The vertical “11s” between the eyebrows, also called glabellar frown lines, age a face faster than almost any other crease. They catch shadows, project tension, and pull the brow downward. When someone tells me they are tired of hearing “Are you upset?” even on a good day, I usually find the answer in those muscles between the brows. Properly placed botox injections can quiet the scowl without flattening your expressions. The key is thoughtful assessment, precise dosing, and practical aftercare.
This is a walk through the full process I use in clinic, from the first glabella squeeze to the last check of symmetry at your follow-up. I will lay out how botox works in this area, what to expect from the botox procedure, how to tailor units to your anatomy, the common pitfalls, and what the botox before and after timeline generally looks like.
What is being treated when we talk about “11s”
The “11 lines” form where a group of muscles converge: mostly the corrugator supercilii and procerus, with help from the depressor supercilii and small fibers that tether the skin. The corrugators pull the brows inward, the procerus pulls them down. Together they create vertical creases that set in with time. If you frown while reading texts or squint in the sun, those lines deepen faster.
Botox for glabella works by temporarily reducing nerve signals to these muscles. Over two to seven days, the muscles relax, so the skin stops folding repeatedly. If the creases are mostly from movement, they often soften dramatically. If they are etched in, botox helps, but may need support from skincare, microneedling, or fillers for deeper grooves. I discuss botox vs fillers daily for this area. Botox treats the cause, which is muscle activity. Fillers address the result, which is a dent or crease. In the right hands, the two can complement each other, but botox for wrinkles here is the anchor.
How botox behaves in the glabella
The glabellar complex is small but powerful. It is also near critical structures, including vessels that supply the skin and the levator palpebrae muscle that lifts the upper lid. That proximity explains why technique matters. A superficial deposit too close to the brow tail can drift and weaken the lid elevator, causing a temporary droop. Too little or too lateral product can leave a “scowl remnant.” Too deep and you can miss the target fibers. The risk of botox gone wrong is low with an experienced injector, but the glabella is unforgiving when shortcuts are taken.
You will see the first changes at day two to three, with full botox results at day seven to fourteen. Function returns gradually at week eight to twelve for most people, and by three to four months you are due for botox maintenance if you want to keep lines from re-etching. Some patients hold closer to five months, some return closer to ten weeks. Muscle mass, metabolism, and dose all affect how long botox lasts.
The initial botox consultation and assessment
Good outcomes start with a clean look at your anatomy. I ask you to frown hard, look surprised, and smile. I palpate the corrugators to feel their bulk and direction. I mark dimples that appear, not generic “map points.” A tall forehead, low brows, or existing asymmetry change the plan. If your brow is already low, you might benefit from a slight botox brow lift laterally to balance the relaxation in the midline. If you tend to recruit your frontalis (forehead elevator) to keep the eyes open, we go gentle on the frontalis, or we defer forehead treatment entirely at the first visit to avoid brow heaviness.
We also review your medical history. Blood thinners mean a higher chance of bruising. Recent illness or active infection means we wait. Pregnancy and breastfeeding are exclusions. If you have a history of eyelid ptosis, I adjust placement. If you have migraines, we discuss how glabellar botox can sometimes help, though formal protocols for botox for migraine involve broader patterns and higher units. My emphasis is safe, predictable botox treatment, not chasing every potential benefit in one session.
Dosing that respects your muscle strength
“How much botox do I need?” is the most common question. For the glabella, typical total dosing ranges from 10 to 25 units, sometimes up to 30 in very strong, male patients or those with thick corrugators. Many clinical trials on botulinum toxin type A for the glabella use 20 units as a standard. I consider that a good benchmark, then adjust for sex, muscle mass, and response history. For baby botox or preventative botox in younger patients with faint lines, I may start at 8 to 12 units and add more at a touch up if needed.
I resist the temptation to split the difference with a “one size fits all.” Under-dosing can leave lines partially active, creating odd patterns. Over-dosing or injecting in the wrong vector can overly flatten expressions or, worse, relax the wrong fibers. If someone has very deep etched lines at rest, I explain that even perfect dosing won’t erase them immediately. We can stage care: botox first, then minor skin resurfacing or a drop of filler after two weeks if there is a persistent crease. Clear expectations reduce disappointment and improve botox reviews because the before and after is aligned with reality.
