Men’s Botox for the 11s (photo)

Question

I am a male about to turn 50. What bothers me most is the lines between my eyebrows immediately people say Botox could assist, but after recently receiving a treatment of 76 units, I still had the issue so I went back two weeks ago and had an additional 20 more to treat the area. Obviously, I still have the problem and I am not sure if it was because of the treatment not being done correctly or if in fact, I should consider something else in terms of a procedure.

Nelson Lee Novick, MD · Answer

I have routinely been treating this very common problem for many years with very gratifying and durable results. Glabellar "frown lines" result from two underlying causes, both of which should ideally be treated in order to achieve satisfying and durable results.
The underlying cause of these lines is typically the daily repetitive movement of the muscles of expression located there, which we tend to use numerous times each day. Over the years, especially as we enter midlife, the overlying :"fabric" of our skin becomes permanently etched and creased, so that even when the underlying muscles are at rest, the skin continues to show the "frown lines."  as is the case here.
So, for best and more durable cosmetic improvement, a two-pronged approach is used. Botox can be used to address the movements of the underlying muscles (The intent is not to "freeze" the muscles so that you cannot emote, but rather to diminish their overactivity), and a low viscosity, malleable, cohesive HA filler can be used to elevate and smooth the creases in the "fabric" of the skin. 
In the hands of an experienced, board certified cosmetic dermatologist filler expert, the very superficially placed injections needed to achieve elevation and smoothing of the etched lines "eleven lines" typically poses little risk. 
Please note: unfortunately, the hard science to promote the use of so-many of today's expensive, here-today-gone tomorrow light and energy-based gizmos, like fraxel lasers, RF devices, etc, lags woefully behind the heavy marketing and social media buzz that hawks them. So, you would be wise to exercise a whole lot of  "buyer beware" when being presented with these types of options  Hope this helps and best of luck.

Anil R. Shah, MD · Answer

A total of 96 units is quite a high amount if most were used for the glabellar (11s) area, since the typical dose there for men is 20–40 units.
If you received Botox to multiple areas, that’s different  but if it was primarily between the brows, and you still see strong frown lines, it likely means:

The injection placement didn’t target the active parts of your corrugator or procerus muscles correctly, or

The product didn’t take (either due to storage/handling issues or individual resistance).

Deep, static lines may also need dermal filler, microneedling, or laser resurfacing in addition to Botox. See an experienced injector or facial plastic surgeon for evaluation and combination treatment options.

William Andrade, MD · Answer

Hello, in my experience, I find that Botox will only completely eliminate the 11s if they are just starting to develop; for example,  in a younger patient in their late 30s - early 40s.  Once deep skin creases or furrows develop, I find that Botox only provides a partial improvement in their appearance.  When you consider that Botox just relaxes the underlying muscle but does not actually fill the furrow, it makes sense that a very established crease might not go away just by relaxing the muscle underneath.  Fillers injected right into the skin can help with this issue, but even then, if one injects a large volume of filler, it might start to spread away from the injection site, making the entire area look "puffy" rather than eliminating the crease.  There are surgical options but you would need to seek a surgeon who focuses on facial cosmetic surgery to better understand if this would be beneficial in your case.  These are just general observations, so for specific recommendations you could consider getting a second opinion by a plastic surgeon in your area.  Thank you for your question.

Ella Fedonenko, MD · Answer

Glabellar lines in your case have significant static component. That’s why you are not seeing good results after the Botox injections. This will likely improve after you have Botox injections several more times.

Jose Telich, MD · Answer

Dear Dude thank you for your question.

Sometimes the 11 limes require adjunct treatment modalities in order to be resolved. Sometimes a bit of hialuronic filler may help in making them less visible, and in certain patients treatments focusing on the skin like CO2 laser or peelings can achieve good results.

Stanley Okoro, MD · Answer

Hello! Thank you for such a great question. When assessing your glabella (the area between your eyebrows), you have what we call "static lines" or lines that are present on your face even at rest with no facial movement. Static lines become increasingly difficult to treat the longer they go without treatment. Starting with Botox to this area is a great first step, as this will relax the muscles that cause these creases (the procerus & the corrugator muscles) and will slowly soften these lines over time.

