Your Guide to Glabellar Botox: Side Effects, How It Works and More

Ever looked in the mirror and noticed vertical lines between your brows? These frown lines, also called glabellar lines, are a common source of concern as they can make you look permanently tired or angry. Luckily, there’s a solution: glabellar Botox.

Botox for Frown Lines

Botox Cosmetic (onabotulinumtoxin a) is a form of botulinum toxin type A developed by Allergan. It’s a purified protein used as a cosmetic treatment to target specific facial muscles, temporarily relaxing them. This relaxation smooths wrinkles and creases formed by repeated muscle contractions.

While Botox is the most well-known, other neuromodulators FDA-approved for cosmetic injections include Jeuveau, Dysport, Daxxify and Xeomin. Each uses a slightly different formulation of the botulinum toxin, but all work in essentially the same way to reduce facial wrinkles such as crow’s feet, forehead lines and today’s topic–glabellar lines.

How Botox treats glabellar lines

Glabellar lines are the vertical lines nicknamed “elevens” that often appear between the eyebrows. Understanding the muscles that create these frown lines is key to appreciating how glabellar Botox works.

The glabella is the area between your eyebrows where the corrugator supercilii and procerus muscles reside. These muscles contract every time you frown, furrow your brow, or squint. The corrugator supercilii muscle, located deep within your brow, is a pyramid-shaped muscle responsible for pulling your eyebrows down and together, creating that characteristic frown. Every time you furrow your brow in concentration or scrunch your face in confusion, the corrugator supercilii contracts. 

Right next door lies the procerus muscle, originating near the bridge of your nose and inserting between your eyebrows. This muscle plays a role in wrinkling your nose and contributes to the formation of vertical lines between the eyes. When you squint or frown intensely, the procerus muscle contracts alongside the corrugator supercilii, deepening those unwanted frown lines. Over time, these repeated muscle contractions can leave permanent creases etched into the skin–usually in the form of two vertical lines, giving them the nickname “elevens”.

Botulinum toxin injections target these muscles, relaxing them and reducing their activity. This smooths the appearance of frown lines, leaving you with a more youthful and relaxed look. Studies show high patient satisfaction with glabellar Botox, as it effectively addresses these lines without drastically altering facial expressions. 

What’s It Like to Get Glabella Botox?

Before diving into the world of smoother brows, a thorough consultation with your chosen injector is essential. This initial meeting allows you to discuss your goals and expectations and for the injector to assess your candidacy and suitability for Glabellar Botox. 


During the consultation, your medical history will be reviewed, including any pre-existing conditions or medications you’re taking. It’s also important to discuss your sun exposure habits, as excessive sun can accelerate wrinkle formation. 

Transparency is key, so don’t hesitate to express your desired results. Whether you want a complete smoothing of frown lines or a more subtle softening, your injector can tailor the treatment plan accordingly. They will also discuss potential side effects, ensuring you understand the risks and benefits involved. 


Once you’ve decided to move forward, the procedure itself is a relatively quick and minimally invasive process. First, the treatment area between your brows will be thoroughly cleansed to minimize the risk of infection. Your injector may use a marking pen to identify precise injection points targeting the corrugator supercilii and procerus muscles. 

The actual injections involve using a very fine needle to deliver small amounts of Botox into the designated areas. The needles are incredibly thin, and most patients tolerate the procedure well. However, if you’re concerned about discomfort, a topical numbing cream can be applied beforehand. 


Following the injections, a cold compress may be applied to the area to minimize any potential swelling or redness. The entire procedure typically takes less than 30 minutes.

Very minimal downtime is involved, and you can resume most daily activities immediately after the procedure. Some patients may experience slight redness, swelling, or bruising at the injection sites. These side effects are typically temporary and resolve within a few days.


The full results of your Botox injections typically take a week to appear. You’ll notice that the area between your brows appears smoother, and it may be difficult or impossible to furrow your brows. These results typically last 2–3 months.

Possible Side Effects of Glabellar Botox

While Botox is a safe and well-tolerated treatment, it’s important to be aware of potential adverse events. The good news? Most side effects associated with glabellar Botox are temporary and resolve on their own within a few days.

Temporary side effects

Although the overall incidence of adverse effects after Botox injections is low, they can happen. The most common side effects experienced after a glabellar Botox treatment are mild and localized to the injection sites. These may include:

  • Redness: Temporary redness at the injection site is very common and typically disappears within a few hours.
  • Swelling: Minor swelling (edema) may also occur, but it usually resolves within a day or two.
  • Bruising: Bruising is less common but can happen, especially if you take blood thinners or have sensitive skin. These bruises typically fade within a week.
  • Flu-like symptoms: These are a rare side effect possibly caused by the body’s temporary reaction to the injection, similar to a mild upper respiratory infection.

