The two vertical creases that form between the eyebrows — often called the “11s” — are the most common reason people ask about Botox. Their clinical name is glabellar lines, and they are the area botulinum toxin was first approved to treat for cosmetic use. At Shield Dental Care in Burke, VA, Dr. Ghorbani treats frown lines as part of our Botox service.
What causes the 11s
Every time you frown, squint or concentrate, two small groups of muscles pull the inner brows down and together: the corrugator muscles, which run along the inner brow, and the procerus, which sits between them at the top of the nose. Repeated thousands of times, that movement folds the skin into lines. At first they show only when you frown; over the years they can stay visible even when your face is at rest.
How Botox softens them
Botox is a purified protein that temporarily blocks the signal from a nerve to the muscle it controls. Placed in the corrugator and procerus muscles, it reduces how strongly they can pull, so the skin between the brows is folded less. The lines soften rather than disappear, and the effect wears off as the nerve endings recover.
This is an FDA-approved use. BOTOX® Cosmetic is approved for the temporary improvement in the appearance of moderate to severe glabellar lines in adults, and the approved dose is 20 units shared between five injection points. Dysport and Daxxify, the other two products we carry, are also FDA-approved for this area (Dysport’s approval covers adults under 65). Frown lines are the one area where all three are approved, so if you are choosing between brands, this is where the choice is widest.
What the appointment involves
- Consultation. We look at your lines at rest and while you frown, go through your medical history and medicines, and talk about how much movement you want to keep.
- Treatment. After cleaning the skin, the dentist makes a few small injections with a very fine needle. Most people describe it as a brief pinch. The injections themselves take a few minutes.
- Afterwards. You can go back to work the same day. We will give you written aftercare, which usually includes staying upright for a few hours, not rubbing or massaging the area, and skipping strenuous exercise for the rest of the day.
When you will see results, and how long they last
The change starts to show within a few days and builds over roughly the following two weeks. For most people, frown lines stay softer for about three to four months before movement gradually returns. Treatment should not be repeated more often than every three months. Daxxify was studied for longer-lasting results, and in its trials many patients' lines stayed improved for around six months. See our Daxxify page for more.
Side effects to know about
Most people have nothing more than small bumps, redness or a bruise at the injection points, which settle within hours to days. A headache the same day is not unusual. The side effect most specific to this area is a temporarily drooping eyelid, which happened to about 3 in 100 people in the Botox Cosmetic trials. It happens when the product affects the muscle that lifts the lid, and it wears off.
All botulinum toxin products carry an FDA boxed warning: rarely, the effect can spread away from the injection site, causing symptoms such as trouble swallowing, speaking or breathing, double vision or general muscle weakness, hours to weeks after treatment. These are medical emergencies. If they happen, get help immediately.
Who should wait or choose something else
- Anyone pregnant or breastfeeding. Cosmetic botulinum toxin has not been adequately studied in pregnancy, so we recommend waiting.
- Anyone with an allergy to a botulinum toxin product, or an infection or active skin problem where the injections would go.
- Anyone with a condition affecting nerves and muscles, such as myasthenia gravis, Lambert-Eaton syndrome or ALS.
- Tell us if you take blood thinners, have recently taken aminoglycoside antibiotics, or have had any botulinum toxin treatment in the last four months, including for medical reasons.
Why a dentist?
Dentists work in the muscles and nerves of the face every day. Since 2023, Virginia law has allowed dentists to give botulinum toxin for cosmetic purposes once they complete the training the Board of Dentistry requires. Frown lines are often treated together with forehead lines and crow’s feet, and you can have more than one area done at the same visit.
Frequently Asked Questions
Will I still be able to frown?+
Less strongly than before, which is the point of the treatment. The dose can be adjusted: some people want the area almost still, others want to keep some movement. We talk that through before we start.
How much Botox is used for the 11s?+
The FDA-approved dose of BOTOX Cosmetic for frown lines is 20 units across five injection points. Your dentist will recommend a dose for your muscles, and units of Botox, Dysport and Daxxify cannot be compared or converted one to one.
Is Botox for frown lines covered by dental insurance?+
No. Treatment for cosmetic reasons is not covered by dental insurance. We will give you the cost before you are treated.
How soon can I be treated again?+
No sooner than every three months, which is how the products are labelled. Most people come back when they notice movement returning.