Does Botox work on horizontal forehead creases?

One truly remarkable consequence of BOTOX ® administration that I have seen over and over again is the gradual complete disappearance of deep, vertical furrows between the eyebrows (frown or 'scowl' lines). With long-standing muscle contraction, the vertical lines between the brows may become actual physical clefts or grooves in the dermis, resulting in creases that are still apparent even when the skin is spread apart tightly with a finger on each side of the crease. In such instances, the initial BOTOX ® injection will soften but not completely eliminate the deep furrow. With regular BOTOX ® treatment, however, such that the frown muscles are never allowed to fully regain their normal ability to contract, the deep furrows may gradually fade completely.

Some patients with chronic, deep furrows between the brows achieve improvement but not complete correction of these creases with repeated BOTOX ® injection. In these cases, a soft tissue filler can be used to eliminate what remains of the furrow. I have used Restylane for this indication in a number of patients with excellent results, and for several of these patients I have performed structural fat grafting of the remaining furrow to provide a permanent correction.

Michael Law MD

Board Certified Plastic Surgeon

Raleigh, Plastic Surgeon

Botox is an excellent choice for softening of these forehead lines, but it's important to have a surgeon perform the procedure who understands the amount of Botox that will be effective as well as the pattern of injection to use. If the procedure is not done properly, it can leave you with an uneven position of your eyebrows or even drooping of your eyebrow or eyelid. So as with any procedure, do your homework, ask to see some Before and After photos, and pick the doctor whom you feel the most comfortable with.

Yes. As the muscle moves up, lifting the eyebrows, the skin creases in horizontal folds as the skin becomes redundant. By relaxing the muscle with Botox, the skin doesn’t move up as much and the creases disappear slowly. Botox minimizes the movement of the forehead muscle to decrease the horizontal lines.

If one’s age has allowed the forehead to droop significantly, it can lower one's upper eyelids. Many people with this condition use their forehead muscles to keep their eyelids open more, and do this without realizing it as a habit. In that case, Botox would be avoided as it could block one’s use of the muscle and the eyelids would droop.

Botox absolutely works great for forehead lines!  Especially in someone as young as you, I have seen it really smooth out a forehead.  See a doctor to determine if you are a good candidate.  It is very effective. 

Botox treatment for dynamic wrinkles on the forehead is a great option for achieving a more youthful and relaxed appearance.

Another thing to consider is skin care. Products like Retin-A and alpha hydroxy acids help the skin to turn over more rapidly, thereby improving skin quality. They help reduce finer wrinkles and take the edge off of deeper wrinkles.

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.

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.