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.

If you still have lines, perhaps either you don't know what to ask for or your doctor does not know how to help you.  The most important thing to understand about BOTOX is that it should not be used to freeze the forehead.  Sure done densely enough there will be very few forehead lines.  On the other hand your eyebrows will drop line stones (think Marcia Cross).  

What one really needs is a BOTOX forehead lift.  While this opens the eyes, and reduced the forehead lines, it may not eliminate all the lines.  Residuals lines may be from muscle activity or creases in the skin.  To further reduce lines without compromising the eyebrow position, careful evaluation of your forehead is needed.  Some need actual forehead surgery, others need a combination of BOTOX and fillers.  Exfoliating the skin in no way will help these types of lines.  Hope this helps.

Botox is just a paralytic - it just paralyzes the muscle underneath.  Unfortunately, the wrinkles have formed over thousands of times as the skin folds in that area.  Paralyzing the muscle prevents you from making them, but in some people, the wrinkles can still be seen.  If they are fine enough, then something to exfoliate them may work well.  However, if they are still visible, you may need some sort of filler ( juvaderm or restylane) to help hide them.  In terms of timing, you should be fine to go ahead and try some exfoliation at this point.

Expression lines on the face develop after years of muscle contraction in combination with aging skin.  Botox can help relax the muscles so that the lines can improve.  It takes time for the lines to improve completely.  In some cases where the lines are very deep, they may never totally go away.  In those cases, sometimes filling agents are used in conjuction with Botox.

An analogy can be made to a sheet that has been folded up in the back of your closet for years.  When you take it out and unfold it, it still has lines in it.  If you hang it up flat, eventually the lines will improve on their own.  In some cases, you may need an iron to help smooth them out, but only time will tell if that is necessary.

Your experience is one that many patients have, since Botox works best on dynamic wrinkles (wrinkles with facial motion) rather than static wrinkles (wrinkles at rest). Lines that were years in the making may not be improved with just one treatment, but patients often find that after repeating Botox every 3-4 months for a few sessions, these lines at rest may begin to diminish as well.  They may not completely disappear however, but they won't continue to worsen either.  Fillers may sometimes be used to improve these lines even further.

If you start BOTOX before you develop any lines then you can prevent them from occurring for a long time. However if you already have lines, they will always come back once the BOTOX wears off. If they are moderate lines BOTOX will help diminish them but they will not disappear. If you have very faint lines usually BOTOX will make these go away, but once it wears off they will return. An alternative method to treating lines are use of fillers or laser resurfacing.