Do you have to inject the glabella for a Botox brow lift even if the patient doesn’t have the 11s?

Question

I keep reading that to achieve a brow lift with Botox, doctors will inject the glabella as well as the lateral part of the brow. My eyebrows are too low at rest and I feel like the lateral parts hang too low. I want them higher and to have more of an arch. I don’t have the 11s or the furrowed brow look. Do doctors have to treat the glabella? I feel like it would be unnecessary in my case and it seems like most of the cost comes from having 20 injections in the glabella.

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist to go over your desired results. Facial fillers (voluma, restylane, juvederm) along with Botox can be used. Botox results take up to 1-2 weeks and last up to 3-4 months in new areas of treatment. See an expert. Best, Dr. Emer

Mehdi (Robert) Motazedi, MD · Answer

No, the injections for these two problems take place in different areas of the forehead. The 11s in the central area and the lift on the outsides or above the lateral most eyebrows.

Shaun Patel, MD · Answer

It's hard to comment on your case without seeing a photo or evaluating you in person. The glabella does not need to be injected in every case to achieve a eyebrow lift.

Marek Kacki, MD · Answer

The short answer is no. I am glad you read about the procedure and question the proposed approach. As you can tell there are many approaches which means there are no standards. Start slow and if no results you change the approach. Good luck!

John J. Bandeian, MD · Answer

If when you smile, you don't have any crow's feet lines, injecting the lateral eyelids will not raise your lateral eyebrows. If you have crow's feet lines when  you smile, injecting the lateral eyelids with Botox or Dysport will raise your lateral eyebrows. If you have your lateral eyelids injected and after 2 week you want elevation of your medial eyebrows, you can have your glabella injected.

Andy Shieh, DMD · Answer

You can always skip the glabella and just do the lateral brow lift and see if you like the results? If you don’t, then you’ll know the glabella region should’ve been done.

Leonard Grossman, MD · Answer

A great majority of people do not want to have the inner portion of the eyebrow liftef, but should this become necessary the so called The 11's need to be injected to get that brow lift. The majority of people want to have what's called a lateral brow lift or the tail of the eyebrow elevated and for that reason the area around the outer portion of the eye needs to be injected. Good luck from New York City

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Jill8944. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.In addition to addressing various wrinkles, Botox can also be used to adjust the position and shape of the eyebrows. It works the same way as it does when addressing wrinkles, namely by relaxing muscles. In the upper forehead, there are muscles that move the eyebrows up and other muscles that move the eyebrows down. The muscle that moves the eyebrows up is on the upper forehead; this is called the frontalis muscle. It is responsible for the horizontal lines seen on the upper forehead when one raises the eyebrows. The muscles that pull down on the eyebrows are located between the eyebrows and at the corners of the eyebrows. The muscle group between the eyebrows is called the glabellar complex. There is another muscle that goes around the entire eye called the orbicularis oculi muscle. The portion of this muscle under the tail of the eyebrow is responsible for pulling down on the tail of the eyebrow. When any of these muscles is relaxes with Botox the position of the eyebrow can be adjusted. When treating the horizontal lines on the upper forehead seen when one raises the eyebrows, if the dose is too high or if the placement of the product is too low it can lead to the feeling of a heavy eyebrow, difficulty raising the eyebrow, or downward movement of the eyebrow. This can also lead to downward movement of the eyelids, making a person appear tired. It also can make it difficult to apply eye makeup. To correct this Botox is placed in the antagonistic muscles, those in the glabella and orbicularis oculi which pull down on the eyebrows. This will raise the position of the eyebrows. These two areas can be treated with Botox to provide a brow lift. To do so 4-20 units of Botox are used in the glabella between the eyebrows and 2-12 units of Botox per side are used at the tail of the brow and/or the entire crow’s feet region.If I had a patient with the concern described here I would want to examine the shape and position of the brows. If only a lateral lift is desired, then I would recommend starting with placing Botox in the tail of the brows or the entire crow's feet area and assessing the results in two weeks. At that point, I may recommend further treatment in the glabella depending on the results.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Kristine Brecht, MD (license suspended) · Answer

Botox is not needed in the 11’s region to give a brow lift.Save the extra money for every 3-6 month injection upkeep.Best. Dr Brecht

Ian Lonergan, DO - Account Suspended · Answer

Hi and Thanks for the question.  Botox treatment can be tailored to the needs of each individual patient.  For example, if you are only concerned with elevation of the lateral brow then you certainly could have Botox placed in the lateral brow area to elevate it and not treat the glabella area.  After having performed thousands of injections of neurotoxins (Botox and Dysport are the number one non-surgical treatment I perform), I can say that each provider will tailor their use of Botox based on their experience and what you will likely find is that no two providers will perform the treatment in exactly the same way.  Best of Luck!

Do you have to inject the glabella for a Botox brow lift even if the patient doesn’t have the 11s?

Answers (10)

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