Smoothing forehead wrinkles with botulinum toxin
Botox in the forehead – The classic
Botox in the forehead is a classic of aesthetic medicine. Smoothing forehead wrinkles with Botox is very effective because forehead wrinkles are usually of mimic origin. They occur because the mimic muscles of the forehead contract. Every time we laugh or frown.
Botox in the forehead reduces the pull that mimic muscles exert on the skin. This is how Botox can be used to smooth forehead wrinkles. And the frown line, which often bothers even more, right along with it. Doing both in one session saves on Botox and lowers the cost. The treatment is low-risk and one of the most common cosmetic uses of Botox worldwide. As a rule, it provides a clearly visible improvement.
In the following article, I would like to explain how I treat forehead and frown lines with Botox in my practice in Munich.
These are the topics:
What to do about wrinkles on the forehead?
Smoothing forehead lines – when and how much?
As mentioned at the beginning, Botox in the forehead is a classic. Removing forehead wrinkles was one of the first cosmetic uses of Botox. Nevertheless, injecting the forehead is not trivial. Because innately, forehead lines have a positive meaning in facial expression. They occur when we listen carefully. Or when we show interest. Wrinkles on the forehead are immediately and clearly visible to our counterpart. By frowning, we signal active participation and empathy. This makes forehead wrinkles an important aspect of our emotional appearance.
Forehead lines look authentic
As people, we appear authentic when our verbal and non-verbal communication match. Our interlocutors hear us verbally, but observe us non-verbally. Anyone who professes to be distressed about a matter is expected to visibly furrow his brow. If he doesn’t, it comes across as insincere. Therefore, when people say of themselves, “I am proud of my wrinkles,” they are usually alluding to their authenticity. And it’s true: For an authentic and sympathetic appearance, functioning facial expressions cannot be underestimated. This includes the ability to form forehead wrinkles. To put it bluntly, being able to frown makes us likeable.
When do forehead lines have a negative effect?
However, the positive impression evaporates when forehead wrinkles appear grim or even unsympathetic. They usually do when they are permanent and particularly pronounced. Deep furrows that run across from one side of the forehead to the other rarely look sympathetic. They create a brooding, doubting impression. Just as if we regarded our counterpart with scepticism or even contempt.
This is particularly true for the central forehead wrinkle between the eyes. It is not by chance that it in German, frown lines are called “anger line” (Zornesfalte). A deep frown line can greatly affect the image people have of you. Furthermore, the image you have of yourself. For example, new research on the possible effect of Botox against depression is primarily based on results from the treatment of forehead and frown lines.
Deep forehead lines look tired and saggy
Deep forehead lines also signal fatigue and flabbiness. We seem tense, without dynamism. And look older than we are. Since the forehead contributes disproportionately to our appearance, this impression is actually reinforced. Other, positive facial expressions fade into the background when a deep frown is the first thing perceived by the counterpart.
Here again the reference to the current research on Botox in depression: Under the negative impression of deep forehead wrinkles one often suffers oneself. Cosmetic intervention in such cases not only improves the external appearance. But it also increases personal well-being. Having forehead lines smoothed out is probably one of the oldest cosmetic procedures for this reason. In the past, wrinkles on the forehead were removed as part of a surgical facelift. Today, Botox is used to smooth forehead lines, in a much simpler way.
Botox in the forehead at relatively low cost
The advantage of Botox in the forehead is not least low cost. Using Botox to treat the forehead, frown lines or even the entire face in one session costs only a fraction of a surgical facelift. This is still often the method of choice when facial expressions are not the cause of wrinkles. But rather an excess of skin, as it occurs with increasing age. However, as long as forehead wrinkles are caused by facial expression, Botox in the forehead is the more cost-effective method. For the treatment of forehead and frown lines, one vial of Botox is usually enough, which only costs a few hundred euros, even in Munich.
Hardly any risks with Botox
Moreover, Botox in the forehead is low-risk when compared to surgical interventions. Because it makes a huge difference whether you have your forehead wrinkles smoothed out on an outpatient basis during your lunch break or in an operation with general anaesthesia. Botox for forehead lines lasts 20 minutes, after which you are ready to go again. Temporary redness and minor haematoma are the primary risks. This is not at all comparable with a surgical procedure. Therefore, Botox for forehead lines has become one of the most common cosmetic interventions worldwide. Good results at low cost and little risk simply speak for themselves.
first-timeRS have botox in the forehead
For many patients who have forehead lines smoothed with Botox, the treatment represents their first contact with aesthetic medicine. In my practice in Munich, I welcome many women and men as “first-timers” when they want to have their forehead, frown lines or both injected with Botox. I’m not surprised, precisely because the forehead has such a strong impact on appearance. Even people who are sceptical about cosmetic procedures consider going to the doctor’s office to have frown lines treated. They accept the smoothing of their forehead, while they continue to disdain lip augmentation or nose correction.
