Botox only in the glabella area? Or in the whole forehead? (photo)

Question

Hi, I have very light wrinkles between my brows and I went to see a specialist who recommended (as a preventive measure) botox injections but with the choice to inject it in the whole forehead (including the glabella area) or just the glabella area. Of course, the last option is less expensive. I was wondering which option was more recommended? Can injecting only my glabella area mess up my facial expression? Thanks! Chloe

Jason Emer, MD · Answer

A formal evaluation would be necessary to determine which treatments would benefit you most. Botox / Dysport / Xeomin would definitely help with the glabellar / 11 lines. Additionally, many of my patients use Botox as a preventative measure to soften the appearance of premature facial wrinkles on the forehead, eyes (Crow’s Feet), chin, nose, and even neck bands/lines.The amount of injection is really a matter of expertise. Too high a dose gives a "frozen," unnatural look but gives a longer result. Too little a dose and very little change is seen. So there is an art to injection placement and dosing for each person; it must be customized. I suggest getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Monica Boen, MD · Answer

It is your choice to either treat just the glabellar lines or address the forehead at the same time. If you don’t see noticeable horizontal lines on the forehead when you raise your eyebrows, you do not have to treat both areas. Make sure you are working with a board-certified cosmetic dermatologist that is also a Botox expert to ensure the treatment you receive will give you the best possible results.

Francis Johns, MD · Answer

Thank you for your question.If you have never had botox done before, I would recommend just starting with the glabella area. Once you see the results, then you can always add more. Otherwise, if you do both at the same time and do not like the result you have to wait for it to wear off.

Julia Ann Sullivan Miller, MD · Answer

Since your wrinkles are very mild, my general advice is less is more, especially since you have never had injections of Botox before.  Start off with the glabella for your first treatment.  If you are happy with your appearance you can always add in the forehead at a subsequent treatment.  You can always do more but you cant do less!

Thomas Trevisani, MD · Answer

Physical exam is essential. You can always treat glabella first and if indicated and desired- you can treat forehead at a later time.

Thomas J. Walker, MD, FACS · Answer

Injecting the glabella with Botox will have 2 benefits: wrinkle reduction and elevating the medial eyebrow. A forehead injection can help with wrinkle reduction but possibly drop the eyebrow down if not done carefully and by an experiences injector. I suggest you see an experienced injector for a consultation. You could always start with the glabella and judge the result after 10-14 days to see whether or not you would still like to treat your entire forehead. Best wishes,

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  Based on your narrative you can seek treatment into the glabellar region alone, without the need for the forehead.  This will not mess up any areas of facial expression, except for the one being treated.  Hope this helps.

Camille Cash, MD · Answer

Based on the submitted photo it appears that a little Botox in the glabella is all that is indicated.  To keep skin healthy focus on a great skin care routine.  Use medical grade skin care products like Transform MD and wear sunscreen every single day.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph Independent9000. 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.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
A common misconception is that Botox is only for those who are in their 60's or 70's. On the contrary, I have a lot of patients in their 20's who receive Botox. This is either for prevention or for those who have expressive faces. I find that the younger one is when one starts receiving Botox treatments the more signs of aging will be delayed. In other words, Botox can be used to prevent wrinkles from either appearing in the first place or from getting deeper over time.
If I had a patient who looked like the person in this photograph, I would want to see the entire face before making a recommendation, but I would likely recommend a global approach as described above.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!

Carmen A. Traywick, MD, FAAD · Answer

Everyone has unique expressions. We move our facial muscles in a repetitive way and over time those repetitive movements cause wrinkles and fine lines. When you start to experience the signs of aging, Botox are available to diminish unwanted wrinkles and creases in your face.Botox lock the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox essentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-7 days with results that can last anywhere from 3-4 months.Botox be used to improve:Worry lines in your forehead Lines between the eyebrows Smile lines Laugh lines from nose to mouth Crow’s feet