Glabella Treatment with Botox
I treat the glabella after the forehead, as I do not want the pressure from the ice pack to push the Botox (BTX) over the orbital rim and into the levator complex. The corrugator is the principal muscle to paralyze, but the procerus should almost always be treated in tandem. Even if the corrugator muscle appears to be the only muscle active, treatment of the corrugator alone will often cause recruitment of the procerus, leading to undesirable observation of procerus movement. Routinely, I treat the procerus with 2.5 units and each corrugator with 6.5 units. With more pronounced activity, I will increase this dosage. Although this initial dosage may seem low, proper injection into the correct plane can provide remarkable and enduring aesthetic benefit. If the procerus demonstrates significant activity, I may use two injections of 2.5 units down the length of the procerus as needed. When treating the glabella and at times when combining treatment with the orbicularis,, other neighboring muscles may be recruited after paralysis treatment (i.e., when certain muscles are blocked the unblocked muscles begin to manifest movement and wrinkling to compensate for the lack of movement elsewhere). This phenomenon is observed in the so-called “bunny lines” that extend down the sides of the nasal dorsum are related to nasalis activity. The physician can inject these lines with 1–2 units of BTX per side as needed.