Beware of the “Botox face”
However, as mentioned above, having your forehead completely immobilized is not advisable. Because this could lead to the so-called “Botox face”. A Botox face looks frozen. A forehead immobilized with Botox looks artificial. It robs you of your natural facial expression that those around you associate with you. It is probably due to the rampant youth craze that you often see Botox faces nowadays. In people whose foreheads are no longer capable of any movement. Some colleagues even consider it a proof of their good work if the patient’s forehead has become absolutely immobile. I think that is wrong.
Keep natural facial expressions!
Whether you laugh, whether you cry, whether you are refreshed or completely exhausted: your forehead would always appear just as smooth. A rigid Botox forehead would appear very strange on your personal environment. You would not be recognized (in an emotional sense). Do you remember the photos and reports that circulated years ago about a famous Hollywood actress? Accompanied by much criticism and mockery? That’s precisely what I mean. And while you may not be a Hollywood star and no people magazine takes note of your looks, the people around you certainly do.
Dynamic smoothing of forehead lines
I therefore advise my patients in Munich to have forehead lines smoothed only in moderation. And not having Botox injected into the forehead in high doses. Especially not in the large frontalis muscle. This is the muscle that primarily causes forehead lines.
My therapeutic goal when I treat forehead lines with Botox is rather to be able to evoke them dynamically: If one is amazed or particularly attentive, then one can very well still show it to one’s counterpart. By raising the forehead as usual and placing it in slight cross folds. However, in all other situations where they would not support facial expression, they are not there.
Smooth forehead wrinkles yes, drooping eyebrows no
Too much Botox is never a good idea
Another risk associated with Botox overdose in the forehead is that it weakens the frontal muscle too much. The frontal muscle pulls the eyebrows upwards. If his pull slackens too much, his muscular counterparts pull their eyebrows down. In this case, one speaks of Brow ptosis. It has a very detrimental effect visually. I will go into more detail about it below.
Low dose Botox for the forehead
Whenever possible, I use a low dosage of Botox in the forehead. The facial expression is thus preserved and excessive weakening of individual muscles, which would disturb the balance of the face, is prevented. Today’s standard regimen for Botox for forehead wrinkles involves a single line of injection. As a rule, I do not deviate from this. There are exceptions, such as those cases where a high forehead requires a 2nd row of injections. But otherwise it is neither necessary nor desirable.
Lower dose, lower cost
Previously, the dose in the standard protocol was still set quite high at 30 units of toxin. Today, however, people are much more cautious. The recommended dose of Botox for the forehead is now only 13 units. That’s less than half. If the glabella and eyebrows are also treated, then there is an additional dose of around 30 units for this. So together 43 units. One vial of Botox contains 50 units. The complete treatment of the upper face can thus be conveniently performed with one vial. Therefore, treating the entire forehead with Botox in one session is attractive in terms of cost. This is because the active ingredient in a vial is optimally utilized, which minimizes the Botox costs per unit.
Careful dosing during initial treatment
Especially when treating new patients, I dose cautiously at first. Why? Because then I do not yet know the subtleties of their face. I can only estimate approximately how the Botox will work. And I’d rather be wrong downwards than upwards. Because I can always add a dose later. A dose that is initially too strong, however, cannot be corrected after injection.
Botox in the forehead for migraine
In some instances, however, high doses of Botox into the forehead cannot be avoided. In the therapy of migraine, for example, they are necessary. 35 units of toxin according to standard protocol. The drooping of the eyebrows is therefore considered a typical side effect of the therapy. For patients who are primarily concerned with relieving their suffering, this may not be so important. Nevertheless, in patients who I treat with Botox for migraine, I still try to keep the dosage low in a first round. Only if the desired effect fails to materialize, patients will have to choose one of two evils.
Micro-Botox for subtle smoothing
Micro-Botox, a fairly new technique, is another way to avoid ptosis and frozen Botox forehead. In the process, the toxin is diluted higher than usual. And then injected into the skin, not the muscle. The effect of Botox thus extends only through the muscle fibres that insert into the skin. The muscle itself remains unaffected. In this way, forehead lines can be smoothed without the risk of a rigid Botox forehead. And since injecting Botox into the skin also reduces perspiration, reduced sweating on the forehead is often a welcome additional effect.
