Robert Paul, MD

A forehead reduction surgery could be performed with an incision at your current hair line.  This would allow your hair line to be advanced and therefore shortening your forehead. At the same time, you could also have a the skin of the forehead re-draped and improvement of your forehead wrinkles.  Most certified plastic surgeons should be able to perform these procedures for you. You need to be evaluated in person though to make sure that you are a candidate and to cover all the risks and benefits of the surgery with you including setting expectations to how much of an advancement of your hair and how much of an improvement of your wrinkles can be achieved.  You should also have your eyebrow positioning assessed during the evaluation to make sure they are sitting in the right position as they could be changed or may be altered during the procedure.

There is no problem or additional side effects of using Botox in your age group.  However, please see a certified physician before seeking this treatment.  Without a picture or seeing you in person, it is difficult to assess your problem that you are experiencing.  A "droopy" brow line could potentially be made worse if you use Botox because you are paralyzing the muscles that elevate your brows. 

It is difficult to provide clear recommendations without a picture, but a white birthmark usually means there is absence of the pigment in the area.   This is more noticeable when you have darker pigmented skin types.  Lasers are used to remove colors from the skin and therefore would not help you in your case.  Depending on the size and location of the spot, you could elect to have it excised.  This would completely remove it, but you would have a scar.  This may be okay if it is in an area that the scar is concealed well.  The other option is Recell. This uses your body's own pigment cells to restore the color to the area.  It will likely not correct the spot to normal, but it can greatly improve it.  I hope this help and always seek out a certified physician before undergoing your treatments.

I agree with Dr. Lim, Recell would greatly improve the area, however, it is unlikely to correct it 100%.  You would then need to undergo hair transplantation as you mentioned to restore your hair line.  Another options would be to excise it and to get the best outcomes in this area it would require serial or multiple excisions since the skin is relatively tight on the back of the neck.  By taking it out in smaller portions, the skin will "stretch" and loosen between surgeries. It then will be able to be completely removed and with minimal tension allowing for a better scar.  Now with this procedure, you would have a scar that would be visible with your hair being short, but the incisions should be designed in a fashion to help make it less noticeable to the eye.  The advantage of this procedure is that the area would be completely removed and you hairline would be restored without the need for hair transplants (which could give you a donor scar anyway depending on the harvesting techniques.  These procedures could all be performed under local if you choose as well.  Good luck and as always, please seek out a certified physician when deciding on which procedure to have. 

Since your smile was already higher on the right, the Botox injections the left would make this more pronounced since muscles on the left are not functioning as well.   If you like the how the left side looks now, then you could add Botox injections to the right side to try and lessen the pull of the muscles on that side and lower your smile.  You could also allow the Botox to wear off on the left side over the next several months and see where your smile sits and then make decisions on how you would like to proceed if anything.  Remember, it is very difficult to use Botox in this way to adjust your smile and asymmetries are likely after treatment.  Also, using Botox in these areas can also cause a frozen face look where your smile looks unnatural and your facial muscles are not functioning in the normal manner.   There are lots of things to consider including surgical lip procedures as Dr. Blinski described.  Please make sure that you are being treated by well trained certified physicians to get the best care.  Good luck and I hope this provides some insight into your question.