Why do I find very small wrinkles on my forehead after getting Botox for a few years?

hi,I am a 33 old woman. I've been getting botox for the last 3 years, almost every 6 month. Now it's the time that I have to renew it. But recently I noticed the skin of the areas I usually got botox for (specifically my forehead) is different than other areas, like my cheeks. The skin of the whole area (forehead) does not look as firm as before. l I read the previous questions and Dr.s replies to such questions that if we stops getting botox our skin won't have more wrinkles (more than before getting botox). Then why my skin looks old and full of very very small wrinkles. I'm afraid if i have to get more and more doze of botox in near future. Please help me!Thanks,Somaye

Doctor Answers 5

Botox Works For Dynamic (Motion-Related) Wrinkles & And Fillers Work For Static (At-Rest) Wrinkles & Crinkles

Facial wrinkles are the result of increasing overactivity of the muscles of facial expression that occurs naturally with chronologic aging and loss of the quality and quantity of the collagen supportive fibers and  elastic fibers within the dermis--the latter due in large measure to photoaging from chronic ultraviolet exposure. 

In general, it needs to be understood that neuromodulators, such as Botox, Dysport or Xeomin are intended to lessen the hyperactivity of the muscles of facial expression.In other words, these agents are directed to reducing dynamic wrinkling. They do not address the fine lines and crinkles that have resulted from the years of accumulated UV damage and the "etching" of the skin that comes from years of a thousand times per day use of the muscles of facial expression. A piece of paper folded just once becomes creased and remains creased even if we attempt to iron it away. It is perhaps this fine etching of the skin to which you are referring.

Fillers, such as Belotero Balance or Restylane L injected very superficiallly can work well raise up these fine lines and "iron them out."  

I often address both problems simultaneously in one treatment session, using fillers to treat fine lines on the forehead, between the eyebrows and in the crow's feet area, and injecting Botox or Dysport in these same areas. Studies have corroborated my personal experience that doing both can result in far longer periods of improvement when compared to using either approach alone.

New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Why do I find very small wrinkles on my forehead after getting Botox for a few years?

In general, Botox can be preventative. For example, if an individual frequently frowns, the Botox can decrease the frowning, thus decreasing the lines that will appear in the future. Botox will not prevent aging of the skin. There are treatments to help improve the appearance of fine lines and wrinkles. I would recommend following up with your physician to see what he/she recommends. I hope this helps, and I wish you the best of luck.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Fine lines after Botox

Botox prevents muscles it is injected into from contracting, and therefore forming lines. However, your actual skin, the surface, will continue to age. The muscles may not be moving when you get Botox, but the skin itself is still subjected to aging, like the sun, environmental factors, etc. You need to be certain you are wearing a good sunscreen, and remember that what you are seeing now in your skin is usually a result of things that occurred 10+ years ago. So if you have been getting Botox for 3 years, that's awesome because it's prevented deep furrows and lines, but the surface of your skin is still affected from what you did in your teens and 20s! 

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Peels, Dysport and Retin-A

Small fine wrinkles are probably a sign of skin damage. I would recommend a chemical peel, IPL photofacial or a resurfacing treatment such  as ematrix. Also, I found that dysport is better for forehead wrinkles than botox. I usually place botox in glabella by dysport into forehead lines. Sometimes, if botox is placed in certain areas and not other it can cause neighboring muscles to compensate and contract more. Just talk to your physician about spreading the neurotoxin out more. Don't forget the improtance of skin care. Retin-a or retinol are essential in improving the appearance of your skin texture. 

Vlada Groysman, MD
Birmingham Dermatologist
5.0 out of 5 stars 2 reviews

Botox & Fine Lines

Botox helps effect the lines of facial expression by blocking muscle movement in the brow, glabella, and crows feet areas. Botox does not cause or prevent fine lines. Maybe you are a good candidate for a chemical peel, non-invasive laser, or invasive laser. Consult a Board Certified Plastic Surgeon Best wishes

George C. Peck, Jr, MD
West Orange Plastic Surgeon
4.8 out of 5 stars 22 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.