This 40 year young woman has a deepening cleft between her eyebrows which catches shadow and suggests a frown. Is there a simple answer? Botox is the first answer, possibly followed by a gel filler after two weeks for the ultimate smoothing. The bottom photo was taken 2 weeks after her 30 units of Botox, showing smoothing of the midline frown crease (and some brow elevation, too.)

Why is this even happening? The muscles primarily responsible for the frown lines are the forehead muscles called the corrugators (yes, like the corrugating in cardboard). They sit on either side of the eyebrows, and have a muscle shape similar to your biceps muscle in the upper arm. The corrugator muscles engage with everyday actions like looking at a screen or monitor, or showing concern or intent, or even with the bright light of the sun. In many people, the corrugator muscles have a resting tone which causes the frown lines to bec ome fairly constant.

Botox works to relax the corrugator (frown) muscles and allows the forehead to smooth. This effect takes 5-7 days and lasts 3-4 months. If the furrow between the eyebrows persists even after Botox, we add a gel filler under the skin to plump up the depression. The good news is that when Botox is present to relax the corrugator muscles, the gel filler lasts up to twice as long as there is not muscle action working on the filler.