Glabellar lines are treated according to what causes them: botulinum toxin when the crease shows only as you frown, a skin booster for fine lines and texture, and laser or radiofrequency for surface firmness. A deep groove that remains after you relax your face is usually filled with filler, but the glabella is a high-risk site where filler that blocks a blood vessel can cause loss of vision, and the U.S. Food and Drug Administration recommends against injecting filler there.
At a glance
Each of the four options targets a different factor: expression muscles, volume, texture, or surface firmness.
The first risk to understand with glabellar filler is tissue death, blindness, and stroke from a blocked vessel.
Botulinum toxin makes frown lines less visible for a time.
Do glabellar lines come from expression or from the skin?
When you frown, the muscles between the eyebrows fold the skin into a vertical crease. Fold the same spot often enough and a groove remains after you relax your face. A line that appears only while you frown and a groove that has already set can show up together on one glabella. Texture that stands out without a deep groove points to fine lines. Skin that has loosened is a firmness problem.
Draw the eyebrows together, then relax and look at the same spot. A line only while you frown points to the expression muscle. A groove that stays when you relax points to volume. Texture without a groove points to fine lines. Loosened surface skin points to firmness.
If you see both, note each depth separately. Depth that increases only while you frown belongs to the expression muscle. Depth that stays after you relax is the groove. Texture changes without a groove are fine lines. Compare a relaxed face and a frown in the same window light to see the difference. Writing only “glabellar lines” lumps four different treatments into one plan.
Horizontal forehead lines and eye-area lines use different muscles. For how to choose, see forehead wrinkle prevention and eye-area wrinkle care.
What do Botox, filler, a skin booster, and laser do between the eyebrows?
Botulinum toxin is an injectable drug that keeps muscles from tightening. The U.S. Food and Drug Administration names Botox, Dysport, Xeomin, and Jeuveau for facial lines and treats them as products other than fillers. Filler is a gel placed under the skin. Approved uses include facial wrinkles such as nasolabial folds and volume in the lips, cheeks, chin, and the back of the hands. For how the drug and the gel differ, see Botox versus filler.
Fillers the body later absorbs include hyaluronic acid, a sugar found in the body; a calcium material that is also a major part of bone; and a synthetic material the body breaks down. The one filler that is not absorbed suspends tiny plastic beads in a collagen solution taken from cows. Its approved sites are the nasolabial folds and acne scars on the cheeks. How filler settles depends on the shape of the tissue underneath, the amount placed, and the material. Products with an ingredient from an animal are checked for allergy before injection.
A skin booster is an injection that places ingredients for texture and fine lines. GOURI, a PCL skin booster, and Juvelook, a PDLLA+HA skin booster, belong to that group. For ingredient differences, see skin booster types. Energy devices such as lasers, radiofrequency, and focused ultrasound deliver heat without cutting the skin. Ulthera HIFU lifting uses focused ultrasound. Thermage FLX uses radiofrequency.
| Treatment | What it does | When it changes, and how long | Downtime | Main risk | Which glabellar line |
|---|---|---|---|---|---|
| Botulinum toxin | Keeps expression muscles from tightening, so lines show less | Most people see a change in 3–7 days, lasting about 3–4 months, sometimes longer | Back to daily life right away. A bruise, if one forms, lasts about 1 week | Drooping eyelid or brow. Rare trouble swallowing or breathing | Vertical lines that appear only when you frown |
| Filler | A gel that adds volume to wrinkles and grooves | How long it lasts depends on material and site. Absorbable gels need repeat treatment | Common swelling and bruising settle over days to weeks. Itching, rash, and tenderness are also common. Reactions can also appear weeks, months, or years later | If it enters a vessel: tissue death, blindness, stroke. The glabella is outside approved use | FDA recommends against glabellar injection |
| Skin booster | Places ingredients in the skin for texture and fine lines | Varies by product | Reaction at the injection sites | Product-specific injection reactions | Texture and fine lines, rather than a deep groove |
| Laser or radiofrequency | Heat for the skin surface and firmness | Varies by device | How long redness lasts differs by device | Heat response | Surface fine lines and firmness |
※ How long a change lasts, and how large it is, differs by product, dose, and skin.
How do a toxin injection and a filler injection differ on the day?
In a single visit, a small purified dose of botulinum toxin is injected into the expression muscles. The American Academy of Dermatology says you can apply makeup after you leave the room.
Filler is a medical procedure that places gel under the skin. The U.S. Food and Drug Administration says to use a licensed clinician with experience in dermatology or plastic surgery. Ask about that training and about experience placing filler in the face. It is injected with a needle or a blunt-tipped cannula. Products bought online, self-injection, needle-free devices, and liquid silicone are the subject of warnings. Confirm three things that day: the product name, the injection site, and the patient information leaflet. Materials differ, so reviewing filler types beforehand makes the product name easier to check.
