Turn that frown upside down!

Sorry for the delay...I should have posted this on the 3rd...life gets in the way sometimes!

Problem Area: Glabella

Let's talk about your 11's, your brow furrow, your scowl...this is a negative expression that we definitely don't need to express.  When you frown your brow, a couple of nasty things happen...your skin creases and forms vertical and sometimes horizontal lines, your eyebrows pull down and in and make your eye space look smaller, your upper eyelid hoods over your eye opening, and I'm sure there's more but these are the things that I notice when evaluating a patient.  A glabella treatment is perfect for someone who is looking for a little lift to their eyebrows to help take some weight off of their upper eyelids.

The Fix: Neurotoxin

To treat this we would use a neurotoxin to temporarily weaken the muscle contraction.  Botox or Dysport are good choices for this treatment area.  An average dose for females for the glabella is 20 units of Botox or 50 units of Dysport.

The result is not seen immediately.  It takes 2-3 days for the neurotoxin to uptake into the muscle.  The product is completely active at 2 weeks out.  On average, the result lasts for 3-4 months.  I tell my patients to budget for their treatment 3-4 times a year, if they want to keep the results up.  Some patients are able to stretch their appointments out and others have to come in sooner.  Metabolism, skin quality and condition, under-dosing, and overall desired result can have an impact on how often you will have a treatment.

Anatomy Lesson: Procerus & Corrugators

Your procerus, which is a triangle shaped muscle in the center of your face between your eyebrows, is responsible for the downward pull of the brows.  Your corrugators are above each of your eyebrows and take on the shape of a comma that has fibers that flare up and away from the midline of your face.  They are mainly responsible for pulling your eyebrows inward toward the midline of your face.  Together these muscles pull the brows down and in.  Someone with a really strong procerus muscle can develop a horizontal line across the bridge of their nose.  This might be an indication to the injector to dose this muscle up a bit more.  Sometimes there is an asymmetry of the corrugator muscles and one eyebrow might pull in and down more.  If the vertical line on one side is more prominent than the other, this could be an indication muscle asymmetry.  The treatment provider would take this into consideration and adjust the dosing accordingly.

Treatment Pattern: Five to Six Pokes

To successfully treat the glabella, plan for five to six pokes from the injection needle.  One to two pokes in the procerus and two pokes in each corrugator.  The procerus sometimes requires two injection pokes if the fibers that radiate up are strong.  This can be identified during animation of the muscles.  Initially the procerus pulls down and then in the following seconds the muscle expresses upward causing horizontal lines on the forehead in the midline.  In this case you would stack your injection sites on top of each other in an inferior and superior fashion.  For each corrugator, one poke to the belly of the muscle and one poke to its tail.  The belly is medial and is the bulk of the movement.  The tail is expressed by the dimpling of the skin lateral to the belly, which tends to be superior to mid pupil.