How to get rid of frown lines: does botox smooth them all?
Your family asks, “Why are you angry?” You are not angry, but your face looks stern. I hear this very often as the reason people come in about frown lines. This spot may look simple, but there are clear things to be careful about.
The short answer
Frown lines that catch when you frown suit botox well. But a deep crease that stays at rest may not smooth out fully with botox alone. A meta-analysis of 14 randomised trials (8,369 people) on the forehead, glabella and eye area confirmed the effect, and when all three areas were treated together, it took about 182 days for the effect to wear off. When filler is used for deep creases, I take particular care with the blood vessels. In an ultrasound study, 41% of 74 wrinkle lines had a vessel right on the line. I could not find a human study on a lasting effect of frown line patches. At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700, I look at your expressions and sort the lines with you.
Why do frown lines form?
They are lines folded by the muscles that pull the brows inward and down (the corrugator and procerus). After thousands of folds, a mark stays even when you relax. So at first they show only when you frown, and at some point they begin to show on a neutral face too.
I also often get asked, “Can I fix it by breaking the frowning habit?” Folding less seems like it would help, but I could not find a comparative study showing that changing the habit reduced wrinkles. If you frown because of glare or because your glasses are not right, sorting out sunglasses and glasses seems to me a first step you cannot lose by. That too is my opinion and not something a study has confirmed.
Which approach suits my frown lines?
| State | Look at first | What not to expect |
|---|---|---|
| Vertical lines only when frowning | Botox | They can fade to almost nothing, but expression movement drops with them |
| Faint lines on a neutral face | Botox, then look again at 2 weeks | Instant disappearance |
| Deep creases on a neutral face | Botox plus a discussion of dermal treatment | Full smoothing from botox alone |
| Thin fine lines and texture | Sun protection, retinoids, skin boosters | Less muscle movement |
I have you make the expression several times, then show you which lines the muscle is making and which creases have already settled in. Muscle size and strength differ from person to person, so I do not simply use a set number.
How well does botox work between the brows?
The glabella is a typical area on botox’s approved list. In the meta-analysis, the effect was confirmed in all three areas, and when they were treated together it took about 182 days to wear off. That is a number from inside trials, so in practice I generally talk in terms of 3 to 4 months.
Movement usually starts to decrease at 2 to 3 days and peaks at 2 weeks. So please do not look at day 3 and decide it did not work. We check both sides and your expressions again at 2 weeks, and we keep at least 3 months between sessions in the same area.
I will not hide the adverse reactions either. In a meta-analysis of 20 randomised trials, the glabella had 1.42 times the adverse reactions of placebo. Most are reactions like bruising and headache that pass with time, but if the drug spreads, an eyelid can droop in rare cases. If one eyelid visibly droops or your vision changes, do not count the days. Contact us.
Can filler go into a deep crease between the brows?
I answer this one carefully. The glabella always comes up when people talk about filler complications. In a literature review of 365 new reports of vision loss after filler, the glabella accounted for 19.0%, and of the 318 cases with a recorded visual outcome, 68.2% did not recover their sight. It is rare. Even so, this is not an outcome to wave away with the word rare.
An ultrasound study shows clearly why it is risky. When 74 wrinkle lines in 42 people were examined by Doppler, 30 of them (41%) had a vessel right on the line. The research team did not put filler into those 30. Wrinkles can look identical on the surface and still differ underneath.
So for the glabella, I first rest the muscle with botox, watch how it goes, and then talk about what remains. If you have severe pain, a change in skin colour or a change in your vision during or right after injection, you need to tell us immediately.
→ More: Vascular occlusion: a rare complication to know about first
What about frown line patches and creams?
A frown line patch stops you from frowning while it is on and presses the skin. The line may look fainter for a while in the morning, but I could not find a human study showing the effect lasts. If your skin is not sensitive, I will not talk you out of it. Still, it is better to let go of the hope that a patch will remove a deep crease.
Creams are for texture and fine lines. Tretinoin has a double-blind trial of 99 people over 48 weeks, and sunscreen has a trial of 903 people over 4.5 years. A cream cannot stop a line that the muscle is folding.
Frown lines: frequently asked questions
Do frown line patches work?
They press the skin while they are on, but I could not find a human study showing the effect lasts after you take them off. It is hard to expect a deep crease to go away.
How long does botox between the brows last?
I generally reckon on 3 to 4 months. In trials it took about 182 days to wear off when the forehead, glabella and eye area were treated together, but in practice it varies from person to person. We keep at least 3 months between sessions in the same area.
Is filler between the brows dangerous?
Vascular complications are rare, but this is a spot where they need care. Of 365 reports of vision loss, the glabella accounted for 19.0%, and in an ultrasound study 41% of wrinkle lines had a vessel right on the line.
Where can I get a frown line consultation in Daegu?
At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
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Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Meta-analysis of forehead, glabella and eye area — Rahman E et al. The Efficacy and Duration of Onabotulinum Toxin A in Improving Upper Facial Expression Lines. Aesthet Surg J 2023;43(2):215-29. PMID 36099476. 14 randomised trials, 8,369 people.
- Meta-analysis of botox adverse reactions — Zhang W et al. Meta-Analysis of Adverse Reactions of Botulinum Toxin A in Facial Rejuvenation Treatment. Aesthetic Plast Surg 49(9):2305-14 (online December 2024). PMID 39623228. 20 randomised trials.
- Literature review of vision loss from filler — Doyon VC et al. Update on Blindness From Filler. Aesthet Surg J 2024;44(10):1091-104. PMID 38630871. 365 new reports, September 2018 to March 2023.
- Ultrasound study of glabellar vessels — Lee W et al. Safe Glabellar Wrinkle Correction With Soft Tissue Filler Using Doppler Ultrasound. Aesthet Surg J 2021;41(9):1081-9. PMID 32644130. 42 people, 74 wrinkle lines.
- Topical retinoids — Griffiths CE et al. Arch Dermatol 1995;131(9):1037-44. PMID 7544967. 99 people, 48 weeks.
- Randomised sunscreen trial — Hughes MCB et al. Ann Intern Med 2013;158(11):781-90. PMID 23732711. 903 people, 4.5 years.
- Korean medical advertising law — Korean Medical Service Act Article 56(2) (no treatment testimonials, no comparisons with other clinics, no superlatives). This is why this column carries no prices, reviews, before-and-after photos or doses.
- Miso Clinic practice guidelines — Miso Clinic botox materials: target muscles by area; lines sorted by having you make expressions; dose planned by muscle size, strength and left-right difference; review at 2 weeks; at least 3 months between sessions in the same area; approved uses explained first.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.