Glabella Lines at Rest: Botox or Filler?

A glabella line that shows while your face is relaxed can still be partly a frown line. The quickest check is whether it deepens when you frown. If it does, part of what you see is a crease left by the muscles between your brows, and easing that movement is often looked at before anything gets added. If a hollow stays no matter what the muscles are doing, filling it is a separate decision, and the area between the brows is one where that decision needs extra care.

In this article, we'll show how to tell the frown part from the hollow part, and what each one means for Botox and for filler.

The short version

• Glabella lines at rest are sorted out by comparing your frowning face with your relaxed face.
• 45% of 225 people had no resting line at least once in each of 3 Botox rounds.
• Hollow only? Glabella filler's risks and approval status are weighed on their own.

Glabella Lines at Rest: Are Your Frown Muscles Still Involved?

Often, yes. Part of the line can still come from muscle movement. Two words make this easier. A crease is a line the skin forms by folding and unfolding over and over. A hollow is what's left when that crease deepens until it stays sunken even after you relax your face.

Between the brows, the expression muscles move a lot, and at first these lines disappear as soon as you relax. Over time, thinner skin, less shallow fat in some spots, and muscles that move more than they need to can add up and set the line in place, so it shows at rest. In a study that compared 21 people with 3D photos, the curve of the lines on a relaxed face measured smaller after botulinum toxin was injected into the glabella muscles.

So a line you can see at rest isn't automatically a hollow that has nothing to do with muscle. That study had no comparison group, though. How much a deep, set-in line might soften for you is better judged with the mirror check below and an in-person exam.

Relax, Frown, Raise Your Brows: What Does Each Face Show?

Glabella lines form where the muscles between your brows, over the top of your nose, and around your eyes all move together. How far your brows pull in and down when you frown, and whether you tend to lift your forehead, can make the very same line look different. Some faces also move unevenly, with one brow dropping lower than the other, so check yourself straight on with both brows in view.

Try these three faces in a mirror. Comparing them gives you a rough sense of which part is bigger for you.

The mirror gets you an estimate. The depth of the hollow and the thickness of your skin are settled at the exam, where the area is felt by hand and checked with light shone across it.

How Much Can Glabella Botox Fade Lines at Rest?

After one round, many people were rated free of resting lines at some point, but fewer managed that in all three rounds. In one study, 225 people whose frown lines were moderate or worse when frowning, and who still had visible lines with a relaxed face, received botulinum toxin (Botox) three times, 4 months apart. In the first round, 76% were rated as having no line at rest at least once during that round. 45% were rated that way at least once in every one of the three rounds.

Keep in mind what that rating means. It doesn't say the lines stayed gone for 4 months. It says that on at least one of the check days in each round, the line was rated as gone. The share of people responding rose a little with each round, and that trend was clearer in people whose lines started out shallow.

Most participants were women (85%) and white (88%), more than half had shallow lines, and older participants responded less often. That's why, for a deep line that has set in, it makes more sense to think about how much it softens than to expect these percentages. How much you see depends on your lines and your skin.

Botulinum toxin works by reducing muscle movement. It doesn't add volume to a spot that's already sunken. So the part that fades with muscle injections and the part that stays behind are assessed separately. The 4-month spacing was simply how the study was set up. It isn't a measure of how long results last, and your own injection schedule is decided at your exam.

Should the Hollow Between Your Brows Be Filled With Filler?

Not just because a hollow is left over. Injecting filler into the glabella isn't one of filler's approved uses, and it's listed as a use that isn't recommended*.

*Based on the US FDA's information on dermal fillers.

The risk of greatest concern with filler is that it accidentally goes into a blood vessel and blocks it. The risks of using filler outside its approved uses aren't known, so a decision to fill the glabella has to weigh both of these together. In Korea, the approved areas for each filler product are checked product by product.

A hollow that stays at rest can be a mix of three changes: thinner skin, less shallow fat, and a crease left behind by muscle movement. That's why your skin thickness, how deep the hollow is, and any glabella treatments you've had before all shape the plan. Which approach fits you gets talked through at the exam, with your provider looking at the hollow directly.

