Botulinum toxin to correct frown lines in Geneva

Types of frown line

Several muscles are involved when frowning — particularly the frontalis, orbicularis oculi, corrugator and procerus. Their activation varies between individuals according to anatomy and expression habits. These muscle dynamics determine five types of frown line, each with a specific shape and depth.
This classification is not merely descriptive : it guides treatment strategy. Injection technique must suit muscle contraction patterns to achieve natural, harmonious results while preserving eye expression. Precise assessment of movements during consultation personalises treatment and optimises effectiveness.

What causes
frown lines ?

The main causes of frown lines are :

Repeated muscle contractions : frown lines primarily result from corrugator muscle activity. These muscles lie at the inner eyebrows. They allow us to frown by lowering the inner brow.
They develop fairly quickly because facial expressions repeatedly engage them, explaining wrinkles even in very young patients.
Wrinkles first appear during expressions, then become permanent once the skin has creased.
Ageing : skin loses elasticity and its ability to fully relax after muscle contraction.
Genetic factors : genetic predisposition may influence wrinkle depth and how early it develops.
Sun exposure : UV damage accelerates skin ageing and wrinkle formation.
Smoking : smoking reduces skin blood circulation, accelerating ageing.

Severity stages of frown lines

Four severity stages of frown lines are described for treatment purposes.

Stage 1 : mild wrinkles

Initially, frown lines appear as fine lines visible only when the corrugator muscles contract during frowning. Skin still retains good elasticity and fine lines disappear at rest.

Stage 2 : moderate wrinkles

At this stage, wrinkles are visible even at rest. They begin becoming permanent as collagen and elastin production declines. Skin starts losing firmness and wrinkles become more pronounced.

Stage 3 : deep wrinkles

Frown lines become deep and permanently visible even when the face is relaxed. Skin elasticity and volume loss is significant and wrinkles more pronounced.

Stage 4 : very deep wrinkles

At an advanced stage, frown lines are very deep and well defined, often accompanied by skin folds. Skin has lost much of its elasticity and volume. Wrinkles give the face a severe, constantly worried appearance.

At early stages, botulinum toxin injection removes the wrinkle.
At more advanced stages, if complete removal is desired, hyaluronic acid injections should be performed one month after botulinum toxin.
The muscle responsible is powerful, and botulinum toxin treatment of deep or very deep wrinkles is possible, but results last 3-4 months. Hence the importance of treating this wrinkle when it first appears.

How can frown lines be removed
without injections ?

Among natural ways to soften this wrinkle, facial exercises offer a non-invasive approach beneficial to skin health. Specific exercises may help reduce frown lines and refresh a tired face.
Facial exercises complement injections, but cannot prevent or treat frown lines without combining them with injections.

Facial exercises : a natural solution for frown lines

Facial exercises involve movements intended to strengthen and tone facial muscles. They may help smooth wrinkles and improve skin firmness. Several targeted movements for frown lines can be incorporated into a daily routine.
The most common exercise places three fingers at the inner eyebrow and stretches it outwards while frowning.

How can you get rid of frown lines ?

There are many options to prevent and treat frown lines and keep skin smooth and youthful.
Botulinum toxin injection is the most widely used and effective treatment.
In certain indications, hyaluronic acid injections may be combined with it.

How can frown lines be removed ?
Botulinum toxin injections
for frown lines

An injection of botulinum toxin blocks corrugator muscle contraction. The patient can no longer frown, but inability to perform this movement does not create a frozen appearance. Inability to raise the eyebrows is what freezes the face.
For some people (particularly certain artistic professions), retaining the ability to frown is important, so partial blocking is possible.
Assessment at rest and during frowning precedes treatment.
Crow's feet injections are often combined to fully open the eye area without changing eyebrow shape.

Poorly performed frown line injection

A poorly performed injection here causes :

Drooping eyelid (ptosis) caused by product spreading to the upper eyelid elevator muscle.
Drooping eyebrow with inability to raise the eyebrows (creating a frozen appearance), caused by injection too high affecting the frontalis muscle.

How botulinum toxin injections for frown lines are performed

Botulinum toxin treatment for frown lines is a medical procedure performed at the practice. Very small quantities are injected into the corrugator and procerus muscles responsible for frowning and vertical wrinkles between the eyes.

Before the session

Consultation assesses upper facial dynamics, muscle contraction intensity and wrinkle depth. Dr Romano checks for contraindications, explains botulinum toxin's mechanism and defines a treatment plan suited to patient anatomy to preserve natural expressions.

During the session

After skin disinfection, two injections are performed with a very fine needle into the targeted muscles. The procedure generally lasts between 10 and 15 minutes and requires no anaesthesia. Doses are precisely adapted to reduce contraction without freezing the face.

After the session

Daily activities can resume immediately. Avoid massaging the treated area during the first hours, as well as intense exercise, sauna, steam rooms and prolonged head-down positions on treatment day.

Contraindications to botulinum toxin injections for frown lines

Botulinum toxin injections are preceded by a medical consultation to exclude contraindications and ensure safety.
The main contraindications are :

Pregnancy and breastfeeding.
Known allergy to botulinum toxin or any product excipient.
Infection or inflammation in the treatment area.
Neuromuscular diseases, particularly myasthenia gravis, Lambert-Eaton syndrome or amyotrophic lateral sclerosis.
Certain medicines that may enhance botulinum toxin's effects, particularly some aminoglycoside antibiotics, following medical assessment.
Swallowing or muscle function disorders when incompatible with treatment.

