The most conservative therapy for the “Angry Look,” or deep glabella rhytids, is neuromodulator therapy (Botox, Dysport, etc) to the paired corrugator muscles. Yes, the effect wears off with time (3-5 months) and must be re-injected 2.5 – 3x/year, but that also means the result isn’t permanent. If you want a little more or less movement in this area just modify the amount injected. For those that don’t want the hassle of repeat therapy, consider that if you use the same injector (who knows the precise amount used per location), the maximum amount of time to treat this area is 15 minutes (cooling the skin, injection, and holding pressure to prevent bruising).

Alternative, and permanent, options involve physically (surgically) removing the muscle tissue. Complications of this procedure include contour irregularities, sensation changes, and permanent asymmetry of the brow. If a patient is already planning on undergoing an upper blepharoplasty or brow lift, this is a reasonable option, but is otherwise an aggressive approach (and generally discouraged).

I recommend attempting the least invasive procedure most likely to provide the desired result. This approach maximizes gain while minimizing risk.