Is there an alternative to Botox for forehead wrinkles, and brow lift? I metabolize Botox too quickly. (Photo)

Hard to believe but I have had Botox on my forehead (recently!) and around eye area and still have "Herman Muenster-like cracks in my forehead. I was told that I am one of the fewer than 1percent on whom Botox does not work. I was also told that I cannot have a brow lift due to my receding hairline. I never seem to feel pretty any more and wondered if any type of peel or any other procedure might be helpful. Thank you so much.

Doctor Answers 13

Alternatives to Botox

Thank you for your question Katherine87590. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression such as those on the forehead. Botox does not work for some people. In these cases, I recommend that my patients try Dysport or Xeomin. Alternatively skin tightening treatments such as Ultherapy can be used. Please consult with a doctor for specific recommendations. Good luck!


Encino Physician
5.0 out of 5 stars 1 review

Skin Rejuvenation (non-surgical) - Combination of Treatments Needed

The best treatment for skin rejuvenation and prevention depends upon an individual’s skin type, age, ethnicity, sun exposure, and overall health. In order to give you an accurate treatment plan, a consultation is required to properly assess your skin. I recommend  a healthy lifestyle: a diet high in fruits, vegetables, nuts, legumes and fish; eight to ten hours of sleep nightly; limiting alcohol intake other than the occasional glass of red wine; and regular exercise. An important step for all skin types is sun protection including the use of daily sunscreen, sun hats and sunglasses, all of which help prevent aging and sunburns.  When it comes to rejuvenating and prevention treatments, a combination of treatments are available including cosmeceuticals (skin care products including ZO® Skin Health or ZO® Medical, Skinceuticals® or Glo-Minerals®), neurotoxins (Botox®, Xeomin®), dermal fillers (Restylane®, Juvederm®, Esthelis®, Belotero®, Emervel®, Radiesse®), skin resurfacing procedures (laser resurfacing with CO2 laser, Er:YAG laser, Fraxel DUAL®, PicoSure® FOCUS Lens Array or OBAGI® controlled depth chemical peel) and other devices such as Ultherapy® can be used.  These are advanced techniques so be sure to get an experienced dermatologist or plastic surgeon consultation for recommendations and treatment options.

Alim R. Devani, MD, FRCPC
Calgary Dermatologist
5.0 out of 5 stars 10 reviews

Nonsurgical brow lift

Dear Katherine87590:

Pellevé and Ultherapy can lift your brows and help to fill in the lines. I will sometimes combine the treatments for the best results. Depending upon your age, we might recommend some supplements and topicals to maximize the response.

All the best,
Dr. Clark 

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Botox and Forehead

I would recommend a combination of Botox or Dysport combined with lasers to have the best cosmetic results.  Please consult an expert.  Best, Dr. Green

BOTOX® Alternative for Forehead Wrinkles & Brow LIft

Thank you for your question. I'm sorry to hear that your BOTOX® treatments have not worked. Fortunately, you have many other options. It sounds like you could benefit from dermal fillers. BOTOX® works by temporarily freezing muscles that lead to wrinkles and lines. Dermal fillers can help smooth out your skin by injecting compounds such as Restylane® and Juvederm® underneath the surface of your skin. Both injectable options need to be repeated to maintain your results.

Remember to choose a board-certified plastic surgeon or skin care expert with experience with these injectables. Best of luck!

Michael Chiaramonte, MD
Washington DC Plastic Surgeon
4.9 out of 5 stars 33 reviews

Alternative to Botox and brow lift for forehead wrinkles

I would say that it is possible that you could be a candidate for a brow lift to rejuvenate your forehead and eyebrows.  There are different methods of performing a brow lift and, at least from your photos, it appears that you could have one.  An examination would be helpful to know for sure though.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Alternatives to Botox for forehead wrinkles.

I am interested in knowing how much Botox you were injected with. I find that in most cases of patients "resistent" to Botox, it is because too small of a dose was used. As for alternatives to Botox in this area, I would consider filler injection (Belotero works great in this area). Resurfacing lasers, particularly fractional ablative and non ablative treatments and microneedling are also great for treating fine lines and wrinkles on the forehead. Topical skincare is important as well. Consider a retinoid such as Retin-A or Tazorac and always combine with daily sun protection.

In summary, make sure you have given Botox a chance with the PROPER dose and if that doesn't work then consider combining filler and laser treatments with good skincare. 

Lastly, looking at your photos, I do see some volume loss along the forehead which filler injection may help with. Juvederm injection deep along the frontal bone (a relatively safe plane) would give your frontalis muscle some support. Belotero could also be injected very superficially into some of your forehead lines to soften them. 

Options For Forehead Lines

How much Botox did you get, and how long ago? In situations which Botox does not work, sometimes another neuromodulator such as Dysport or Xeomin may work. It's important to understand that deep lines that are present at rest may not be completely taken away with Botox alone. In those situations Fillers can also be used to provide some further improvement. Make sure you find an experienced injector. Best wishes.

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 9 reviews

Forehead Wrinkles -- Botox, Lasers, Fillers, Needling

Botox, fillers and lasers work in combination for this area. Botox for the movement lines, fillers for deep lines that remain at rest and needling/lasers for complexion, glands, smoothness of this area. Please see an expert. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Alternative to Botox for Forehead Wrinkles and Brow Lift

Depending on the location of your hairline which is not visible in these pictures I have treated patients like yourself with the Irregular Trichophytic Hairline Incision technique which we described many years ago. With this approach I can do a brow lift and lower the hairline at the same time. More pictures would be helpful.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 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.