Glabella Filler Side Effects: When Should You Go to the ER?

After filler between the brows, your vision, your speech, and your skin color are the first things to watch. Bruising, swelling, redness, and itching at the injection site often settle within a few days, or at most a few weeks. The signs below are different. Act on them without waiting.

• If your vision blurs or changes, go to the nearest emergency room right away.
• If you suddenly have trouble speaking, numbness or weakness in your face, arms, or legs, difficulty walking, a drooping face, a severe headache, dizziness, or confusion, go to the nearest emergency room right away.
• If the skin near the injection site turns white, gray, or blue, don't wait. Get medical care first.
• If you have unusual pain that's different from what you expected, get medical care right away.

When filler blocks a blood vessel, tissue death (necrosis), vision problems up to and including blindness, and stroke have been reported, and these can be serious and permanent. They're described as unlikely. Still, with any of these signs, getting examined comes before sending the clinic a message. Reactions after botulinum toxin can differ from those after filler, so which signs to watch depends on what you had, and that's gone over separately at your consultation.

Fitting Glabella Treatment Into a Trip to Seoul

If you're planning glabella treatment during a visit to Korea, three points are worth sorting out before you book.

Your flight comes first. If you weren't sedated that day, the treatment itself is no reason to move your flight home. Sedation is the one exception.

Next, what a single visit can do. A few treatments, filler among them, change shape on the same day. Most don't change your face dramatically in one visit and instead bring it gradually closer to how it used to look. Think of one visit as a starting point.

Last, what happens once you're home. You can still send the clinic photos and questions through its consultation chat. If any of the warning signs listed above appear, see a local hospital or emergency room first.

The Bottom Line: Bring Three Photos to Your Consultation

A good opening question for your consultation is: "Is my glabella line more about frowning, or more about a hollow?" The answer decides whether muscle injections or a different approach gets discussed first.

Before you go, take three photos in the same light and from the same distance: one relaxed, one frowning, and one with your brows raised. Take them again under the same conditions before your next visit, and you'll be able to compare the change for yourself. When you contact Beautystone, a clinic in Seoul's Hapjeong area, include those three photos, the type and timing of any past glabella treatment, and anything that bothered you afterward.

Sources

• Why filler between the brows isn't recommended, and the signs of a blocked blood vessel (US FDA)
• Lines at rest and while frowning measured in 3D in 21 people after glabella botulinum toxin (Aesthetic Plast Surg, 2019)
• 225 people with glabella lines at rest treated with botulinum toxin three times in a row (Dermatol Surg, 2016)
• How expression lines set in and how each layer of the face ages, a review (Clin Cosmet Investig Dermatol, 2021)

Frequently Asked Questions

Q. Does Botox work less on deep glabella lines?

A. With glabella lines, the response varied with how deep the lines were. In a repeated-injection study, the share of people rated as having no line at rest rose with each round, and that trend was clearer in people whose lines started out shallow. More than half of that study's participants had shallow lines, so for deep lines, set expectations around how much the line softens, and any hollow that remains is assessed separately.

Q. Can glabella filler cause blindness?

A. Glabella filler, like filler elsewhere, can cause vision problems including blindness if it accidentally enters and blocks a blood vessel, and such cases have been reported. It's described as unlikely, but when it happens it can be permanent. If your vision blurs or changes during or after treatment, go to the nearest emergency room right away without waiting.

Q. Should forehead lines and glabella lines be treated together?

A. Forehead lines and glabella lines are both formed by expression muscles moving over and over, so they're looked at together. How much to treat at the same time depends on your brow height and whether you tend to lift your forehead, so sometimes only the glabella is treated. If you raise your forehead often, mention that habit at your consultation.

Q. Can you get Botox and filler in the glabella at the same time?

A. Whether Botox and filler can safely be combined hasn't been evaluated in controlled clinical trials, according to the US FDA. That note covers using filler with other treatments such as botulinum toxin in general, not the glabella alone. Glabella filler is itself a use that isn't recommended in the US, so combining the two isn't treated as an automatic next step, and the risks and alternatives are reviewed at your exam.