Frown Lines Between the Eyebrows: Causes and Treatment
People tell you that you look angry, tired or worried when you are not. Looking in the mirror, you notice a vertical crease between your eyebrows: that is a frown line. It first comes from the movement of the muscles that knit the brows, and that movement is what an injection can act on. Among cosmetic injections, the one that relaxes a muscle acts on movement, while filler targets a hollow that has already set in.
At a glance
Five things to know before deciding- What causes it: repeated frowning by the muscles between the eyebrows, then age and the condition of the skin, which eventually set the crease even at rest.
- What an injection can do: relax that muscle so that frowning decreases; it does not fill a furrow that has already set in and does not guarantee it will disappear.
- Duration: temporary, several months, varies from one person to another, with no guarantee.
- Risk specific to this area: a drooping eyelid or eyebrow when the injection is poorly placed.
- Before any treatment: a medical assessment, which may lead to postponing or changing the injection, or to the physician deciding not to perform it.
What creates the crease between the eyebrows
When you frown to read, concentrate or squint in the sun, the muscles between your eyebrows contract and fold the skin. Over the years, this movement draws one or two vertical lines: people sometimes speak of frown lines, in the plural, when the crease splits in two. At first, the crease only appears when you frown. With time, the skin loses elasticity, the muscles thin, and the mark remains even with the face at rest. Crow's feet, by contrast, fan out at the corners of the eyes: they are different creases, in a different area of the face.
Sun is the factor that damages the skin the most and can carve fine as well as deep wrinkles into it; smoking and heredity also contribute. The crease does not set in at the same age for everyone. Sun, smoking and heredity do not contribute in the same way for each person either.
- Dynamic crease
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Visible only when the muscle works, that is, when you frown.
- Static crease
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Visible even at rest, because the skin has kept the imprint of the movement.
- What adds to it
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Sun, smoking, heredity and the loss of skin elasticity with age.
What a muscle-relaxing injection changes, and what it does not
A muscle-relaxing injection blocks the ability of the facial muscles to contract. It is also called a neuromodulator, with brand names such as Botox® or Dysport®. Between the eyebrows, the goal is to relax the muscles that make you frown: when they no longer pull, frowning decreases and the crease deepens less. Four weeks after the injection, the lines between the eyebrows are more reduced than with a placebo, as rated by physicians and by the people treated.
The injection has a limit, however: it acts on movement, not on a furrow that has already set in. A crease that is well marked at rest responds less, and deep furrows call for other treatments, such as filler or laser. In some people, the crease visible at rest has faded over repeated treatments. The mechanism is not yet known, and this improvement is not guaranteed.
This injection is also used when the jaw clenches, with a masseter injection, or when bands appear on the neck, with the Nefertiti lift. It is therefore not limited to wrinkles and can also act against excessive underarm sweating. Precautions differ from one area to another.
- Acts on
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The movement of the muscle that folds the skin, not on a hollow or furrow that has already set in.
- Who it is for
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An adult whose crease deepens mainly when frowning, after an assessment by a physician.
- When to postpone or decline it
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Inflamed or infected skin, hypersensitivity to an ingredient of the product; extreme caution is required in cases of neurological disorders, difficulty swallowing or breathing problems.
- What it does not guarantee
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The disappearance of a crease marked at rest, nor an identical result from one person to another.
- Who performs it
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A physician, or a nurse injector supervised by a physician.
- Areas and product
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During the assessment, the doctor determines what CARE MD can treat, with which product and within which limits; these choices are not made in advance.
How long the effect lasts
The effect does not come the same day: it usually appears two or three days after the injection, sometimes as early as the next day, and the muscle is fully relaxed between five and fifteen days. The effect is temporary: it fades over several months. The result and its duration vary by person and by product.
To maintain the effect, another injection is needed. The schedule is discussed during the assessment, according to your crease and what you want. In practice, many people choose a new injection before the crease has returned to its initial appearance: how it looks matters as much as its return in this decision. Pain and bruising at the injection site are among the reported effects.
- Onset
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A few days, and up to about two weeks for the muscle to be fully relaxed.
- Duration
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Temporary, over several months, varies from one person to another.
- Maintenance
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To be discussed during the assessment; no session frequency is promised.
- Guarantee
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Neither the result nor its duration is guaranteed.
Drooping eyelid and the other risks in this area
Between the eyebrows, the main risk is ptosis, that is, a drooping eyelid. It is associated with a poorly placed injection in the forehead or around the eyes. The injection reduces wrinkles, but it probably increases the risk of a drooping eyelid. In this area, ptosis is the main serious effect reported. It remains rare and most often temporary: in most cases, it lasts less than three weeks.
This is one reason to entrust these injections to a qualified health professional who is experienced with them, and to understand the risks and benefits before starting.
- Drooping eyelid (ptosis)
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Rare, associated with a poorly placed injection; report it as soon as it appears.
- At the injection site
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Pain or bruising.
- Other reported effects
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Headache, facial pain, swelling of the eyes, rash or allergic reaction, local muscle weakness of the face; generally temporary, they can last several months.
- Rare but serious
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Spread of the product away from the injection site, mostly associated with non-cosmetic uses.
Signs that require medical attention
After an injection, most effects are mild and temporary. Call CARE MD if an eyelid or an eyebrow droops, or if an unusual effect persists or worries you. Only a physician can tell what it is.
Seek care right away
If you have difficulty swallowing, speaking or breathing, or muscle weakness away from the injection site, after an injection of this kind. These signs require immediate medical care.
Is there anything other than an injection?
