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