What Are ’11 Lines,’ and Is There Actually Anything You Can Do About Them?

If you’ve ever caught your reflection mid-frown and noticed two vertical grooves sitting right between your eyebrows, you’ve met your “11 lines.” They are named, unimaginatively but accurately, for looking like the number 11. Clinicians call them glabellar lines.

Start with daily sunscreen

Sunscreen is the lowest-risk step here, and it has trial evidence for skin aging in general (not for these lines). In a randomized trial of 903 adults under age 55 in Nambour, Australia, people assigned to daily broad-spectrum sunscreen showed 24% less skin aging after 4.5 years than people who used sunscreen only when they chose to (relative odds 0.76, 95% CI 0.59 to 0.98).^[1] Skin aging was graded from skin surface impressions by assessors who did not know which group each person was in. The authors noted that some outcome data were missing and that the trial had modest power to detect moderate effects.^[1]

What about a retinoid?

A 2006 overview of retinoids for skin aging (a narrative review rather than a systematic one) found that many of them have shown visible and tissue-level improvement. Most of that work was done in people with sun-damaged skin. Tretinoin was the most studied.^[2]

The same review notes that burning, scaling, and irritation limit how many people stick with them. Retinol and retinaldehyde were considerably less irritating than tretinoin. The authors said more elaborate clinical studies are needed to confirm the advantage of newer ways of delivering topical retinoids.^[2] If you want to try one, a pharmacist or dermatologist can help you pick a strength and ramp up slowly. Retinoids are not recommended during pregnancy or when trying to conceive, so avoid them if that applies to you and ask your clinician.

The in-office option: botulinum toxin

The most studied medical treatment for these lines is botulinum toxin type A. A Cochrane review pooled 65 randomized trials with 14,919 participants. The glabella, the area between the brows, was the treated area in 43 of them.^[3]

For glabellar lines, onabotulinumtoxinA at 20 units probably gave a much higher success rate than placebo at week four, whether success was judged by the participant (risk ratio 19.45) or by a physician (risk ratio 17.10). Major side effects, defined as eyelid droop, eyelid sensory problems, or crossed eyes, were probably more common with the toxin than with placebo (Peto odds ratio 3.62), although the overall rate of any adverse event may not have differed from placebo (risk ratio 1.14).^[3] The effect also wears off: in the trials the average duration of the treatment effect was about 20 weeks, so treatment has to be repeated to keep the result.^[3]

The review also found that none of the trials were at low risk of bias in every area, and most participants were women aged 18 to 65.^[3] Results may differ for you, and cost and risks are worth weighing. A conversation with a board-certified dermatologist is the right place to start.

There is no wrong choice here. Treating the lines, leaving them alone, or sticking with sunscreen are all reasonable, and which one fits is up to you.

References

^↑︎ Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med. 2013;158(11):781-790. DOI: https://doi.org/10.7326/0003-4819-158-11-201306040-00002

^↑︎ Mukherjee S, Date A, Patravale V, Korting HC, Roeder A, Weindl G. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006;1(4):327-348. DOI: https://doi.org/10.2147/ciia.2006.1.4.327

^↑︎ Camargo CP, Xia J, Costa CS, Gemperli R, Tatini M, Bulsara M, Riera R. Botulinum toxin type A for facial wrinkles. Cochrane Database Syst Rev. 2021;(7):CD011301. DOI: https://doi.org/10.1002/14651858.CD011301.pub2

Kurt Greiner

Kurt is a digital strategist and IT professional blending emerging technology with practical application to help businesses and individuals streamline their digital presence. His current work focuses on the intersection of intentional living and technological resilience, exploring how individuals can leverage modern tools to navigate the second half of life with purpose.