The day of the botox procedure
Numbing cream is optional for the glabella. Most patients rate the discomfort at two to three out of ten. Ice works well. I clean the skin thoroughly, often with an alcohol or chlorhexidine swab, and map injection points while you actively frown to highlight the muscles. I place small amounts per site, keeping the needle perpendicular where safe, and superficial enough to capture the target fibers. The procerus usually takes a small central dose; the corrugators get a medial and sometimes lateral point, tailored to your anatomy.
A common pattern uses five points across the glabella. That pattern is a starting point, not a rule. An injector who never deviates from a five-dot template is likely missing subtleties. If you have asymmetric lines, I may weight units unevenly. If you have a short forehead or low-set brows, I keep my lateral corrugator injection higher to avoid diffusion near the levator palpebrae.
The injections take three to five minutes. Tiny wheals can form at each site and settle within thirty minutes. You can drive yourself home. Makeup can go on after a few hours, ideally with clean brushes.
Immediate aftercare that matters
Once the injections are done, two goals guide aftercare: minimize bruising and keep the product where it was placed while it binds. Most diffusion happens within the first few hours. You do not need to freeze in place, but give common-sense support.
Short, simple aftercare checklist:
- Stay upright for four hours. Skip strenuous exercise for the rest of the day. Avoid rubbing or massaging the treated area. Hold off on facials, saunas, or steam rooms for 24 hours. Use ice in short intervals if you notice swelling or mild botox bruising.
This is one of the two lists in this article. It saves headaches later. If you forget and do a spin class that evening, it does not guarantee a problem, but it nudges the odds the wrong way. Blood thinners, red wine, and supplements like fish oil raise bruising risk. If you bruise, it fades in a few days and can be covered with concealer. Arnica helps some patients, but evidence is mixed.
When does botox start working and what to expect
You may feel a “heavy” or “quiet” sensation by day two. By day three to five, the lines soften at rest. Full effect typically appears at day seven to fourteen. Compare photos to avoid second-guessing. People often forget how strong their frown was a week earlier. Good botox for 11 lines reduces vertical creasing and eases the inward pull, but keeps your ability to convey concern or focus in a lighter way.
Some patients come back at day seven and ask for more because they can still make a faint line when they really strain. That is a moment for judgment. More units can push the result from natural to frozen. I prefer a small botox touch up only if the pattern remains caricatured or if asymmetry appears. Otherwise, waiting until the next cycle and maintaining consistent dosing yields smoother long-term botox results.
Durability, maintenance, and timing
How long botox lasts here is usually three to four months. Athletes with higher metabolism sometimes metabolize faster. Men with heavier muscle mass may return closer to ten to twelve weeks at first. If you find that your results fade at eight weeks, increasing your units slightly, up to a safe range, can stretch the interval. If you go too high, you risk a flat brow for a month and still find yourself back in the chair at twelve weeks. There is no prize for the highest dose. Precision beats brute force.
How often to get botox depends on your goals. For soft prevention, twice a year can be adequate. For etched lines you are trying to reverse, every three months for the first year builds momentum, then you can stretch to four months as the muscle weakens and the skin remodels. Skin quality work around the treatment, like sunscreen, retinoids, and consistent hydration, extends your gains.
Safety, side effects, and where trouble hides
Is botox safe? For healthy adults under the care of a trained botox provider, yes. The most common botox side effects are temporary: redness, a small bump at the injection site, a pinpoint bruise, and a mild headache. Headaches can appear within 24 hours and typically settle with rest and hydration. Allergic reactions to the modern formulations are rare. Infection is very rare with proper prep.
The complication to respect is eyelid ptosis, a droop that can occur if toxin diffuses toward the levator palpebrae. It is uncommon when technique is sound, usually shows up at day four to seven, and resolves naturally as the toxin effect fades. Eye drops can help lift the lid temporarily by stimulating a different muscle. Another pitfall is a “Spock brow,” where the lateral brow arches too high if the forehead is treated but the lateral fibers are left too strong. It is correctable with a small additional dose laterally.