Due to the high dilution, Micro-Botox into the forehead will not require a full vial of toxin. However, since I generally charge every vial opened, it makes sense from a cost standpoint to use residuents in complementary treatments in the same session.
Smooth forehead wrinkles and frown lines in one session
Video: Botox forehead – glabella – eyebrows
Finding the correct balance – key to a natural look
The muscles in your face are arranged so that their forces act in opposite directions. Thus, they balance each other out. If you look at a face vertically from the front, there are muscles that lift the facial expressions (levators). And those that pull them down (depressors).
The large forehead muscle (Musculus frontalis), which causes the transverse wrinkles of the forehead, has a levator function: it raises the eyebrows. If you weaken it with Botox, then its upward force is neutralized. Often, this can be just right and create a perfectly natural expression.
In other cases, however, it may mean that the opposing muscles of the frontal muscle are now too strong. We are talking about the depressors of the eyebrow region. Because the forehead muscle no longer counteracts them strongly enough, their force pulls the forehead down. With the result that the eyebrows sag. This is a very unwelcome result called brow ptosis.
Keep muscles in balance – prevent ptosis
Brow ptosis has a very detrimental effect visually. Especially for people of advanced age. As a practitioner, you have to take care to keep the muscles of the upper third of the face in balance: If you weaken one, the opponent must also lose strength. Otherwise, the overall optical impression gets out of balance.
Do not treat only the frontal muscle
In the specific case of forehead wrinkles, this means injecting Botox not only into the large forehead muscle. But at the same time, to treat the eyebrows and glabella. This keeps the upper third of the face in balance. The facial expression looks natural and sympathetic.
No rule without exception
In some cases, however, it may be advisable to do the opposite and first treat the glabella and then wait 2 weeks for the Botox to take full effect, before the rest of the forehead gets treated. Such an approach is recommended when it is unclear to what extent the glabella muscle, the Musculus procerus, is involved in the formation of forehead lines. If you weaken it first with Botox and then find that the wrinkles on the forehead have already receded significantly, then treatment of the main forehead muscle may no longer be necessary. At least not with the full dose.
Prices for Botox against forehead lines at LIPS and SKIN
Botox in the forehead – cost
The price range for Botox treatment of forehead lines at LIPS and SKIN is €290-€400. For this, you get a whole vial of toxin with 50 units. This is usually enough to treat forehead wrinkles, glabella, and eyebrows in one session. I would like to point out that prices are indicative, the calculation of an actual treatment follows the German Medical Fee Schedule (GOÄ).
What patients want to know about smoothing forehead lines with Botox
Frequently asked questions
No, success is not guaranteed. There are differences in the expected outcome. Optimal results can be expected in patients who can evoke forehead lines and make them disappear when they voluntarily tense and relax the forehead. On the other hand, in patients in whom the transverse forehead lines are always visible due to high muscle tone (basic tension), satisfactory results cannot be expected from Botox treatment alone. In such cases, a complementary augmentation with dermal filler is recommended. Alternatively, a thread lift with PDO threads.
No. Botox does not work for sleep lines. This is because these perpendicular lines do not have muscular causes. Rather, they are caused by the skin repeatedly and persistently contracting when lying on one side during sleep. Mostly along a line running vertically through the forehead, centred on the eye. You can check whether such a line is a sleep line by putting your hand to your cheek and forehead in front of the mirror, turning your head to the side on which you sleep. If they are sleep lines, they are accentuated clearly in this posture. Sleep lines on the forehead are best treated with dermal filler.
If you experience brow ptosis after Botox injections in the forehead, do not be alarmed: the effect is temporary and should go away within a few weeks. Massaging the eye area with your fingertips or the back of an electric toothbrush will accelerate the process. Similarly, stimulating the muscles by repeatedly opening and closing the eyes has proven helpful. Drug support may include eye drops containing apraclonidine (please consult your doctor first). This stimulates the receptors that encourage the eye muscles to contract. It can often be used to lift the eyelid by 2-3 mm.
A suitable alternative to classic Botox in the forehead, as mentioned above, is a procedure called Micro Botox. Here, the active ingredient is injected into the skin in a higher dilution and not into the muscle. The facial expression is not affected. However, Micro-Botox can smooth only subtly and is therefore only suitable for relatively fresh forehead wrinkles, as long as they are not yet too deep.
In all cases where forehead wrinkles do not have a mimic origin or cannot be optimally treated with Botox due to increased muscle tone, dermal filler and thread lift are principal alternatives. Depending on the specific wrinkle pattern, combinations of Botox and dermal filler or thread lift are also conceivable.