Should I still need to have Botox?

Question

I had forehead lift in December of last year. The results were great shortly after the procedure- browline lifted, etc. But 3 months after, the skin had settled back so that my eyelids still looked heavy, not as much lift on the brow. So the procedure made some difference, but not enough. I went in today for Botox because the lines between the eyes are back. Does the whole procedure need to be redone? I was hoping that I would not need Botox anymore! Thanks,

Brian Bassiri-Tehrani, MD · Answer

This is an excellent question. A forehead lift simply lifts the forehead skin to give the forehead and eyebrows a more lifted appearance. Sometimes as part of this procedures, the muscles that cause the wrinkles between the eyebrows (corrugator muscles) can be disrupted or divided entirely, eradicating the need for botox in the future. This is not always done as part of a forehead lift. Additionally, even if attempted to disrupt or divide the muscle, the muscles may have some residual activity that cause the wrinkles to return nonetheless. When this happens, toxins are the best option for reducing the wrinkles and raising the medial or inner part of the eyebrows. I hope this helps!

Anil R. Shah, MD · Answer

Hello SCady! My name is Jessica, I am a physician assistant, and one of the providers of Shah Facial Plastics. In general, results from Botox injections will last up to 3-4 months. After that, it is totally normal to schedule another appointment for another treatment in order to improve the areas of concern. I hope this helps!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Kenneth D. Steinsapir, MD · Answer

It is possible that the effects of your forehead lift were short-lived. That can happen especially if the surgeon does not sufficiently release the forehead tissues. It is not necessary to radically remove forehead muscles to get a great long term effect. That can often lead to an atrophic, immobile look that is awful. However, without an adequate forehead release and a long term strategy for readhering the mobilized forehead, surgery effects can be short-lived rather than long term. Properly done (which is not the same as over-done) the surgery can last 10 to 15 years or longer. Now some become convinced that Botox should freeze the forehead. That frozen look does let you know that the Botox is working but it is also very unnatural and usually associated with unnatural forehead muscle recruitment or a very heavy forehead. It is possible to have a very specific Microdroplet forehead lift effect that relaxes and lifts the brow without the freeze. I am attaching a video about that. However, as you know, Botox treatments last 4 to 6 months and then the effects are gone. With a questionable forehead lift, it may be that you are seen the unwanted effect from the Botox wearing off and a poorly done forehead lift. It sounds like you would benefit from a second opinion. I strongly encourage you to get more than one opinion before deciding how to proceed.

Anna Chacon, MD, FAAD · Answer

In general, Botox lasts 3-4 months. There will certainly be patients in which it lasts longer, in that 4-6 month range, or shorter, in that 2-month range. My recommendation is that as soon as you feel that your Botox is wearing off when you're getting movement back, for most people around the 3-month mark you should come in for another treatment if you'd like to maintain your original result. Hope this helps.

Sara Salas, MD · Answer

When you get a facelift done, the surgeons lifts your inner tissue and helps treat the saggy areas in your face. The procedure itself does not change the ability of the muscle to contract and wrinkle your face. Both, botox and facelift, can work together to give you a great youthful look.

Camille Cash, MD · Answer

I encourage you to discuss your concerns about your surgery results with your surgeon.  Unfortunately with no before/after photos it's difficult to comment on them.  It is not unusual to still desire Botox after a forehead lift.  The surgery improves brow position as well as some wrinkles, but the muscle activity will continue which means more lines can form.  Botox can also address crow's feet as well as give a more refreshed appearance to the eyes.

Nancy de Kleer, MD, FRCSC (Plast) · Answer

Yes you will still need Botox afters forehead lift.

A forehead lift repositions the brows, however Botox works to relax dynamic muscles that affect facial expression.
While both work in the forehead area, they complement each other, but do not replace each other.

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