What are the treatment options for cosmetic and neurological concerns in the glabella area, including the use of Botox (botulinum toxin)?

From the Guidelines

Botulinum toxin (Botox) is the primary and most effective treatment option for both cosmetic and neurological concerns in the glabella area, including glabellar frown lines and conditions like blepharospasm. The use of Botox in this area is supported by its efficacy in treating various conditions, as outlined in the updated guidelines on the uses of botulinum neurotoxin 1. For cosmetic purposes, Botox injections are typically administered in doses of 20-25 units, divided across five injection points, to address glabellar frown lines. This treatment approach has been shown to provide significant improvements in appearance, with results becoming visible within 3-7 days, peaking at 2 weeks, and lasting approximately 3-4 months before retreatment is necessary.

Key considerations for the use of Botox in the glabella area include:

• The selection of appropriate candidates, excluding those with contraindications such as pregnancy, breastfeeding, neuromuscular disorders, and infection at the injection site.
• The potential for side effects, including temporary bruising, headache, ptosis (drooping eyelid), and rarely, flu-like symptoms.
• The importance of consultation with a qualified provider to determine the most appropriate treatment approach, considering individual patient needs and conditions.

In terms of neurological conditions, Botox has been found to be effective in treating blepharospasm, with OnaBoNT-A and incoBoNT-A being equally effective and considered for treatment, as noted in the guidelines 1. Similarly, for cervical dystonia, all FDA-approved formulations of botulinum neurotoxin, including AboBoNT-A, are commonly used, despite differing evidence levels, highlighting the versatility and efficacy of Botox in addressing a range of neurological concerns in the glabella area and beyond.

From the FDA Drug Label

JEUVEAU is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients.

The treatment options for cosmetic and neurological concerns in the glabella area, including the use of Botox (botulinum toxin), are:

• Botulinum toxin injections: JEUVEAU (prabotulinumtoxinA-xvfs) is specifically approved for the treatment of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients.
• Administration techniques: To reduce complications, injections should be placed at least 1 cm above the bony supraorbital ridge, and the injected volume/dose should be accurate and minimal.
• Contraindications and warnings: JEUVEAU is not approved for the treatment of spasticity or any conditions other than glabellar lines, and caution should be used in patients with preexisting swallowing or breathing difficulties, inflammation at the proposed injection site, or excessive weakness or atrophy in the target muscle. 2 2 2

From the Research

Treatment Options for Cosmetic Concerns in the Glabella Area

• The use of Botox (botulinum toxin) is a common treatment option for cosmetic concerns in the glabella area, including horizontal and vertical glabellar lines 3, 4.
• A refined 3-point injection technique targeting the muscular origin of the procerus and the corrugator supercilii muscles has been shown to be effective in treating glabellar frown lines with minimal adverse events 3.
• The onset of the neuromodulator effect can be as early as 3.5 days, and the treatment can last for up to 4 months 3.

Treatment Options for Neurological Concerns in the Glabella Area

• Botulinum toxin has been used to treat various neurological disorders, including dystonia, spasticity, and cerebral palsy 5, 6.
• The use of botulinum toxin type A has been shown to be safe and effective in the treatment of patients with neurological disorders, including those with dystonia and spasticity 5, 6.
• A national survey of physicians found that the use of botulinum toxin type A is a common treatment option for patients with neurological disorders, with 66% of physicians treating patients with dystonia and 80% treating adults with spasticity 6.

Other Considerations

• Cutis verticis gyrata is a rare morphological condition that can affect the glabella and nasal bridge, and can be associated with hyper-IgE syndrome 7.
• The treatment of cutis verticis gyrata can involve surgical management, and the condition can be challenging to treat due to its rarity and limited understanding of its causes 7.