Can anything be done to achieve a smooth forehead and minimise these frown muscle 'bumps'? (Photo)

Question

I have prominent frown muscle 'bumps' above my eyebrows (relaxed face in picture). It creates a groove through the center of the forehead. It makes my face look older, quite masculine and like I am frowning. I have a scar between my eyebrows too which makes it look even more frowny. I had consultation for botox, but the doctor did not seem confident that would help me (because the problem is muscle or skull, not wrinkles). Suggestions of the cause or a treatment are appreciated! Thanks

James Lee, MD · Answer

Thank you for your question. Those muscle bumps you are referring to are part of your glabellar muscles, more specifically your corrugator muscles. Botox can help relax those muscles and give your glabellar region (area just above and between your eyebrows) a smoother and softer look. The groove that in the centre that you are referring to that makes you look "frowny" will be softened. The botox injections would not however do anything for your scar between your eyebrows. Hope this helps.

Kian Karimi, MD, FACS · Answer

Thank you for your question and photos! The “bumps” you have described are a result of strong corrugator muscles. By injecting these muscles with a neurotoxin (Botox, Dysport, Xeomin) they will become more relaxed and give a much softer appearance. I recommend microneedling with PRF or microneedling with radiofrequency to reduce the appearance of your forehead scar. As always, these treatments should be performed by an experienced provider to optimize safety and effectiveness.
Best of luck,
Dr. Kian

Sam Speron, MD, FACS · Answer

Botox it Is a wonderful option for improving wrinkles of the forehead/eyes and it can be very addictive because people love what they see. When given in certain spots, your surgeon can achieve a “chemical Brow lift” with Botox alone. There are also many other options such as laser and chemical peels that can further improve the skin itself. Botox works by relaxing the muscles and usually needs to be repeated every 3 to 6 months.
Surgery is another option but obviously more invasive and has scars.
I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of brow lifts but also offers all the nonsurgical options such as Botox injectables and laser treatments. Go over your concerns with them and make sure you walk out of there with several options. I hope this helps.

Aldo Guerra, MD · Answer

Botox has an excellent track record and is FDA approved for the frown lines. However, a full in-person evaluation is preferred for every patient before administering treatments addressing specific concerns.For best results, always see an expert injector. Dr. ALDO

Sach Mohan, MBBS · Answer

Dear Peppypiper, 
Thanks for your question, botox can work by relaxing the muscle and over time this should reduce the muscle bulk. You may not achieve the result you want the first time you have treatment but over several sessions this muscle will hypertrophy and be less visible. The reason for this is that botox blocks the signal from the nerve to the muscle and prevents the muscle from contracting. 
All the best

Monika Soni, MD · Answer

Unfortunately, your anatomy is dictating the shape of your forehead.  Botox cosmetic interacts with muscle contracture to soften lines and wrinkles.  The scar that you are referring to may be improved with a micro needling procedure.  Best to consult with an experienced office who can evaluate your particular circumstances.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs peppypiper. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.If I had a patient with the concern described here I would say she is a good candidate for this treatment.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Cosmoplastic Surgery - New York · Answer

Thanks for your question! While it's hard to say without examining you, the "bumps" your referring to are likely due to you having large corrugator muscles ("frowning" muscles), although there may be a bony (skull) component to it as well. If the bulk of the "bump" is being made up by the corrugator muscle then Botox treatments will help atrophy or shrink the muscles over time, causing them to soften and flatten slightly. It will also minimize further development of wrinkles in the future if treatments are done regularly. If the prominence is due largely to a bony formation, the Botox will not help. The Botox will not do anything for the scar, however microneedling would be a good treatment option to improve the quality of the scar.

Bruce E. Katz, MD · Answer

Thank you for your question. Based on your photo you would be a great candidate for Botox. One of the main causes of forehead wrinkles is repetitive facial movements from muscle memory. Muscle memory happens over time as we teach our muscles to automatically do complex tasks without our consciously controlling every single motion.  Botox is a good option to consider because it targets the nerves controlling these muscles, causing the muscles to relax. The result is a temporary soothing of wrinkles caused by overactive muscles. I recommend getting a consult from a board-certified dermatologist.

Deborah Kessler Hudak, MD, MHA · Answer

The "bumps" are due to strong Corrugator muscles (which cause vertical frown lines when contracting) can most definintely be softened with Botox or Xeomin or (concentrated) Dysport.
The scar would best be treated with microneedling, especially done with PRP (Platelett Rich Plasma, as used in Vampire Facials).
I hope that helps!

Can anything be done to achieve a smooth forehead and minimise these frown muscle 'bumps'? (Photo)

Answers (12)

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