Does Botox work on horizontal forehead creases?

How do you know if you are getting the actual number of units (Botox) that you are paying for, when should you notice results and can you tell if the Botox has been diluted? Also, recently at a local MedSpa in Fresno California, I paid $440 for Botox (10/07/08)..the nurse left the room for more than a few minutes to get the product and then when asked about "dilution" of the product, advised that there is a "range" of the amount of saline (hopefully preservative free)she uses to dilute the dry form. Is this true, if so, what is the range. Of all the research I've done on the prescribing information, no where does is say to use "anywhere from" 1.0 mlto 2.5 ml. It says to use 1.25ml for a 50 unit vial and 2.5 for a 100 unit vial. Should this nurse be using less than either of these?

Hi Kym! Non-Surgical treatment of your forehead lines depends on whether those lines are seen at rest or in motion (e.g., when you raise your brows). For many patients, Botox treatment of the forehead does a great job of relaxing lines in motion. Great results usually occur when this is performed by a Doctor with experience in treating forehead lines with Botox. Sometimes, lines at rest may improve with Botox, especially in younger patients - and I emphasize the word sometimes! Botox normally just helps with lines due to muscle contraction. If lines at rest improve as well, consider it a “bonus,” but don’t bet on it happening. What about lines at rest? These can be improved by several types of treatments, including chemical peels and laser resurfacing. Although deeper chemical peels were used in the past and still are used somewhat today, they are generally less reliable than laser skin resurfacing. Fractionated lasers are being used more frequently to treat lines at rest. Older lasers would vaporize the majority of the treated area’s surface at once, leading to significant downtime. Fractionated lasers treat only a fraction of the skin during one treatment - the result is a less dramatic improvement and, frequently, a need for multiple treatments. The advantage: significantly less downtime and side effects. Remember- It’s Your Face! For best results, consult with an experienced Medical Doctor who treats patients him- or herself.

There are 2 kinds of creases: those that are present at rest (static creases/wrinkles) and those that are present with motion (dynamic creases/wrinkles). Botox works very well for dynamic creases and wrinkles. With repeated treatments, even static creases and wrinkles seem to get better, espeically if the Botox treatments are peformed before the last treatment totally wears off. You can get an even better result by treating the creases with a fractional resurfacing laser (such as the Lux 1440 by Palomar) about 2 weeks after the Botox treatment. However, there is a potential problem. The forehead muscle is the ONLY muscle that allows you to raise your brow and move your eyebrows. If the injector is too aggressive (treats too much of the forehead) you can get a pretty awful brow drop. The older you get, the more you need your forehead to hold up your brow to see and read. I have seen pateints that had absolutely smooth foreheads that had such a bad brow drop that it looked like the only thing holding up their eyebrows were their eyelids! There is no treatment to fix a bad brow drop, you just have to wait until the Botox wears off. Also, the creases over the lateral eyebrow are not good candidates for treatment with Botox in patients with normally shaped eyebrows. Putting even a small amount of Botox directly over the lateral eyebrow can cause the eyebrow arch to become flat or even make the lateral eyebrow droop. This complication occurs even more often when the client insists that they only want to treat the forehead. Without simultaneously treating the brow depressors (the frown line area and crows feet area) you are increasing your risk of getting a brow drop. As always, the key to getting a good result with Botox is to find a good injector.

Agree with the above that this is an excellent region for BOTOX administration. The forehead muscle (frontalis) is a strong vertical muscle. It pulls the skin downward and causes a horizontal crease. My advice is to allow your dermatolologist or plastic surgeon to administer BOTOX in the glabella area (the groove formed between your eyes). This might even be performed first, and the forehead injections two weeks later. As Dr. Shelton mentioned above, the forehead muscle may be at dynamic tension, pulling the forehead up without your being conscience of this. By relaxing the brow, the forehead does not need to work as hard and the lines may diminish without as much of a need for BOTOX. Thus, if you wait two weeks, you will need less BOTOX, your cost will be less and your results better---no lines and minus the "deer in headlight" look, i.e. you will look relaxed and fresh without the appearance that you had anything done.

Hello Ms. Burton, Like many things, this depends on the integrity of the physician. There is nothing untoward about the nurse telling you that there is a range of dilution. Further, there should be nothing suspicious about the nurse leaving the room for a few minutes. The nurse was most probably drawing up the syringes for the proper dilution. As for the dilutions, many of us including myself use different dilutions depending on which facial muscles need relaxation. For example, injecting around the mouth (peri-ocular)or beneath the eye (sub-orbit), one needs precision and little diffusion. Thus, a 1 cc dilution. However, in injecting the forehead, we prefer more diffusion and thus 2-3 cc dilution (some even use 10 cc). As far as the use of preservative free saline, most of us disobey the package insert and inject with preserved saline. It lasts much longer and hurts less since Benzyl alcohol acts somewhat as an anesthetic. Hope this answers your questions, and eases your mind.