Do I have to treat glabellar every time with forehead?

Question

My first time with Botox I had a very pushy consultant who tried to keep pushing more but I had done some research before and really didn’t think that I needed much for my first time. They injected so much Tox into the Glabella area that it froze completely which was NOT the results I wanted. I only went to treat forehead lines but know both areas need to be treated together. My question is: when going for forehead touchup, does Glabella need to be treated again if it is still not moving?

Jason Emer, MD · Answer

​For glabellar lines (or frown lines / "11" lines), we inject Botox, Xeomin, or Dysport into the muscle, causing the muscle to weaken and improving the appearance of the lines. These work by binding to receptors that send nerve signals for muscles to contract. Since your body makes new receptors and neurotransmitters all the time, it needs to be maintained otherwise the wrinkles will slowly return as the muscle regains function over time. Neurotoxins take 2 to 4 weeks to start working and lasts for up to 6 months.

For deeper glabella lines or strong 11s, I use a combination of Botox with fillers, lasers and microneedling with PRP. I suggest getting a formal evaluation with an experienced cosmetic dermatologist and expert in lasers and fillers. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question.  No you need not treat the glabella at the same time as your forehead. The decision is up to you.

Nelson Lee Novick, MD · Answer

I have been injecting Botox for cosmetic reasons since 1991. First, Botox can and should be injected to treat the areas that the individual finds problematic. That means if the forehead is the problem, yes, it can be selectively treated without touching other areas. It's absolutely NOT an all or nothing treatment modality. Second, no experienced physician injector these days (and for at least the past fifteen years) tries to freeze any area; it simply does not look natural and natural results are the goal. After all, if you look at young children, they can freely emote, but when at rest, the forehad and area between their eyebrows are smooth. And that's the current goal of Botox treatment.--natural looking results. Finally, if one encounters a "pushy" consultant, that should be reason enough not to seek treatment there. A consultant is just that: an experienced injector who works with you to understand your goals and to set realistic goals, but certainly not to push you in any particular direction, such as doing more than you want or can afford. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Best of luck going forward.

Vibha Gambhir, MD · Answer

In short, yes. When treating the forehead lines, botox has the ability to cause heaviness in the forehead causing the brows/eyelids to lower. To combat this, and to give the brows a nice lift, the glabellar portion needs to be treated.

Camille Cash, MD · Answer

No, you do not need to treat the glabella with more Botox if it is not moving.  You can elect to treat the forehead only.  Botox treatments are adjusted by the injector to fit each patient's individual needs.

Douglas Taranow, DO, FACOS · Answer

Simple answer.
ONLY TREAT THE AREAS THAT BOTHER YOU!  
Not the areas that bother your injecting surgeon (nurse/NP/PA...)
Best wishes.
Dr. Taranow

Kurt Kuhlman, DO · Answer

We frequently treat the glabella at the same time we inject the forehead to help prevent the medial brow from dropping, but this certainly is not necessary. In fact if low dose Botox is injected in the mid and upper forehead, the glabella does not need treated at all.

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!Botox is a neurotoxin which temporarily paralyzes the muscles into which it is injected, usually lasting 3-4 months or so. Replenishment is required when muscle function begins to return. Unfortunately it appears that your glabellar paralysis outlasted your forehead injections. If you undergo forehead treatment alone now, your glabellar wrinkles may return before your forehead wrinkles, meaning more frequent visits to your provider as you will out of sync. You can either wait a bit longer to allow return of function to the glabella before scheduling your forehead treatment to "re-sync" your appointments, or pursue treatment of each area separately as needed.Best wishes...

Do I have to treat glabellar every time with forehead?

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