These temporary side effects are usually manageable with simple home care, such as applying a cool compress to the area. If you experience any discomfort, over-the-counter pain relievers like acetaminophen can also be helpful. However, it’s important to avoid taking medications like aspirin or ibuprofen before your treatment, as these can thin the blood and increase the risk of bruising.

Possible serious side effects 

While uncommon, more serious adverse reactions can occur. Here’s a breakdown of some potential concerns:

Brow or eyelid ptosis (drooping)

In rare cases, the upper eyelid may appear slightly droopy after treatment. This can happen if a small amount of Botox unintentionally migrates from the injection site and affects the levator palpebrae superioris muscle, responsible for eyelid elevation. Similarly, if injections are placed in the brow muscles, you may experience brow ptosis. 

In the rare instance of a droopy eyelid occurring, it’s important to remember that this is a temporary side effect. The effects of Botox typically wear off within 3-4 months, and the drooping eyelid or brows will resolve on its own.


Headaches can occur after glabellar Botox, though the exact cause is not fully understood. Some theories suggest it might be related to temporary muscle weakness or slight dehydration after the procedure. Thankfully, these headaches are usually mild and temporary, often resolving within a day or two. Over-the-counter pain relievers can help manage any discomfort. Staying hydrated after the procedure is also a good practice.

Facial asymmetry 

While uncommon, facial asymmetry can occur if the Botox injections are not placed precisely on both sides of the face. This is another reason why choosing a skilled injector with experience in facial anatomy is crucial. They will have the expertise to ensure balanced injections for symmetrical results.

Blurred vision

Blurred vision is a rare but potential side effect following glabellar Botox. It occurs when the neurotoxin migrates to nearby eye muscles, causing temporary muscle weakness. 

Like other temporary side effects, blurred vision associated with Botox typically resolves on its own within a few days to a week as the effects of the treatment wear off. However, if you experience any vision changes after Glabellar Botox, it’s important to contact your injector right away. They can assess your situation and advise on the best course of action. In most cases, no intervention is needed, and your vision will return to normal as the Botox wears off. However, your injector can provide reassurance and monitor your progress.

Dysphagia (trouble swallowing)

This side effect of Botox is more commonly associated with injections made into the neck to sculpt the jawline or for the treatment of cervical dystonia, a condition causing painful muscle spasms. Should this occur, contact your provider immediately. 

Dry eyes

Dry eyes and dry mouth, though uncommon, can be temporary side effects of Botox. Dry eyes are more likely after injections around the crow’s feet near the outer corners of the eyes, as these muscles help produce tears. Dry mouth can occur after injections targeting the masseter muscle in the jaw, which can unintentionally affect nearby salivary glands. Thankfully, these effects are usually mild and resolve on their own within a few days. 

Allergic reactions 

Allergic reactions to Botox are extremely rare. However, it’s always a good idea to discuss any allergies or sensitivities you may have during your consultation. If you experience severe swelling or difficulty breathing after getting Botox, seek medical attention immediately.

Long-term effects

Extensive research has shown no known long-term side effects associated with Botox when used appropriately by a qualified medical professional. The effects of Botox wear off gradually over time, typically lasting 3-4 months. If you choose to maintain your results, you can schedule follow-up treatment sessions.

Importance of a qualified injector

We’ve emphasized the importance of choosing a qualified injector throughout this post, and for good reason. A skilled injector such as a plastic surgeon, dermatologist or experienced licensed aesthetician can significantly minimize the risk of side effects and ensure optimal results. They will take the time to understand your goals, discuss your medical history and perform a thorough assessment to determine your candidacy. Furthermore, their expertise in injection techniques ensures precise placement of Botox, minimizing the risk of complications like ptosis or asymmetry.

Who Shouldn’t Get Glabellar Botox?

While glabellar Botox is a safe and effective treatment for many, it’s not suitable for everyone. Here are some factors to consider if you’re unsure about your candidacy:

  • Pregnant or Breastfeeding: Botox is not recommended for pregnant or breastfeeding women due to a lack of safety data on potential effects for the developing baby.
  • Underlying Medical Conditions: Certain medical conditions related to the nervous system, such as myasthenia gravis and Lambert-Eaton myasthenic syndrome, can make Botox potentially risky. It’s important to disclose any pre-existing medical conditions during your consultation with the injector.
  • Allergy to Botox: Allergic reactions to FDA-approved Botox are extremely rare. However, if you have a known allergy to botulinum toxin type A or any ingredients in the Botox formulation, you should avoid this treatment.

Glabellar Botox vs. Alternatives

While Glabellar Botox is a popular and effective treatment for frown lines, it’s not the only option. Let’s explore some alternatives:

Alternative neuromodulators

The world of aesthetics offers other injectable neuromodulators with similar results to Botox. These include:

Dysport: Like Botox, Dysport (abobotulinumtoxinA) is a purified form of botulinum toxin type A used to relax muscles and smooth wrinkles. It works similarly to Botox, targeting the same muscles and achieving comparable wrinkle reduction, particularly for frown lines. The main differences lie in their onset and duration of action. 

