Do I need to get Botox in my 11's (frown lines) before I get it in my forehead?

When we treat forehead lines, it is important to look at the position of the eyebrows. If the eyebrows have dropped  or are naturally low, you are using the forehead muscle to lift the brow. Overtime forehead lines develop. If the forehead lines alone are treated the brow may feel even heavier.If the brows have settled, it is more appropriate to treat the frown lines between the brow, and the crows feet as these muscles pull the eyebrow down. The forehead line treatment depends on the height of the forehead. if you have a small forehead, a small amount of BOTOX may do the job. Larger foreheads will require more.

Great question.  You can certainly treat both areas at the same time. There is no real need for staged treatment.  Results will be seen after 1-2 weeks. Hope this helps!

No, you can treat both areas at the same time. It will take 1-2 weeks for final results. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Hi Keith. Both of those statements from your provider are false.  Botox (Dysport, Xeomin) are commonly used to treat the frown lines and forehead (above the brows) at the same time. This is Standard practice.As for the second statement, drooping of the eyes is about injection technique and amount of product used.  If the dose is too high or the area wrong, yes forehead heaviness or eyelid droop can occur.  But these issues are independent of injecting the frown lines as they are different muscle groups.  Best of luck.

Without posted photos and the benefit of physical exam- it's difficult to comment accurately. If a patient presents with forehead and frown lines both areas can be treated at the same time. With proper injection techniques and proper dosages- a good result can be expected.

Thank you for sharing your excellent question.  As each patient needs to be considered for a personalized treatment plan it is difficult to offer you advice on what would be the best areas to approach, but it is entirely possible to treat only the forehead lines and not treat the 11's.  Hope this helps.

The muscles in your forehead help raise your eyebrows. If you temporarily weaken them with Botox you may have some drop in your brow position. The amount of drop depends on your anatomy and how much the muscle is weakened. The muscles in your 11's pull the brow down, so weakening these muscles gives you a lift, which can counteract the drop from the forehead lines.Its definitely possible to treat just the forehead, but the results are often better if you also treat the 11s.Make sure you dont have forehead lines because your eyelids are heavy and hooded. If they are, treating the forehead lines will only make this problem worse. 

Thank you for your question keith75. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.The pivotal studies for the horizontal lines on the upper forehead were published many years after doctors had been using Botox. In these studies, 20 units of Botox were used to treat this area. However, in my experience I find that anywhere from 10 to 20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.If I had a patient with the concern described here I would recommend a global approach as described above to maintain a harmonious balance in the upper face and to prevent the brow from descending as recommended by the doctor who performed the consultation.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

I find that patients are most satisfied with their treatments when both the frown lines and horizontal forehead lines are treated at the same time. A study in one of our medical journal has also recently confirmed this. 

Thank you for your question! There is a tug of war between all of these muscles regarding brow and forehead position. The injections between the brows soften the elevens but also can impact the forehead because of spread of the Botox. Treating the forehead lines can be tricky because these muscles elevate the brows. If a dosage that is too high is given or if the injections are close to the brows, droopy brows can results. If you have strong and active muscles between your brows, they probably should be treated as well as the muscles in your forehead. Best of luck!