Is There a "Secret" Injection Technique for Botox for Frown Lines?

I had Botox for 6 years from 4 different doctors. Only one (an oculoplastic surgeon) has been able to immobilise my frown muscles. I went to him for several years. With the others any effect was gone in 2-14 days no matter how many units they injected (50 in one case). I noticed that the oculoplastic surgeon injected much closer to the eyes. I now have an otherwise fantastic dermatologist and don't want to use multiple doctors - but he can't get my frown muscles immobilised. He tells me I need a filler to fill in the frownline.

Doctor Answers 13

Sometimes a person needs Botox and a filler to get the best results for frown lines

After 6 yrs you may now need both botox or dysport and a filler to achieve the results you want. 8-10 tiny shots in an area tends to give a better result than 3-5 bigger injections.


Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 35 reviews

Frown line options

Thank you for your question. The frown lines between the brows can be address two different ways:
1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest. The effects typically last 3-4 months depending on the dose. I generally use between 15-40 units of Botox (30-120 units of Dysport) in the frown area depending on the strength of the muscle and the degree of frown reduction we are trying to achieve. Also, I have found many patients report that certain injectors cannot get the frown lines to stop moving.  This is very likely due to technique variations amongst injectors coupled with a inadequate understanding of the patient's individualized anatomy.
2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression. This can last for a year or more when used in conjuction with Botox.
For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together.
I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.

The technique needed to be effective changes from patient to patient and in each patient over time.

I have been usihg botox since before it was released for cosmetic use.

Interestingly, patients will sometimes over time  learn to frown using more of their orbicularis muscle closer to the eyelids rather than the forehead muscles.  This makes it more difficult to quiet their frown making it important to inject parts of the orbicularis muscle.

Other patients will have so much loss of tissue under their frown lines that a filler must be used to get a good result even if the botox has worked very well to stop their muscle motion. Typically we do the botox first and then bring the patient back for the injection so that the material stays in position because the frown has been reduced.

Dr. Mayl

Fort Lauderdale

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon
4.5 out of 5 stars 7 reviews

No Botox secrets

Botox results are very technique-dependent. It seems as though you want total immobilization from your Botox injections, though most people do not. Also, sometimes fillers are useful to supplement Botox since Botox will not fill out a facial crease. However, the bottom line is that if your dermatologist cannot satisfy your goals you should return to the oculoplastic surgeon.

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.5 out of 5 stars 16 reviews

Precision Botox injecting comes with experience

There isn’t a secret to good injection technique. There is however a significant difference in the understanding of facial and perioccular anatomy form one injector to the other.

Surgeons with experience in occuloplastic surgery are working with the orbicularis muscle and perioccular tissues on a daily basis. The ability to precisely inject these muscles comes with experience.

Your occuloplastic surgeon, who is intimately familiar with the mucles near the eye area, may be comfortable injecting closer to the eyes than other physicians, who are concerned about creating eyelid droop.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 93 reviews

Effectiveness of Botulinum toxin for frown lines

The problem with injecting that close to the eye is that you risk eyelid drooping. This is the likely reason why the other physicians are avoiding this. Botulinum toxin tends to last from 3-5 months. It is strange that you state you are only experiencing a 14 day response.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 72 reviews

Botox injections

There is a certain level of expertise involved in getting the results that patients want.  This usually requires a thorough exam and discussion with the patient about their goals.  Injectors can be different in technique - if you were happy with the oculoplastic doctor, then perhaps you should go back to that doctor.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 23 reviews

Botox for frown lines

if you had success with the treatment from only one of those doctors, you might want to see that doctor again, even if it is an inconvenience for you, because if that doctor can not provide you with the result you wish any longer, than you know not to keep chasing the effect. On the other hand, if that doctor once again injects Botox preventing you from frowning, you would know not to have the filler done. Keep in mind, that injecting closer to the eye, especially in the vertical plane that crosses the pupil, may increase your risk of lowering your upper eyelid and that can last three months or more.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 37 reviews

Secret methods - not really

Not everyone is looking for that frozen look. Occasionally it is necessary to also help the eleven lines with filler. I have developed a patent pending Mirodroplet Botox method that permit injecting in the eyebrow area which permit a much better forehead lift effect than can be achieve with other methods. The method is well described on my web site: www.lidlift.com. The method is not secret but has not been widely published and I am only working on the book to describe the method.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

Everyone is different

There are profound differences in how patients frown. Some use more of the corrugator muscle, others the procerus. Some people have long corrugators, others short, and others recruit from the nasalis muscle. In addition, after 6 years, you likely do have additional skin aging and may, indeed, need a little filler for the lines. In summary, give your current dermatologist a try. Touch-ups at 2 weeks, and a little experience doing you more than once, may make it a perfect relationship.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 13 reviews

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.