Using 25 Units Max In The Glabella, What Are The Best Spots For Botox Injection?

Question

I would like to know excatly where best for injections of botox for glabella only region, no forehead. Would they be slightly different when forehead not being treated?

Harold J. Kaplan, MD · Answer

This question is best answered when the patient is being evaluated at the time of the treatment. Animation, gender, treatment goals, use of other facial muscles etc. are factors that are taken into consideration.

Richard Baxter, MD · Answer

Botox and Dysport work by relaxing hyperactive muscles of expression such as the "corrugator" muscle that causes the vertical furrows between the eyebrows. This region is often referred to as the glabella, but in terms of Botox dosing and placement it is important to understand that it is the muscle that is injected, not arbitrary surface landmarks or regions. An expert injector asseses the size and activity level of the muscle as well as its specific anatomy in each patient. Another factor that is considered is the fact that these muscles overlap so getting the balance right requires individual analysis.

Matthew Schulman, MD · Answer

I find this question a bit puzzling. I am all for patients being informed and knowledgeable, but it seems odd that a patient would be asking for specific dosing and injection site information. If this question is coming from a physician looking for technique instruction, then there are more appropriate ways to learn this,

Colin Pero, MD, FACS · Answer

It is important that you have an experienced doctor evaluate you in order to achieve the results you are looking for. If you have a particularly low-set brow, care must be taken not to further drop the brow. Treatment of the forehead at the same time will definitely change one's strategy based on the interplay of the two areas with regards to brow position. That being said, I typically treat with 20-25 units divided between the midline, head of each brow, near a line even with the medial limbus (inside edge of colored part of eye) at top of brow, and top of brow even with pupil. That is average, but there can be considerable variation in location and dosage depending on muscle bulk, strength, brow position, etc. This isn't for the person without proper training...

Boris Volshteyn, MD, MS · Answer

When treating the glabella region with Botox, 2 groups of muscles are injected. The procerus muscle creates a horizontal line across the bridge of the nose. The corrugator muscles lie somewhat parallel to and above the eyebrows and create vertical lines between the brows. On average 25 unitsis used with 1 injection to the procerus and 2 injections to each corrugator muscle for a total of 5 injections.

Daniel I. Wasserman, MD · Answer

25 units can definitely be helpful to most patients, however, everyone is different.  I have some patients that require 35 units to the glabella and anything less results in significant persistance of the lines.  So while 25units is a great go to dose, it may not be what you need. 

	Furthermore, where can depend on each patient as well.  some patients recruit from farther out on the forehead laterally for muscle movement, while some people are much more central.  So without any pictures or a formal consult it would be difficult to provide you with the exact answer you are looking for.  I hope this helps.

Kyle S. Choe, MD, FACS · Answer

Botox is best used for expressive or dynamic facial lines.  The upper one-third of the face is perhaps the most popular place for Botox injections. Glabella is a region of the forehead between your eye brows. There are three muscles that contributes to either vertical and/or horizontal lines in this region. One of the muscles called the procerus runs vertically while the other two paired muscles called corrugators run obliquely.

Botox should be injected into these muscles. Having a firm understanding of the anatomy is crucial for optimal results with Botox. I often have my patients animate to see the best place for injection. Be careful not to get too close to the brow or else you run the risk of upper eyelid droop or decent of the brows.

Sumit Bapna, MD · Answer

To treat just the glabella (vertical lines near the head of the brows and the horizontal line at the top of the nose), 25 units of Botox should be enough to get 3-4 months of correction. The doses should be placed directly between the brows (near the top of the nose), near head of each eyebrow, and then finally just above the pupils where the top most hairs of the eyebrow are. My dosing strategy is 5 units in the procerus muscle (the middle injection) and 10 units in each corrugator muscle (clubhead and mid eyebrow injection). The 10 units are divided for each side so that 6 or 7 units are placed in the clubhead of the brow and 3-4 units in the tail of the muscle or midbrow. Each patient is different, so there can be variances in the dosing and placement of injections.

Using 25 Units Max In The Glabella, What Are The Best Spots For Botox Injection?

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