When deep static lines are present, it may take multiple treatments of Botox to truly start to soften these lines, as they have been forming for 50 years and have become a deep crease. The use of Botox will be great to prevent these lines from getting any deeper as you continue to age as well.

However, wanting to treat these lines completely may require multiple modalities of treatment including Botox + potentially using filler to fill these lines to help minimize their appearance.

Mohamed Elmaraghy, MD, FRCS(C) · Answer

If botox alone doesn't soften the "11" wrinkles then consider filling in the furrows with filler. this will immediately correct the issue of concern and is long lasting. You should still keep up the botox treatments indefinitely and things will continue to improve further with time. Filler in this location can last years but beware there are additional risks injecting filler in the glabella!

Jeffrey M. Darrow, MD · Answer

Botox’s only effect is to give a temporary paralysis of the muscle that it is placed in. If you start with a completely smooth forehead at rest, with no creases between your eyebrows, but you can create deep creases by frowning, then Botox will return you to a smooth appearance between your eyebrows.  However, if you have creases between your eyebrows at rest and over developed frown muscles, Botox will not immediately get rid of these creases nor the over developed muscles. It will take time for the muscles to atrophy and smooth out, and for the creases to get as good as they can be. This usually takes multiple treatments with Botox, separated by approximately 4 months, so that the muscles can’t become active and can’t flex the skin.  Even with persistent paralysis of the frown muscles, some patients lines will never completely disappear because they have become “fixed“ due to a lifetime of frowning and flexing the skin.  Adding volume to the area, such as Restylane or Juvaderm, help to camouflage these lines.  As it seems that you have only recently undergone your treatment, I would think that you need to be patient for many more months and continue your Botox regularly to actually see what your best result would be. Best wishes.

Anna Chacon, MD, FAAD · Answer

I understand your concerns regarding the persistent lines between your eyebrows, often referred to as "the 11s." Botox is a common treatment for these dynamic lines, but there are several factors that could influence the outcome of your treatment:

Dosage and Placement: While you have received a significant amount of Botox (96 units in total), the effectiveness can depend on precise placement and individual anatomy. It's important to ensure that the injections are administered by a skilled and experienced practitioner who can assess your specific facial muscle structure.

Muscle Strength: Some individuals have stronger muscles in this area, which may require a higher dosage or more strategic placement of Botox.

Timing: Botox typically takes full effect within two weeks, but in some cases, it may take slightly longer to see optimal results. Additionally, the effects are temporary, lasting about 3-4 months, so regular treatments are necessary for maintenance.

Alternative Treatments: If Botox alone isn't providing the desired results, you might want to consider complementary treatments. Dermal fillers can be used to address deeper static lines, which are present even when the face is at rest. In some cases, laser treatments or chemical peels may also help improve skin texture and reduce the appearance of lines.

Consultation: I recommend discussing your concerns with a board-certified dermatologist or plastic surgeon. They can evaluate your situation and suggest a tailored treatment plan, which may include adjusting Botox techniques or exploring other options.

Remember, each individual's response to treatment can vary, and a personalized approach is often the most effective.

Best of luck with your treatment journey.

Tulsi Kotecha, MD · Answer

Hi! It sounds like you’re dealing with static wrinkles rather than purely dynamic ones, which is why Botox alone isn’t fully addressing your concerns.
 Dynamic Wrinkles - Caused by repeated muscle movement (like frowning). Botox works well here by relaxing the muscles to prevent deeper creasing.
Static Wrinkles → These are present even when your face is at rest and are due to collagen loss, skin thinning, and deep-set lines (11s). Botox alone won’t erase these completely.
To address static wrinkles - we need to build collagen in that area. Consult with your doctor about Smoot PDO Threads to lift and build collagen in that area.
Also, men typically need higher Botox doses than women due to stronger facial muscles, so precision matters! 96 units are more than plenty for that area to soften the wrinkles if they were dynamic.

Men’s Botox for the 11s (photo)

Answers (13)

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