Why Inject Botox/Dysport Above Brows for Frown Lines?

I use Botox or Dysport for frown lines and I have been to two plastic surgeons. One of them injects Botox/Dysport in frown area and also above eyebrows for frown lines and the other only in frown area. I was wondering if it is more effective when injected along the muscle (all above the eyebrows plus frown area) or is it enough to inject only in frown area to avoid ptosis. I don't use Botox/Dysport for forehead area since I don't have any lines there only for frown lines. Thank you, Poly

Doctor Answers 22

Botox for frown linees

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This is a good question.  The muscle definitlely runs from the area between the brows up just above the brow to about the pupil level.  To get the whole muscle, some injection has to be placed just above the brow.  However, if the goal is simply to prevent the medial (toward the middle) portion of the muscle from contracting, which is the main part that causes the vertical lines between the brows, then medial only injections would probably be fine.  If injected in small volumes just above the brow, the risk of eyelid ptosis is extremely low.  Bottom line is that if you get results that you are happy with by getting only medial injections, then that's all that matters.

Botox / Dysport Injections Above Brows for Frown Lines

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Botox / Dysport Injections Above Brows for Frown Lines are performed in order to target the fibers of the muscle that creates the frown lines and that runs just above the eyebrows, but this done mostly medially (closer to the central part). Injection above the eyebrow, on the lateral (outermost) aspect should be avoided. 

Botox and Dysport for frown lines

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Placement of Botox or Dysport depends on your muscle movement.  Both techniques may be appropriate for you.  Decide if you prefer one treatment over the other and continue treatments with that doctor.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

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Botox Treatment Best Tailored to Your Concern and Anatomy

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The frown lines are caused by the action of 2 muscle groups-- the Procerus and the Corrugators.  Generally, full treatment of these groups is necessary for best results when treating "Frown Lines" (Glabellar wrinkles).  The Procerus runs down the midline from the forehead to the nasal bone, and is pretty consistent among people.  The Corrugators tend to have more variation but generally run above the eyebrow and the middle forehead.  I have patients make a number of facial expressions prior to Botox so we can properly find the size, shape and extent of their Corrugators.

So-- it is important that your particular muscle anatomy is evaluated and treated.  Most importantly--- that you are happy with the results!

Botox for Frown Lines

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The frown lines are caused by the action of the Corrugator muscle that is attached to the bone between the eyebrows and to the tissue under the mid portion and upper part of the eyebrow on each side. Usually Botox is injected near both end of the muscle to be most effective. But if it is injected too low on the lateral end of the muscle,it could cause eyelid ptosis. If you had similar results with one site or two sites injections, then I would continue with just the frown area injection since that injection alone should not cause any eyelid ptosis even with an inexperienced injector 

A. H. Nezami, MD
Jacksonville Plastic Surgeon

Botox/Dysport for frown lines

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The placement of the neurotoxin depends on your specific anatomy.  The corrugators (the muscles that push the brows toward each other) are usually horizontally- or diagonally-oriented, so it is usually worthwhile to inject botox above the eyebrows as well as between them.  The side effect of ptosis is relatively rare (probably < 1%).  

Ultimately, the most important consideration is how you like the result with each injection technique.  If you like them both the same, then go with the person that uses less units, since that will save you some money.

Why Inject Botox/Dysport Above Brows for Frown Lines?

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The corrugator muscles which are responsible for frown lines are located just above and between the eyebrows. If you watch yourself frown in the mirror, you can see the muscles pushing in from above the brow toward the middle creating a furrow(s). The Botox or Dysport is injected into the muscle where contraction occurs causing relaxation resulting in improvement or disappearance of frown lines.

Lori Stetler, MD
Dallas Dermatologic Surgeon

Botox injection finesse depends on recognizing muscle anatomy

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There are 2 muscles active in the frown area between the eyebrows. The one that causes vertical lines is the corrugator, which contracts in a horizontal direction; it attaches to the skin over the mid-eyebrow on each side, but this exact point is variable so the injector needs to identify it in order to maximize the effect. In the mddle, between the eyebrows, another muscle called the procerus is more active; this contracts vertically, causing a horizontal wrinkle. So injections between the eyebrows affect mostly that muscle, while it is the more laterally placed injections that treat the vertical wrinkles. It may seem paradoxical but injecting at the wrinkle area doesn't work as well.

Botox for frown lines needed lateral to frown lines

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The muscles responsible for your "frown lines"  extend laterally sometimes for about 2/3 of the length of the eye brow. This is best seen if you get Botox injected near the lines and then several days later  try to frown. I only inject laterally IF this movement causes the line to persist of is not aesthetically pleasing. Some individuals require a bit of Botox there... some don't!  If the doctor uses 2-3 units there and limits it to areas he sees  movement, there is little chance of causing Brow Ptosis.

Manuel M. Pena, MD
Naples Plastic Surgeon

Injection of Botox above the brow for frown lines.

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The corrugator muscle is what causes your frown lines. It starts above the medial part of the brow and goes obliqley downward to your nose. Ideally, you must inject the corrugator muscle to eliminate the frown, but if you go too far into the area above the brow, it may drop your brow.

The best bet is to inject into the frown line and into the medial brow as well, trying not to get too far above the brow. Above the brow is the frontalis muscle, which raises the brow. If this is injected. the brow drops.

Hope this is helpful information.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.