Treating the Upper Face with Botulinum Toxin: Glabella, Forehead and Crow's Feet
The upper face is where almost every injector's botulinum toxin journey begins — and for good reason. The three classic areas — the glabellar complex, the frontalis and the lateral orbital “crow's feet” — are common patient requests and, treated well, deliver reliable, natural results. Treated without a firm grasp of the underlying muscles, they are also where the most recognisable complications occur.
It starts with dynamic anatomy
Botulinum toxin relaxes muscle, so the entire treatment is really an exercise in applied anatomy. The upper face is a balance between muscles that pull the brow down (the glabellar complex and the orbicularis oculi) and the one that pulls it up (the frontalis). Every injection shifts that balance — which is why assessing the patient's movement before treatment matters as much as the injection itself [1].
The glabellar complex
The frown lines between the brows are produced mainly by the corrugator supercilii and procerus muscles. This was the first indication approved for cosmetic botulinum toxin and remains a cornerstone treatment. The key safety consideration is depth and placement near the upper medial orbit: injecting too low or too close to the orbital rim risks diffusion to the levator palpebrae and consequent eyelid ptosis. Understanding the muscle's origin and course — not just memorising injection points — is what prevents this.
The frontalis
The frontalis is the only elevator of the brow, so it is the area that most rewards restraint. Over-treating it can drop the brow and leave the patient looking heavy or tired; treating it too low can cause brow ptosis. Because the frontalis works against the depressors, it is usually treated in balance with the glabella rather than in isolation. Preserving some movement — and respecting the patient's anatomy and brow position — is what keeps results looking natural rather than frozen.
Crow's feet
The lateral orbital lines are formed by the orbicularis oculi. Injections here are placed superficially and kept lateral to the orbital rim to avoid affecting the muscles of the mouth or the risk of asymmetry. As always, the amount of animation the patient wishes to keep should guide dosing.
Common pitfalls — and why supervision matters
- Eyelid or brow ptosis from misplaced glabellar or frontalis injections.
- The “frozen” or over-elevated “spock” brow from unbalanced frontalis treatment.
- Asymmetry from failing to account for the patient's baseline differences.
Almost all of these are anatomy-and-assessment problems, not hand-skill problems — which is exactly why the upper face should be learned with a mentor who can teach you to read the individual face in front of you. Structured, supervised practice on real patients, with feedback on assessment and dosing, is the safest route to consistent, natural results.
References
- Carruthers J, Carruthers A. Botulinum toxin in facial aesthetics: consensus recommendations (general reference).
This article is educational and does not replace formal, supervised clinical training or local regulatory requirements.
Hands-on courses on this topic
- Botulinum toxin masterclass (company test) — City of Zagreb
- Botox Training Ignas TM (Copy) — Vilnius
- Dysport Training Ignas TM — Vilnius