Anatomy of the Glabellar Complex

The glabellar region contains three key muscles responsible for frown lines: the corrugator supercilii (draws brows medially and downward), the procerus (pulls the medial brow inferiorly), and the depressor supercilii. Repeated contraction of these muscles creates the characteristic vertical furrows known as “11 lines.” The frontalis muscle, running vertically across the forehead, produces horizontal creases when it contracts to raise the brows. Understanding this anatomical interplay is essential for effective treatment — relaxing one muscle group without considering its antagonists can lead to unnatural results such as brow ptosis or compensatory hyperdynamic lines.

Botulinum Toxin for Dynamic Wrinkles

Botulinum toxin type A (BoNT-A) remains the gold standard for dynamic glabellar lines. It works by blocking acetylcholine release at the neuromuscular junction, temporarily paralyzing target muscles. A landmark randomized controlled trial by Carruthers et al. (2002) demonstrated that BoNT-A injection produced significant improvement in glabellar lines in 80% of patients at day 30, with effects lasting 3-4 months. Modern micro-dosing techniques, as practiced at RE:BERRY Myeongdong, use smaller quantities distributed across more injection points to achieve natural-appearing muscle relaxation. This approach reduces the risk of the “frozen” forehead while providing effective wrinkle smoothing. The onset of action is typically 3-5 days with peak effect at 14 days. Regular maintenance every 4-6 months can gradually weaken the treated muscles over time, potentially extending intervals between treatments.

Radiofrequency Microneedling for Static Lines

While BoNT-A addresses the muscular cause of dynamic wrinkles, it does not resolve dermal atrophy or collagen loss responsible for etched static lines. Potenza RF microneedling delivers bipolar radiofrequency energy through insulated gold-plated microneedles directly into the dermal layer. Choi et al. (2020) published in the Journal of Cosmetic Dermatology that fractional RF microneedling induced significant neocollagenesis and elastin fiber reorganization in the upper and mid-dermis, with histological evidence of increased collagen type I and type III deposition at 12 weeks. The combination of mechanical micro-injury from the needles and thermal energy from RF creates a dual wound-healing response that remodels scar-like static wrinkle tissue. At RE:BERRY Myeongdong, the Potenza device offers both insulated and non-insulated tips, allowing Dr. Baek to customize treatment depth and energy delivery for each wrinkle pattern.

Combination Therapy: Synergistic Outcomes

A growing body of evidence supports multi-modal approaches for facial wrinkles. Park et al. (2019) in the Archives of Dermatological Research demonstrated that patients receiving combined BoNT-A and fractional RF showed statistically greater improvement in static wrinkle depth compared to either modality alone (p<0.01). The BoNT-A relaxes the muscle that causes repetitive creasing, while RF microneedling rebuilds the dermal scaffold. This combination is particularly effective for patients aged 35-55 who present with both dynamic movement lines and structural volume loss in the forehead region. For patients with significant volume depletion, hyaluronic acid fillers can be added to instantly restore the concavity beneath deep creases, providing immediate visual improvement while the collagen remodeling from RF takes effect over subsequent weeks.

References: Carruthers JA et al. Multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. J Am Acad Dermatol. 2002;46(6):840-849. DOI:10.1067/mjd.2002.121356 | Choi M et al. Fractional radiofrequency microneedling for skin rejuvenation: A systematic review. J Cosmet Dermatol. 2020;19(9):2164-2171. DOI:10.1111/jocd.13656 | Park KY et al. Combination of botulinum toxin type A and fractional radiofrequency for forehead wrinkles. Arch Dermatol Res. 2019;311(3):219-226. DOI:10.1007/s00403-019-01898-8