Still Have Faint Forehead Lines After Botox

I had botox done about 2 1/2 weeks ago on forehead and bunny lines. The middle area of my forehead is "frozen" but I can still see faint lines. Is this normal? Will they go away in time? My doctor said to exfoliate the area because it is the new skin coming in that will be void of lines. Is this correct? And if so how long do I have to wait before exfoliating? (I had my touch up on Tuesday) Thank you!!

Doctor Answers 18

Combining Botox With Other Treatments for Best Effects on Diminishing Wrinkles

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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.

New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Remaining Lines After Botox

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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.

Joshua Zeichner, MD
Manhattan Dermatologist

Forehead lines remaining after Botox need filling in or peeling off

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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.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

Botox will relax lines, but may not completely remove them

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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.

Chad L. Prather, MD
Baton Rouge Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Botox takes a while to work

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox for Forehead lines

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Botox usually works very well for forehead lines. Allow at least 7 days for the full effect and any residual lines may be related to residual muscle activity which may require some additional botox. However, if there is little to no movement in the region treated with botox and there is residual lines, then you may be a candidate for the additional of soft tissue fillers or fractional ablative technology, such as fractional CO2, Fractional Erbium or Fractional RF.

Of course, you should consult at medical specialist skilled in the art and science of aesthetic medicine before embarking upon any treatment plan

R. Stephen Mulholland, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 100 reviews

Likely will Not Go away

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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.

Samson Lee, MD
Seattle Facial Plastic Surgeon

Botox for forehead wrinkles

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Botox is great for relaxing muscles and minimizing the appearance of wrinkles but sometimes there are limitations because the muscle has been used over many years and consequently the wrinkles associated with it are deep. The wrinkles that are most likely to still be present after adequate treatment with botox are those that are present at rest. A filler may help to minimize the appearance of these lines. This in conjunction with Botox to prevent further deepening of the lines will probably be most beneficial to you.

Ritu Saini, MD - Account Suspended
New York Dermatologic Surgeon

Wrinkles still evident after Botox

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The main goal of Botox and Dysport is to temporarily stop the muscles ability to move and create wrinkles.  Once the wrinkle has formed,  you will need more than Botox to erase the line.  Depending on the depth of line/wrinkle, you have several options.  Topicals with Tretinoin (Retin-A), Alpha Hydroxy Acids and Vitamin C are great home products to reduce the appearance of wrinkles but it does take time and patience.  If you are looking for an faster result,  you can try a more aggressive approach with chemical peels(TCA), Microdermabrasion or laser resurfacing. 

With either approach, don't forget to use your sunblocks and keep up with your Botox injections.  Prevention is the best way to ward off the signs of aging. 

Lee Robinson, MD - RETIRED
Portland Facial Plastic Surgeon

Options for persistent wrinkles after botox

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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.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 56 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.