The frown line is a vertical rhytid — occasionally double or triple — that develops between the eyebrows. It results from repetitive contractions of the corrugator supercilii and procerus muscles, which are responsible for frowning in the glabellar region. Initially apparent during facial expressions (concentration, irritation, stress), it progressively becomes permanent, even at rest, conferring a severe, fatigued, or concerned appearance to the face.
Effective attenuation of this frown line requires understanding its dual etiology: both dynamic (muscular) and static (cutaneous). Currently, multiple therapeutic modalities are available, depending on the depth of the frown line, patient age, muscle tonicity, and skin quality.
Among all methods, botulinum toxin injection (Botox®, Azzalure®, Bocouture®, etc.) is the first-line treatment to reduce the frown line. Its efficacy is based on a precise mechanism: the toxin temporarily inhibits the release of acetylcholine at the neuromuscular junctions, resulting in targeted relaxation of the muscles responsible for frowning.
By neutralizing the activity of the corrugator and procerus muscles, Botox smooths the skin. The effect generally appears within 3 to 5 days, with optimal results after 10 to 14 days. It lasts between 4 and 6 months depending on the patient.
This treatment is particularly recommended for dynamic wrinkles, primarily caused by muscle contraction. It is also used preventively in younger patients, to prevent the wrinkle from becoming permanent.
Beyond aesthetic correction, botulinum toxin plays a preventive role when injected in younger patients, generally between 25 and 35 years old. In these patients, repeated frowning begins to affect the skin, even though the wrinkle is not yet visible at rest.
A low-dose injection partially relaxes the corrugator muscles, without freezing the gaze or altering expression. This preventive treatment, often called “Baby Botox,” significantly delays the appearance of the frown line. It is particularly favored in modern approaches to aesthetic medical procedures, focused on prevention rather than correction.
When the frown line has become static, that is, visible even in the absence of movement, muscle blockage with Botox injection is no longer sufficient. In this case, a hyaluronic acid injection can be considered to fill the dermal defect and improve skin quality. This treatment involves injecting a gel of varying fluidity, depending on the depth of the wrinkle. It must be performed with extreme caution, as the glabella is an anatomically high-risk area, richly vascularized. Therefore, the indication must be determined by an experienced physician. In most cases, hyaluronic acid is used in combination with Botox, once muscle activity has been partially or fully neutralized.
For patients with a mildly marked frown line but dehydrated skin, treatment with Skinboosters can be beneficial. This involves an injection of very lightly cross-linked hyaluronic acid, applied in a layering technique into the mid-dermis, with the aim of restoring skin hydration, improving elasticity, and stimulating collagen production.
This treatment does not directly erase the frown line and does not affect muscle contraction. However, it improves skin quality in the targeted area and is a relevant complement to botulinum toxin injections. It is often offered as maintenance between two Botox sessions, to optimize skin quality and limit the appearance of new creases.
In certain cases, particularly in patients with a pronounced frown line associated with signs of overall photoaging, skin regeneration techniques can be offered as a complement. Fractional lasers or fractional radiofrequency stimulate collagen synthesis and the reorganization of dermal fibers.
These treatments do not aim to paralyze muscles or fill a groove, but to strengthen the weakened dermal structure, smooth the skin surface, and reduce the depth of wrinkles. Their effectiveness on the frown line remains partial, but significant when integrated into a combined treatment plan.
They require multiple sessions, spaced a few weeks apart, and provide gradual results over several months. Their indication must be carefully evaluated, particularly according to phototype and skin tolerance.
Although widely used, anti-wrinkle creams alone cannot erase the frown line. Their action is strictly superficial, limited to the epidermis. Even the most effective active ingredients (retinol, peptides, hyaluronic acid, niacinamide) cannot reach the muscle or fill deep creases.
However, they can play a maintenance role: maintaining good hydration, strengthening the skin barrier, improving skin suppleness, and prolonging the effects of medical treatments. They are useful for prevention or as a complement, but do not constitute a therapeutic alternative to injections.
While the frown line can be effectively reduced by the treatments mentioned, it is equally important to highlight the risks associated with suboptimal management. A poorly performed Botox injection can cause eyebrow drooping, a frozen gaze, or facial asymmetry. Similarly, hyaluronic acid injection in the glabella, if not perfectly controlled, can result in an unsightly bulge or, more seriously, a vascular occlusion leading to skin necrosis, and in rare cases ocular complications such as blindness.
Although these complications are rare, they justify an absolute requirement in the choice of physician: only an experienced doctor can guarantee results that are aesthetic, durable, and safe. Treatment of the frown line should never be considered a minor cosmetic procedure, but a medical procedure.
The management of expression lines, with the frown line being the most emblematic example, is constantly evolving. New approaches are emerging, such as botulinum toxins with moderate action, ultrafine fillers using nanodoses, and neuromuscular electrical stimulation technologies.
At the same time, clinical trials are exploring the development of topical forms of botulinum toxin, which could eventually offer a non-injectable alternative for the treatment of superficial wrinkles. Although these solutions are not yet available in clinical practice, they reflect a continuous effort to improve tolerance, safety, and the naturalness of results in this particularly expressive area.
Article written by Dr Romano Valeria
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