The 5 glabellar types & how to assess them

Glabellar lines are not just about the classic ‘11s’ shape. Dr David Eccleston from MediZen Clinic in the UK explores five different types of patterns and what this can mean for evolving your clinical practice.

Addressing patients’ concerns about their lines and wrinkles is a mainstay of most aesthetic practices. But what if you could take your consultations to the next level by stepping away from the cookie-cutter approach and refining your recommendations to match the unique ways these lines form in each of your patients?

An individualised approach to the glabella

In the past, studies focused on the glabellar complex typically described a standard approach to assessment that doesn’t take into account individual anatomical differences. Yet as our understanding of anatomy has evolved, so too has the knowledge that muscle contractions differ between patients, leading the way for a more personalised approach rather than a one-size-fits-all.

Five types of glabellar contraction patterns were first published by Ada Regina Trindade de Almeida et al¹, providing a tool to optimise botulinum toxin treatment and allow for a patient-specific approach.

‘When considering lines on the face, we know that the origin of the muscles, where they sit and how they work are broadly similar,’ Dr David Eccleston from MediZen Clinic in the UK explains. ‘Yet how each person uses those muscles is as unique as they are. I believe that understanding these differences in muscle movements helps to deepen our knowledge of anatomy and may unlock new ways to evolve your clinical practice.’

5 glabellar contraction patterns

The two most common contraction patterns identified were the U and V shapes.

“BY IDENTIFYING THE DIFFERENT GLABELLAR CONTRACTION PATTERNS, YOU CAN ENHANCE YOUR CONSULTATION WITH YOUR PATIENTS. CHECK OUT THE COURSES ON THE EVOLUS WEBSITE TO LEARN ABOUT MORE ABOUT EACH TYPE.”
– Dr David Eccleston

The U-shape

The U-shape was identified as the most common type of glabellar line, found in 32% of the study cases.¹ The muscles most often involved are the procerus and corrugators.

‘With the U-shape, we tend to see approximation and depression of the space between the eyebrows with variable intensity but generally little range,’ says Dr Eccleston. ‘As a result, the movement takes the form of the letter U. At rest, the eyebrows tend to form an arch.’

A deeper understanding of the different anatomical features helps to define an individual patient’s expression. Classifying glabellar lines makes the identification of the prevalent contraction patterns easier, which can enhance your consultation practice.

The V-pattern

The V-type glabellar line contraction pattern was identified as the second most frequent type, seen in 30% of cases.¹

‘It is a more profound movement,’ explains Dr Eccleston. ‘At rest, the eyebrows tend to be more horizontal or rectified and lower. And due to increased involvement with the procerus muscle, the medial brow tends to be pulled down more than in the U-type of contraction.’ AMP