Injections for frown wrinkles
Frown line injections is one of the most popular procedures at our Sydney clinic. We use muscle relaxing injections to relax the frown lines to make the patient look less angry.
Frown lines aka glabella frown lines are the vertical lines which appear in your forehead when you’re expressing a negative emotion like, anger, frustration, concern or worry. Some people use these muscles when they are concentrating.
When a person frowns, they often use a combination of muscles including the corrugator and procerus and orbicularis oculi muscles. Over time, with regular frownline, these lines etch in permanently and are there even when the person is not frowning. Often there is a genetic component, which predisposes the person to etching these lines in deeply.
Muscle relaxing injections are the first line treatment for frown lines, dermal fillers can also be used to enhance the effect.
TREATMENT OF FROWN LINES
The first line treatment for frown lines is antiwrinkle injections (due to Australian regulations, we are not allowed to name the drugs used) and if the line or fold is present at rest, then dermal filler may be considered.
Small injections using a very fine needle are performed to the frown area into the muscles which cause the frown . Somewhere between 3-7 injections will be performed
The consultation for antiwrinkle injections for frown lines
History-taking is very important in the treatment of frown lines. The following should be explored:
- Is there a genetic component? ie are there others in the family who have a strong frown line at an earlier age? How has this progressed?
- Has the patient had treatment before? Were they happy every time? Did the effect of the antiwrinkle injections last well
- Which area came back first?
- How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
- Is it the vertical frown line, or the horizontal line between the brows which are bothering the patient
- Have they every had any complications, eg eyelid droop or eyebrow droop or strange smile etc
- Does the patient want a more natural frown lines treatment, with some movement left, or do they want the maximal effect possible?
The injector will examine the face and frown line. In particular, she will look at many features, such as:
- Where the lines are.
- Whether there is any eyelid droop or asymmetry
- Whether the frown line/fold is etched in at rest.
- The type of skin, whether there are a lot of large pores near the frown line.
Choosing the number of units for the frown lines treatment dose
The doctor will assess the face and decide on the best dose after taking a history and examining the patient.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen. Males will need a greater dose than females in general due to larger muscle size
Pain relief during treatment
A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Most patients do not bother with numbing cream because it takes so long to work and because the treatment isn’t very painful anyway.
Ice is often used to decrease pain and to reduce the risk of bruising.
Nitrous oxide / Happy gas is available to patients
If the patient requires dermal filler, then local anaesthetic may be injected in the area of the frown line first
What happens during the frown line injections treatment itself?
The following procedure is used for frown lines treatment with injectables
- The face will be cleaned with alcohol and chlorhexidine
- Ice will be applied to the area briefly before treatment
- The doctor will inject approx 3-7 sites around the middle of the forehead above the brows, injecting in the muscles which cause frowning.
- Then pressure with gauze will be applied.
The procedure itself takes less than 5 minutes.
Side Effects and risks of antiwrinkle injections in frown line
In general, treatment of the frown line with muscle relaxing injections is very low risk. Risks include:
- Headache happens in around 10% of new users.
- Bruising occurs in a significant number of cases.
- Asymmetry: Often one side is better treated than the other, this is usually because the patient is asymmetrical to start with.
- Patient needs a higher dose to achieve loss of complete movement
- Infection is a very rare complication, but always a possibility when the needle goes into the skin.
- Eyelid droop and eyebrow droop are possible risks with treatment of frown lines. It is very uncommon and in our practice below 0.01% over the last decade which is much lower than the stated rate. The risk increases with larger dose
Please see scientific research on the topic of wrinkle injections for frown lines including side effects.
After frown line injections
Instructions for care afterward
Follow these instructions after frown lines treatment:
- No makeup for 4 hours
- No massage that day
- No heavy exercise that day
- No lying down for 4 hours
- Lots of frowning is suggested for a few hours
- Avoid acid face products for 24 hours
What to expect after frown line injections?
Sometimes there is nothing to see immediately after frown lines treatment. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolve quite quickly.
Most people could come during their lunch break during work and go back without their coworkers noticing anything
The effect of the injections will not start to occur for 2-8 days.
The maximal effect of the drug will be at 4 weeks, so a review should be booked in at 4 weeks (only after the first treatment, for subsequent injections, a review appointment shouldn’t be required).
What if I am worried that the result isn’t enough at some time before the 4 week point?
You should wait until the maximal effect occurs at 4 weeks before reviewing. Reviewing before this time is pointless, as the effect will continue to improve.
What do I do if at 4 weeks post treatment I still have movement?
This is not uncommon, it really depends on the amount of movement and the look you are going for.
Patients often come in and they only have 5% of movement left and are concerned about this. We believe that a little bit of movement is not a bad thing! There are no lines when there’s 5% movement, just a small amount of movement. You don’t look older or worse in any way. I fact, you will look slightly more “natural” with more movement. We would like patients to move away from complete loss of movement as their goal. The goal should be to look younger and more attractive.
However, it is up to the individual, and further treatment can be performed at 4 weeks.
What to do if at 4 weeks after the treatment all of my movement has gone but I still have an etched in frown line or fold?
If after stopping the movement in the frown line and there is still a deep fold, dermal filler for the frown line or threads can be considered at this stage. We would recommend several muscle relaxant treatments before considering dermal fillers in this area.
How long will the treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
Typically this is what happens:
- At 4 weeks, there is a maximal effect
- At 8 weeks, movement starts to return
- At 12 weeks, 50% of movement should be back
- At 16 weeks 80% of movement should be back.
With an adequate dose, for most patients, this is very close to what occurs.
When should I have my next treatment for frown lines?
Patients should be retreated when the movement is between 50%-80% back ie sometime from 3-4 months.
Some patients have treatment every 8 weeks because they do not like any movement at all