A skin booster is also placed through injections in the skin. Laser and radiofrequency do not stop a muscle or fill a groove. A device handpiece delivers heat.
What are the vessel-warning signs, and who should not be treated?
If filler enters a blood vessel, blood flow stops. The U.S. Food and Drug Administration lists tissue death, vision injury, and stroke as results. The risk is low, but when it happens the injury is serious and can be permanent. In a published case review, the high-risk sites were the nose, glabella, forehead, and nasolabial folds. The symptoms that showed up most often were vision loss, pain, trouble moving the eye, and a drooping eyelid. No single treatment reliably restored vision.
The U.S. Food and Drug Administration says to get care immediately if the signs below appear during the procedure or shortly after it.
| Sign | What it looks like | What to do |
|---|---|---|
| Vision | Blurred vision or loss of vision during the procedure or shortly after | Emergency care immediately |
| Skin color | Skin near the injection turns white, gray, or blue | Emergency care immediately |
| Pain | Unusual pain during the procedure or shortly after | Emergency care immediately |
| Stroke | Sudden trouble speaking, weakness in the face, arm, or leg, trouble walking, a drooping face, severe headache, dizziness, or confusion | Emergency care immediately |
The U.S. Food and Drug Administration does not recommend cosmetic botulinum toxin injection during pregnancy or breastfeeding. Clinical reports include facial weakness and pain, swelling, and redness at the injection site. Rare reports include double vision and dry eyes. Approved filler use is for adults 22 and older. Safety has not been established under that age, during pregnancy or breastfeeding, or in people prone to keloid or hypertrophic scars. Treatment should wait until any inflammation or infection has cleared. Tell the clinician about any bleeding disorder or severe allergy before the procedure.
What determines the cost?
Botulinum toxin is given again when the line returns, so the number of sessions sets the fee. Material and amount set the filler fee, ingredient and session count set the skin-booster fee, and the device and the area set the laser or radiofrequency fee.
Combining two on the same day adds to the bill. The U.S. Food and Drug Administration states that the safety of using filler with botulinum toxin, and of repeatedly using filler over a long period, has not been evaluated in controlled clinical studies.
What home care comes before and after treatment?
Daily care at home is moisturizer and sunscreen. Apply moisturizer after washing, and sunscreen before going outside. Ultraviolet light speeds skin aging.
The American Academy of Dermatology says that on the day of botulinum toxin you should not rub or massage the treated skin so the drug does not spread to other muscles, should apply makeup gently without pressing, and should wait 2 hours before exercise that raises your heart rate.
What do you check in the mirror?
A resting face and a frown are the only two views you need.
- □ Under the same light, look at a resting face and a frown, and write whether the line appears only with expression or remains after you relax.
- □ Mark the one change that bothers you: expression line / resting groove / texture and fine lines / surface firmness.
- □ Write down pregnancy or breastfeeding, skin inflammation or infection, a bleeding disorder, and severe allergy.
- □ Mark whether you expect to repeat treatment when the line returns, or plan to have it only once.
- □ Write down whether moisturizer and sunscreen are already part of your daily routine.
Frequently asked questions
Q1. Will Botox leave me without expression?
The American Academy of Dermatology describes the aim as weakening the targeted muscles while preserving a natural expression. Sensation in the treated skin remains. Drooping of the brow or eyelid has been reported when a neighboring muscle is also weakened.
Q2. What happens when the line comes back?
When the line returns, the next treatment date is set. With repeat treatment the muscle can thin, and the effect sometimes lasts longer.
Q3. Can I be treated with botulinum toxin bought online?
The American Academy of Dermatology says botulinum toxin bought on the internet can harm your health.
Q4. How is filler that is already in the skin reduced?
Reducing or removing filler requires further injections, surgery, or other procedures. Permanent filler, and materials other than hyaluronic acid, can be difficult or impossible to remove.
Q5. Can laser replace botulinum toxin for frown lines?
Laser and radiofrequency deliver heat into the skin. Stopping the frowning muscle is the job of botulinum toxin.
Sources
- U.S. Food and Drug Administration: Dermal Fillers (Soft Tissue Fillers)
- U.S. Food and Drug Administration: Dermal Filler Do's and Don'ts for Wrinkles, Lips and More
- American Academy of Dermatology: Botulinum Toxin Therapy: Overview
- American Academy of Dermatology: Botulinum Toxin Therapy: FAQs
- Beleznay K et al. (2019), Aesthet Surg J: Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature (PMID 30805636)
This article provides general information and does not replace personal medical care.
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