Glabella lines 2017-10-19T11:21:41+00:00

Glabella lines

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The best way to figure out whether your specific condition can be treated or not is to give us a call. We can answer any questions you have and help you clarify which treatment options might be suitable for you.

There are different treatment options available for this condition and the most common ones are listed below:

Learn more about treatment options

Glabella Lines Condition

Glabella lines are the short vertical lines found between the eyebrows and extending up the central forehead for a centimetre or so.

They are often the first wrinkles to appear on the forehead even as early as the mid 20’s. They make the person look older and slightly angry.

Initially glabella lines are intermittent, only apparent when the person frowns. These are called dynamic lines. With time the glabella lines gradually become deepened and more permanent so that there is always a static element present.

Glabella lines are particularly deep looking because the skin in the glabella is thick compared to the eyelid skin at the outer end of the eyes which is very thin and develops the finer wrinkles called crow’s feet.

Glabella lines are created by the dynamic action of the underlying muscles, the corrugator supercilliaris, the procerus and the depressor superciliis. When these muscles are well developed they pull the central ends of the eyebrows inwards and a downwards, causing the furrows.

Glabella lines are sometimes called No. 11 furrows as they are line parallel lines.

Depending on each person’s musculature, their angle and shape can vary.

Ageing gracefully:

As the person gets older, other lines can appear such as the horizontal forehead muscles, from frontalis muscle lifting the eyebrows upwards, often when there is excess upper eyelid skin. The crow’s feet at the outer corners of the eyes develop in the early to mid-30’s. If these lines are all in balance, many people don’t mind and are happy to age gracefully, especially if the overlying skin is healthy and of good quality.

Medical conditions:

People with medical conditions such as thyroid eye disease where the eyelids look very open or retracted, can have particularly deep central glabella lines as they are trying to pull their eyebrows.

People with sensitive dry eyes and any form of blepharospasm can use their glabella muscles more and get deeper glabella lines.

External factors:

People exposed to high levels of sunlight, smokers, pollution, can have worse glabella lines. Even mood can worsen the glabella lines as a truly angry person constantly frowning will indeed have more glabella lines.

However, having glabella lines does not mean the person is angry, and that is one reason treatment is so often sought, as the face is giving false interpersonal signals.

Symptoms

Glabella lines make the patient feel tired and angry. The effect of constantly contracting the glabella muscles contributes to headaches and central forehead heaviness.

Cosmetically the glabella lines make the patient look angry or cross.

The glabella lines also make the upper face look heavy as the muscles to the sides of the lines bunch up instead of looking refined, open and relaxed.

  • The peri-orbital area is the first place people look as they look at your eyes
  • An open relaxed appearance is attractive

Many people change their hairstyle to hide the glabella and forehead lines.

Can my upper eyelid blepharoplasty be sutureless?

Examination

At Clinica London the Oculoplastic surgeon does an aesthetic assessment and listens to what bothers you about the glabella lines, how the face has changed, how the lines make you feel. Then they examine the area around the eyes, called the peri-ocular or peri-orbital area, including the forehead muscles, eyelid closing muscles and your facial expressions.

In order to work out what the best treatment plan is a drawing is made on which the glabella and other lines are marked and the treatment planned.

Treatment

If you are happy with your glabella lines, then nothing needs to be done and you your face to grow older gracefully and harmonically. You can practice relaxing the glabella muscles, wear dark glasses, keep the eyes and eyelids healthy and avoid dry eyes and photophobia.

The mainstay of treatment is Botox (botulinum toxin A) injection and dermal filler such as Restylane.

Botox

Injection of botulinum toxin A into the glabella muscles paralyses their downward and inward muscle action which produces the angry looking glabella lines.

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The botulinum toxin is given as Botox, Azzalure, Dysport or Xeomin as 2 to 5 small injections into the muscle, in a pattern specific for each person’s musculature.

Great care is taken to avoid “Dr Spock” or “Mephisto” appearance with the characteristic change in eyebrow shape, arched towards the outer ends. This can be avoided by a tiny injection into the mid outer forehead muscle on each side to counteract the effect.

Whenever injection the glabella lines, there may be other areas that also require rejuvenation such as the crow’s feet or lateral outer brow to give a lateral brow lift and open up the eyes aesthetically.

If the glabella lines are kept relaxed by regular botulinum toxin injections, the deep vertical glabella lines will become less noticeable and fewer new ones will form.

Treatment is aimed at “softening” or reducing the lines and not giving a “frozen look” so we always start by using small doses and work out what best suits the patient. If a small additional amount is required, this is given within a week to ten days of the original injections.

Botulium toxin is a reversible neuromodulating agent, which takes 5 to 8 days to work then gradually diminishes its actions over the ensuing three months. The treatment then needs repeating.

  • Many younger patients start using Botulinum toxin in their late 20’s or early 30’s as a way to prevent glabella lines advancing. This is called glabella line prophylaxis.

How Botox works

Botox injections temporarily paralyze muscle activity. This toxin is produced by the microbe called clostridium botulinum, and is used in very safe tiny doses to stop the action of the muscle end plate, making the muscle inactive for up to three months.

The onset of action is within 5 to 8 days then gradually wears off. You can experience a slight frontal headache in the first few days after injection and before the full effect.

Botox medical track record

Botox injections are noted primarily for their ability to reduce facial wrinkles. They are also used to treat medical problems such as neck spasms (cervical dystonia), excessive sweating (hyperhidrosis), overactive bladder and lazy eye muscles causing squint. Botox injections help prevent many people with troublesome migraines. Botulinum toxin was first used medically at the start of the 1990’s for eye muscle squint correction.

Botox is a product trade name. Other products include Dysport, Azzalure and Xeomin. Each differ in dose units.

Prescription only

Botulinum toxin used for glabella lines is a prescription only drug.

  • The oculoplastic surgeon assesses and prescribes

Botulinum toxin injections

  • Full signed consent for treatment is obtained
  • All injections are done in the clean treatment room under sterile conditions. Clinica London is Care Quality Commission registered
  • Injections are by the oculoplastic surgeon or the Clinica nurse under supervision of the doctor
  • Topical anaesthetic cream is not required
  • Using room temperature botulinum toxin and cooling of the skin at the propsed injection site reduces discomfort

Dermal Filler Restylane

  • Deep static element of glabella lines are treated with dermal filler

If the glabella lines are particularly deep and do not disappear with botulinum injections, they can be filled by a dermal injection of Restylane with Lidocaine or Perlane with Lidocaine

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Well done and thank you! You saw me last November for my annual RP assessment. You recommended to see the Glaucoma unit which I duly attended last week. (There was a delay because I had a cataract op in February)I do indeed have glaucoma as well as RP. Thankfully glaucoma is likely to be treatable with drops, so now at last the deterioration in my sight may be least partially arrested. I hope you will recommend to the retinal team that all RP suffers are tested for Glaucoma at fitting intervals. Yours sincerely, Edmund S.”
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