Some patients ask about long term effects of botox. With periodic use, the most predictable change is muscle thinning from disuse, which is the goal for overactive frowners. There is no credible evidence that therapeutic cosmetic dosing harms the skin or the brain. Using sterile technique and appropriate intervals keeps risk low. The biggest risk remains inexperience or rushed technique. Choose a botox doctor, nurse injector, or botox specialist who does this daily, not once a week between unrelated services.
Cost, units, and what influences price
Botox cost is either quoted per unit or per area. In the glabella, the unit approach is more transparent. Per-unit prices vary by region and by injector’s experience, often ranging from roughly 10 to 20 USD per unit in many US markets, with boutique practices higher. The total botox price then depends on how many units you need. A standard 20-unit glabella treatment can be a few hundred dollars. Botox unit cost, packages, botox specials, or seasonal botox promotions do appear. I advise focusing less on discounts and more on the injector’s track record. A cheap fix that needs a redo is not a bargain.
If you are searching “botox near me,” read botox reviews but weigh details over star counts. Look for mentions of natural results, clear communication, and careful aftercare. Ask how many glabella treatments they perform weekly. Ask about their plan if you need a small adjustment at day ten. Good botox services build those answers into their routine.
Integrating glabella treatment with the rest of the face
Treating the 11s in isolation often helps, but the face works as a system. If you have heavy frowning and also deep horizontal forehead lines, we plan so that frontalis remains strong enough to keep the eyes open. Sometimes that means staging: glabella first, forehead at a lighter dose two weeks later. If crow’s feet are prominent, softening the lateral orbicularis can complement the improvement between the brows. For patients seeking a subtle lift, a tiny lateral brow dose can counterbalance the muscle relaxation in the center. When done thoughtfully, botox for forehead, botox for crow’s feet, and a chic botox brow lift blend into natural facial rejuvenation, not a “done” look.
For those with bruxism or tension, botox for masseter and botox for TMJ can soften a square jaw and reduce clenching. That is a separate area with different dosing and risks, but it often pairs well with a calm glabella for a less stressed expression. If hyperhidrosis is an issue, botox for excessive sweating in the underarms or hairline can be life-changing. Again, separate patterns and doses, yet part of a whole-person plan. The one area I avoid at the same session as a first-time glabella patient is aggressive forehead dosing, to minimize brow heaviness while we learn how your muscles respond.
Special considerations: men, first timers, and prevention
Men often have thicker corrugators and need 20 to 30 units for the glabella to achieve a natural reduction in movement. I avoid over-flattening, which can look unnatural on a strong brow. Many men want to retain some frown capability for intensity in the boardroom or on camera. We calibrate by starting at the lower end of effective dosing and adjusting at the touch up.
First time botox patients benefit from a conservative start. You should still see a clear change, but we learn your anatomy and response. That first cycle sets your baseline. Photos, both animated and at rest, guide adjustments next time. Preventative botox in your late twenties or early thirties targets early dynamic lines before they etch in. This usually means smaller, well-placed doses at longer intervals. The benefit is compounding: less folding now means fewer lines to chase later.
Comparing brands: Botox vs Dysport, Xeomin, Jeuveau
All are botulinum toxin type A formulations. Differences lie in accessory proteins, diffusion characteristics, and unit equivalence. Some injectors find Dysport a touch faster in onset in the glabella, others prefer the predictability of onabotulinumtoxinA. Xeomin is a “naked” toxin without complexing proteins. Jeuveau is another modern option. In practice, when dosing is adjusted appropriately, botox results are similar across brands. If you have had a great response with one, staying consistent has value. If you experienced a short duration or a heavy feel, a brand switch or a pattern tweak can help. The best brand is the one your injector knows well and can deploy precisely.
When botox is not enough and what to add
If you have deep, etched 11 lines that persist at rest even after a full cycle, a small amount of hyaluronic acid filler can level the groove. This is advanced terrain. The glabella has vessels that do not forgive mistakes. Filler in this area should be done only by a seasoned injector with a cautious technique and, ideally, ultrasound guidance. Often we can avoid filler by softening over several botox cycles and improving skin with retinoids, gentle peels, or microneedling. If a crease still reads as a shadow on Zoom calls, a conservative filler pass can finish the job.
