Glabellar Botox isn’t flattening the area between my eyebrows: quite the opposite. Why does this keep happening? (photo)

Question

I get glabellar Botox a few times a year and every time, without fail, it wears off at approximately the six to eight-week mark. I could live with that if only the area between my eyebrows was flat for at least the first six weeks but the problem is it never lies flat. It always seems bumpy and lumpy, as pictured. Does anyone know why this keeps happening? I have been getting the BOTOX injections from an experienced plastic surgeon, not a random injector. Thank you for reading.

Ramandeep Sidhu, MD · Answer

if you are getting botox from an experienced injector and you are doing it regularly then might be its time for the filler in the area to clean up the deep wrinkle and then continue with botox.

Ron Shelton, MD · Answer

If you can still make some muscle movement and bring the eyebrows together or see contraction of the muscle bulges getting bigger in the mirror then you know you haven't had enough units of Botox for your specific muscle thickness.  If however, the muscles are quiet when you try hard to contract, then it means that Botox is not enough for you. Some people do have filler injected there but there is a risk of blood flow compromise and worse even blindness from fillers injected into the glabella (and other facial areas). I often find that those people who have such an issue do not keep up their Botox treatments regularly enough and with time that lapses after the Botox wears off, the muscles start contracting again so that there isn't a chance for the muscles to remain flat and have less of a groove between them. There are people whose Botox wears off at 8 weeks and in those cases, I would recommend every 8 week Botox for several sessions to keep the muscles quiet and see over a year if there is flattening before considering a filler. Also some cases won't look good with a filler trying to fill in the groove between the muscles as it may only serve to raise the groove and create more of an unnatural fullness in between the eyebrows.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Michael I. Echavez, MD · Answer

I would recommend using a filler in addition to the Botox to treat your glabellar region.  Botox will help to relax the muscle, but you also have some depressions in the area.  A filler could be injected to help with this issue.  I would discuss this option with your plastic surgeon.

Shaun Patel, MD · Answer

It would be helpful to see before treatment photos as well as photos of your glabella at rest and with animation. It is possible that you require a higher dose of Botox or Dysport. Alternatively, you may now need add filler to the glabella, in addition to the Botox, to get the result you are looking.

Glabellar Botox isn’t flattening the area between my eyebrows: quite the opposite. Why does this keep happening? (photo)

Answers (8)

Answer: Botox results

Answer: Botox results

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Glabellar Botox isn’t flattening the area between my eyebrows: quite the opposite. Why does this keep happening? (photo)

Answers (8)

Answer: Botox results

Answer: Botox results

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.