Botulinum Toxin for Glabella Lines (Between the Eyebrows)

Botulinum toxin in the glabella is one of the most requested procedures in orofacial harmonization (HOF). The goal is to reduce the contraction of the muscles that form the vertical lines between the eyebrows, known as "11 lines" or "angry lines." Patients often describe their concern as "I always look worried" or "I look angry even when I'm not."

On this page you will find the indication, typical units in ranges, duration, risks, and how to set up the simulation in Harmy so you can show the patient, before treatment, the kind of smoothing being aimed for.

What is botulinum toxin in the glabella?

It is the injection of botulinum toxin into the muscles of the glabellar complex: the corrugator supercilii, the procerus, and, in part, the depressor supercilii. These muscles pull the eyebrows together and down. With less contraction, the vertical lines and the horizontal line at the root of the nose tend to soften.

Unlike a filler, toxin does not add volume. It modulates movement. That is why the effect is clearer on dynamic lines, the ones that show when the patient frowns, than on marks present at rest.

Who is glabella toxin usually indicated for?

Generally, for patients with:

• vertical lines between the eyebrows that appear or deepen when frowning;
• a habit of furrowing the brow when concentrating, reading, or squinting in the sun;
• early marks at rest that still respond to muscle relaxation;
• a wish for a more rested look, without changing their features.

Patients with deep static lines may see only partial improvement. In those cases, expectations need to be aligned during the consultation, and a combined approach may be considered, at the professional's discretion.

General contraindications include pregnancy, breastfeeding, neuromuscular junction disorders, active infection at the site, known allergy to components of the formula, and medications that potentiate the effect of the toxin. The decision always rests with the qualified professional, following the rules of their professional council in Brazil, after a complete medical history.

Which areas are involved?

The main area is the glabella, in the upper third of the face, between the inner ends of the eyebrows and above the root of the nose. In practice, planning usually also considers the forehead lines, because the balance between the muscles that lift and those that lower the eyebrow affects its final position.

Which product is used and how is the dose measured?

The product is botulinum toxin type A, in different commercial presentations. The dose is expressed in toxin units, and here is a point that confuses even those just starting out: units from different products are not interchangeable. Each manufacturer has its own potency measure, and converting between them is not a simple rule.

It is also worth remembering that dilution changes the volume in which the units are delivered, but it does not change the dose. What matters clinically is how many units reach each muscle.

What doses are typical in the glabella?

The ranges below are general references for products whose label uses the most widespread scale on the market. The final dose is always set by the qualified professional, after assessing muscle strength, contraction pattern, and the patient's history.

For presentations with a different potency scale, follow the label of the chosen product.

How long does glabella toxin last?

The effect usually starts between 2 and 5 days, peaking around 2 weeks. The usual duration is generally between 3 and 4 months, and it can be somewhat longer in some patients. Factors that shorten or extend it include the dose, muscle strength, metabolism, intense physical activity, and the product itself.

A follow-up at about 15 days is common practice to check symmetry and decide on any touch-up.

What are the risks and complications?

The most common effects are mild and short-lived: pain at the injection site, a small bruise, redness, and headache in the first few days. The complications that deserve attention during the consultation and in the consent are:

• Eyelid ptosis: drooping of the upper eyelid due to the product spreading to the levator palpebrae muscle. It is usually temporary, but it bothers the patient and needs to be explained beforehand.
• Eyebrow ptosis: a lower or heavier eyebrow, especially when the glabella and forehead are treated without considering the balance between them.
• Asymmetry: a difference in height or movement between the sides, sometimes adjustable at follow-up.
• Spread to neighboring muscles, with an effect outside the plan.
• Allergic reaction and, rarely, loss of response over time.

Toxin is not a filler and does not use hyaluronidase as a reversal agent. Even so, it is worth noting that the glabella is a high vascular risk area when considering filling residual static lines with hyaluronic acid. If that combination is considered, hyaluronidase must be available and the professional must be prepared to recognize and treat a vascular occlusion. For an overview, see safety and complications in HOF.

What not to promise the patient

• That the lines will "disappear." The more honest wording is smoothing.
• An exact duration. The range is an estimate and varies from person to person.
• Absolute symmetry. Faces are asymmetrical by nature.
• That the look in the first week is already the final effect.
• That toxin replaces care for deep static lines.

Recording these conversations in the informed consent protects both patient and professional.

Simulation in Harmy

The image at the top of this page was generated by Harmy itself, from the photo of the fictional person we use across all our pages, marking only the Glabella point. Drag the line to compare. The change is subtle on purpose: the AI alters only the marked area and does not apply makeup, retouch the skin, or change the expression, lighting, or background. It is an honest projection, which helps the patient understand the kind of smoothing being sought without creating unrealistic expectations. It is an illustrative simulation, not a promise of results.

Why does Harmy show "ml" for a toxin?

In the Plan, each area gets a value from 0.5 to 5, in steps of 0.5, labeled ml. For fillers, that number is the volume in milliliters. For toxin, it does not represent toxin units or dilution volume: it is a planning unit of the app that guides the intensity of the simulation. In the image above we used the value 1, which produces a light smoothing.

In practice, you can adopt a simple convention, such as "1 = standard glabella treatment," and use that same value in the PDF quote, where the price is set per ml of each area. The actual dose, in units of the chosen product, remains your clinical decision and goes into the patient record.

How to simulate in 3 steps

1. In New projection, enter the patient's name and take or choose a standardized frontal photo.
2. In the marking screen, tap the Glabella point and, in the Plan, set the value (start with 1 for a light effect).
3. Tap Create projection and use the Before / After slider during the consultation.

The full step-by-step, with screenshots, is in how to mark areas and volumes. To guide the conversation with the patient from the image, see how to present before and after in the consultation.