Forehead Wrinkles?

Hi I have a lady who insisted on having treatment solely into her frontalis muscle as she wants her forehead lines treated and has been having this done for the last few years. I injected the standard 10 units into the frontalis and now 2 weeks on she says she has some response but not as much as usual. She is due her touch up appointment this weekend but i'm unsure exactly where I should retreat as i'm worried about brow droop if I inject any more without the glabellar area being treated also

Doctor Answers (12)

Laxity of forehead

+2

when I determine if there will be droopiness, I put my fingers on the forehead and push the skin caudad (toward the mouth) and see how much laxity there is of the skin. In some people, the frontalis muscle and eyebrows don't go down too much with this maneuver, so it is safe to inject more Botox. Stay between the pupils when you inject until you go up much higher on the forehead where you can drift above the lateral eyebrows and you can be safe. Do not inject too close to the eyebrows when you are a beginner injector so as to prevent droopiness of the eyebrow. Don't be afraid to inject Botox and read a nice book that describes the technique of injection. Remember, err on the side of safety and inject less as you can also add more on a follow-up visit.


Buffalo General Surgeon
4.5 out of 5 stars 6 reviews

Undertreated Forehead

+1

I would not say that 10 units to treat the frontalis muscle is standard.  

  • It depends on the size of the forehead
  • Acitivity of the mimetic musculature in the region
  • Maintenance of regular injections

 

Brow droop is only encountered when Botox is placed into the incorrect area of the frontalis (too low, too lateral, too much) and should not be an issue for an experienced injector.  She would be best referred to a board certified specialist to meet her desired result.

Best Regards,

Dr. LeBeau

Jacque P. LeBeau, MD
Pensacola Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Frontalis Injection Without Brow Ptosis

+1

    Frontalis injection with Botox will not cause brow ptosis if the Botox is injected well above the brow.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 209 reviews

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Botox for forehead lines

+1

Good for you for knowing your limitations.  The amount of Botox required depends on the patient's muscle movement and response to Botox, and everyone will be different.  If you are uncertain how to treat, suggest that the lady see a specialist.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 16 reviews

True experience with facial surgical anatomy and musculature key for Botox/Dysport.

+1

Glampy,

As the other physicians have said here, it is unclear from your posting what your credentials or experience are with Botox injections. It's good that you are concerned about further frontalis/forehead injection without "support" injections at and below the brow line. If you aren't confident of your plan and are looking on the internet for physicians' input, just to be safe in this case, you may want to be referring your patient to a board-certified physician injector in one of the four core cosmetic specialties that all have facial surgical training: dermatologic surgery, plastic surgery, ENT/facial plastics, and oculoplastics. Good luck to you and your patient both.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
5.0 out of 5 stars 40 reviews

Botox and forehead

+1

Maybe it's time to try a different neuromodulator - and as it's been reported, repeated smaller doses of Botox aren't always indicated.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 140 reviews

Botox for forehead wrinkles

+1

I generally inject from 10-18 units into the frontalis muscle, based on the age of the patient, how much compensation they make in using the muscle, the strength of the muscle, and their expected outcomes. I treat most people with 12 units, and a few (usually men) with 18 units. Aim for the top one-third of the frontalis muscle to be safe.

Benjamin Barankin, MD
Toronto Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Don't use too much

+1

I have a number of transverse forehead lines only patients. How much Botox depends on the muscle strength. I have used up to 18 units, but usually more like 12. Placement is important. As an aside I tried injecting way up high in my own frontalis, to get compensatory increased tone of the uninjected frontalis below, a Botox brow lift. I got maybe a millimeter at most, not terribly effective.

Alexander Lewis, MD
Walnut Creek Dermatologic Surgeon

Brow droop

+1

If the person is compensating versus animating, then paralyzing the entire frontalis will give you drooping. 10 units is not the standard as far as I know. Experience and individual dosing still is priority. Do not know your specific qualifications to inject, but as suggested...maybe the patient should go elsewhere

Michael Hueneke, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 25 reviews

Treatment for forehead lines

+1

I usually start with 10 units of Botox in the forehead.  I use a slightly higher Botox dilution, which gives slightly more diffusion and, in my opinion, greater clinical effect for a given number of units.  For a typical female patient, it's best to start with 10 units max to avoid the risk of eyebrow ptosis.  You can always add more but you can't take it out if you put too much in.  I agree that it's usually better to treat the glabella at the same time to relax the brow depressors.

For a touch up, I would look to see where the movement and forehead lines are most visible.  Many times in the forehead, a touch up is needed most at the lateral forehead to improve excess lateral eyebrow arching (the Spock look).  It all depends on where the lines and movement seem to be most prominent.  You can try to stay higher in the forehead to help avoid eyebrow ptosis.

Richard Ort, MD
Lone Tree Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.