How Many Botox Units for Horizontal Forehead Lines?

I have about four forehead wrinkles that are getting deeper every day.  I call it my "washboard" forehead. How many units of Botox would I need to relax these forehead lines?

Doctor Answers 59

Botox or Dysport for horizontal forehead lines: Catch 22.

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When a patient comes to me with "washboard forehead" as you call yours, my first role is to lower expectations of what Botox or Dysport may be able to do for him or her. Unfortunately, the forehead can be a Catch 22 with Botox. The people with the deepest forehead lines use their frontalis forehead muscle the most to keep the brows up while talking and often to help them see. Trying too hard to smooth all of the lines out can weaken the muscle so much that you might end up with a flat forehead and drooping brows. This can be a, luckily temporary, disaster for the wrong person. 

I always recommend trying first to support the brows from underneath with a Botox or Dysport "brow lift", which can have a secondary effect of allowing the frontalis to relax, creating fewer wrinkles there naturally, while not causing any downward pressure on the eyebrows. After this kicks in for a few weeks, a lower number of strategically placed units can be lightly scattered in the forehead to soften without weighing down. 

Please see only a very experienced physician injector if your forehead has many deep wrinkles so you don't end up with a 3 to 6 month problem.

New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

There is no hard and fast rule.

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Dear Cabbie02

I am not a big fan of injecting BOTOX into the forehead. The muscle up there, the frontalis muscle is the only elevator of the eyebrows. This means that any BOTOX injected into the frontalis muscle will drop the eyebrow position.

Yes one can certainly create a glass smooth forehead (Think Marcia Cross) but the price is a fall in the eyebrow position. The aesthetic price is very high because one gets this frozen forehead and a drop in the eyebrows that screams: MY FOREHEAD IS FROZEN BY BOTOX.

However, is there an alternative? The answer is absolutely: Microdroplet BOTOX. This is my patent pending method where tiny microinjections of BOTOX are place between the skin and the muscles of facial expression that insert into the skin along the eyebrow, root of the nose and the crows feet area.

This provides a degree of control over the placement of BOTOX that has not previously existed. The muscles responsible for pulling the eyebrow down and furrowing the eyebrow and glabella can be precisely targeted.

With the eyebrow depressing muscle treated in this fashion, the tug of war between the eyebrow lifting muscle and the eyebrow depressing muscles shifts to favor the brow elevator, the frontalis. This means that the frontalis muscle does not need to work so hard.

The eyebrow comes up and at the same time the lines in the forehead diminish without a bit of forehead freeze. This is one of the most popular BOTOX treatments in Los Angeles- the actors love it because they retain facial expression while at the same time having a very natural improvement in their appearance.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox, Dysport, Wrinkle Treatment, Beverly Hills Botox Dysport, Los Angeles Botox Dysport

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The number of Botox units will depend on the number, length and depth of the forehaed lines.  We typically use between 16- 36 units of Botox for the forehead.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

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No Need to Over-treat!

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“Washboard” forehead, ay? J The strength of the frontalis muscle varies tremendously from one patient to the next. While this muscle is a relatively thin one, it can create multiple ripples on the overlying skin surface.  Some of my patients just need about 8-10 units here (also depends upon the width of your forehead), while some of my wider-faced men need up to 24u (!). The last thing we want to is to overtreat this area leading to a heavy, Cromagnon looking forehead. I’d rather go a bit lighter, then touch up at no charge if necessary a week later.

Bobby Buka, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Botox Dose for Forehead Lines

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To soften up the forehead lines whilst at the same time still allowing some movement of the frontalis muscle, I will typically use 10-12 units.  Hope this information helps.  Wishing you treatment success.

Forehead wrinkles

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The typical forehead and 11's will require about 40 units for treatment. The forehead by itself could be treated with 20 units.  The crow's feet can require 5 to 10 units. It depends on the the size of the face and the muscular strength.

Judicious use of Botox on the forehead

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Botox can be used to lessen the transverse creases of the forehead but it will not iron them out completely.  If you plaster the forehead with Botox then the eyebrows will drop.  Not a desired look.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Botox is ideal for forehead wrinkles

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I love injecting Botox into the forehead! It has such wonderful and beautiful results. Proper placement and skill is needed in this area to prevent your eyes from appearing droopy.  Please consult a board certified dermatologist who has many years of experience in injecting Botox.

Botox needed for forehead lines depends on sex

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This would depend quite a bit on which sex you are. Males require many more units than females. The general configuration of your forehead lines would also be important. If your forehead lines extend all the way around and curve around the frontal region you would require a few more units to avoid the Dr. Spock look (for us SF fans), sometimes called the Jack Nicholson look (for Laker fans).

There has been a marked tendency among dermatologists and plastic surgeons to decrease the number of units in the forehead. In fact, the recent guidelines, as outlined by Dr. Lupo, one of the superior contributors on this site, recommend far fewer units than previous guidelines. Injecting fewer units decreases the chances of a brow drop.

I also feel it gives patients a much more natural look and avoids the deer in the headlight look....or the zombie-ish appearance that our VP Joe Biden gave us all during the debates (can't this man find a good PS or Dermatologist...first the weird hair transplant then the botched Botox job!).

I feel that 6-14 units in a female (if glabellar injections are given simultaneously) and 14-22 units in a male is the range I use. If need be more can always be injected as the physician and patient see fit.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Botox Injection of The Forehead: It's Not Just About The Number Of Units

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There is no absolute number of units of Botox a patient should receive to treat a specific number of forehead wrinkles.  In our practice, the range of units that we use can vary from four to thirty-four, but this does not really tell the story. Not merely the dosage of Botox, but the placement and number of injections in which muscles, and which portions of the muscles, needs to be individualized to the anatomy and aesthetic goals of each patient.

The treatment of forehead wrinkles with Botox injections is really a double-edged sword.  Many patients have the transverse wrinkling of the forehead that they see, because they have brow ptosis, i.e., the soft tissue of the brow has descended to some degree, and the patients need to fire their frontalis muscles on a virtually continuous basis to elevate the overlying soft tissue, so that their field of vision, especially on upward gaze, is not diminished.  This activity causes wrinkles to form in a direction perpendicular to the vector of pull of the paired frontalis muscles.

However, when a physician injects Botox into the frontalis muscles underlying these wrinkles, he is causing a weakening of those muscles, and thus a diminution of their ability to elevate the ptotic soft tissue of the brow.  Inject too much Botox in the wrong places, and you will have actually exacerbated, or, in some cases, caused, brow ptosis in your patient.

In our practice, we make a point of first supporting the brow by injecting Botox in the periorbital muscles whose vectors of pull naturally counteract that of the frontalis muscle.  Once we have done this, we are extremely deliberate, precise, and conservative, in both the dosing, and the placement, of Botox injections in the forehead.  Remember too, that in addition to causing ptosis of the brow, it is also possible to cause ptosis of the upper eyelid by injecting Botox in the wrong anatomic location, or at the wrong depth, in the inferior portion of the forehead.  

Botox injection of the forehead is an extremely useful tool to achieve subtle improvements in the upper third of the face of both men and women.  But, like any powerful tool, its indications, limitations, complications and side-effects must be well-understood by a physician who is experienced with the procedure, knows how to avoid the problems that can result, and is prepared to address any possible untoward effects that might arise

Peter Lee, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 49 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.