aspirin (and NSAIDs), fish oil, gingko biloba, ginseng, and garlic. If you are on a prescription blood thinner, it is possible to have injections as long as your primary care physician gives the okay and you are not in critical health.
If you have high anxiety or are really nervous, you may have a history of fainting with injectables, like getting needle pokes or giving blood. This is called vasovagal syncope. To avoid fainting, make sure you have eaten before the appointment, avoid coffee, and be hydrated. Communicate your fainting history to your provider. It helps to talk during the treatment, or be distracted. To avoid fainting, make sure you do not hold your breath. Relax your upper body. If you feel yourself about to faint, squeeze your abdominal muscles, and tell your provider so they can lay you down.
If you love to workout, plan your workout before your appointment. Sweating profusely is discouraged for the rest of the day, or 24 hours after tox.
What Are Frown Line Botox Appointments Like?
First your provider will assess your concern. They will estimate the amount of units and check your medical history. You should disclose any medical conditions, allergies, medications, and current pregnancy or breastfeeding information. The only people who should not get Botox are those who are pregnant, breastfeeding, severely or acutely ill, or who have some muscular weakness disorders.
They should take baseline pictures in consistent lighting of your muscles relaxed and contracted to store in your chart. They should educate you on the risks of the procedure. They should assess the characteristics of your muscles.
Your forehead will be cleaned, and the product will be injected in 3-5 injection sites.
What Do Botox Injections Feel Like Between The Brows?
The injection feels like a tiny pinch, maybe equivalent to plucking a thick hair in the area being injected. If the injector is heavier handed, or your tissue is very thin, you may feel a crunching sensation. This is okay, though your risk for bruising and sensitivity is increased with a more aggressive injection. You may or may not feel the fluid being injected. It has the consistency of water. It may or may not be cold. You may or may not feel a little bit of blood from this area after the injection. It is common and normal for blood to come out of an injection site, though the injection site may also not bleed.
You may feel like the treatment is working immediately, but that is just the presence of the fluid in the tissue. It takes a minimum of hours, usually a few days to begin seeing effects.
What Should I Avoid After My Treatment?
There were general rules created when tox was developed for cosmetic use. These are "do not sweat, workout, or use a sauna for 24 hours after, do not lay down for 6 hours after, and do not touch the area treated for an hour." You can also contract the muscles treated more after the treatment to help the tox kick in faster.
What Does Botox Feel Like Kicked In Between The Brows?
Squeeze your hand tight. This is what your muscles do without Botox. Move your hand a little bit, but don't squeeze it tight. This is what Botox feels like. You won't be able to squeeze the muscles of the area tightly. You may be able to move them, but they will not squeeze tightly.
All toxin products take ten days to fully kick in. The strength is the greatest in the beginning, and will wear off with each passing week. For some people, you may feel a little tight in the beginning. The tightness (or heaviness if you do feel heavy) will soften with the passing weeks. If you can move the muscles in the beginning (at day 10) they will be able to move more with the passing weeks.
What To Expect From My Treatment
If you express your goals and expectations to your provider, your provider should be able to educate you on if those goals and expectations are realistic or not, and what they recommend.
If you want your lines gone, you will need to fully freeze the muscles. This does not mean you will not be able to make expressions. The expressions that utilize the frowning muscles between the brows will be limited. Fully paralyzing the muscle may not fully get rid of your lines. If your sheet has a crease and Botox keeps the sheet flat, you may need ironing treatments to help soften the crease. Some creases may never fully go away.
If you want to be able to move the muscles that are treated, your treatment will not last as long. If 20 units in the lower forehead last 3-4 months, less units will last less time.
If you move too much for your liking before the three month mark, it does mean you need more units. More units will last longer. A fully frozen muscle for 3-4 months is not a realistic expectation. The effects of the treatment continually soften past the two week mark. The muscle will slowly regain movement and strength between the treatment duration.
Which Tox Product or Brand Should I Pick?
I could make a whole blog post on this topic alone. Early in my injectable career, I set out to compare every single publication on all types of toxin for cosmetic use for efficacy. I spent over half a year trying to compare all of the studies, and learned that it was impossible to compare. The indicators of efficacy such as onset, duration, or improvement in lines are defined differently in every study. Most studies are funded by pharmaceutical companies that profit off the product and have bias. There can be flaws found in every single study, or findings can be disputed. The points used in-vitro to support a product as 'the best' are also not necessarily indicative of product efficiency. I could ramble on end about this topic.
Here's my advice. I feel every patient should at some point try every product type. All of the products are so incredibly similar. Every patient has a different goal and different opinions on what they feel is the best outcome for them. Keep in mind placement of injection is greatly responsible for patient satisfaction. Placement is directly influenced by the patient's communicated expectations and feedback. Providers are also heavily influenced by the price they get the product for and politics associated with the companies. If you feel too pressured by a provider to pick a specific product, they are not the right provider for you.
Try whichever product makes you feel the most secure. Try the product the injector recommends for you. Try a different product if you weren't happy with the previous treatment (and communicate your concerns to the provider to alter their injection placement if not previously satisfied).
Am I A Good Candidate for Botox Between My Brows/Frown Lines?
You are not a candidate if you have some rare muscular disorders, expect tox to remove all of your lines, or do not accept the risks that come with the injection. You are also not a good candidate if you expect absolute perfection with your first treatment. Your first treatment is a learning experience, and even though this is one of the most simple areas, you may need to communicate to your provider if you need more units or feel too heavy. It is also very possible to not enjoy what tox feels like, and will take trying it with the right provider to learn if this is the right treatment for you.
A good candidate is someone who is looking to soften the lines between their brows. They may have static or dynamic lines. They understand and consent the risks of the injection. They do not expect lines to fully eradicate immediately after tox kicks in. They are able to be local to the clinic ten days to two weeks later in case they need a touch up.
If you live in Southern California, specifically Los Angeles, Orange County, or San Diego, schedule to see Jasmin in Costa Mesa, California for Botulinum Toxin Frown Lines Elevens. Consultations are free.