To treat the signs of skin aging, several options exist: surgery, laser, microdermabrasion, chemical peel, filler and the muscle-relaxing injection. For this particular crease, everything depends on what you see: a crease that only deepens when you frown is related to muscle movement, while a furrow already visible at rest is more likely to call for filler or laser. CARE MD also offers laser and focused ultrasound, with no needle; during the assessment, the physician will tell you whether one of them is appropriate for your crease.
No natural treatment for frown lines, nor any other non-medical care, has been shown to erase this crease. Sun, for its part, is the leading factor that damages the skin, followed by smoking.
- Crease visible mainly when frowning
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The muscle-relaxing injection is the most studied option.
- Furrow visible at rest
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Other treatments are added, such as filler or laser.
- Natural care
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No evidence that it erases the line.
- Offered by CARE MD
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To be discussed during the assessment.
Why a medical assessment comes first
Before suggesting any treatment, the physician needs to know your situation. During the assessment, the physician examines your crease at rest and when you frown, as well as the position of your eyebrows and eyelids. The physician also takes the time to listen to what you expect. The assessment can also lead to postponing or changing the injection, or to the physician deciding not to perform it. Inflamed or infected skin, hypersensitivity to an ingredient of the product, a history of neurological conditions, difficulty swallowing or breathing problems can motivate that decision.
Bring information that may affect the decision: your medical history, allergies, medications and supplements, and previous treatments. Let the physician know if you are pregnant or breastfeeding. Also ask how these injections can interact with other products, other procedures or medications you take for other conditions. Prepare your questions about the improvement you can expect, the risks specific to this area, how long the effect lasts and what happens if the effect does not suit you.
- What to bring
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Medical history, allergies, medications, supplements, previous treatments, pregnancy or breastfeeding.
- What can change the plan
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Inflamed or infected skin, hypersensitivity, a history of neurological conditions, difficulty swallowing or breathing.
- Who you will see
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A physician, or a nurse injector supervised by a physician.
When the crease between the eyebrows is not the whole story
Forehead lines and other expression lines can also be treated with a muscle-relaxing injection, one of the cosmetic injections that CARE MD offers.
An eyelid that droops after an injection is not the same as an eyelid made heavy by age. If the eyelid droops after the injection, report it to CARE MD as soon as it appears. CARE MD also treats dark circles, under-eye bags and facial aesthetics.
Ask us your questions about the crease between your eyebrows
The injection is not performed on inflamed or infected skin, nor in cases of hypersensitivity to an ingredient of the product.
Frequently asked questions
Does the injection erase frown lines for good?
No. It relaxes the muscle that knits the brows, which softens the crease deepened by that movement, but the effect is temporary and a furrow already set at rest responds less. In some people, the crease has improved after repeated treatments, without the mechanism being established; it is not a guaranteed result.
Sources3 references
Is a drooping eyelid common after an injection between the eyebrows?
It is rare and most often temporary, but it remains the main serious effect reported in this area. It is associated with a poorly placed injection: that is one reason to choose a qualified professional and to report it as soon as it appears.
Sources3 references
When is the effect visible, and how long does it last?
The effect sets in within a few days and can take up to about two weeks to be complete. It then fades over several months, at a pace that differs from one person to another; no duration can be guaranteed to you, and you and the physician decide how often to have follow-up injections.
Sources3 references
Which signs after an injection require calling CARE MD?
A drooping eyelid or eyebrow, or an unusual effect that persists or worries you, warrants a call to CARE MD. Difficulty swallowing, speaking or breathing, or muscle weakness away from the injection site, requires immediate medical care.
Sources1 reference
Can frown lines be reduced without an injection?
No natural care has been shown to erase this crease. Sun is the leading factor that damages the skin, followed by smoking. Other treatments, such as laser or filler, exist for a furrow that has already set in. During the medical assessment, the doctor determines whether one of them is appropriate for your crease.
Sources2 references
What information should you bring to the medical assessment?
Information about your medical history, allergies, medications and supplements, and previous treatments. Let the physician know if you are pregnant or breastfeeding. Also note your questions about what you can expect, the risks in this area and how long the effect lasts: the physician will answer before any decision, and may postpone the injection or decide not to perform it if your situation requires it.
Sources1 reference
Sources7 references+
- Health Canada — Cosmetic injections (opens in a new tab)
- Cochrane — How well does botulinum toxin (type A; often called 'Botox') treat wrinkles on the face? (opens in a new tab)
- Applied Anatomy for Botulinum Toxin Injection in Cosmetic Interventions (Springer, 2020) (opens in a new tab)
- Treatment of Glabellar Lines with Botox (onabotulinumtoxinA): Development, Insights, and Impact (Medicine, 2023) (opens in a new tab)
- Progressive Improvement in Static Glabellar Lines After Repeated Treatment With DaxibotulinumtoxinA for Injection (PMC) (opens in a new tab)
- Onset and Duration of AbobotulinumtoxinA for Aesthetic Use in the Upper Face: A Systematic Literature Review (PMC) (opens in a new tab)
- Treating Glabellar Lines with Botulinum Toxin Type A–Hemagglutinin Complex: A Review of the Science, the Clinical Data, and Patient Satisfaction (PMC) (opens in a new tab)
Frown lines: what an injection does not guarantee and what calls for caution
Every person is different: during the assessment, the physician determines what suits you.
Limitations and precautions
Report your medical history, allergies, medications and supplements, and let the physician know if you are pregnant or breastfeeding.
Extreme caution is required in cases of neurological disorders, difficulty swallowing or breathing problems.
Difficulty swallowing, speaking or breathing after the injection requires immediate medical care.
No result is guaranteed: it varies from one person to another.
A crease marked at rest responds less than one that only deepens when frowning.
How long the effect lasts varies from one person to another, and the effect of repeated treatments on the crease is not established.
A drooping eyelid is rare, but possible; report it as soon as it appears.
