Botox: safe injection points for frown lines (glabella)

Injection points can often seem similar between practitioners, yet different approaches and techniques are always used by different aesthetic injectors. With only millimetres to differentiate the injection sites, the impact that these differences can have on the aesthetic outcome for the patients can vary wildly.

In this blog, Dr Tim Pearce explores three different injection points when treating the glabellar area or frown lines with Botox® (botulinum toxin), the benefits and downsides of each, and the anatomy to consider so you can reduce complication risk and create the best results for your patients.

To be among the first to receive exclusive updates on the launch of Dr Tim’s new movement, featuring an immersive 3D learning experience, comprehensive Botox lessons, and much more, simply sign up here to join the priority waiting list.

Good and bad injectors

The area of the upper face, above the eyebrows and into the glabellar region is the most common location for injecting botulinum toxin to reduce lines and wrinkles. When you begin your career as an aesthetic clinician, you will start to understand the significant impact that small movements in your needle placement make on the result, and this will ensure that you become a wiser injector. Dr Tim notes that the difference between someone who is well-trained and someone who is not is that a badly trained person knows where to inject, but a good injector knows what the result will be when they inject in a slightly different place. Understanding the impact, wherever you inject, will make you more likely to inject accurately.

Injection point one: above the corrugator insertion point

This injection point (as you can see from the illustration) is above the insertion point of the corrugator muscle.

The corrugator muscle insertion point is often visually confused with bunching occurring above the muscle on contraction, explains Dr Tim. If you have a look at a person who is frowning strongly, you will often see a bunching of the tissue above the insertion point of the corrugator. This bulge is deceptive and looks a little bit like the bulge created to indicate a muscle belly.

Unfortunately, as Dr Tim points out, many injectors (and trainers) are mistaken and will inject into this point, whereupon they are placing the dose into the frontalis muscle. Sadly, even with a low dose, this will likely cause a medial brow drop, in a high percentage of patients, when the aim is brow elevation. It might improve horizontal forehead lines, but that is not the aim in this instance.

Injection point two: in the tail of the corrugator

Moving down approximately 5 to 8mm will place the injection point in the insertion point of the corrugator muscle.

The corrugator inserts directly into the dermis, and you should see this on the surface of the untreated patient’s skin. A small dent should be visible, formed on frowning, just above the mid-pupillary line or slightly lateral to it, manifesting as a small shadow with a couple of small boomerang-shaped creases adjacent.

This point – the tail of the corrugator – is a great place to deliver botulinum toxin to decrease lines and wrinkles. By being accurate, you should not affect the frontalis or the orbicularis oculi muscle. Dr Tim recommends a low dose of one to two units of Botox.

Injection point three: the orbicularis oculi

The next injection point to discuss descends a further 5 to 8mm lower, placing the needle in the orbicularis oculi muscle.

The orbicularis oculi muscle is often treated with botulinum toxin when the aim is to lift the eyebrow. Most commonly, we achieve the best benefit for lifting an eyebrow laterally, but you can treat more medially and get a little bit of a lift, explains Dr Tim. However, there will be a problem if you go too deep, he warns.

By going too deep, you will no longer be treating the orbicularis oculi muscle but will have passed through it, through the orbital membrane, and be within the zone of residence of the levator palpebrae muscle, within the orbit. Injecting at this point, depending on the depth of the injection, will therefore very likely result in eyelid ptosis.

Read up on eye anatomy to prevent eyelid ptosis from BOTOX® plus how to identify and fix eyelid ptosis caused by Botox injections.

How can you tell you are safe when anatomy varies by patient?

Dr Tim concluded that understanding the core principles of anatomy is vital, but knowing how to apply them to each unique patient face in front of you is the crucial part. Every face will give you clues about the patient’s individual anatomy, the most important of which will be the insertion points of the muscle and the position of the crease(s) that follow on from that muscle when it is contracted.

As you study their face, you can relate treatment to the individual, performing precise injection points to help them based on the broad anatomical principles you already understand.

Read up on injecting the glabella: Botox injection points & safety advice for additional guidance on treating the glabellar area and brush up on upper face muscle anatomy and how to avoid Botox side effects.

Similarly, you can download Dr Tim Pearce’s 26 essential injection patterns for botulinum toxin.

Dr Tim is always keen to hear about the experiences of his followers and guide newer practitioners with educational content. So, if you have any questions, case studies, or discussion points for him, you can find Dr Tim Pearce on Instagram.

Aesthetics Mastery Show

The best Botox injection points for frown lines

Dr Tim says:

“In this episode I discuss the differences between 3 injection points that are fairly close in proximity but will produce wildly different results. It’s important to know that small movements make big differences and the impacts they have so that you can create beautiful results for your patients.”

Watch the full Aesthetics Mastery Show here.

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BOTOX (Botulinum Toxin) eLearning Courses

If you want to increase your confidence in botulinum toxin injections, or learn how to avoid and handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:

• BOTOX® Foundation Course
• Botulinum Toxin Complications Mastery

Both give CPD and certificates on completion.

In addition, browse our FREE downloadable resources on complications.

3D anatomy learning experience movement

In the next few weeks, Dr Tim Pearce is going to be launching something amazing that involves an incredible 3D learning experience for injectors, a community of clinicians on the same mission as you to help you achieve your goals, and exclusive online access to him and his team, to help you become a pro injector. Be the first to join the movement by joining the priority waiting list.

Botox® is a registered trademark of Allergan Aesthetics plc.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.