Why do forehead wrinkles occur?
Wrinkles along the forehead appear normally during facial expressions, particularly with surprise or joy. The muscle that creates these lines is also the muscle that lifts the brows. This muscle, called the frontalis muscle, is a thin sheet of muscle that begins along the brows and stretches up to insert near the hairline. This is a common place to experience wrinkles since we make the expressions utilizing the frontalis muscle all of the time.
What happens with the Botox® or Dysport® injections?
When we soften the upward pull of this muscle, the forehead smoothes out nicely and we maintain some lift of the brows. It is important to carefully place the injections specific to the persons wrinkling pattern, and in balance with the symmetry or asymmetry of their forehead and brows. Ideally, we maintain existing symmetry and help even out any existing asymmetry. Most patients also prefer a more natural look with the ability to raise their brows somewhat maintained. Other patients may prefer more of a frozen look. While our goal is always to maintain as natural a look as possible, we can vary our technique to achieve results we are both happy with.
What are some possible adverse effects?
Undertreatment of the area may lead to persistent wrinkles, or if undertreated to the sides of the forehead, may lead to a "spock-eye" or wrinkling that is prominent just over the outer brows, giving a surprised look. While this is uncommon, it occurs on occasion and can easily be treated with a tiny touch up to soften that area of muscle pull.
Alternatively, overtreatment may lead to a heaviness to the brows or a feel of, or true eyelid droop. Please refer to the Botox® product page for further information.
When should I start Botox®?
This muscle may be overactive for some people due to genetics and cause premature wrinkling. In this case, preventative Botox® may be something to consider even in the 20s. Our recommendation for most people is to start in their 30s.
Who should consider other treatments?
The frontalis muscle is overactive in those with heavy or hooded eyelids as they depend on the lift of the brow to keep their eyes wide open. The eyes are the most focal point of a persons face in general, so we may not treat the forehead at all, or at most very cautiously, in these individuals. If this is the reason for overactive forehead wrinkles, it is also likely that the person would actually benefit most from a surgical intervention to remove the excess tissue above the eye so that they no longer have to constantly elevate the lids to compensate. After the procedure, most people can then get the benefits of Botox® injections without risking a droop of the lids.
Prior to Botox® treatment, we evaluate your anatomy and movement with you relaxed and then making facial expressions, raising your brows, smiling, squeezing eyes shut, etc. We will determine the proper location and dose for the injections. We offer complimentary consultations to answer all of your questions and determine the best treatment for you.
Many patients, both young and old, have excessive upper eye tissue with a hooded lid. Even with expert placement of neuromodulator, this problem can inadequately be treated, or worsened with treatment. While not everyone is a surgical candidate or would be interested in this option, we always have your best interest at heart and will refer you to a specialist to consider surgical intervention if this should be a consideration.
Most patients require 5-10 injections to the forehead that are placed specific to the patient's pattern of muscle action and wrinkling. It is important to keep a proper balance between the muscles that lift and lower the brow, so most all individuals require treatment of the glabella, or "frown lines", to maintain this balance.
Injections may feel like a tiny pinch, but are not considered painful. We offer a vibrating tool that distracts from the injections and most patients feel only the vibration rather than the pinch.
The injections take about 1 minute to perform.
There is no recovery time. You may have tiny red bumps, like mosquito bites. This generally goes away within minutes. Rarely, a small bruise may occur.
We recommend not lying down, exercising or touching the treated area for 4 hours after the injections.
As with other Botox® injections, results come on gradually and usually are apparent in 3-4 days with maximum effect in 7-14 days. Dysport® tends to take effect quicker with visible results in 1-3 days and full effect within 7 days.
Botox® and Dysport® both last on average 3-4 months, so to maintain results, you will need to come in for touch-ups a few times a year.
Rarely, the injections may result in undertreatment, slight asymmetry, which are generally easily treated at a follow up appointment. Very rarely, patients may heaviness or slight droop. Botox® is not permanent.
*results may vary