I have about four forehead wrinkles that are getting deeper every day. I call it my "washboard" forehead. How many units of Botox would I need to relax these forehead lines?
How Many Botox Units for Horizontal Forehead Lines?
Doctor Answers (24)
There is no hard and fast rule.
I am not a big fan of injecting BOTOX into the forehead. The muscle up there, the frontalis muscle is the only elevator of the eyebrows. This means that any BOTOX injected into the frontalis muscle will drop the eyebrow position.
Yes one can certainly create a glass smooth forehead (Think Marcia Cross) but the price is a fall in the eyebrow position. The aesthetic price is very high because one gets this frozen forehead and a drop in the eyebrows that screams: MY FOREHEAD IS FROZEN BY BOTOX.
However, is there an alternative? The answer is absolutely: Microdroplet BOTOX. This is my patent pending method where tiny microinjections of BOTOX are place between the skin and the muscles of facial expression that insert into the skin along the eyebrow, root of the nose and the crows feet area.
This provides a degree of control over the placement of BOTOX that has not previously existed. The muscles responsible for pulling the eyebrow down and furrowing the eyebrow and glabella can be precisely targeted.
With the eyebrow depressing muscle treated in this fashion, the tug of war between the eyebrow lifting muscle and the eyebrow depressing muscles shifts to favor the brow elevator, the frontalis. This means that the frontalis muscle does not need to work so hard.
The eyebrow comes up and at the same time the lines in the forehead diminish without a bit of forehead freeze. This is one of the most popular BOTOX treatments in Los Angeles- the actors love it because they retain facial expression while at the same time having a very natural improvement in their appearance.
Botox or Dysport for horizontal forehead lines: Catch 22.
When a patient comes to me with "washboard forehead" as you call yours, my first role is to lower expectations of what Botox or Dysport may be able to do for him or her. Unfortunately, the forehead can be a Catch 22 with Botox. The people with the deepest forehead lines use their frontalis forehead muscle the most to keep the brows up while talking and often to help them see. Trying too hard to smooth all of the lines out can weaken the muscle so much that you might end up with a flat forehead and drooping brows. This can be a, luckily temporary, disaster for the wrong person.
I always recommend trying first to support the brows from underneath with a Botox or Dysport "brow lift", which can have a secondary effect of allowing the frontalis to relax, creating fewer wrinkles there naturally, while not causing any downward pressure on the eyebrows. After this kicks in for a few weeks, a lower number of strategically placed units can be lightly scattered in the forehead to soften without weighing down.
Please see only a very experienced physician injector if your forehead has many deep wrinkles so you don't end up with a 3 to 6 month problem.
Botox is ideal for forehead wrinkles
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Units of Botox for forehead
There is no set number for the number of Botox units in the forehead since every forehead is different. The number of Botox depends of various factors, including how deep the creases are, how big the forehead is, how expressionless you want the forehead to be etc... That being said, its also always a balance of injecting enough to get a good result without causing droopiness of the eyebrows and without looking too frozen. I am a true believer of putting less than more in the forehead and I'm not a big fan of the frozen look. I have a lot of patients that are always in front of the camera and I don't want them to be expressionless. That being said, my starting out average is about 7.5 to 10units per person. If someone wants it frozen (which I don't usually recommend), I will go up to 12 or 15 however I always also inject 2.5units in the lateral eyebrow area to combat the possible heaviness from the injection in the forehead. Dr. Behnam, Santa Monica.
Botox needed for forehead lines depends on sex
This would depend quite a bit on which sex you are. Males require many more units than females. The general configuration of your forehead lines would also be important. If your forehead lines extend all the way around and curve around the frontal region you would require a few more units to avoid the Dr. Spock look (for us SF fans), sometimes called the Jack Nicholson look (for Laker fans).
There has been a marked tendency among dermatologists and plastic surgeons to decrease the number of units in the forehead. In fact, the recent guidelines, as outlined by Dr. Lupo, one of the superior contributors on this site, recommend far fewer units than previous guidelines. Injecting fewer units decreases the chances of a brow drop.
I also feel it gives patients a much more natural look and avoids the deer in the headlight look....or the zombie-ish appearance that our VP Joe Biden gave us all during the debates (can't this man find a good PS or Dermatologist...first the weird hair transplant then the botched Botox job!).
I feel that 6-14 units in a female (if glabellar injections are given simultaneously) and 14-22 units in a male is the range I use. If need be more can always be injected as the physician and patient see fit.
Average Botox Units in Forehead
In the Majority of Patients, the Forehead can be Treated with 20-25 Units of Botox. It Varies from Patient to Patient
The amount of botox needed to treat transverse forehead wrinkles varies from patient to patient and depends on several variables. These include the patient's athletic goals and the strength of the frontalis muscle. The frontalis muscle is an elevator of the brow and is responsible for the development of transverse forehead wrinkles. When transverse forehead wrinkles are eliminated completely, brow sag can be a potential complication. This should always be a consideration when treating forehead wrinkles. For this reason, it's appropriate to be conservative during the initial phases of treatment.
In the majority of patients the forehead can be adequately treated with 20 to 25 units of botox. This may vary depending on the patient’s aesthetic goals. It's important that these goals be discussed with the provider before proceeding. This will ultimately lead to a higher level of patient satisfaction.
Botox to the horizontal forehead lines
No Need to Over-treat!
“Washboard” forehead, ay? J The strength of the frontalis muscle varies tremendously from one patient to the next. While this muscle is a relatively thin one, it can create multiple ripples on the overlying skin surface. Some of my patients just need about 8-10 units here (also depends upon the width of your forehead), while some of my wider-faced men need up to 24u (!). The last thing we want to is to overtreat this area leading to a heavy, Cromagnon looking forehead. I’d rather go a bit lighter, then touch up at no charge if necessary a week later.
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.