When Getting Botox for "11s", do I Need to Also have Injections Above the Eyebrows? (photo)

 


Injections for the frown lines do need to be placed above the eyebrows as you had described in order to soften the facial expression in this area.

Rather than placing the injections exclusively between the eyebrows to avoid getting a frozen look, I would recommend instead to have your doctor administer a lower dosage.

The skill and technique of the practitioner is extremely important for getting the results that you want. So please seek help from a board certified dermatologist.


 

Most people have a dense group of three muscles that contribute to the vertical frown lines between the eyebrows. If only the points between the eyebrows are injected then not all muscle groups and not all the parts of the muscles involved will be affected by the botox. The photograph you supplied shows corrugator muscles that are active significantly above the eyebrows, which is normal, but a lack of treatment above the plane of the eyebrows would result in an incompletely treated glabella and the frown lines would partially persist.  Treating the frown lines does not prevent you from maintaining muscle action of the forehead above the eyebrows and the mid to upper part of the middle forehead. You would still have a lot of normal action. Should one's anatomy however, demonstrate activity of a corrugator muscle that is placed lower on the forehead, or does not have as much vertical girth as the normal muscles in this area, then possibly that person's doctor could deliver Botox to just the plane between the eyebrows and as long as the frontalis muscle does not cause much of your frown lines, then they may obtain a good enough improvement.  This is why an expert is needed to evaluate you before your treatment, and should be a dermatologist or plastic surgeon who would examine you and treat you, not the textbook!

Botox to treat the 11's needs to work on the muscle that runs from the nasal side (medial aspect) of the eyebrow to about the mid eyebrow where you may feel a notch.  If you only inject between the eyebrows you probably will not temporarily paralyze the whole muscle unit and will not be full pleased with your results.

There are many different ways to inject botulinum toxin A cosmetic.  Most doctors are willing to honor your concerns and provide a treatment that matches what you are looking for.

There are 2 main muscles that should be treated to properly reduce the "11s". The procerus and corrugator supercilli muscles, which require injections in the middle and above the brows. I would go for a lower dose overall to minimize a frozen look and reassess in 2 weeks for possible addition of botox units, rather than only treating 1 of the 2 important frowning muscles.

You are correct, you do not need botox injection in your forehead to reduce your " worried lines". As a matter of fact you will have better elevation of your eyebrows without getting a "frozen forehead " if you did not receive botox injection in your forehead. Usually 4-5 injection site, 4 units in each site would provide a googd and natural result.

Your photo shows prominent vertical lines which are due to activity of the corrugator muscles.  The corrugators run horizontally/diagonally from above the eyebrows toward the medial or inner part of the eyebrow area.  To treat your lines effectively, injections should be done above the medial part of the eyebrow.  This should not affect forehead movement very much as long as the injections stay low along the eyebrow, but above the orbital rim.  Treating just between the brows would target mostly the procerus muscle and this would not be effective for your vertical glabellar lines.  The procerus muscle is responsible for the horizontal lines which appear on the upper nose when frowning, but you don't appear to have those.  The key to successful Botox treatment is to have a thorough understanding of the underlying anatomy.  Botox treatment is extraordinarily safe when done by an experienced injector. 

If you are concerned about achieving a natural appearance and maintaining some motion in the frown area, you may consider using a slightly lower dose than average. The degree of imobility of the muscle making the frown and the duration of the affect of the Botox is dependent on how much you put in. For patients like you who have special concerns I will often start at a total amount of botox than average and see you back in 7-10 days and see if you like the result; if you would like the result to be more noticable, then another dose could be added. This approach allows us the finesse the results to just what you are looking for. Occasionally, its even better to combine some Juvederm Ultra using a blunt tip canula in that area with the botox to get a more natural, longer lasting result. Best of Luck!

 The photos show a strong Glabellar muscle response but no real horizontal forehead lines.  Botox to the Glabellar in the standard manner should work very well.  I typically do a Botox treatment and then repeat the treatment at 1 month to further weaken the targeted muscle followed by 3-4 month intervals thereafter.