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Treatment for Horizontal Forehead Wrinkles?

asked 3 years ago by NotLuke in Charlotte, NC
Latest answer by Daniel Shapiro, MD
Question viewed 16,825 times
Tags: forehead, lines, horizontal

I was told by my plastic surgeon, that Juvederm would not "effectively address" the horizontal wrinkles that run across my forehead. These lines are not deep, but they are very noticeable. If a combination of Botox and Juvederm won't work to reduce these wrinkles, then is there an injectible treatment for them? What are my other options?

15 answers to Treatment for Horizontal Forehead Wrinkles?

Horizontal Forehead Wrinkles

I don't agree with your doctor unless you have absolutely no response to Botox. Most of my patients have a combination of Static and Dynamic Forehead wrinkles. I always start with 30 to 40 units Botox in the Forehead, but I have no problems using hyaluronic acid fillers which can help soften these lines. I would avoid a surgical browlift (endoscopic or open). I think in most cases you can get just as good or better results in the forehead with botox and fillers.

Daniel Reichner, MD
Newport Beach Plastic Surgeon

Injectables vs. surgery

Assuming you do not have significant brow and lid ptosis then Botox would probably be the first thing to try. Be advised that if you do have a lot of sagging tissue over your brow and lids that your frontalis muscle (the muscle over your forehead) is likely helping to keep skin out of your visual fields. Botox can make this worse. Patients with these issues may need a brow lift or an upper lid blepharoplasty. I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon

Botox then fillers

As you can see, Botox is the primary treatment for forehead lines because it paralyzes the muscles that cause the wrinkles. IF you have practiced these wrinkles long enough, they becaome permanent and might also need some fillers to improve them. Chemical peels and laser resurfacing and browlifts can also be necessary in extreme cases to improve the region.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

You may need a brow lift

If you have horizontal wrinkles which are only present with animation of your brows, then Botox will take care of them. If the wrinkles are there at rest, then you may need a combination of filler and Botox. However, if you have significant wrinkles at rest, the you may actually benefit from a brow lift which will stretch out the skin on your forehead. It really depends on the severity of your wrinkles and how much correction you are looking to achieve. David Shafer, MD Manhattan... more

David Shafer, MD
New York Plastic Surgeon

www.ShaferPlasticSurgery.com

A Little of This, (?) a Pinch of That: Paralyze, Then Patch

Wrinkle lines on the face or forehead which are the result of muscular activity typically cannot be effectively addressed by Hyaluronic Acid (HA) fillers. These "dynamic" lines will still be noticeable even after filling with HA, since the underlying cause has not been addressed. HA fillers do their best work in correcting volume loss and "static" lines and wrinkles that are less-directly-related to muscle activity, such as the nasolabial folds and marionette lines... more

Athleo Louis Cambre, MD
Los Angeles Plastic Surgeon

Your plastic surgeon hit the nail on the forehead

Notluke, Trust in your board certified plastic surgeon. He/she knows best, having examined you and assessed your individual needs. Go for the Botox. That is where your money is for softening the forehead lines. If it doesn't provide enough flattening or not a quick enough effect for you, then you can add fillers for deeper lines. The combination of the two will also allow for a longer effect of the filler. And it will stop your sweating. Good luck!

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

Botox will help-But there is a price

As the several other doctors have mentioned, the lines of the forehead are due to the action of the muscles that lift the brows. The lines that come and go with expression (dynamic wrinkles) can be treated with Botox. The lines that are still present when you relax your brows (static wrinkles) will, initially, not be improved with Botox. Over time (many treatments) the skin will continue to regenerate and the static lines will improve. An important issue is that the muscles that cause... more

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon

Botox is the best choice to reduce forehead lines.

Horizontal lines across the forehead are caused by muscle contractions under the skin. Botox temproarily paralyzes these muscles and therefore reduces the lines in the overlying skin. Fillers such as Restylene and Juvederm are used to fill in deep lines or grooves. Fillers work best for static lines such as marionette lines ( those lines going downward from the corner of the mouth) or nasolabial lines ( sometimes called smile lines). I have found that overtime with continued use... more

Susan E. Downey, MD
Los Angeles Plastic Surgeon

Horizontal Forehead Lines and Botox... Does She or Doesn't She, Only Her Injector Knows for Sure

Not Luke Again, Botox to your forehead will greatly improve if not obliterate any and all horizontal lines. The price one pays for this is that the muscles that originally caused those horizontal forehead lines are unable to lift the brows, so that you will not get that nice Botox lift of your eyebrows. Nicole Kidman and Marcia Cross don't seem to mind. There is a happy medium where a skilled injector with thorough knowledge of the facial muscle anatomy can reduce your "not so... more

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

Botox along with a filler usually helps.

To NotLuke, If the lines are not deep, Botox injections alone often work (20-25 units). If the lines are still bothersome after Botox (you have to wait 2 weeks to see), then adding a filler does the trick, but I would use a more forgiving filler for superficial lines. I would use Restylane or even Cosmoplast here, even though I really like Juvederm for deeper lines and hollows. Restylane won't last as long, but you are less likely to get bumps. For some patients, a subcutaneous forehead... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Aesthetic analysis is vital

A combination of Juvederm and Botox can be very effective in the treatment of transverse forehead wrinkles. The Botox would paralyze the frontalis muslce weakening or eliminating dynamic rhytides (wrinkles from expression) while the Juvederm could be used to fill in any remaining static wrinkles. Depending on your anatomy, though, this may not have been the best option for you. If you have a low eyebrow position, weakening your frontalis muscle would cause your brow to drop even further. ... more

Edward S. Lee, MD
Englewood Plastic Surgeon

Significant improvement with Ulthera

The FDA has given its blessing to a fantastic new device that uses ultrasound technology to erase the worry from your forehead. Ulthera recently got thumbs up for the use of its Ulthera™ System to achieve a non-invasive forehead life, or frequently called and eyebrow lift. Many patients who desire a "brow lift" to erase forehead wrinkles but are not getting adequate results from injections but don't yet need or a surgical procedure are seeking extremely impressive... more

Daniel Shapiro, MD
Scottsdale Plastic Surgeon

Horizontal brow wrinkles

Speaking in general, I like Botox and Dysport in the upper half of the face and fillers in the lower half. I suggest you again try Botox or Dysport to treat these pesky lines. After this, a forehead lift could be considered.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon

Fillers do not work well in this area

Fillers do not work well in dynamic lines such as the forehead creases because every time you contract the muscle the skin pleats. The filler would tend to spread next to the crease and might make it look deeper, or if it does look good at rest without raising your forehead, you might see the filler “beading” up when the skin moves with contraction. Botox is the best but some patients whose forehead has started to drop with age, will drop their forehead after Botox and with... more

Ronald Shelton, MD
Manhattan Dermatologist

Horizontal Forehead Wrinkles are Treated with Botox

Horizontal forehead wrinkles are known as dynamic 'laugh lines,' as they arise from animation of the face (namely lifting of the forehead muscles). Since these are dynamic wrinkles and not static (wrinkles while laying still), they are best addressed by Botox. Static wrinkles are present at rest and are thus best corrected by facial fillers.

Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon

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