Dysport may work slightly faster than Botox, with results noticeable within a few days, while Botox typically takes 3-7 days to show full effect. However, Dysport’s effects may also wear off a bit sooner, lasting around 3-4 months compared to Botox’s 3-6 months.

Xeomin: Another alternative is Xeomin (incobotulinumtoxinA), a purified form of botulinum toxin type A lacking certain inactive ingredients. These inactive ingredients do not affect the wrinkle-reducing properties but may slightly reduce the risk of allergic reactions in some individuals already sensitive to those specific additives. In terms of effectiveness and side effects, Xeomin closely resembles Botox, offering temporary relaxation of muscles and wrinkle smoothing.

At-home solutions

Beyond in-office cosmetic procedures, several at-home options can be incorporated into your daily skin care routine to maintain healthy, youthful-looking skin:

Gua sha: This traditional Chinese medicine technique involves using a smooth stone tool to massage the face. Proponents believe it promotes lymphatic drainage, reduces puffiness and improves circulation, potentially leading to a more youthful appearance. 

Wrinkle patches: Worn at night, these silicone patches adhere to the skin, aiming to physically prevent wrinkles from forming while you’re asleep. While they may temporarily smooth the skin’s surface, they can’t prevent muscle contractions made during the day that cause frown lines.

Good skin care practices: Maintaining a healthy skin care routine is crucial for overall skin health and appearance. This includes daily cleansing, moisturizing and sun protection. Using products containing ingredients like retinol or antioxidants may also help reduce the appearance of fine lines and wrinkles over time.

How Often Can I Get Glabellar Botox?

The frequency of your Botox treatments depends on how long your results last. Typically, the effects wear off gradually within 3–4 months. To maintain smooth brows, plan for follow-up treatments before the lines fully return. Consulting your injector is crucial–they can assess your individual response to Botox and recommend the optimal timing for your next session.

Coordination is key if you’re considering Botox in other areas alongside glabellar lines. The generally accepted standard is to not get Botox more often than every 12 weeks, in order to prevent development of antibodies that reduce efficacy. However, new research shows that intervals of 6–10 weeks may be acceptable. 

Discuss your overall aesthetic goals with your injector during the consultation, which will allow them to create a personalized treatment plan that effectively addresses your concerns while ensuring a balanced and natural look.

Can Fillers Treat Glabellar Lines?

Dermal fillers are injectable substances that add volume and lift to targeted areas. However, fillers are not ideal for treating frown lines. Fillers work best for addressing static wrinkles, those lines present even when your face is relaxed. Frown lines, on the other hand, are dynamic wrinkles, caused by muscle contractions. Botox, with its muscle-relaxing properties, is a more effective solution for these lines.

Can Botox Cause Botulism?

The short answer is: it’s extremely unlikely. While Botox is derived from the same bacteria that causes botulism, a serious and potentially life-threatening illness, the two differ significantly in their production and use. Here’s why you can relax (pun intended):

  • Dosage and purification: Botox is a highly purified form of botulinum toxin type A. During the manufacturing process, the toxin undergoes rigorous purification to remove any harmful components. The resulting Botox used for cosmetic purposes contains only a tiny, precisely measured amount of the toxin, far less than what could cause botulism.
  • Targeted injections: Botox is injected directly into specific facial muscles. This targeted approach ensures the toxin stays localized in the treatment area and doesn’t spread throughout the body, unlike botulism poisoning, which can affect various muscle groups.
  • Medical supervision: Glabellar Botox is administered by qualified healthcare providers who understand facial anatomy and proper injection techniques. This further minimizes the risk of the toxin migrating to unintended areas.
  • Safety record: Botox has a long history of safe and effective use both cosmetic procedures and medical applications. It’s used to treat a huge number of neuromuscular disorders, including chronic migraine headaches, hyperhidrosis (excessive sweating) blepharospasm (involuntary eyelid movements) strabismus (crossed eyes) and spasticity (muscle stiffness) caused by cerebral palsy. Extensive research and clinical trials support its safety profile when used appropriately by a qualified injector.

While the possibility of botulism from glabellar Botox is incredibly remote, it’s always a good idea to discuss any concerns with your injector during the consultation. They can address your questions and provide further reassurance about the safety measures in place.


Frown lines can be a source of cosmetic concern, making you appear angry or tired even when you’re not. Glabellar Botox offers a minimally invasive and effective solution by relaxing the muscles responsible for frown lines formation, leaving you with a refreshed and more youthful appearance. 

Remember that like any medical treatment, it’s not without potential side effects. Understanding these temporary side effects and choosing a qualified injector are crucial for achieving optimal results and minimizing risks.
If you’re considering glabellar Botox, the next step is simple: schedule a consultation with a qualified injector!

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