Looking for an alternative to Botox for managing wrinkles on my forehead: Cutting the nerves? Partial Brow Lift?

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your exact situation.

For less significant issues, there are nonsurgical treatments: To give the eyebrows a nice lift, we use injectable fillers to improve the eyebrow, upper eye, forehead and temple. A filler is placed on the bone and in the fat pads of these areas to contour and lift without it looking overdone. We use cannulas to limit pain and swelling.

Surgery (browlift and/or upper blepharoplasty) is a great option for more significant improvement- for example if there is more substantial eyebrow drooping. You do NOT want to cut the nerves, as the ones involved in migraines (as you mentioned) are sensory only, and if you cut the motor nerves for the forehead, you would not get the results you desire! I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Donald Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

Hello mnumannThe specific procedure your brow lift entails will depend on your needs. Factors such as whether entire brow or only the outer brow is to be raised, repositioning of the hairline, and the patient’s individual facial contours will determine the placement and extent of the incisions. The cost of a brow lift can vary quite a lot because brow lifts themselves can be done in a variety of ways. The factors which contribute to the cost of a brow lift are:
Type of brow lift performedSurgeon’s feeFacility feeMedications

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon to determine your candidacy for various surgical and non-surgical techniques.
Best wishes,

 The   corrugator muscles and the frontalis muscles of the forehead can be softened, but not paralyzed otherwise you have a frozen forehead, and look like you had a stroke. Softening of the corrugator muscles between the eyebrows helps with the depressor action of the eyebrows and the vertical lines between them. Softening the frontalis muscle of the forehead helps with the horizontal lines. These muscles are softened at the time of a forehead lift. For more information and many before-and-after examples, please see the link and the video below

The nerves that are sometimes cut are to the corrugators, which cause the frown lines.  No one cuts the nerves to the frontalis muscles, which lifts the brows.  The frontalis muscle is responsible for the horizontal wrinkles across the forehead.  A non-surgical injury to the nerves can be done with radio-frequency devices (Thermi-Rase).  I don't know of anyone in Colo Spgs doing this, and my understanding is its only partial effective.  Through an upper eyelid approach the corrugator muscles can be partially removed, which yields about a 50-60% improvement to the frown lines.  Nothing works better than botulinum toxin neuromodulators (Xeomin, Botox, Dysport).  Another option that you might consider is to to try some Zytaze before your next injections.  In many patients it can potentiate the effects to be more powerful and last longer.  It is also not very expensive relative to the costs of getting "Botox."  Another issue is that your injectors may be placing the injections in a suboptimal manner and/or dosing.  I get a fair number of poor wrinkle blocker responders that come to my office and with optimal dosing they do better.  Without an in-person consultation it is hard to give any additional specifics.  I practice in Colo Spgs if you wish to come in for a consultation.  I also have published on neuromodulator injections and taught at national symposia on wrinkle blocker injecting techniques.  Unfortunately there are a few small percentage of patients that don't respond well to wrinkle blockers, but this number in my experience of 20 years is very small. Best regards.  

Brow lift is the answer. There are a few types of brow lift and an in-person exam can determine which is best for you. Brow lift softens the frontalis and corrugator muscles directly. It lifts the brows and removes the wrinkles like Botox by softening those muscles. Endoscopic and trichophytic brow lifts are my favorites, but sometimes coronal is indicated for some people. Cost is around $9000.

Consider discussing the option of a prehairline browlift with an experienced board certified plastic surgeon to weaken both the frown lines and horizontal forehead wrinkles. Correction of significant wrinkling of your forehead suggests that you will be helped by a prehairline browlift that removes some skin for a long lasting benefit without raising your hairline.Regards,Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Member, ASAPS, ASPS

Extreme Makeover Surgeon, ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Yes, when doing an open brow lift we strip out selected portions of the corrugator muscle (the one that makes the lines above the nose) and the frontalis muscle (responsible for the horizontal lines). No one actuelly cuts the nerves but taking away the muscle in selected areas works well and any experienced plastic surgeon who does open brow lifts can do that for you.