How can frown lines be removed ? Filling frown lines with hyaluronic acid

Sometimes botulinum toxin alone cannot correct a frown line. Filling with hyaluronic acid becomes relevant, particularly when the patient cannot receive botulinum toxin (contraindications, refusal…) or when the wrinkle has formed a genuine skin crease. In the latter case, hyaluronic acid injection is generally performed about a month after botulinum toxin for optimal results.
An experienced doctor must use a cannula, because this delicate area carries a risk of necrosis or visible product irregularities. Product selection depends on wrinkle depth : a volumiser is preferred for a deep wrinkle, while a Skinbooster-type acid suits a very superficial crease.

Before / after results of botulinum toxin injections for frown lines

Frown line treatment softens expression and removes the severe or displeased appearance it may create. The eye area looks immediately more rested and rejuvenated.
Botulinum toxin effects begin from the second day after injection and become fully visible after about a week. They last five to six months on average. Follow-up, potentially with a touch-up, is scheduled one to three weeks after the session. Recovery is generally straightforward, with occasional slight swelling for a few minutes and mild headaches that may persist for up to five days.
Hyaluronic acid injection results are immediate and last one year.
After-effects are minimal, allowing immediate resumption of daily activities.

What is the price of an injection for frown lines ?

In Geneva, botulinum toxin injection for frown lines costs 300 CHF for women and 350 CHF for men, 450 CHF for two areas in women and 500 CHF in men, and 600 CHF for three areas in women and 650 CHF in men. If complementary hyaluronic acid injection is needed, it costs 600 CHF per syringe.
The treatment plan is personalised. At the initial consultation, Dr Romano and the patient define the solution best suited to individual needs for a natural, harmonious result.
Whether preventing a frown line or softening an established wrinkle, the goal is a relaxed, open expression without freezing the face.
All procedures take place in a medical environment using certified products.
Botulinum toxin injection prices for frown lines in Geneva vary according to the number of areas (frown lines count as one) and sex (because muscle strength differs).

For women

1 area (frown line) : 300 CHF
2 areas : 450 CHF
3 areas : 600 CHF

For men

1 area (frown line) : 350 CHF

2 areas : 500 CHF
3 areas : 650 CHF

If the wrinkle is too pronounced to disappear completely with botulinum toxin, complementary hyaluronic acid injection may be offered for optimal results. This injection costs 600 CHF.

WHAT THE STUDIES SAY

A double-blind randomised trial involving 301 adults compared a botulinum toxin with placebo for frown lines. At one month, 65.8% of treated patients achieved an improvement of at least two grades according to combined physician and patient assessments, compared with none in the placebo group. The median onset of effect was two days, and an improvement persisted in some patients for up to six months.

Source: AbobotulinumtoxinA Treatment of Glabellar Lines Using a New Reconstitution and Injection Volume: Randomized, Placebo-Controlled Data — Joel Schlessinger, Daniel P Friedmann, Flor Mayoral et al. Journal of drugs in dermatology, 2021.

Two phase III randomised trials included 609 participants with moderate to severe frown lines. At four weeks, around 74% of patients receiving the botulinum toxin formulation studied achieved an improvement of at least two grades, compared with 0 to 1% with placebo. A severity rating of none or mild was maintained for a median duration close to twenty-four weeks. This duration is specific to the formulation studied and cannot be applied interchangeably to other products.

Source: DaxibotulinumtoxinA for Injection for the Treatment of Glabellar Lines: Results from Each of Two Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase 3 Studies (SAKURA 1 and SAKURA 2) — Jean D Carruthers, Steve Fagien, John H Joseph et al. Plastic and reconstructive surgery, 2020.

A multicentre randomised trial involving 540 adults compared two botulinum toxin formulations with placebo for frown lines. At thirty days, the lines were absent or mild during contraction in 87.2% and 82.8% of patients in the two treatment groups, compared with 4.2% with placebo. These results confirm the effectiveness of the formulations assessed in reducing moderate to severe glabellar lines.

Source: A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Single-Dose, Phase III, Non-Inferiority Study Comparing PrabotulinumtoxinA and OnabotulinumtoxinA for the Treatment of Moderate to Severe Glabellar Lines in Adult Patients — Berthold-Josef Rzany, Benjamin Ascher, Rui L Avelar et al. Aesthetic surgery journal, 2020.

Frequently asked questions

Why does a frown line appear between the eyebrows ?

Frown lines mainly develop through repeated contractions of the muscles that draw the eyebrows together and down, particularly when frowning. With ageing, the skin loses elasticity and the line can become visible even at rest, sometimes giving the face a stern or upset appearance.

How does botulinum toxin act on frown lines ?

Botulinum toxin temporarily reduces contraction of the muscles responsible for frown lines. It therefore softens expression lines and relaxes the area between the eyebrows. When the line is deep and remains visible at rest, it may persist despite treatment.

How long does botulinum toxin take to soften frown lines ?

The first effects of botulinum toxin generally appear after 2 to 5 days. The result gradually stabilises and is usually assessed after 10 to 14 days. Any touch-up should only be considered after this period, depending on the result obtained.

Is hyaluronic acid needed to fill a deep frown line ?

Not necessarily. A deep frown line may remain visible at rest despite botulinum toxin injections. An additional hyaluronic acid injection is indicated in this case.

What are the possible side effects of botulinum toxin injections for frown lines ?

The most common side effects are redness, local tenderness, bruising or headaches. Asymmetry of the eyebrows or temporary drooping of the eyelid may also occur. More rarely (with injections in the lower third of the face), swallowing or breathing difficulties require urgent medical attention.

Do frown lines worsen when botulinum toxin is stopped ?

No. Stopping botulinum toxin injections does not worsen frown lines. When the treatment wears off, the muscles gradually regain their activity and expression lines may reappear. Skin ageing continues naturally, independently of the injections. There is therefore no obligation to repeat the treatment.