Will Botox for my horizontal forehead wrinkles cause my already droopy eyes to droop worse?

Question

Hello. I'm 23 and I've started noticing wrinkles on my upper forehead (some even when resting the forehead) about 6 months ago. I have droopy eyes to begin with (genetics) and I don't want my eyes to droop further. I believe the wrinkles are due to overworking my frontalis muscle subconsciously. The wrinkles are making me self-conscious. Will Botox in my forehead make my droopy eyes worse? Which doctor would be best qualified for me to receive these Botox injections from? Thank you in advance!

Jacob Sedgh, MD · Answer

With paying attention to anatomical details of the forehead and its muscle innervaations Botox placement can improve forehead wrinkles and even give a modest elevation to the brows simultaneously.

Jason Emer, MD · Answer

"​For glabellar lines (or frown lines / ""11"" lines), we inject Botox, Xeomin, or Dysport into the muscle, causing the muscle to weaken and improving the appearance of the lines. These work by binding to receptors that send nerve signals for muscles to contract. Since your body makes new receptors and neurotransmitters all the time, it needs to be maintained otherwise the wrinkles will slowly return as the muscle regains function over time. Neurotoxins take 2 to 4 weeks to start working and lasts for up to 6 months.

For deeper glabella lines or strong 11s, I use a combination of Botox with fillers, lasers and microneedling with PRP. I suggest getting a formal evaluation with an experienced cosmetic dermatologist and expert in lasers and fillers. Best, Dr. Emer
​"

Philip K. Robb Jr., MD, FACS · Answer

Excellent question and this is something that many people (including many injectors) don't realize. 
The face is a complex series of give and take muscles. There are muscles that lift things and muscles that lower things. When we weaken the lifters but not the lowerers... things (brows) become lower. 
When done correctly, the brows should not lower, the eyes should appear more open, refreshed, and inviting. 
Find someone who's experienced, who does a lot of this, and who you trust. This is a great treatment that my patients really love! 
Good Luck and God Bless!
Dr. Robb

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  If correction of your genetically droopy eyes is not a possibility I would advise caution with dosing of Botox because you are using that forehead muscle most likely to open your eyes further.  Once paralyzed you may see some increased drooping to the lid.  Share your concerns with a board certified plastic surgeon, they should be able to help you make the best decision.

Kenneth Yu, MD · Answer

Hello.  The forehead wrinkles are caused by the frontalis, which raises the brow.  It's important for the injector to inject the frontalis accurately.  If injected too low, that will cause your brow to drop, and that may make your eyes worse.  Though Botox is super safe (such that non physicians are injecting it), if you want good results, you really need to see a board certified cosmetic physician.  If a nurse or aesthetician injects you, it's critical they work under a board certified cosmetic physician in a practice focused exclusively on cosmetic treatments, and not some general practice which also happens to want cash paying patients.  Take care.

Thomas Fiala, MD, FACS, FRCSC · Answer

It would be important to not inject the area immediately above the eyebrows - otherwise they could certainly drop lower when the Botox causes the frontalis muscle (which holds them up) to relax.

Ellen A. Mahony, MD · Answer

Hi there,
Botox can be successfully placed in the forehead creases without effecting the eyelids.  It's best to go to an experienced surgeon who understands facial anatomy and can properly assess your unique face!
Good luck!
In good health,
Ellen Mahony, MD

Carmen Kavali, MD · Answer

Thank you for your question.  Horizontal lines in the forehead are caused by movement of the same muscles that elevate the eyebrows.  So, yes, a full treatment of your forehead lines would indeed make your brows heavier.  However, judicious dosing and placement of Botox can still be helpful for you.  (I personally have this same issue, and I may able to treat my forehead lines.)I'd be happy to see you!  Botox and fillers are a huge part of my practice, and I'm a national trainer for Allergan, the company that makes Botox.I hope this helps,Dr. K

Shaun Patel, MD · Answer

Thanks for sharing your question. It's hard to give you a specific answer without seeing a photo of your upper face or evaluating you in person. That being said, based on what you have described, if your frontalis (forehead muscle) is being used to keep your eyebrows up and eyes open, I would be hesitant to relax it using Botox. A smaller dose of Botox could be used and the Botox should be placed high on the forehead if the decision is made to inject Botox.

Mark T. Boschert, MD · Answer

Botox will improve those lines. That is one of the greatest things that it does. However seek out someone who has a significant experience with facial aesthetics including Botox and ways to improve the droopiness of the eyebrows and eyelids. An overall evaluation is probably the best way before embarking on any treatment. Best of luck!

Will Botox for my horizontal forehead wrinkles cause my already droopy eyes to droop worse?

Answers (13)

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