Patients sometimes ask about botox alternatives. For movement lines, alternatives are limited. Skincare and lasers help skin quality; they do not turn off a corrugator. Microcurrent, facials, and face yoga feel nice but cannot match the predictability of neurotoxin. If needles are off the table, focus on sun protection, habit changes like wearing sunglasses to reduce squinting, and topical retinoids. The gains will be smaller, yet real.
A realistic timeline: from first visit to steady-state
Most patients experience this arc. At day zero, the shots sting a little, ten minutes total visit time. That evening, the skin feels normal. Day two to three, the frown weakens. Day five to seven, the 11s look softer and the “resting scowl” disappears in photos. Weeks three to eight, it feels seamless, and makeup sits Great site smoother. Weeks nine to twelve, movement creeps back. If you schedule your next botox consultation at the ten to twelve week point during your first year, we stay ahead of re-etching. After a few cycles, many stretch to fourteen to sixteen weeks without losing ground.
Small choices that improve results
Two practical details help deliver natural results. First, keep your frontalis honest. If you habitually lift your brows to counter a strong glabella, treating only the glabella can reveal a habit of forehead scrunching. A light polish of the upper forehead later can balance this without dropping the brows. Second, watch lighting. Harsh downlighting exaggerates lines. Good skin care and lighting can enhance the perceived botox benefits and the satisfaction you see in photos.
Who should treat you and how to vet them
A qualified botox provider can be a physician, physician assistant, or nurse injector with focused training and frequent practice. Ask about their experience with botox for 11 lines specifically, not just “botox for face.” Ask to see botox before and after photos, ideally of patients with similar anatomy to yours. Inquire about their plan for follow-up and whether a minor adjustment at day ten is included. Advanced credentials are great, but good judgment, anatomy fluency, and a calm injection room matter just as much.
If you are tempted by botox deals or botox specials today you saw online, pause and verify the clinic’s qualifications. Promotions can be legitimate, particularly during slower seasons, but your result is only as good as the hands and eyes guiding the syringe. Quality usually costs what it costs. Look for transparency in botox price, clear documentation of botox units used, and sensible scheduling for your botox recovery and check-in.
Rare scenarios and edge cases
Some patients barely frown but have etched 11s from decades of squinting. They may need fewer units, yet still benefit from consistent maintenance to keep the lines from rebounding. Others have a very low brow position at baseline. Aggressive glabella dosing can make the brow feel heavier in these cases, so I mix in a gentle lateral brow lift to keep the balance. For those with previous eyelid surgery or a history of ptosis, I keep injections high and midline, avoiding the lower lateral corrugator entirely, and accept a softer reduction rather than chase absolute stillness.
If you are on a tight timeline for an event, plan backward. Since peak result is around two weeks, schedule your botox services roughly three weeks before photos. That allows one week for any small touch up. Trying to squeeze a first-time botox procedure into the week of a wedding invites stress. Steady planning beats scrambling.
A compact plan for your first 11s treatment
Step by step for a smooth first experience:
- Book a consult with an experienced injector and bring photographs that show your typical expression under normal lighting. Avoid alcohol and high-dose fish oil for 24 to 48 hours pre-treatment if bruising is a concern, after clearing with your doctor. Treat the glabella with an individualized dose, expect a 5 to 10 minute session, and follow the simple aftercare checklist above. Check progress at day seven to ten, discuss any asymmetry or residual strain, and consider a small, targeted touch up if warranted. Plan maintenance every three to four months for the first year, plus daily sunscreen and nighttime retinoid for skin quality.
This is the second and final list in this piece. Everything else belongs in the nuance of conversation with your injector.
Final thoughts drawn from the chairside view
The best botox for frown lines does not erase your personality. It softens a habit of expression that no longer serves you and lifts how rested you look without pulling the strings too tight. Respect the anatomy, dose with intent, be patient through the first two weeks, and keep the maintenance sensible. If you ever feel pressure to add more “just because,” pause. Great work often looks like restraint.
When the glabella is calm, eyes appear more open, and the face reads friendlier. That small change ripples across daily interactions, from a kinder look on video calls to fewer “Are you okay?” comments in the hallway. The technique behind it is simple on paper and exacting in practice. With a skilled botox expert and a little planning, those 11s can step out of the spotlight and let your expressions do the talking again.