Is it possible to get rid of forehead lines without causing a eyelid/eyebrow droop?

I have been injecting Botox for expression-related (i.e. movement-related, dynamic) horizontal "worry" lines ever since the early 1990s. It has long been known that if one injects within one-inch or so or less within the region above the eyebrows, then a brow drop (ptosis of the brows and lids) is a likely unwanted consequence. And this may be what happened in this particular case. Expert, experienced injectors are careful to respect the appropriate muscle anatomy in order to avoid such unwanted results as described here  And although for the past ten years I prefer Dysport for most facial uses (since I find its benefits start a bit earlier, are a bit stronger, and last a month or two longer), Botox & Xeomin are each quite effective, as well. My guess is that the brow/lid heaviness relates to Dysport simply having been injected a bit too low on the forehead. As to whether a hyaluronic acid filler would be helpful, the answer depends upon whether or not there are static wrinkles present (i.e. wrinkles evident when the expression muscles are at rest). If so, then a hyaluronic acid filler can be quite helpful for elevating and smoothing the lines. Belotero Balance is my favorite for this in my NY practice, since it possesses little tendency to engenger the unwanted bluish/gray Tyndall Effect when injected superficially within the skin. (In my Israel satellite facility, where a far greater number of regulatory agency fillers are available, I typically opt for Toesyal Redensity II or Aliaxin FL for this purpose). Combining Botox and filler typically produces results that last considerably longer than the results of either treatment alone. Make sure that you are consulting with a board certified aesthetic physician and be certain to ask to see his/her before and after photos before agreeing to proceed. Best of luck.

I appreciate your question. An injection of Dysport involving 20 units is very small. I’m surprised to see you’ve had a drop in the eyebrows. Injections in the forehead can be effective to reduce forehead wrinkles, but the injections should be done away from the brows.Best wishes. Dr. Aldo

Hi,Thank you for your question.Botox is FDA approved for the treatment of forehead lines but care should be taken not to over treat the area because the frontalis (forehead muscle) is the only muscle that elevates the eyebrows. Generally speaking, I advise against isolated treatment of the forehead without treating the glabella complex because it will result in unopposed depressor activity from the glabella and orbicularis. Depending on whether your forehead lines are static (at rest) or dynamic (with movement), you may benefit from filler treatment. Botox is typically recommended first, or in conjunction with fillers, as it prevents the wrinkles from deepening. I would encourage you to see an experienced injector for Botox treatment to see if you can achieve your desired outcome without the brow heaviness.Hope this helps!

Filler can improve the forehead lines without drooping the brows. Hyaluronic acid fillers like Restylane, Juvederm and Belotero work well. If the lines are superficial then Belotero will be the best option. RegardsDr.Janjua

Yes forehead lines can be safely addressed with Dypsort/Botox. It is important that you visit with an experienced injector for treatment and discuss the concerns with your current treatment. Filler is not recommended typically for the forehead due to risk.

Hi Wendy! This is definitely possible. To help you achieve the best results I recommend always starting with a consult to touch base with your injector and to get an understanding for what is achievable. To prevent your eyebrows dropping and any droopiness we recommend treating the entire upper face instead of chasing lines. This will insure everything is balanced and give you the most natural look.

It is usually possible to treat forehead lines with proper dosing and placement of the Dysport and not drop the brows. However, if you already have low brows and the body is lifting the brows subconsciously, then treating with Dysport is not a good idea. It will make the problem worse. I have found that filling the lines with HA filler is not a satisfactory result. A surgical brow lift / blepharoplasty will help the problem in many cases. Sometimes a combination of low dose Dysport, fillers/lasers will give a good result as well. It all depends on the examination.

Wrinkle relaxers like Botox and Dysport are the best treatments currently available for softening dynamic horizontal forehead lines. Results are technique dependent and if you injector used too much Botox/Dysport or placed it too close to the eyebrows, it could have caused the eyebrow ptosis (droopiness). Certainly patients with baseline heaviness of the eyebrows or eyelids may not be good candidates for Botox/Dysport treatment to the frontalis. In some cases, fillers can be injected into the forehead to reduce the dose of Botox/Dysport required. I think the most important thing for you to do is to get an in person consultation with an experienced injector to determine what it is that you need. It is hard to comment any further on your specific case without seeing a photo or evaluating you in person. 

It is absolutely possible to smooth forehead lines without causing eyelid and eyebrow drooping! This type of issue is common with inexperienced cosmetic injectors. It is important that you consult a qualified and experienced injector that understands the muscle anatomy of the face, in order to avoid this unsatisfactory result. As far as using fillers for forehead lines, it is generally not recommended due to the safety risk associated with fillers in this area. My first choice of treatment for forehead lines is Botox, because it is the safest and most effective treatment for this concern. 

Thank you for your question.
It is possible that you may require a lower dose of Dysport to achieved you desired results without the unwanted side effects of eyebrow drop/ptosis. The outcome may also be determined by the technique used by your injecting practitioner (eg. depth of injection and distribution of injection sites).
I recommend that you consult with an experienced and highly trained practitioner to ensure your safety and for optimal results to be achieved.
Best wishes.