Still Have Faint Forehead Lines After Botox

Creases in the forehead have been formed over many years of contracting the muscles. Once the muscles stop contracting, the lines can take quite a while to disappear in some patients.  If you continue to maintain the inability of the muscles to contract by having repeat Botox before the muscle wakes up ( around 3 to 4 months), the lines should continue to improve.  Patients who have suffered a stroke which affects their forehead may display one side of the forehead that is very smooth, but this takes time! If you have a social function coming up and you want the lines to look better sooner, then you can have your doctor inject fillers.

Lines, wrinkles and furrows often have two components to them. One is a static component, i.e. lines that we see when the face is at rest. The second is a dynamic component, i.e. the wrinkling that we see with movement of the muscles of facial expression.  In youth, when we smile, scowl, or raise our eyebrows, the force of the movement of our facial expression muscles is countered by the presence of normal and healthy collagen and elastic fibers. After years of sun exposure and chronologic loss and displacement of volume in our face, when we smile, the sides of our eyes fold like accordions (crow's feet) and our foreheads pleat with furrows. After years of repetitive movement even the surface of the skin becomes etched with lines like a sheet of paper folded repeatedly.

Since Botox and Dysport work only on muscular activity, these treatments address only dynamic wrinkles. It is not uncommon, therefore,  to see the lines, like etch marks, remain on the forehead, around the eyes, etc. after adequate treatment with these agents.

Fortunately, a variety of treatments are available if  further improvement of  the superficial lines and etching marks is desired.  One way is to use fillers diluted sufficiently so that they can be administered immediately below the etchmark-like line to raise them. A series of mesotherapy treatments may also prove successful. Still other approaches include medical microneedling, radiosurgical skin tightening, and a series of peels.

If the lines are still there after botox or dysport then you need a filler to fill them in or a chem peel to peel them off or both.  Just exfoliating with a cream doesn't usually do it.

As you know, botox relaxes hyperactive muscles that cause wrinkles by repeatedly folding the skin with expression. Over time these may become "etched in" so that botox will not erase them completely. Some people find that acceptable because it is a more natural look, but there are options for further treatment. In your case it sounds like the botox did its job in terms of relaxing the muscle.

I would advise waiting another few weeks because sometimes the etched in lines continue to fade. Other options inlcude injectable fillers such as Juvederm or Restylane but these are not as useful for very superficial lines. Exfoliation might help, can't hurt.

Botox is a "neuromodulator". What that means in layman terms is that it acts to weaken or paralyze the muscles that are responsible for creating the lines on top of the muscles. By placing botox into the muscles, the lines tend to soften because the muscles can no longer pull the skin edges up or down. However, over time just like a deep wrinkle on a shirt or blouse, the line becomes engrained in the skin. Botox only makes the lines less deep. However, with continued use of the product the lines tend to gradually diminish over time. I hope this information helps.